Skip to main content Accessibility help
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 13
  • Print publication year: 2003
  • Online publication date: December 2009

12 - Self-disturbance in schizophrenia: hyperreflexivity and diminished self-affection

from Part III - Disturbances of the self: the case of schizophrenia



The present chapter offers a unifying but nonreductive interpretation of schizophrenia, one that attempts to show how the diverse signs and symptoms of this illness may all be rooted in certain fundamental alterations in the acts of consciousness that constitute both self and world. Schizophrenia, I argue, can best be understood as a two-faceted disturbance of self-experience. Phenomena that would normally be inhabited – and in this sense experienced as part of the self – come instead to be taken as objects of focal or objectifying awareness (hyperreflexivity). Intimately connected with this development is a profound weakening of the sense of existing as a subject of awareness, as a presence for oneself and before the world (diminished self-affection). Both facets imply a key disturbance of ipseity, i.e. of the basic sense of existing as a vital and self-coinciding subject of experience or first-person perspective on the world. (Ipse is Latin for self or itself.)

To explain the nature of this self-disturbance, I borrow the philosopher Merleau-Ponty's concept of the intentional arc along with Michael Polanyi's notion of an experiential continuum stretching between the object of awareness and what has a more tacit form of existence. I also distinguish between compensatory, consequential and more basic forms of hyperreflexivity. I consider the positive, negative and disorganized syndromes or types of schizophrenic symptom; and attempt, in each case, to illuminate the role of shared disturbances of consciousness and the sense of self.

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Washington, DC: American Psychiatric Press
Andreasen, N. (1979). Thought, language, and communication disorders: I. Archives of General Psychiatry, 36, 1315–21
Andreasen, N. (1984). The Broken Brain: The Biological Revolution in Psychiatry. New York: Harper and Row
Andreasen, N. (1999). A unitary model of schizophrenia: Bleuler's ‘fragmented phrene’ as schizencephaly. Archives of General Psychiatry, 56, 781–7
Angyal, A. (1936). The experience of the body-self in schizophrenia. Archives of Neurology and Psychiatry, 35, 1029–53
Angyal, A. (1964). Disturbances of thinking in schizophrenia. In Language and Thought in Schizophrenia, ed. J. S. Kasanin, pp. 115–23. New York: Norton
Arieti, S. (1978). Volition and value: a study based on catatonic schizophrenia. In On Schizophrenia, Phobias, Depression, Psychotherapy, and the Farther Shores of Psychiatry, ed. S. Arieti, pp. 109–20. New York: Brunner/Mazel
Armbruster, B. & Klosterkoetter, J. (1986). Basic versus negative symptoms. In Biological Psychiatry 1985, ed. C. Shagass, R. C. Josiassen, W. H. Bridger et al. pp. 1148–50. New York: Elsevier
Armstrong, D. M. (1993). A Materialist Theory of the Mind. London: Routledge
Artaud, A. (1965). Antonin Artaud Anthology, ed. J. Hirschman. San Francisco, CA: City Lights Books
Artaud, A. (1976). Antonin Artaud: Selected Writings, ed. S. Sontag, translated by H. Weaver. New York: Farrar, Straus, & Giroux
Berenbaum, H., & Oltmanns, T. F. (1992). Emotional experience and expression in schizophrenia and depression. Journal of Abnormal Psychology, 101, 37–44
Bernet, R., Kern, I. & Marbach, E. (1993). An Introduction to Husserlian Phenomenology. Evanston, IL: Northwestern University Press
Berrios, G E. (1985). Positive and negative symptoms and Jackson. Archives of General Psychiatry, 42, 95–7
Blankenburg, W. (1969). Ansätze zu einer Pschopathologie des ‘common sense’. Confinia Psychiatrica, 12, 144–63. [First steps toward a psychopathology of ‘common sense’, English translation in Philosophy, Psychiatry, Psychology, 8, 303–15.(2001).]
Blankenburg, W. (1991). La Perte de l'Evidence Naturelle: Une Contribution a la Psychopathologie des Schizophrenies Pauci-Symptomatiques. Translated by J.-M. Azorin & Y. Totoyan. Paris: Presses Universitaires de France. Originally published in 1971: Der Verlust der Naturlichen Selbstverstandlichkeit: Ein Beitrag zur Psychopathologie Symptomarmer Schizophrenien. Stuttgart: Ferdinand Enke Verlag
Bleuler, E. (1950). Dementia Praecox, or The Group of Schizophrenias. Translated by J. Zinkin. New York: International Universities Press
Bleuler, M. (1978). The Schizophrenic Disorders. Translated by S. M. Clemens. New Haven, CT: Yale University Press
Bouricius, J K. (1989). Negative symptoms and emotions in schizophrenia. Schizophrenia Bulletin, 15, 201–7
Breier, A., & Strauss, J S. (1983). Self-control in psychotic disorders. Archives of General Psychiatry, 40, 1141–5
Cahill, C. & Frith, C D (1996a). A cognitive basis for the signs and symptoms of schizophrenia. In Schizophrenia: A Neuropsychological Perspective, ed. C. Pantelis, H. E. Nelson & T. R. E. Barnes, pp. 373–95. New York: John Wiley
Cahill, C. & Frith, C. D. (1996b). False perceptions or false beliefs? Hallucinations and delusions in schizophrenia. In Method in Madness: Case Studies in Cognitive Neuropsychiatry, ed. P. W. Halligan & J. C. Marshall, pp. 267–91. Howe, East Sussex, UK: Erlbaum
Clark, M. J. (1981). The rejection of psychological approaches to mental disorder in late nineteenth-century British psychiatry. In Madhouses, Mad-Doctors, and Madmen: The Social History of Psychiatry in the Victorian Era, ed. A. Scull, pp. 271–312. Philadelphia: University of Pennsylvania Press
Costello, C G. (1992). Research on symptoms versus research on syndromes: arguments in favour of allocating more research time to the study of symptoms. British Journal of Psychiatry, 160, 304–8
Cutting, J. (1985). The Psychology of Schizophrenia. Edinburgh: Churchill Livingstone
Cutting, J. (1990). The Right Cerebral Hemisphere and Psychiatric Disorders. Oxford: Oxford University Press
Cutting, J., & Murphy, D. (1988). Schizophrenic thought disorder: a psychological and organic interpretation. British Journal of Psychiatry, 152, 310–19
Cutting, J., & Murphy, D. (1990). Impaired ability of schizophrenics, relative to manics or depressives, to appreciate social knowledge about their culture. British Journal of Psychiatry, 157, 355–8
Damasio, A. R. (1994). Descartes' Error: Emotion, Reason, and the Human Brain. New York: Avon Books
Damasio, A. R. (1999). The Feeling of What Happens: Body and Emotion in the Making of Consciousness. New York: Harcourt Brace
Dillon, M. (1997). Merleau-Ponty's Ontology, 2nd edn. Evanston, IL: Northwestern University Press
Ey, H. (1973). Traité des Hallucinations. Paris: Masson
Fenton, W. S., & McGlashan, T. (1991). Natural history of schizophrenia subtypes: II. Positive and negative symptoms and long-term course. Archives of General Psychiatry, 48, 978–86
Frith, C D. (1979). Consciousness, information processing, and schizophrenia. British Journal of Psychiatry, 134, 225–35
Frith, C D. (1987). The positive and negative symptoms of schizophrenia reflect impairments in perception and initiation of action. Psychological Medicine, 17, 631–48
Frith, C. (1992). The Cognitive Neuropsychology of Schizophrenia. Hove, UK: Lawrence Erlbaum
Frith, C. D., & Done, D J. (1989). Experiences of alien control in schizophrenia reflect a disorder in central monitoring of action. Psychological Medicine, 19, 359–63
Frith, C. D., Blakemore, S.-J., & Wolpert, D M (2000). Explaining the symptoms of schizophrenia: abnormalities in the awareness of action. Brain Research Reviews, 31, 357–63
Gallagher, S. (1997). Mutual enlightenment: recent phenomenology in cognitive science. Journal of Consciousness Studies, 4, 195–214
Gallagher, S. (2000). Philosophical concepts of the self: implications for cognitive science. Trends in Cognitive Science, 4, 1–35
Gallagher, S. & Meltzoff, A. (1996). The earliest sense of self and others: Merleau-Ponty and recent developmental studies. Philosophical Psychology, 9, 211–33
Gibson, J. J. (1979). The Ecological Approach to Visual Perception. Boston: Houghton Mifflin
Gibson, E. J. (1993). Ontogenesis of the perceived self. In The Perceived Self, ed. U. Neisser, pp. 25–42. Cambridge, UK: Cambridge University Press
Goldman-Rakic, P. (1994). Working memory dysfunction in schizophrenia. Journal of Neuropsychiatry and Clinical Neurosciences, 6, 348–57
Gottesman, I. (1991). Schizophrenia Genesis: The Origins of Madness. New York: W. H. Freeman
Gray, J. A., Feldon, J., Rawlins, J. N., Hemsley, D. R., & Smith, A. D. (1991). The neuropsychology of schizophrenia. Behavioral and Brain Sciences, 14, 1–20
Grene, M. (1968). Tacit knowing and the pre-reflective cogito. In Intellect and Hope: Essays in the Thought of Michael Polanyi, ed. T. A. Langford & W. H. Poteat, pp. 19–57. Durham, NC: Duke University Press
Gross, G. (1986). The Bonn scale for the assessment of basic symptoms. In Biological Psychiatry 1985, ed. C. Shagass, R. C. Josiassen, W. H. Bridger et al. pp. 1142–4. New York: Elsevier
Hafner, H., Maurer, K., Loeffler, W., et al. (1998). The ABC schizophrenia study: a preliminary overview of the results. Social Psychiatry and Psychiatric Epidemiology, 33, 380–6
Handest, P. (2002). The Prodromes of schizophrenia. Doctoral dissertation. In Danish with English summary. Copenhagen: medical faculty, University of Copenhagen
Hemsley, D. R. (1987). An experimental psychological model for schizophrenia. In Search for the Causes of Schizophrenia, vol. 1, ed. H. Hafner, W. F. Gattaz, & W. Janzarik, pp. 179–88. New York: Springer
Hemsley, D. R. (1998). The disruption of the ‘sense of self’ in schizophrenia: potential links with disturbances of information processing. British Journal of Medical Psychology, 71, 115–24
Henry, M. (1973). The Essence of Manifestation. Translated by G. Etzkorn. The Hague: Martinus Nijhoff. Original in 1963: L'Essence de la Manifestation. Paris: PUF
Hoenig, J. (1983). The concept of schizophrenia: Kraepelin–Bleuler–Schneider. British Journal of Psychiatry, 142, 547–56
Hoffman, R. (1986). Verbal hallucinations and language production processes in schizophrenia. Behavioral and Brain Sciences, 9, 503–48
Hoffman, R., Kirstein, L., Stopek, S., & Cichetti, D. (1982). Apprehending schizophrenic discourse: a structural analysis of the listener's task. Brain and Language, 15, 207–33
Holzman, P. S., Shenton, M. E., & Solovay, M R. (1986). Quality of thought disorder in differential diagnosis. Schizophrenia Bulletin, 12, 360–72
Huber, G. (1986). Negative or basic symptoms in schizophrenia and affective illness. In Biological Psychiatry 1985, ed. C. Shagass, R. C. Josiassen, W. H. Bridger et al., pp. 1136–41. New York: Elsevier
Hunt, H T. (1985). Cognition and states of consciousness. Perceptual and Motor Skills, 60, 239–82
Hunt, H. T. (1995). On the Nature of Consciousness. New Haven, CT: Yale University Press
Hurlbut, R. T. (1990). Sampling Normal and Schizophrenic Inner Experience. New York: Plenum
Husserl, E. (1989). Ideas Pertaining to a Pure Phenomenology and to a Phenomenological Philosophy, vol. 2. Translated by R. Rojcewicz & A. Schuwer. Dordrecht: Kluwer
James, W. (1981). The Principles of Psychology. Cambridge, MA: Harvard University Press
Jaspers, K. (1963). General Psychopathology. Translated by J. Hoenig & M. W. Hamilton. Chicago: University of Chicago Press
Johnson, R. (1978). The Anatomy of Hallucinations. Chicago: Nelson Hall
Johnstone, E. C., & Frith, C D. (1996). Validation of three dimensions of schizophrenic symptoms in a large unselected sample of patients. Psychological Medicine, 26, 669–79
Kim, Y., Takemoto, K., Mayahara, K., Sumida, K., & Shiba, S. (1994). An analysis of the subjective experience of schizophrenia. Comprehensive Psychiatry, 35, 430–6
Klosterkötter, J. (1992). The meaning of basic symptoms for the development of schizophrenic psychoses. Neurology, Psychiatry, and Brain Research, 1, 30–41
Klosterkötter, J., Gross, G., Huber, G., et al. (1997). Evaluation of the ‘Bonn Scale for the Assessment of Basic Symptoms’ (BSABS) as an instrument for the assessment of schizophrenia proneness. Neurology, Psychiatry, and Brain Research, 5, 137–50
Koehler, K., & Sauer, H. (1984). Huber's basic symptoms: another approach to negative psychopathology in schizophrenia. Comprehensive Psychiatry, 25, 174–82
Kring, A. M., & Neale, J. (1996). Do schizophrenic patients show a disjunctive relationship among expressive, experiential, and psychophysiological components of emotion? Journal of Abnormal Psychology, 105, 249–57
Kring, A. M., Kerr, S. L., Smith, D. A., et al. (1993). Flat affect in schizophrenia does not reflect diminished subjective experience of emotion. Journal of Abnormal Psychology, 102, 507–17
Lang, J. (1938). The other side of hallucinations. American Journal of Psychiatry, 94, 1089–97
Liddle, P F. (1987). The symptoms of chronic schizophrenia: a re-examination of the positive–negative dichotomy. British Journal of Psychiatry, 151, 145–51
Liddle, P. F., Carpenter, W. T. & Crow, T. (1994). Syndromes of schizophrenia: classic literature. British Journal of Psychiatry, 165, 721–7
Maj, M. (1998). Critique of the DSM-IV operational diagnostic crireria for schizophrenia. British Journal of Psychiatry, 172, 458–60
Marneros, A., Andreasen, N. C. & Tsuang, M. T. (eds) (1991). Negative versus Positive Schizophrenia. Berlin: Springer-Verlag
McClamrock, R. (1995). Existential Cognition: Computational Minds in the World. Chicago: University of Chicago Press
McGhie, A., & Chapman, J. (1961). Disorders of attention and perception in early schizophrenia. British Journal of Medical Psychology, 34, 103–15
McGlashan, T H. (1982). Aphanasis: the phenomenon of pseudo-depression in schizophrenia. Schizophrenia Bulletin, 8, 118–34
McGlashan, T. H., & Fenton, W S. (1992). The positive–negative distinction in schizophrenia: review of natural history indicators. Archives of General Psychiatry, 49, 63–72
McKenna, P. J. (1994). Schizophrenia and Related Syndromes. Oxford, UK: Oxford University Press
Mellor, C S. (1970). First rank symptoms of schizophrenia. British Journal of Psychiatry, 117, 15–23
Merleau-Ponty, M. (1945). Phenomenologie de la Perception. Paris: Gallimard
Merleau-Ponty, M. (1962). The Phenomenology of Perception. Translated by C. Smith. New York: Routledge and Kegan Paul
Mlakar, J., Jensterle, J., & Frith, C D. (1994). Central monitoring deficiency and schizophrenic symptoms. Psychological Medicine, 24, 557–64
Mojtabai, R., & Rieder, R O. (1998). Limitations of the symptom-oriented approach to psychiatric research. British Journal of Psychiatry, 173, 198–202
Naudin, J., Banovic, I., Schwartz, M. A., et al. (2000). Définir l'hallucination acoustico-verbale comme trouble de la conscience de soi. Evolution Psychiatrique, 65, 311–24
Ostwald, p. & Zavarin, V. (1980). Studies of language and schizophrenia in the USSR. In Applied Psycholinguistics and Mental Health, ed. R. W. Rieber, pp. 69–92. New York: Plenum
Parnas, J., & Bovet, P. (1991). Autism in schizophrenia revisited. Comprehensive Psychiatry, 32, 7–21
Parnas, J. & Sass, L. (2001). Self, solipsism, and schizophrenic delusions. Philosophy, Psychiatry, Psychology, 8, 101–20
Persons, J. (1986). The advantages of studying psychological phenomena rather than psychiatric diagnoses. American Psychologist, 41, 1252–60
Petitot, J., Varela, F. J., Pachoud, B. & Roy, J.-M. (eds) (1999). Naturalizing Phenomenology: Issues in Contemporary Phenomenology and Cognitive Science. Stanford, CA: Stanford University Press
Polanyi, M. (1964). Personal Knowledge. New York: Harper Torchbooks
Polanyi, M. (1967). The Tacit Dimension. Garden City, NY: Anchor Books
Polanyi, M. (1968). Sense-giving and sense-reading. In Intellect and Hope: Essays in the Thought of Michael Polanyi, ed. T. A. Langford & W. H. Poteat, pp. 402–31. Durham, NC: Duke University Press
Ricoeur, P. (1992). Oneself as Another, translated by K. Blamey. Chicago: University of Chicago Press
Rosenthal, D. M. (1997). A theory of consciousness. In The Nature of Consciousness, ed. N. Block, O. Flanagan & G. Guzeldere, pp. 729–53. Cambridge, MA: MIT Press
Rumke, H. C. (1990 [1941]). The nuclear symptom of schizophrenia and the praecox feeling. History of Psychiatry, 1, 331–41
Sass, L. (1992). Madness and Modernism: Insanity in the Light of Modern Art, Literature, and Thought. New York: Basic Books (Harvard University Press peperback, 1994)
Sass, L. (1994). The Paradoxes of Delusion: Wittgenstein, Schreber, and the Schizophrenic Mind. Ithaca, NY: Cornell University Press
Sass, L. (1996). ‘The catastrophes of heaven’: modernism, primitivism, and the madness of Antonin Artaud. Modernism/Modernity, 3, 73–92
Sass, L. (2000). Schizophrenia, self-experience, and the so-called ‘negative symptoms.’ In Exploring the Self: Philosophical and Psychopathological Perspectives on Self-experience, ed. D. Zahavi, pp. 149–82. Amsterdam: John Benjamins
Sass, L., & Parnas, J. (2001). Phenomenology of self disturbances in schizophrenia: some research findings and directions. Philosophy, Psychiatry, Psychology, 8, 347–56
Sass, L. & Parnas, J. (in press). Explaining schizophrenia: the relevance of phenomenology. In The Philosophical Understanding of Schizophrenia, ed. M. C. Chung, K. W. M. Fulford & G. Graham. Oxford: Oxford University Press
Schwartz, S. (1982). Is there a schizophrenic language? Behavioral and Brain Sciences, 5, 579–88
Selten, J. P. (1995). The Subjective Experience of Negative Symptoms. Doctoral dissertation. Rijksuniversiteit Groningen, The Netherlands
Selten, J.-P., van den Bosch, R. J. & Sijben, A. E. S. (1998). The subjective experience of negative symptoms. In Insight and Psychosis, ed. X. F. Amador & A. S. David, pp. 78–90. New York: Oxford University Press
Selten, J.-P., Wiersma, D., & Bosch, R J. (2000). Discrepancy between subjective and objective ratings for negative symptoms. Journal of Psychiatric Research, 34, 11–13
Sokolov, A. N. (1972). Inner Speech and Thought. New York: Plenum
Solovay, M. R., Shenton, M. E., & Holzman, P S. (1987). Comparative studies of thought disorder: mania and schizophrenia. Archives of General Psychiatry, 44, 13–20
Sommers, A A. (1985). Negative symptoms: conceptual and methodological problems. Schizophrenia Bulletin, 11, 364–79
Spitzer, M. (1997). A cognitive neuroscience view of schizophrenic thought disorder. Schizophrenia Bulletin, 23, 29–50
Stanghellini, G., & Monti, M R. (1993). Influencing and being influenced: the other side of ‘bizarre delusions.’ Psychopathology, 26, 165–9
Storring, G. (1987). Perplexity. In The Clinical Roots of the Schizophrenia Concept, ed. J. Cutting & M. Shepherd, pp. 79–82. Cambridge, UK: Cambridge University Press
Tatossian, A. (1997). La Phenomenologie des psychoses. Paris: L'Art du Comprendre.
Tausk, V. (1933 [1919]). On the origin of the ‘influencing machine’ in schizophrenia. Psychoanalytic Quarterly, 2, 519–56
Tissot, T. (1984). Fonction Symbolique et Psychopathologie. Paris: Masson
van den Bosch, R. (1994). Context and cognition in schizophrenia. In Advances in the Neurobiology of Schizophrenia, ed. J. A. den Boer, H. G. M. Westenberg & H. M. van Praag. pp. 343–66. Chichester, UK: Wiley. Available at
Bosch, R. J., Rombouts, R. P., & Asma, M. J. O. (1993). Subjective cognitive dysfunction in schizophrenic and depressed patients. Comprehensive Psychiatry, 34, 130–6
Vygotsky, L. (1962). Thought and Language. Translated by E. Hanfmann & G. Vakar. Cambridge, MA: MIT Press
Zahavi, D. (1999). Michel Henry and the phenomenology of the invisible. Continental Philosophy Review, 32, 223–40