Self-disorders and schizophrenia: a phenomenological reappraisal of poor insight and noncompliance.
Mads G Henriksen, Josef Parnas
Schizophrenia Bulletin June 24, 2013 DOI: 10.1093/schbul/sbt087 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Theoretical or philosophical paper Peer reviewed |
|---|---|
| Topics | Philosophy of mind |
| Keywords | Humans Antipsychotic agents Patient compliance Self concept Schizophrenia Psychotherapy Schizophrenic psychology Medication adherence Early medical intervention Vulnerability Double bookkeeping |
| Key points | Argues that poor insight and treatment noncompliance in schizophrenia are not primarily caused by ineffective self-reflection or psychological defenses, but by anomalous self-experiences (self-disorders) that weaken the basic sense of reality and allow a solipsistic attitude to coexist with the ordinary one, a condition Bleuler termed "double bookkeeping." |
Abstract
Poor insight into illness is considered the primary cause of treatment noncompliance in schizophrenia. In this article, we critically discuss the predominant conceptual accounts of poor insight, which consider it as an ineffective self-reflection, caused either by psychological defenses or impaired metacognition. We argue that these accounts are at odds with the phenomenology of schizophrenia, and we propose a novel account of poor insight. We suggest that the reason why schizophrenia patients have no or only partial insight and consequently do not comply with treatment is rooted in the nature of their anomalous self-experiences (ie, self- disorders) and the related articulation of their psychotic symptoms. We argue that self-disorders destabilize the patients' experiential framework, thereby weakening their basic sense of reality (natural attitude) and enabling another sense of reality (solipsistic attitude) to emerge and coexist. This coexistence of attitudes, which Bleuler termed "double bookkeeping," is, in our view, central to understanding what poor insight in schizophrenia really is. We suggest that our phenomenologically informed account of poor insight may have important implications for early intervention, psychoeducation, and psychotherapy for schizophrenia.
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Citations in the library
Cited by 27
- Mysticism and schizophrenia: A phenomenological exploration of the structure of consciousness in the schizophrenia spectrum disorders. Consciousness and Cognition July 1, 2016
- Phenomenological and neurocognitive perspectives on delusions: A critical overview. World Psychiatry June 1, 2015
- Double bookkeeping and schizophrenia spectrum: divided unified phenomenal consciousness. European Archives of Psychiatry and Clinical Neuroscience December 1, 2021
- Disordered Selfhood in Schizophrenia and the Examination of Anomalous Self-Experience: Accumulated Evidence and Experience. Psychopathology 2021
- Phenomenology of auditory verbal hallucination in schizophrenia: An erroneous perception or something else? Schizophrenia Research March 1, 2024
and 22 more in the library
Cites 7
- Self‐experience in the early phases of schizophrenia: 5‐year follow‐up of the Copenhagen Prodromal Study World Psychiatry October 1, 2011
- Rediscovering psychopathology: the epistemology and phenomenology of the psychiatric object. Schizophrenia Bulletin December 23, 2012
- A disappearing heritage: the clinical core of schizophrenia. Schizophrenia Bulletin July 19, 2011
- Looking at the schizophrenia spectrum through the prism of self-disorders: an empirical study. Schizophrenia Bulletin June 15, 2009
- Phenomenology and Mysticism 2007
and 2 more in the library