Exploration of Self-Consciousness through Self and Other Recognition in the Mirror: Towards New Perspectives in Schizophrenia

Abstract

Self-experience impairments have been described since many years as part of core features of schizophrenia, but are currently neglected in research and clinical practice. First, a literature review on self-consciousness is developed in this article with regard to definitions (including the concepts of self and self-consciousness) and different approaches (especially cognitive, developmental and neurobiological approaches). Self-consciousness can be divided into three levels: minimal-self with implicit pre-reflexive consciousness, reflexive-self with explicit reflexive consciousness (consciousness of a permanent self as an invariant over time through multiple experiences and actions), and social-self (style, habits, and historical narrativity) with explicit self-consciousness. These levels appear progressively in the child from bodily perception (pre-reflexive consciousness) to identification of the self in the mirror at approximatively two-years old (reflexive consciousness) and appearance of mental representations later (self-consciousness). Second, self-consciousness impairments observed in schizophrenia are described in this article and discussed in light of the literature presented. Converging evidence suggests that exploring self-disorders in schizophrenia could help clinicians to understand daily-life patients difficulties and might be of interest for developing a therapeutic alliance. Finally, this critical literature review opens new perspectives to understand better disorders of the self and social interaction impairments in schizophrenia, and to propose a therapeutic use of the mirror based on cognitive remediation helping individuals with schizophrenia to improve self-other differentiation.