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= FINAL TYPESCRIPT OF:

Sass, L., Parnas, J. & Zahavi, D. (2011). Phenomenological psychopathology and schizophrenia: Contemporary approaches and misunderstandings. Philosophy, Psychiatry, and Psychology, 18: 1-23.

PHENOMENOLOGICAL PSYCHOPATHOLOGY AND SCHIZOPHRENIA:

CONTEMPORARY APPROACHES AND MISUNDERSTANDINGS

Louis Sass

Dept of Clinical Psychology, GSAPP, Rutgers—the State University of New Jersey,

U.S.A.

(email: lsass@rci.rutgers.edu)

Josef Parnas

Hvidovre Psychiatric Center and Danish National Research Foundation: Center for

Subjectivity Research, University of Copenhagen, Denmark

(email: jpa@hum.ku.dk)

Dan Zahavi

Danish National Research Foundation: Center for Subjectivity Research, Dept. of Media,

Cognition and Communication, University of Copenhagen, Denmark

(email: dza@hum.ku.dk)

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ABSTRACT:

The present paper clarifies key issues in phenomenology and phenomenological

psychopathology (especially of schizophrenia) through a critique of a recent article that

addresses these topics. Topics include:

1, Phenomenology’s role in clarifying issues not amenable to purely empirical

methods.

2, The relationship between a phenomenological approach (focusing on the

subjective life of the patient) and empirical science, including neuroscience.

3, The nature of self-experience, especially in its pre-reflective form (“ipseity”—

involving “operative intentionality”), and its possible disturbance in schizophrenia

(“hyperreflexivity” and “diminished self-affection”).

4, The relationship between self disturbance in schizophrenia and disorders of

both temporality and (what Husserl termed) “passive syntheses.”

5, The role of intentional or quasi-volitional processes in the perceptual (and

other) disorders in schizophrenia.

6, The nature and diversity of phenomenology’s potential contribution to the

enterprise of “explanation.”

7, The meaning of several concepts: “hermeneutic” or “existential” approach;

phenomenological “reflection”; “negative symptoms.”

(abstract = 146 words)

6-8 KEYWORDS:

Self-disorder, pre-reflective self-awareness, ipseity, hyperreflexivity, self-affection,

phenomenological reflection, phenomenological explanation

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INTRODUCTION

The phenomenological approach to schizophrenia has undergone something of a

renaissance in Anglophone psychiatry in recent years. There has been a proliferation of

works that focus on the nature of subjectivity in schizophrenia and related disorders, and

that take inspiration from the work of such German and French philosophers as Husserl,

Heidegger, and Merleau-Ponty, and such classical psychiatrists as Minkowski,

Blankenburg, and Binswanger (Rulf 2003; Sass 2001a, 2001b). This trend includes

predominantly theoretical articles, which typically incorporate clinical material as well as

reviews of empirical and experimental findings in psychopathology. Some very recent

examples (since 2000) are studies of self-experience (Sass & Parnas 2003), temporal

experience (Fuchs 2007), delusions and delusional mood (Parnas & Sass 2001, Fuchs

2007), and psychiatric classification and diagnosis (Parnas & Zahavi 2002), as well as of

values and disturbances of common-sense (Stanghellini 2001, 2004; Stanghellini &

Ballerini 2007), affect or emotion (Sass 2007a; Ratcliffe 2008), negative symptoms (Sass

2003a), perception (Schwartz, Wiggins, Naudin & Spitzer 2005; Sass 2004c; Nelson &

Sass 2008), and personhood and autonomy (Sass 2007b, in press). A major event of

recent years is the appearance of a series of empirical studies that demonstrate the reality

of clinical-phenomenal disorders of self-experience as a core factor in early

schizophrenia and that differentiate diagnosis of schizophrenia-spectrum from other

forms of psychosis or psychopathology (Møller & Husby 2000; Parnas, Jansson, Sass &

Handest 1998; Parnas, Handest, Jansson & Sæbye 2003; Parnas, Handest, Jansson &

Sæbye 2005; Parnas et al 2005).

This trend does not, of course, represent the first attempt to study subjectivity in

schizophrenia, nor is it the first time that the continental phenomenological tradition has

been introduced. Both Mayer-Gross’s famous textbook of psychiatry (1954) and Fish’s

Schizophrenia (Hamilton 1984, originally1962) attempted—nobly but with limited

success—to bring phenomenological psychopathology into the mainstream of English-

language psychiatry. The work of Karl Jaspers’ disciple, Kurt Schneider, on the “First

Rank Symptoms” of schizophrenia, was clearly Jaspersian on the methodological plane,

but unfortunately was interpreted more in an operational than a truly phenomenological

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sense. Existence, an anthology edited by Rollo May, Ernst Angel, and Henri Ellenberger

(1958), influenced humanistic trends in American clinical psychology. An important

precursor to the above-mentioned empirical work is the research on schizophrenia-

patients’ experience of the so-called “basic symptoms” of schizophrenia, carried out since

the end of the 1960s by Huber, Klosterkötter, and colleagues in Germany (Klosterkötter

1988, 1992; Klosterkötter et al 1997; 2001).

The most prominent Anglophone attempt to emphasize the importance of the

subjective dimension of schizophrenia was R. D. Laing’s first and finest book, The

Divided Self (1959), a work admired by many who remain skeptical of Laing’s later

contributions. The Divided Self, which uses ideas from Sartre, Heidegger, Minkowski,

and Binswanger, was something of a bolt from the blue. Laing own interests and

influence were soon diverted in an anti-psychiatric and sometimes romanticizing or

otherwise anti-scientific direction. There was, in fact, very little writing—at least in

English (for French and German contributions see Tatossian 1979; Naudin 1997)—

specifically treating the phenomenology of schizophrenia in the 25 years between the

publication of Laing’s book and the appearance, starting in the mid-1980s, of articles by

several authors. These include Sass (1985, 1987, 1988a, 1990a, 1990b, 1992b)—

culminating in his books, Madness and Modernism: Insanity in the Light of Modern Art,

Literature, and Thought (1992a), and The Paradoxes of Delusion (1994)— Schwartz &

Wiggins (1987; also Wiggins, Schwartz & Northof 1990), Cutting & Dunne (1989), and

Parnas & Bovet (1991, Bovet & Parnas 1993) . A superb anthology of classical European

contributions on schizophrenia, edited by John Cutting and Michael Shepherd, appeared

in 1987. Cutting’s (1997) book on brain laterality had a strong phenomenological

component. Now, however, we are seeing a reasonably broad-based attempt to bring

phenomenological perspectives to bear on scientific psychiatry, particularly on

schizophrenia, in the now-dominant world of Anglophone psychiatry and clinical

psychology.

These recent developments in phenomenological psychopathology coincide with

significant trends in both the mental health professions and the mind sciences. One such

trend is a growing disillusionment, within mainstream psychiatry, with the extreme

emphasis on operationalizable concepts that began with the advent of DSM III in 1982.

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A number of recent editorials by key figures in North American and European psychiatry

(Andreasen 2007, Maj 2005; see also Mullen 2007; Parnas, Sass & Zahavi 2008) have

noted the relative lack of real scientific progress in the study of schizophrenia and many

other disorders, and have related this to the loss of validity that can occur when there is

an over-focus on reliability (operational concepts). These editorials have related this lack

of progress to the loss, which they lament, of the rich, psychopathological tradition of

European psychiatry, which is strongly (but not exclusively) rooted in phenomenology.

This disillusionment coincides with a certain malaise, notable among younger

psychiatrists and clinical psychologists, who are frustrated with the increasingly

mechanical role they are expected to play in a clinical world defined by bureaucratic

demands, and doubtful about a scientific world dominated by empirical methodologies

that can seem divorced from significant theoretical issues.

Another, more broad-based trend is the disillusionment with purely

neurocentristic, cognitivist, and computationalist approaches that seems to be spreading

among scholars and scientists in philosophy and the various sciences of mind, brain, and

behavior. One can find a diverse group of thinkers including Dreyfus (1979), Varela,

Thompson & Rosch (1991), Clark (1997), Gallagher (2005), Zahavi (2005), Thompson

(2007), and Gallagher & Zahavi (2008) who all in various ways have criticized the

standard picture by insisting on the need for a renewed focus on subjectivity and on the

embodiment and embeddedness of the human subject . More recently, the concepts of

self and of self-experience have also gained something of a renaissance in philosophy,

psychology, and the cognitive sciences (cf. Gallagher & Shear 1999; Kircher & David

2003; Sass, Whiting & Parnas 2000).

The revival of a phenomenological approach to psychiatry precedes the most

recent of these trends, but fits in comfortably with current developments. The

phenomenological approach emphasizes the need to delve below superficial levels of

behavioral description or common-sense symptomatic descriptions (Zahavi & Parnas

1998, Parnas & Sass 2008). By offering a richer and more empirically grounded,

theoretical approach to the understanding of abnormal action and experience, it promises

an escape from the operationalist cul-de-sac that contemporary psychiatry is in danger of

entering. The phenomenological study of schizophrenia in particular is of signal

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importance, not only because of schizophrenia’s preeminent place in the history of

psychiatry, but also because of the profound, enigmatic, and potentially revelatory nature

of the alterations of subjectivity and selfhood that it involves. The increased focus, over

the last 15 years, on early intervention for mental disorders, particularly psychotic

disorders, has particularly highlighted the importance of understanding subjective

experience in pre-schizophrenic and schizophrenic conditions, which may be relevant for

prediction, identification of high-risk, as well as treatment efforts (Nelson et al 2008;

Nelson et al in press; Parnas 2005).

A SOURCE OF MISUNDERSTANDINGS

In this context, it is surprising that, very recently, an article should have appeared,

addressed to a general psychiatric audience, in which recent trends in the

phenomenological psychopathology of schizophrenia and key notions of

phenomenological philosophy are presented in a manner that is not only confusing but

highly inaccurate. Rather than clarifying matters, the article in question blurs key

theoretical issues and leaves the reader with the impression that much of

phenomenological psychiatry must be, at its core, an obscure discipline,

incomprehensible and somehow deeply anti-scientific in nature.

The article in question, published in Current Opinion in Psychiatry in 2007, was

authored by Aaron Mishara and carries the title “Missing links in phenomenological

clinical neuroscience: Why we still are not there yet.” Mishara’s critique primarily

targets two articles by Sass and Parnas (2003, 2007), but also criticizes Sass (1992a),

Parnas (2003), and Zahavi (2005). In his contribution, Mishara strives to offer an

ambitious review of the relationship between phenomenology and neuroscience, and to

construct a stark opposition between what he calls “neo-phenomenology” versus

“existential or hermeneutic phenomenology.” Mishara wishes to associate the first term

with the work of Sass, Parnas, and Zahavi, and the second term with his own work and

that of such figures as Binswanger, Blankenburg, Conrad, von Weizsaecker, Matussek,

and Wiggins and Schwartz. As we will argue, however, the distinction in question is

confused and misleading. i

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The publication of Mishara’s account is not entirely to be lamented, however: it

articulates certain misunderstandings that may be widespread enough to be worth

addressing in detail, thereby giving us the opportunity to correct potential

misapprehensions and to explain some basic points about our own approach and the

phenomenological enterprise more generally.ii In the present article, we will take his

publication as an occasion for clarifying a number of important issues (sometimes

overlapping) concerning phenomenology and its role in the study of psychopathology in

general and schizophrenia in particular; in this way, we offer a discussion that should be

of general interest (see also Gallagher & Zahavi 2008). The issues treated below are the

following:

1, The role of phenomenology in clarifying issues not amenable to purely

empirical methods.

2, The relationship between a phenomenological approach (focusing on the

subjective life of the patient) and that of empirical science, including neuroscience. (This

relationship involves what is sometimes referred to as the “naturalizing” of

phenomenology.)

3, The nature of self-experience, especially in its pre-reflective form, and its

possible disturbance in schizophrenia.

4, The relationship between self disturbance in schizophrenia and disorders both

of temporality and of (what Husserl termed) “passive syntheses”

5, The possible, contributing role of intentional or quasi-volitional processes in

the perceptual disorders in schizophrenia.

6, The nature—and especially the diversity—of phenomenology’s potential

contribution to the enterprise of “explanation” (broadly understood, in contrast with

“mere” description).

7, We also provide a number of necessary clarifications: of the meaning of a

“hermeneutic” or an “existential” approach; of the nature and role of “reflection” in

phenomenological accounts; and of the meaning of the concept of “negative symptoms.”

Mishara’s main justifications for distinguishing between what he calls “neo-

phenomenology” and “existential/hermeneutic phenomenology” are two. The fact that

his article vacillates between the two justifications, without distinguishing them clearly,

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adds to the confusion. One justification is largely methodological in nature, having to do

with the status and role of phenomenology. According to Mishara (2007a), whereas (so-

called) “neo-phenomenology claims to circumvent experimental procedures,” the (so-

called) “existential phenomenology” with which he associates himself is, by contrast, “in

an excellent position to supply hypotheses [and “testable constructs”] for further

experimental study” (pp. 559-60). The second justification is more substantive: it

pertains to discussions related to the structure of consciousness and the specific nature of

the psychological abnormality in schizophrenia. Here Mishara rejects the claim that

consciousness is as such characterized by a pervasive but tacit dimension of pre-reflective

self-consciousness, and denies that self-disturbance is a central core feature of

schizophrenia. We consider Mishara’s claims and criticisms to be both mistaken and

misleading. We begin with general methodological and philosophical issues: namely,

with Mishara’s views on the relevance of phenomenology, the notion of “constraint” (a

term we use), and the nature of phenomenological “facts”. Later we shall turn to

selfhood and other topics.

NATURE AND ROLE OF PHENOMENOLOGY

In his article, Mishara states that Sass and Parnas (2007) and Zahavi (2005)

“proposed that phenomenology is able to constrain neuroscience when applied to

disorders such as schizophrenia” (Mishara 2007a, p. 559, emphasis added). He explains

this point by stating that, according to Sass, Parnas, and Zahavi, ”phenomenology

provides conclusive knowledge or limits, what Zahavi calls ’facts’, about the patient’s

subjective experience” (Mishara’s words). We are said to believe that these facts could

(in Mishara’s words once again) “be directly incorporated into clinical neuroscience”

without requiring any kind of “experimental procedure.” Mishara continues: “Rather

than furnishing hypotheses or testable constructs to neuroscience, neo-phenomenology

claims to circumvent experimental procedure by offering constraints about the nature of

(human) subjectivity with a foundation in philosophical phenomenology.” He contrasts

this with what he calls the “existential-phenomenological ... view that phenomenology

provides initial systematic means” for studying subjectivity and seeks only to “supply

hypotheses for further experimental study” (pp. 560).Mishara’s account is problematic.

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Not only does he not grasp the standard meaning of “constrain” as this term is used in

recent discussions on the relation between phenomenology and cognitive science; he also

fails to capture our own view of the matter, and ultimately provides a superficial picture

of what the phenomenological tradition has to offer to contemporary psychiatry or the

project of the “naturalization” of consciousness (the inclusion of consciousness within a

general scientific perspective).

We agree, of course, that a major role for phenomenology is indeed to supply

hypotheses for further empirical study. However, we reject the idea that

phenomenology’s relevance should be restricted to this role. Psychiatry, after all, is

faced with a host of philosophical questions—e.g., questions concerning the nature of

rationality, the definition of delusion, the possibility of empathy with abnormal states of

mind, and so forth. To think that such questions can be settled by clinical trials or other

purely empirical methods would amount to a kind of scientism that would certainly be

rejected by all the major theorists of phenomenology. Phenomenology, together with

other philosophical approaches, has something to say on these issues.

MUTUAL “CONSTRAINTS”; PHENOMENOLOGICAL “FACTS”

To clarify phenomenology’s role within the mind sciences, we must consider

precisely what it means to say that phenomenology can constrain neuroscience. When

using the term “constrain” (Sass & Parnas 2007, p. 73), we cited a well-known paper by

Gallagher (1997): “Mutual enlightenment: Recent phenomenology in cognitive science.”

In the next paragraph we cited another well-known article: “Neurophenomenology,” in

which (the late) Francesco Varela (1996) speaks of “mutual” or “reciprocal constraints”

between “phenomenological accounts of the structure of experience and their

counterparts in cognitive science” (pp. 343). Thompson (2007), who collaborated

extensively with Varela, clarifies: “By ‘reciprocal constraints’ [Varela] means that

phenomenological analyses can help guide and shape the scientific investigation of

consciousness, and that scientific findings can in turn help guide and shape the

phenomenological investigations” (p. 329).

The term “constrain” does not, then, mean anything like “inhibit” or “dictate to in a

rigid or unilateral fashion.” To say that the facts of subjective life “constrain”

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neurobiological explanation is simply to say that these facts are among those which an

adequate neurobiology must ultimately take into account. It would seem that any person

with a remotely phenomenological bent would have to accept this latter point; indeed it

should even be accepted by reductionists who believe that consciousness is entirely

dependent on the biological substrate. After all, conscious experience is “an

explanandum in its own right” (Chalmers, 1995, p. 209). And “without some idea … of

what the subjective character of experience is, we cannot know what is required of

physicalistic theory” (Nagel 1979, p. 71).

This does not, by the way, rule out the possibility that cognitive or neurobiological

findings might actually suggest new ways of thinking about and describing aspects of

phenomenal experience. On the contrary: we (like both Gallagher and Varela) are

precisely arguing that the influence goes both ways, i.e., it would also be a question of

letting phenomenology profit from – and be challenged by – empirical findings.iii

When it comes to cashing out this idea about mutuality or reciprocity in more

concrete detail, various complementary proposals are currently on offer. One proposal,

entitled neurophenomenology, was initially proposed by Varela (1996) and subsequently

developed by Lutz (2002), Lutz and Thompson (2003), and Thompson (2007). Here the

basic idea is to train experimental subjects to gain greater intimacy with their own

experiences. Subsequently the subjects are asked to provide descriptions of these

experiences using an open-question format, thus minimizing the imposition of pre-

determined theoretical categories. The ensuing descriptive categories are subsequently

validated intersubjectively and then used to interpret correlated measurements of

behavior and brain activity. At the same time, however, it is also suggested that, say, a

consideration of insights from neurobiology and dynamical systems theory can help us

improve and refine the classical phenomenological analyses (see Varela 1996, Thompson

2007). How is that supposed to happen?

The basic idea is quite simple: Let us assume, for instance, that our initial

phenomenological description presents us with what appears to be a simple and unified

phenomenon. When studying the neural correlates of this phenomenon (with MRI, e.g.),

we discover that two quite distinct mechanisms are involved: mechanisms that are

normally correlated with distinct experiential phenomena, say, perception and memory.

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This discovery might motivate us to return to our initial phenomenological description in

order to see whether the phenomenon in question is truly as simple as we thought.

Perhaps a more careful analysis will reveal that it harbors a concealed complexity.

However, it is important to emphasize that the discovery of a significant complexity on

the sub-personal level – to stick to this simple example – cannot by itself force us to

refine or revise our phenomenological description. It can however serve as motivation for

further inquiry.

More recently, Gallagher (2003) has made a slightly different proposal which he

has entitled front-loaded phenomenology. Rather than focusing on training experimental

subjects, the idea is to start with the experimental design, and to allow insights developed

in phenomenological analyses to inform the way experiments are set up. To take a

concrete example, let us consider the study of self-consciousness within developmental

psychology, where the so-called “mirror-recognition task” has occasionally been heralded

as the decisive test for self-consciousness (Lewis 2003). A phenomenological approach

suggests moving beyond reliance on mirror-recognition alone – which phenomenologists

would typically consider evidence for the presence of a rather sophisticated form of self-

consciousness – and attempting to detect the presence of more primitive forms of

proprioceptive body-awareness (Zahavi 2005). To front-load phenomenology, however,

does not imply that one simply presupposes or accepts well-rehearsed phenomenological

results. Rather it involves testing those results and, more generally, incorporates a

dialectical movement between previous insights gained in phenomenology and

preliminary trials that will specify or extend these insights for purposes of the particular

experiment or empirical investigation (Gallagher & Zahavi 2008).

Once one grasps the actual (and, in this discourse, standard) meaning of

“constrain,” one will immediately see that the opposition Mishara poses—between

phenomenology serving as a “constraint” versus as a generative source of hypotheses—is

entirely spurious. Indeed, it is only because experience is implicated in the overall

causal/explanatory nexus (which is to say, that it serves as a “constraint”—according to

the standard understanding of “constrain”) that it could possibly be relevant for

hypothesizing. It is precisely this kind of “mutual constraint” (between empirical data on

neuro-developmental problems, phenomenological data on initial stages of the illness,

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and neurobiological data concerning ontogenesis of cortico-cortical connectivity) that led

one of the present authors to propose, in 1996, a binding problem associated with the

phenomenological core features of schizophrenia, within a distributed mis-connectivity

model of neurodevelopmental vulnerability to the illness (Parnas, Bovet & Innocenti

1996; Parnas et al 2001; Parnas, Bovet & Zahavi 2002).

Before leaving the issue of methodological “constraints,” it is interesting to

consider the peculiar way in which Mishara tries to establish our supposed commitment

to the idea that phenomenology can provide conclusive and substantive knowledge about

the nature of the mind that would determine the boundaries of neuroscientific research in

a unidirectional manner. The textual evidence Mishara offers consists in only three

quotations and references, all to works by Zahavi (2004 p. 343; 2005 p. 136; see Mishara

2007a, p. 559). These Zahavi references are quotations taken out of context or

tendentious attempts to paraphrase. Indeed, Mishara himself seems to recognize this last

point, for he immediately goes on to admit (quite correctly) that “Zahavi himself does not

endorse this position.” No quotations from Parnas or Sass are offered. But where, then,

is the evidence that any of the three of us actually adopts the view Mishara attributes to

us?

A closely related misunderstanding concerns Mishara’s characterization of our

understanding of phenomenological “facts”. Nowhere do we say that phenomenological

methods generate absolutely precise and certain descriptions that cannot possibly be

criticized or improved upon—that is, that are not defeasible, in the sense of being in

principle open to revision or valid objection. It is odd, then, to find Mishara claiming for

himself the label of “hermeneutic phenomenology.” If hermeneutic phenomenology

means a phenomenology that rejects aspiration to apodictic certainty in favor of a more

humble understanding of the nature of the phenomenological enterprise (i.e., as an

enterprise that requires interpretation rather than offering infallible description), then our

work—like that of many others—certainly falls under the rubric “hermeneutic.”iv

Mishara (2007a) has no basis for claiming that we believe our phenomenological

accounts to be “immune to error” (p. 561). Nor does Mishara offer any textual evidence

to sustain his claim that “neo-phenomenology” “claims to circumvent experimental

procedures.” Actually, a considerable amount of empirical work has been done and is

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underway to test the validity and relevance of our phenomenologically inspired model of

schizophrenia (see further below).

THE IPSEITY- OR SELF-DISTURBANCE (IHM) VIEW

The second major way in which Mishara distinguishes between what he calls “neo-

phenomenology” and “existential phenomenology” is by saying that, whereas the former

postulates disorders of selfhood (ipseity-hyperreflexivity model [IHM]) as the core of

psychopathology of schizophrenia, the latter emphasizes, rather, disorders of “passive

syntheses”, binding, temporalization, and perceptual organisation. In his article, the

ipseity-hyperreflexivity model (IHM) becomes an object of Mishara’s passionate attack.v

Here however, Mishara misunderstands most of the key elements of our ipseity-, self-

disturbance, or IHM view, which are clearly laid out in the two articles he targets (Sass &

Parnas 2003, 2007). Briefly, this model claims that instability of pre-reflective self-

awareness is a core, generative feature of schizophrenia; the disorder affects what in

cognitive literature is called minimal or core self.Here are some key passages from our

account (Sass & Parnas, pp. 68-70, unless otherwise noted).

IPSEITY DISTURBANCE: [T]he core abnormality in schizophrenia a particular

kind of disturbance of consciousness and, especially, of the sense of self or ipseity

that is normally implicit in each act of awareness. (Ipseity derives from ipse,

Latin for “self” or “itself.” Ipse-identity or ipseity refers to a crucial sense of self-

sameness, of existing as a subject of experience that is at one with itself at any

given moment [Henry 1973; Ricoeur 1992; Zahavi 1999].) This self or ipseity

disturbance has two main aspects or features that may at first sound mutually

contradictory, but are in fact complementary. The first is hyper-reflexivity—

which refers to a kind of exaggerated self-consciousness, that is, a tendency to

direct focal, objectifying attention toward processes and phenomena that would

normally be “inhabited” or experienced as part of oneself. The second is

diminished self-affection—which refers to a decline in the (passively or

automatically) experienced sense of existing as a living and unified subject of

awareness.

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Ipseity disturbance” also involves a concomitant disturbance of the field of

awareness that we label “disturbed hold” or “grip” (Sass 2004c; Sass & Parnas 2003, p.

436).

HYPERREFLEXIVITY: The notion of hyperreflexivity includes some fairly

volitional, quasi-volitional, or intellectual processes, which we term “hyper-reflectivity”.vi

However:

the hyperreflexivity in question is not, at its core, an intellectual, volitional, or

“reflective” kind of self-consciousness; nor is it merely an intensified awareness of

something that would normally be taken as an object (e.g., in the case of an

adolescent’s self-consciousness about his or her appearance). Most basic to

schizophrenia is a kind of “operative” hyper-reflexivity that occurs in an automatic

fashion. This has the effect of disrupting awareness and action by means of an

automatic popping-up or popping-out of phenomena and processes that would

normally remain in the tacit background of awareness (where they serve as a

medium of implicit self-affection), but that now come to be experienced in an

objectified and alienated manner (see Merleau-Ponty 1962, p.xviii re. “operative

intentionality”—fungierende Intentionalität).

Phenomenally speaking, hyperreflexivity can be manifest as an emergence or

intensification of experience as such or a prominence of proximal over distal aspects of

stimuli (see e.g. Sass 1994 re “phantom concreteness”), or as focal awareness of

kinesthetic bodily sensations, “inner speech,” or the processes or presuppositions of

thinking.

DIMINISHED SELF-AFFECTION involves diminished sense of being a vital,

first-person perspective on the world. It pertains to a

fundamental sense of existing as an experiencing entity …, as a kind of implicit

subject-pole that would normally serve as the vital center-point of subjective life.

… [One] patient with schizophrenia described the condition of lacking this crucial

if ineffable self-affection that is essential to normal ipseity: “I was simply there,

only in that place, but without being present” (Blankenburg 1971, p. 42; 1991, p.

77).

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The hyperreflexivity and diminished self-affection central in schizophrenia involve

distinctive disruptions of the tacit-focal structure of experience.

[T]hese two features are best conceptualized not as separate processes but as

mutually implicative aspects or facets of the intentional activity of awareness.

Thus, whereas the notion of hyperreflexivity emphasizes the way in which

something normally tacit becomes focal and explicit, the notion of diminished self-

affection emphasizes a complementary aspect of this very same process—the fact

that what once was tacit is no longer being inhabited as a medium of taken-for-

granted selfhood. (Sass & Parnas 2003, p. 430)

It makes little sense, incidentally, to characterize our ipseity or IHM view by using

a simple opposition between “too much” versus “too little” self-experience—as do

Lysaker & Lysaker (2008a, p. 32) in their interesting study of dialogical dimensions of

schizophrenia. On our view, there is a sense in which the person with schizophrenia has

both too little sense of self (diminished self-affection) and too much self-consciousness

(hyperreflexivity). Selfhood is too complex an issue to lend itself to uni-dimensional

characterization and requires, among other things, sophisticated phenomenological

analysis (Zahavi 2005). Before elaborating on theoretical issues, we outline recent

empirical work that supports our self-disorder position.

EMPIRICAL SUPPORT FOR THE IPSEITY-DISTURBANCE (IHM) VIEW

Like virtually all scientific work, the IHM is partly rooted in theoretical work,

including such psychopathological studies as Sass 1987 and 1992a (chapter 7) and

Spitzer 1988, as well as philosophical work including Henry (1973, 1975) and Zahavi

(1999), among many others. It is important to point out, however, that our

phenomenological claims concerning anomalous self-experience as a core feature of

schizophrenia-spectrum disorders, is not a product of arm-chair theorizing or anecdotal

discussion, as Mishara portrays it, but derives, in large measure, from years of clinical

experience and a considerable empirical research. This includes descriptive and follow-

up studies of different diagnostic categories (Vollmer-Larsen 2008), predictive work on

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early psychosis (see below), and also some experimental work correlating anomalies of

experience with neurocognitive measures (Parnas et al 2001).

Thus in contemporary psychiatry the notion of self-disorders as the initial, core

features of schizophrenia was almost simultaneously first reported from a Danish study of

19 first-onset schizophrenia-spectrum patients (Parnas et al 1998) and a Norwegian study

of 20 first admitted schizophrenia patients (Møller & Husby 2000). These findings were

subsequently supported in a longitudinal study of 155 first admitted patients, of which

about 60% suffered from schizophrenia or schizotypal disorders (Parnas et al 2005;

Handest and Parnas 2005). These patients have been re-assessed at a 5-year follow-up,

showing that self-disorders are predictive of new incident cases of schizophrenia

spectrum disorders (Vollmer-Larsen, 2009. A separate study comparing residual

schizophrenia patients with remitted psychotic bipolar illness patients demonstrated that

self-disorders were characteristic of schizophrenia (Parnas et al 2003), suggesting a

certain specificity to schizophrenia spectrum disorders.. Currently several other samples

are being studied (Skodlar et al 2008), and data analyses are being conducted on

opportunistic samples of high-risk and genetic research performed in Copenhagen.

Similar research-projects and studies on early identification of schizophrenia are being

undertaken in several European countries, Israel, and Australia. A phenomenologically

oriented, semi-structured psychiatric interview—the EASE scale (Parnas et al 2005)—has

been developed and shown to achieve good inter-rater reliability (Vollmer-Larsen,

Handest & Parnas 2007). The EASE-scale’s description of self-disorders seems to have

satisfied a clinical void as testified by the fact that the scale has so far been translated into

seven languages. In summary, there is now considerable empirical evidence available that

shows “trait-like” presence of self-disorders in the schizophrenia spectrum disorders. The

measures of self-disorder are now being included in studies targeting early recognition

and treatment of schizophrenia.

In his article, Mishara omits all the (then available) empirical studies mentioned

above. Oddly, however, he does mention one vignette from a conceptual publication by

Parnas and Handest (2003), only to warn his readers that “we must be careful not to draw

conclusions from anecdotal self-reports” (Mishara 2007a, p. 565, italics added).

16

THE NOTION OF IPSEITY OR PRE-REFLECTIVE SELF-AWARENESS

Mishara (2007a) also gets the central theoretical features of our view on self-

disorder (ipseity disturbance) wrong in various ways. Consider his statement that we

view “the core deficit in schizophrenia to be on the level of intentionality of fully

constituted objects and self” (p. 560, italics added). This is incorrect.

The IHM-model claims that a central phenomenon of the schizophrenia spectrum

disorders is a disturbance in pre-reflective self-awareness (or ipseity, from Latin:

ipse=self, itself), i.e., a disturbance of the very mineness or first-person perspective that

characterizes any experience.

What do we mean by first-person perspective, by pre-reflective self-awareness,

and what does the mineness of experience refer to?

When we refer to the mineness of experience, we are not referring to a specific

content of experience, like yellow, or being salty or spongy. We are referring to the first-

personal presence, givenness-to-me, or perspectival ownership of experience, to the fact

that experience feels like something for somebody. For a subject to own something in a

perspectival sense, is for the experience in question to present itself in a distinctive

manner to the subject whose experience it is. Ipseity could be defined as the self-presence

(the presence to itself) of the self-as-subject. These pre-reflective aspects of experience

contribute to what we (and others) call the minimal self (cf. Zahavi 1999, 2005).vii We

admit, however, that an analysis of the minimal self is something of an abstraction as

long as it fails to include the temporal dimension (more about this in a moment). The

basic or minimal self-experience to which we refer is not something willed or explicitly

assumed, nor does it involve reference to a full-fledged self, as Mishara seems to think. It

is a passive and automatic process that must be regarded as the diachronic and synchronic

prerequisite or pre-condition for any more substantial or elaborate sense of self.

Having or embodying a first-person perspective does not, incidentally, require

being able to articulate it linguistically. Indeed it provides an experiential grounding of

the latter possibility All the major figures in phenomenology—including Husserl,

Merleau-Ponty, Sartre, and Michel Henry—considered a minimal form of self-

consciousness to be an integral part of experience. This, for instance, is what Sartre

17

meant when he declared that self-consciousness constitutes the mode of being of

intentional consciousness (Sartre 1956, liv).

THE ISSUE OF PHENOMENOLOGICAL “REFLECTION”

Mishara (2007a) claims that Zahavi’s (2005) argument for the existence of a

pervasive pre-reflective self-awareness (ipseity) is tenuous because of numerous

conceptual problems. He then mentions the following difficulty: there is no way of

knowing whether what I describe in reflection was truly there prior to reflection, since the

reflecting itself may have somehow added or inserted precisely those aspects I was

looking for (Mishara 2007a, p. 561). As is widely acknowledged, recognition of this

methodological or epistemological problem is an utter commonplace in

phenomenological discussion. It was broached by Husserl himself (see, e.g., his

discussion with H.J. Watt in §79 of Ideas I [Husserl 1982]) and was later discussed by

numerous authors within the phenomenological tradition (cf. chapter 4 in Zahavi 2005).

All the phenomenologists recognized that, rather than merely copying or

repeating the original experience, reflection actually transforms it, or as Husserl explicitly

admitted, it alters it (Husserl 1950, 72, 1987, 89). Husserl spoke of reflection as a process

that discloses, disentangles, explicates, articulates, and accentuates (herausgehoben) all

those components and structures that were implicitly contained in the pre-reflective

experience (Husserl 1984, 244; 1966a, 129; 1966b, p. 205, 236).

One might see the phenomenological position as being situated between two

extremes. On one hand, we have the view that reflection merely copies or mirrors pre-

reflective experience faithfully;on the other, the view that reflection distorts lived

experience irredeemably. The middle course is to recognize that reflection involves both

a gain and a loss. For Husserl, Sartre, and Merleau-Ponty, reflection is constrained by

what is pre-reflectively lived through; it is answerable to experiential facts and is not

constitutively self-fulfilling. But at the same time, they recognized that reflection qua

thematic self-experiences does not simply reproduce the lived experiences unaltered, and

that this may be precisely what makes reflection cognitively valuable. As Husserl put it,

in the beginning we are confronted with a dumb experience that through reflection must

then be made to articulate its own sense (Husserl 1950, p. 77; Merleau-Ponty 1945, 207).

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A widely held view, to which we adhere, then, is that phenomenological

reflection does contain the potential for a kind of iatrogenic error, and that this is one

reason why its results cannot be considered to have the status of apodictic certitude. This

does not, however, preclude the value of phenomenological reflection so long as this

reflection is imbued with a self-critical awareness of precisely such dangers. Moreover,

as Husserl argued, any skeptical claim to the effect that reflection necessarily falsifies the

lived experiences and that they consequently elude it completely is self-refuting: after all,

this very claim must presuppose knowledge of those very same lived experiences, and

how should one obtain that except through some kind of reflection (Husserl 1982, §79)?

Thus, rather than adding new distorting components and structures to the

experience reflected upon, a reflection might, at best, simply be accentuating structures

already inherent in the lived experience. But how does this apply to the specific issue of

the first-personal givenness of experience that we were just discussing? To claim, as

Mishara does, that it is reflection that creates the distinctive first-personal quality of

experience, that experience lacked such qualities prior to becoming the object of a first-

person thought, is to attribute quite exceptional powers to reflection. Such a view is not,

however, unprecedented. Indeed, on one reading, this is precisely the position adopted by

many “higher-order thought” theorists in contemporary analytic philosophy of mind.

Some of them have bitten the bullet and accepted the consequences of their position

regarding the ascription of phenomenal consciousness to creatures that lack the capacity

for higher-order first-person thoughts. Carruthers for instance holds the view that animals

(and children under the age of three) are simply blind to the very existence of their own

mental states; and that there is, in fact, nothing at all that it is like for them to feel pain or

pleasure (Carruthers 1998, p. 216). Such a position certainly seems counter-intuitive. And

as Carruthers himself notes, it might have profound implications for our moral attitudes

towards animals and animal suffering (Carruthers 1996, p. 221). Is this the kind of

position that Mishara is endorsing?

SELF-AWARENESS AND ABSORPTION IN THE WORLD

Throughout his writings, Husserl, the founder of phenomenology, is very explicit

in arguing that self-consciousness—rather than being something that only occurs during

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exceptional circumstances, namely whenever we direct explicit attention to our conscious

life—is a feature characterizing normal human subjectivity as such, no matter what

worldly entities the subject might otherwise be conscious of and occupied with. As

Husserl for instance puts it in Zur Phänomenologie der Intersubjektivität II, “To be a

subject is to be in the mode of being aware of oneself” (Husserl 1973, p. 151). It is

clearly erroneous, then, for Mishara to take Husserl as supporting his claim that world-

absorption and self-awareness are mutually exclusive (Mishara 2007a, 560-561). When

Husserl talks about Selbstverlorenheit in connection with our intentional absorption in the

world, he does not refer to a complete loss of self, as Mishara (2007a) seems to think (p.

561), but to the absence of a thematic or reflective self-experience (see Zahavi 1999).

Heidegger—a key figure for “hermeneutic” and “existential” trends in

phenomenology—is also referring to pre-reflective self-experience when he argues that

the self is present and implicated in all of its intentional (world- or object-directed)

comportments; that the co-disclosure of the self belongs to intentionality as such

(Heidegger 1989, 225). Heidegger also wrote that every worldly experiencing involves a

certain component of self-familiarity, and that every experiencing is characterized by the

fact that “I am always somehow acquainted with myself” (Heidegger 1993, 251; 1989,

225).

Mishara’s draws a supposed contrast between, on one hand, Sass &

Parnas’s (2003) claim that “we are self-aware through our practical absorption in

the world of objects” (p. 430), and, on the other hand, what he calls the

“existential phenomenological” notion that what he terms “self-awareness” and

“absorption in experience” are “mutually exclusive” (Mishara 2007a, p. 560).

There is, in fact, no contrast here at all: it is just that two different notions of self,

both clearly distinguished in much of the phenomenological tradition, are being

conflated by Mishara. As Sass and Parnas emphasize, the self-awareness (ipseity)

to which they primarily refer is not self-as-intentional-object-of experience but

rather the implicit or pre-reflective self-awareness of the self-as-subject—which

most phenomenologists see as a concomitant of object-awareness and a

prerequisite of reflective self-awareness (for details see Zahavi 1999; 2005).

Thus Paul Ricoeur (1966, pp. 60-61), the most prominent synthesizer of

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phenomenology and hermeneutics, criticizes the view that “consciousness turned

towards the other [is] unconscious of itself” and that “self-consciousness [he is

referring to pre-reflective self-consciousness or ipseity] corrod[es] the

consciousness which is directed towards something other than itself.”

It is noteworthy that, here again, there appears to be slippage in Mishara’s

treatment of the issues: at one point he seems to acknowledge the non-object-like and (in

a sense) non-representational nature of ipseity: citing Sass & Parnas (2007), he notes that

the IHM model speaks of a “disruption of a tacitly functioning operative intentionality

which forms the background of consciousness” (Mishara 2007a, p. 560). But then, when

he attempts to argue against ipseity’s fundamental role in experience, he clearly conflates

ipseity with an objectlike or representational mode—what he now calls “self-awareness

(in terms of self-reference)” or an “image-representation of self, that is, having a self, a

‘me’, rather than being a self, an ‘I’” (p. 560). Yet the distinction between pre-reflective

self-experience and the experience of self-as-object is at the very heart of the articles by

Sass and Parnas (2003, 2007) that Mishara criticizes and a book by Zahavi that Mishara

also cites (Zahavi 2005; also 1999).

In summary: the IHM does not focus on disturbance of a fully constituted self or

self-as-object nor of fully constituted object, nor does it speak of a focal, thematic

intentionality. Rather, we speak of disturbed or unstable pre-conditions for the normal,

concordant and smooth articulation of the self-object correlation. Once one grasps this

key point, one sees that the dynamic, ever-shifting qualities of self-experience that

Mishara (2007a) rightly emphasizes (p. 563) are, in fact, perfectly consistent with what

we mean by ipseity. It is obvious that the pre-reflective self would not be a static entity,

but something more like an ongoing process that must exist and constantly reconstitute

itself in time.viii

“PASSIVE SYNTHESES” AND “OPERATIVE INTENTIONALITY”

As a supposedly “existential-phenomenological response” or alternative view,

Mishara (2007a) proposes that the primary disorder of schizophrenia resides in “passive

syntheses” of “pre-attentive binding between subcomponents of the self (e.g., I, me, and

mine…)” (p. 562). (He does not, however, say much about how this would cash out in

21

fundamental clinical features of schizophrenia.) Mishara wants to offer the reader a

polarized choice between ipseity, on one hand, and passive synthesis or temporality, on

the other, as potential candidates of a generative disorder in schizophrenia. In this way he

falsely reifies phenomenological concepts into mutually exclusive natural-kind-like

categories, while failing to grasp key distinctions between levels of discourse and of

psychological reality.

Mishara thus fails to grasp that, when we speak of such phenomena as

schizophrenic autism, lack of self-affection, operative hyperreflexivity, lack of common

sense, loss of natural self-evidence, diminished feelings of immersion, perplexity, and

other aspects of the ipseity disturbance, we are also referring to the phenomenal

manifestations of disturbed passive synthetic processes. Our use of the term “operative

intentionality,” coined by Husserl and elaborated by Merleau-Ponty, refers precisely to

the tacit, pre-objectival, largely “passive” processes that found the coherence of the

experiential field of the embedded subject (Sass and Parnas 2007, pp. 69, 82-85; Sass

2003a , p. 157). Mishara (2007a) does in one passage (p. 560) note our use of the phrase

“operative intentionality,” but then ignores this key point when he goes on to criticize our

position.

In a recent article by Uhlhaas and Mishara (2007) our IHM or ipseity-disturbance

approach is described as being essentially a top-down model that emphasizes “deficits in

higher cognitive functions” or “an excess of rationality and reflectiveness” (pp. 142-43,

150). Uhlhaas and Mishara describe Sass’s (1992a) and Sass and Parnas (2003) as

“claim[ing] that fragmentation and destruction of the self come from above by means of

an excess of rationality or hyper ‘self-consciousness’” (p. 146). As summaries of the

IHM or Sass’s current or earlier writings, these are clearly misreadings.

Hyperreflexivity certainly can involve intellectual or volitional processes, which

can indeed have pathogenetic importance. (The parallel with modernism makes these

processes especially salient in Sass’s Madness and Modernism.) But contrary to what

Uhlhaas & Mishara imply, both Sass and Sass and Parnas have stated explicitly that

hyperreflexivity should not be equated with intellectual or volitional processes of a

“higher” nature—which might better be termed “hyper-reflectivity”—but also involves

the popping out, in a kind of automatic fashion, of phenomena that would not normally

22

be in the focus of awareness. Sass (2003b p. 249) and Sass & Parnas (2007, pp. 69, 82-

85) term this latter process “operative hyperreflexivity.” They state that the operative

type is likely in fact to be more primary in a pathogenetic sense than is the reflective type

of hyperreflexivity (p. 83),ix“affecting what Blankenburg (following Husserl) calls the

‘fundamental receptivity’ of the automatic or ‘passive syntheses’ that structure the basic

act of consciousness and constitute a person’s most immediate and fundamental

relationship to self and to world”(Sass 2003a, pp. 167, 157). Earlier Sass (1992a) noted

the possibility of neurophysiological “disturbance of those ‘lower’ and more automatic

processes that normally allow for spontaneity while providing a sense of natural

embeddedness in the practical and social world” (p. 396).

Mishara’s characterization of our position as one that views schizophrenia as

essentially determined by “higher” or volitional processes is thus a misrepresentation of

what is, in fact, an attempt to demonstrate the complexity of the interaction of

intentional/reflective and non-intentional or “operative” factors.

In a recent article, Lysaker and Lysaker (2008b) adopt this mistaken view,

portraying Sass as placing exclusive emphasis on the “withering” effect of an “inward

gaze of radical intensity” (p. ??*). As their citations and phrasings indicate, their

discussion of Sass’s views derives largely from a single, second-hand source: a paper by

Mishara (2004). They cite only one paper by Sass (2000), while ignoring passages from

that paper that contradict theirs and Mishara’s portrayal. The Lysakers’ uncritical

acceptance of Mishara’s interpretation mars the treatment of phenomenology in their

otherwise useful review article, and seems to have lead them into absurdities of which

they are perhaps unaware. Thus they portray Parnas and Sass as having incompatible

views when, in reality, Parnas and Sass have been close collaborators for ten years, with

congruent views as co-authors of papers on self-disorder and the phenomenology of

schizophrenia.

Also misleading is the Lysakers’ (2008b, p. ??*) reference to what they call

“Mishara’s suggestion” (emphasis added) re the core pathogenetic role of disruption of

“bodily systems that allow persons, without self-conscious effort, to suddenly attend to

novel information.” In fact, the pathogenetic significance (for schizophrenic cognition)

of disruption of automatic processes that normally orient attention toward the novel, is

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perfectly explicit in work by Hemsley and Gray, who emphasize disorders of the

hippocampus-based “comparator system” (Hemsley 1987; 2005). Also mistaken is the

Lysakers’ presentation of this view as somehow antithetical to Sass’s position (also

implied by Uhlhaas & Mishara 2007, p. 150, who cite Hemsley). Indeed, , this view is

perhaps the main neurocognitive hypothesis Sass singles out for its compatibility with his

own position (see references in Sass 1992a, 2007a p. 83, and other articles).x In Madness

and Modernism, Sass (1992a, p. 228) discusses the role such factors might play in self-

fragmentation and bodily alienation—the very point the Lysakers ascribe to a 2005

publication by Mishara. The compatibility of Hemsley’s comparator approach with Sass

is acknowledged in Hemsley (1998).xi

TEMPORALITY AND SELF-EXPERIENCE

Here we will not attempt to discuss, in any detail, the relationship between

temporality and self-experience. Clearly, however, there is something absurd, from a

phenomenological standpoint, about treating self-experience and temporal experience as

if these were distinct faculties of the mind—as Mishara (2007a, p. 565) seems to do when

arguing that temporality is more basic than self in the schizophrenia disturbance. Indeed

the central point of Zahavi’s influential interpretation of Husserl’s writings on time was

precisely that the latter’s notion of inner time-consciousness amounts to a form of pre-

reflective self-awareness (Zahavi 1999, 2003a, 2003b).

The temporal distortions of schizophrenia have long been recognized, in both the

experimental and phenomenological literature on schizophrenia (e.g., Minkowski 1927,

1933/2005; Bovet & Parnas 1993). Before being convinced that temporality in particular

is playing a foundational role in the pathogenesis of schizophrenia, it would be necessary

to show (at least) A. that the disorder is reasonably specific to schizophrenia in particular;

and B. that the temporal abnormality is more striking than other abnormalities in

schizophrenia (thereby addressing some of the concerns raised long ago by Chapman &

Chapman 1973). Mishara has not addressed either of these concerns.

By now it should be clear that in his article, “Missing links in phenomenological

clinical neuroscience,” Mishara tends to oversimplify, misrepresent, and offer misleading

24

polarization of alternatives. So far we have focused primarily on his polemical treatment

of our own work. Over-simplification and polarization are also characteristic of his

conceptualizations of the possible underlying psychopathology of schizophrenia. Both

tendencies emerge with clarity if we compare Mishara’s with Sass’s discussion of the

German Gestalt psychiatrist Matussek’s ideas about prodromal features (including the so-

called Wahrnehmungstarre) and of the relevance of Wolfgang Blankenburg’s work for

understanding negative symptoms, and also Mishara’s attack on Sass & Parnas’s (2007)

exploration of the possible explanatory relevance of phenomenology.

DIE WAHRNEHMUNGSTARRE AND THE EXISTENTIAL COMPLEXITY OF

SCHIZOPHRENIC SYMPTOMS:

In Madness and Modernism (1992a, chapter 2), Sass uses the phrase “Truth-

taking stare” to capture the phenomenon described in German psychiatry by the term

Wahrnehmungstarre. Wahrnehmungstarre refers to the fixed gaze that can be especially

common in early phases of schizophrenia; it would typically be translated as “rigidity of

perception” (as both Sass 1992a, p. 423 n.4 and Mishara 2007a, p. 564 note). In his

article, Mishara claims that Sass’s use of the phrase “truth-taking” is a “fanciful but

apocryphal” (p. 564) mistranslation which suggests that Sass misunderstands the meaning

of the German term Wahrnehmungstarre, which means “perceptual rigidity”; and that

this is one indication of what Mishara calls a gross lapse of "textual/philological

accuracy" that should call Sass’s scholarly reliability and hermeneutic competence into

question. Mishara goes so far as to accuse Sass of “overlook[ing] the fundamental

hermeneutic principles” by “granting [himself] the license to slip at these basic levels of

textual-philological accuracy (e.g., translation, historical context, or careful and correct

citing of sources)” (p. 564f).

It is not difficult to show that the misunderstandings and textual/philological

“lapses” are entirely Mishara’s. This should be apparent from Mishara’s apparent failure

to take into account the following endnote, which is appended to Sass’s first mention of

the term Wahrnehmungstarre: “Warhrnehmung means ‘perception’ or ‘observation’ in

German. I have chosen to translate this in an unusually literal way—as ‘truth-taking’—

25

because this seems better to capture the schizophrenic experience in question” (Sass

1992a, pp. 44, 423).

Wahr in German means “true,” as in the term “Wahrheit”, meaning “truth.”

Nehmung is derived from “nehmen” as in “to take.” (Starre means “stiffness” or

“rigidity.”) The above-quoted note makes it perfectly obvious that Sass was deliberately

and overtly using a kind of poetic license (in accordance with the etymology of the parts

of the word, and with full knowledge of the standard meaning of Wahrnehmung) in order

to convey a sense of the patient’s experience of a kind of revelation that can accompany

the fixed or rigid stare common in prodromal schizophrenia. There is, incidentally,

something of a tradition of this kind of creative etymology within phenomenology,

especially in the later Heidegger.

Mishara commits other “textual/philological lapses” against both Sass and

Matussek. At one point, Mishara (2007a, p. 564) criticizes Sass for not following

Matussek’s lead more closely, and thereby failing to appreciate the role of “rigidity or

attentional capture” while overemphasizing instead what Sass calls a “mode of

deliberateness and hyperawareness.” In fact, Sass (1992a, pp. 72, 427f, notes 43, 44)

criticizes Matussek’s (Gestalt) theoretical account for downplaying the role of

intentionality, while noting that, in his clinical descriptions, Matussek emphasizes both

intentional and non-intentional aspects. Matussek (1987) does say that the schizophrenic

“is held captive by the object”; but he also writes, “The schizophrenic … is capable, to a

much greater degree, of fixing his attention on an isolated object …,” noting the patient’s

“ability” and “pleasure” in doing so (pp. 93-94, emphasis added).

Mishara’s characterization of Sass displays a lack of familiarity with the

arguments put forward in the works he criticizes. In writing on schizophrenia, Sass never

denies the role of deficiencies, dysfunctions, or other forms of “affliction.” Indeed Sass

(1992a, p 73) states that it would be “absurd” to claim that schizophrenic states are

entirely under the patient’s control, and “foolish to view schizophrenia as purely

volitional and entirely self-aware” (p. 114).

Mishara’s attempt to appropriate for himself the label “existential

phenomenology” is peculiar. The approach Mishara offers in his article fails, in fact,to

26

go beyond a rather mechanical or passive vision of the nature of schizophrenia, in which

the patient’s role is simply to be afflicted with disturbances of passive synthesis; little if

anything is said about broader human or “existential” consequences or about the

patient’s conscious and self-conscious project of “being-in-the-world.” By contrast, much

of the work that Mishara criticizes does explore these aspects in considerable depth (see

espec. Sass 1992a, 2003a, 2004a,; Sass and Parnas 2007). Recently Sass has focused on

the nature of both personhood (2007b) and autonomy (in press) in schizophrenia, noting,

e.g., that schizophrenia, a heterogeneous condition, can sometimes involve not simple

diminishment of autonomy, but more complex disruptions of the normal balance between

independence and dependence or between autonomy and heteronomy

Mishara’s overly mechanical portrayal of passive syntheses seems particularly

unsuited to accounting for the remarkable variability of schizophrenic symptoms and

cognitive/affective abnormalities, which as often noted (e.g., Bleuler 1950, p. 72) may

vary with context, motivation, and attitude. It is noteworthy, e.g., that cognitive and

perceptual disorganization is by no means constant, and often disappears in the presence

of a strong motivation toward practical activity (for ref.s see Sass 1992a, chap 1 p. 24 &

n.s 47, 48, 49; chap 2 p. 71 & n.s 105, 112). In this sense it seems to be linked up with

particular orientations of the self (including forms of reflexivity and self-affection). An

understanding of ipseity disturbances is also relevant for conceptualizing

psychotherapeutic interventions. It suggests the potential danger in overemphasizing

certain forms of confrontation and self-reflection in the therapeutic process. It may also

help to illuminate the potentially agentive role of the patient, and thereby suggest more

subtle ways of helping patients both to identify with their experiences and to engage in

the therapeutic encounter (Nelson, Sass & Skodlar in press).

NEGATIVE SYMPTOMS

In the same paragraph in which Mishara questions Sass’s translation of

Wahrnehmungstarre, he accuses Sass of another scholarly error; but once again, it is

Mishara who commits errors of both fact and logic. Mishara (2007a, p. 565) says that the

phrase “negative symptoms” had not been applied to schizophrenia at the time that the

phenomenological psychiatrist Blankenburg published his book, The loss of natural self-

27

evidence, in 1971, and that for this reason it is inappropriate for Sass to consider the book

to be relevant to what we now call “negative symptoms.”

As it happens, Mishara is wrong on the historical point: several French

psychiatrists, including De Clerambault, Nayrac, and Ey, spoke of negative symptoms in

schizophrenia quite early in the 20th century (Berrios 1985, 1991). This historical error is

almost beside the point, however. Even if Mishara had been factually correct, his point

would amount to a non-sequitur that, if taken seriously, would preclude our finding much

of contemporary relevance in older works of psychopathology, which often apply

somewhat different terminology to recognizable conditions that now have different

labels. (Often, of course, the overlapping of categories is only partial, and this

complicates the comparisons.) Mishara (2007a) also states that what Blankenburg calls

“schizophrenia simplex” is a “very different diagnostic category” from that of negative-

symptom schizophrenia (p. 565). The concept “negative symptom” is not, however, a

diagnostic category at all, but part of a currently popular way of subtyping symptoms of

schizophrenia (and some other conditions); negative symptoms are typically

distinguished from positive and disorganization symptoms.

It is obvious, in any case, that “schizophrenia simplex,” which lacks both positive

and disorganized symptoms, exemplifies at least one, particularly clear type of the

negative syndrome. Indeed Mishara’s own description of schizophrenia simplex, in the

article of his own that he cites here (his only relevant citation on the issue; Mishara 2001,

pp. 319-20), actually describes schizophrenia simplex (following ICD-10) in clear

negative-symptom terms, namely, as “exhibit[ing] the basic but not the accessory

symptoms of schizophrenia,” as being “fairly undramatic and inconspicuous in its own

right,” as manifesting “decline in total performance,” and as having the “characteristic

'negative' features of residual schizophrenia (e.g., blunting of affect, loss of volition)

[which] develop without being preceded by any overt psychotic symptoms." If this is not

a negative-symptom syndrome, what is?

PHENOMENOLOGICAL EXPLANATION

28

We end by considering the important but complex topic of phenomenology’s

relevance for explanation. We approach this issue by discussing the inaccuracies in

Mishara’s characterization of Sass and Parnas (2007), “Explaining schizophrenia: The

relevance of phenomenology.” Mishara describes Sass and Parnas as offering a

“proposal to conflate explanation and understanding” in their 2007 article, and as

somehow suggesting that phenomenological explanation need “not rely on experimental

procedure.” He also states that “Sass and Parnas opt to associate their phenomenology

with everyday explanation” (p. 563). Each of these three statements is flatly mistaken. It

is not surprising, then, that in the paragraphs containing these statements, Mishara offers

virtually no quotations from Sass & Parnas (2007) (except a single phrase, and even that

turns out to be inaccurate: on page 87 the phrase used is not “explanatory power” but

“explanatory significance”; see Mishara 2007a, p. 563).

The first point to be realized is that the Sass & Parnas article from 2007 does not

in any way deny the crucial role of neurobiological factors in the explanation of

schizophrenia (nor does Sass 1992a, which in fact contains a lengthy appendix discussing

“Neurobiological Considerations”). The article focuses, rather, on the distinct yet often

complementary role that an understanding of subjectivity can play. The second point is

that the article does not focus primarily on the distinction between understanding and

explanation but on that between description and explanation. Sass and Parnas (2007)

attempts to show that a commonly held view—namely, that phenomenology is relevant

only to description and not to explanation—is inaccurate. It then proceeds to differentiate

a variety of senses of the word “explanation.” The paper explicitly offers a “preliminary

taxonomy of six forms of phenomenological explanation” (p. 67) divided into two

groups, the first involving a kind of “phenomenological implication,” the second a kind

of “at least quasi-causal significance.” The diversity of these modes of explanation is

central to the argument.

The point, then, in Sass & Parnas (2007), is to show that phenomenological

accounts are not merely descriptive. But this in no way implies that all that is non-

descriptive, or “explanatory” in some sense of the latter term, is somehow the same—as

Mishara’s accusation regarding “conflating” would seem to imply. (If A = not-x and B =

not-x, this does not imply that A = B.) On the contrary, the whole point of the article is

29

to make it very clear that not only the general term “explanation” but also the forms of

explanation to which phenomenology is relevant are extremely various, ranging from the

demonstration of meaningful unities to the clarification of causal sequences and

interactions.

In the article, Sass and Parnas (2007) note that phenomenology (namely, the

description of forms of experience or of subjective life) can help to “explain”, in one

sense of that term, by showing, for example, how seemingly distinct features of conscious

experience may actually be mutually interdependent in the sense of being different

aspects of the same experiential whole (this is called a kind of “implicative” relationship).

In another sense of the term “explanation”, phenomenology can help one to understand

(and also to explain) how one form of experience might lead into another, as when

unusual features of the subjectively experienced perceptual field (e.g., perceptual

fragmentation) can inspire or motivate certain forms of (over-focused) attention, which

can in turn lead to further transformations of the perceptual field (eventually involving,

say, “delusional percept”—as discussed by Matussek and also Sass 1992a, chap 2). The

understanding of such sequences has “explanatory significance” in the sense that it

clarifies forms of causal or quasi-causal relationship that link one phase to another (viz.,

it is because the visual world has a certain kind of peculiar look—a feature of

subjectivity—that the patient is motivated to scrutinize what is before him, and this in

turn leads to certain consequences). Sass and Parnas take the view that mental patients

are conscious human beings; and that, in addition to manifesting the relatively direct

consequences of neurobiological abnormalities, they will also react to their abnormalities

in all kinds of ways that may sometimes require the categories of meaning and experience

in order to be understood or explained.

There is something surprisingly mechanistic about the proposal Mishara (2007a)

makes. Although he does not say this in so many words, he discusses the patient as if he

or she were exclusively the victim of brain events—as if intentional activity were

irrelevant and subjective experience no more than epiphenomenal. Mishara’s

characterization of natural science as generally “seeking out explanatory relationships

between ever-smaller parts” (p. 563) represents a highly reductionistic vision of science

30

that runs counter to mainstream views in both modern and contemporary philosophy of

science (re the latter, see articles in Kendler & Parnas, 2008)

Sass and Parnas do not dispute that neural abnormalities play a crucial role, nor

indeed that they may often play the most fundamental role in terms of kicking off the

sequence of events. “In its most primary form, then, this ‘irritation’ may well occur in a

largely passive manner, and therefore represents an ‘operative’ rather than ‘reflective’

kind of hyper-reflexivity,” write Sass and Parnas (2007, p. 83; also Sass 1992a, 68-73,

374-397). “This ‘irritation’ may, in fact, be a rather direct consequence of a neurally

based cognitive dysfunction.” As examples of the latter dysfunction, Sass and Parnas

mention disturbances of the hippocampus-based comparator system or of ‘cognitive

coordination’ (citing Gray et al, 1991; Phillips and Silverstein, 2003).

This does not mean, however, that experiential phenomena, together with

responses to these phenomena, involving different degrees of volition, may not also play

a key role. After all, even in the case of major physical illnesses, we are nearly always

confronted with a complex combination of factors, which include both the organism’s

and the person’s defensive and compensatory responses to the originating cause. In the

case of psychiatric disorders, these responses are particularly likely to involve reactions

(both “consequential” and “compensatory”; Sass & Parnas 2007) to lived experiences of

various kinds. Bleuler (1950), who firmly believed in the physical nature of

schizophrenia, nevertheless recognized the crucial importance of these factors, as can be

seen in his subtle discussion of the precise nature of the affective disturbance in

schizophrenia (see pp 40-53, 363-73). Even if something like a neurologically based

disorder of attention (see e.g. Hemsley 2005 for an especially plausible account) is

primary in a chronological sense, we are nevertheless presented with a person who, over

time, develops a particular cognitive/perceptual style, way of living, and world

perspective—none of which can be entirely reduced to the attentional dysfunction itself

(Sass 2007b). Understanding such styles or perspectives is of obvious relevance for

understanding pathogenetic pathways and also in the therapeutic encounter and for

devising new forms of psychological intervention.

Consideration of possible psychological, meaning-driven sequences is not,

incidentally, something that can be separated from the search for neurobiological causes.

31

Just one possible contribution of the former type of analysis, for instance, is that it may

help the neuroscientist to pare away features that may not be directly related to a

malfunctioning or abnormal neural substrate (since these features are psychologically

explicable) in order to have a purified understanding of the more direct cognitive or

behavioral consequences of the substrate condition. But it is also true that a predilection

for particular modes of attention or experience may have its effect on the neurobiological

plane (sometimes termed “downward causation”). In his discussion, Mishara shows no

sensitivity to these possibilities.

It is also simply false to say that Sass & Parnas “opt to associate their

phenomenology with everyday explanation” (Mishara 2007a, p. 563). Indeed, in the

article Mishara criticizes, Sass and Parnas (2007, pp. 74-76) explicitly contrast the

distinctive explanatory contribution of phenomenology with the practical syllogism and

the belief-desire paradigm of mental causation that is commonly proposed in analytic

philosophy and that is generally associated with everyday forms of explanation. Sass and

Parnas do not deny the relevance of the belief-desire paradigm for explaining certain

things. However, they note the problems inherent in applying this unadulterated form of

everyday explanation to many apparently irrational actions and beliefs (such as found in

schizophrenia); and they argue that phenomenological explanation typically directs one’s

attention in a different direction, namely, “toward formal or structural features that

involve more pervasive aspects or infrastructures of human experience (e.g., modes of

temporal or spatial experience, general qualities of the object world, forms of self-

experience)” (Sass & Parnas 2007, p 76). As Sass and Parnas say, the latter features are

typically not part of everyday explanation—which is one reason why psychiatrists and

psychologists would do well to be familiar with the phenomenological tradition precisely

in order to be able to go beyond the resources of everyday or common-sensical

explanation (Zahavi & Parnas 1998, Parnas & Zahavi 2002, Gallagher & Zahavi 2008,

Parnas & Sass 2008).

In several publications, Bovet, Parnas, and Sass (Bovet & Parnas 1993; Parnas &

Sass 2001, 2008; Sass 1990b, 1992a chap 9, 1992b, 1994, 2004b) have emphasized, for

example, the relevance of such non-everyday, phenomenological distinctions as

Heidegger’s between the “ontological” and the “ontic” for the understanding and

32

explanation of delusions. They have noted, e.g., that whereas many paranoid delusions

do imply fairly straightforward forms of “poor reality-testing” (the patient believes

something false about a world whose structure is largely analogous to the normal

world—“ontic” or “empirical” delusions), this is not so clearly the case with some of the

more bizarre or metaphysical (“ontological”) delusions in schizophrenia. Recently Sass

(2004b, 2007a) has argued that phenomenological notions about ipseity and the

“horizons” of experience can help to explain some of the anomalies of emotion and affect

in schizophrenia (including certain neurophysiological findings), notably the curious

possibility that such patients can experience a heightening of certain forms of affectivity

(awe, ontological anxiety) simultaneous with a diminishment of the more passionate or

standard forms of emotionality.

CONCLUSION

Overall, Mishara’s arguments in “Missing link” betray misunderstanding of the

relevant phenomenological and psychiatric literature as well as failure to grasp the key

points of the publications he criticizes. In this article, we have addressed most of

Mishara’s errors, attempting to do so in a way that serves the larger purpose of clarifying

general issues pertaining both to phenomenological psychopathology and to our own

perspective on schizophrenia. We have concentrated especially on several broad points:

these include the mutuality of the relationship between the phenomenological enterprise

and cognitive (neuro)science; the nature of self-experience—particularly ipseity or pre-

reflective self-consciousness together with the notions of hyperreflexivity and dimished

self-affection and their possible disturbance in schizophrenia; the potentially complex

interactions of intentional or quasi-volitional with non-volitional processes in the

formation of symptomatology; and the possible (and diverse) contribution of

phenomenology to psychological explanation.

END

33

REFERENCES

Andreasen N.C. 2007. DSM and the death of phenomenology in America: An

example of unintended consequences. Schizophrenia Bulletin, 33: 108-112.

Berrios GE. 1985. Positive and negative symptoms and Jackson. A conceptual

history. Archives General Psychiatry, 42: 95-98

Berrios GE. 1991. French views on positive and negative symptoms: A

conceptual history. Comprehensive Psychiatry 32, 5: 395-403.

Blankenburg, W. 1971. Der Verlust der naturlichen Selbstverstandlichkeit: Ein

Beitrag zur Psychopathologie symptomarmer Schizophrenien. Stuttgart: Ferdinand Enke

Verlag. (The loss of natural self-evidence.)

Bleuler, E. 1950. Dementia praecox or the group of schizophrenias. New York:

International Universities Press.

Bovet, P. and Parnas, J. 1993. Schizophrenic delusions: A phenomenological

approach. Schizophrenia Bulletin, 19: 579-97.

Carruthers, P. 1996. Language, thoughts and consciousness. An essay in

philosophical psychology. Cambridge: Cambridge University Press.

Carruthers, P. 1998. Natural theories of consciousness. European Journal of

Philosophy 6, #2: 203–222

Chalmers, D. 1995. Facing up to the problem of consciousness. Journal of

Consciousness Studies, 2: 200-219.

Chapman, L.J. and Chapman, J.P. 1973. Disordered thought in schizophrenia.

New York: Appleton-Century-Crofts.

Clark, A. 1997. Being there: Putting brain, body, and world together again.

Cambridge MA: MIT Press.

Cutting, J. 1997. Principles of psychopathology: Two worlds—two minds—two

hemispheres. Oxford, UK: Oxford University Press.

Cutting, J. and Dunne, F. 1989. Subjective experience of schizophrenia.

Schizophrenia Bulletin, 15: 217-231.

Cutting, J. & Shepherd, M. (Eds.) (1987). Clinical roots of the schizophrenia

concept. Cambridge UK: Cambridge University Press.

34

Dreyfus, H. 1979. What computers can’t do, Rev. edition. New York: Harper and

Row.

Fuchs, T., 2005: Delusional mood and delusional perception – A phenome-

nological analysis. Psychopathology 38:133-139.

Fuchs, T. 2007. The temporal structure of intentionality and its disturbance in

schizophrenia. Psychopathology 40: 229-235.

Gallagher, S. 1997. Mutual enlightenment: Recent phenomenology in cognitive

science. Journal of Consciousness Studies, 4: 195-214.

Gallagher, S. 2003. Phenomenology and experimental design. Journal of

Consciousness Studies 10, #Ss 9-10: 85-99.

Gallagher, S. 2005. How the body shapes the mind. Oxford: Oxford University

Press.

Gallagher, S. and J. Shear, eds. 1999. Models of the self. Thorverton UK:

Imprint Academic.

Gallagher, S. and Zahavi, D. 2008. The phenomenological mind: An introduction

to philosophy of mind and cognitive science. London: Routledge.

Gray, J. A., Feldon, J., Rawlins, J.N., Hemsley, D.R., and Smith, A.D. 1991. The

neuropsychology of schizophrenia. Behavioral and Brain Sciences, 14: 1-20.

Hamilton, M. 1984. Fish’s schizophrenia, 3rd edition. Bristol: PSG Wright

(original edition 1962).

Handest & Parnas. 2005. Clinical characteristics of first-admitted patients with

ICD-10 schizotypal disorder. British Journal of Psychiatry, 187: s49-s59.

Heidegger, M. 1989. Die Grundprobleme der Phänomenologie. Gesamtausgabe

Band 24. Frankfurt am Main: Vittorio Klostermann.

Heidegger, M. 1993. Grundprobleme der Phänomenologie (1919/1920).

Gesamtausgabe Band 58. Frankfurt am Main: Vittorio Klostermann.

Hemsley, D. R. 1987. An experimental psychological model for schizophrenia. In

Search for the causes of schizophrenia, ed. H. Häfner, W. F. Gattaz, & W. Janzarik.

Berlin: Springer.

35

Hemsley, D.R. 1998. Disruption of the “sense of self” in schizophrenia: Potential

links to disturbances of information processing. British Journal of Medical Psychology

71: 115-124.

Hemsley, D.R. 2005. The development of a cognitive model of schizophrenia:

Placing it in context. Neuroscience and Biobehavioral Reviews 29: 977-988.

Henry, M. 1973. The essence of manifestation, trans. G. Etzkorn. The Hague:

Martinus Nijhoff. Original 1963: L’Essence de la manifestation. Paris: P.U.F.

Henry M. 1975. Philosophy and phenomenology of the body, trans G. Etzkorn.

The Hague; Nijhoff.

Husserl, E. 1950. Cartesianische Meditationen und Pariser Vorträge, Husserliana

I. Den Haag: Martinus Nijhoff

Husserl, E. 1966a. Zur Phänomenologie des inneren Zeitbewußtseins (1893-

1917), Husserliana X.

Husserl, E. 1966b. Analysen zur passiven Synthesis, Husserliana XI. Den Haag:

Martinus Nijhoff.

Husserl, E. 1973. Zur Phänomenologie der Intersubjektivität II, Husserliana

XIV.Den Haag: Martinus Nijhoff.

Husserl, E. 1982. Ideas pertaining to a pure phenomenology and to a

phenomenological philosophy: First book, trans. Kersten. Dordrecht, Holland: Kluwer.

Husserl, E. 1984.. Einleitung in die Logik und Erkenntnistheorie, Husserliana

XXIV. Den Haag: Martinus Nijhoff.

Husserl, E. 1987. Aufsätze und Vorträge (1911-1921). Husserliana XXV.

Dordrecht:Martinus Nijhoff.Husserl, E. (1989). Ideas pertaining to a Pure

Phenomenology and to a Phenomenological Philosophy: Second Book: Studies in the

Phenomenology of Constitution. Translated by R. Rojcewicz and A. Schuwer. Dordrecht,

Holland: Kluwer.

Jaspers, K. 1963. General psychopathology, trans. J. Hoenig and M.W. Hamilton.

Chicago: University of Chicago Press.

Kendler & J. Parnas, eds. 2008. Philosophical Issues in Psychiatry: Exlanation,

Nosology and Phenomenology. Baltimore MD: Johns Hopkins University Press, 2008.

36

Kircher, Tilo and David, A., eds. 2003. The self in neuroscience and psychiatry,

Cambridge UK: Cambridge University Press.

Klosterkötter J. 1988. Basissymptome und Endphänomene bei Schizophrenia.

Berlin, Springer.

Klosterkötter, J. 1992. The meaning of basic symptoms for the development of

schizophrenic psychoses. Neurology, Psychiatry, and Brain Research, 1: 30-41.

Klosterkötter, J., Schultze-Lutter, F., Gross, G., Huber, G., and Steinmeyer, E.M.

1997. Early self-experienced neuropsychological deficits and subsequent schizophrenic

diseases: an 8-year average follow-up prospective study. Acta Psychiatrica Scandinavica,

95: 396-404.

Klosterkötter, J., Hellmich, M.; Steinmeyer, E.M. & Schultze-Lutter, F. 2001.

Diagnosing schizophrenia in the initial prodrome phase. Archives of General Psychiatry:

58: 158-164.

Laing, R. D. 1959. The divided self. Harmondsworth UK: Penguin.

Lewis, M. 2003. The development of self-consciousness. In Agency and self-

awareness, eds. J. Roessler and N. Eilan, pp. 275–295. Oxford: Oxford University Press.

Lutz, A. 2002. Toward a neurophenomenology as an account of generative

passages: a first empirical case study. Phenomenology and the Cognitive Sciences 1:

133–167.

Lutz, A. and Thompson, E. 2003. Neurophenomenology: integrating subjective

experience and brain dynamics in the neuroscience of consciousness. Journal of

Consciousness Studies 10: 31–52

Lysaker, P.H. & Lysaker, J.T. 2008a. Schizophrenia and the fate of the self.

Oxford UK: Oxford University Press..

Lysaker, P.H. & Lysaker, J.T. 2008b. Schizophrenia and alterations in self

experience: A comparison of six perspectives. Schizophrenia Bulletin REF??*

Maj M. 2005. "Psychiatric comorbidity": an artefact of current diagnostic

systems? British Journal of Psychiatry, 186:182-4.

Matussek, P. 1987. Studies in delusional perception. In The clinical roots of the

schizophrenia concept, eds. J. Cutting and M. Shepherd. Cambridge: Cambridge

University Press, pp. 89-103.

37

May, R.; Angel, E. and Ellenberger, H. 1958. Existence: A new dimension in

psychology and psychiatry. New York: Basic Books.

Mayer-Gross, W., Slater, E. and Roth, M. 1954. Clinical psychiatry. London:

Cassell.

Merleau-Ponty, M. 1945. Phénomenologie de la perception. Paris: Gallimard.

English translation, 1962: The phenomenology of perception, trans. C. Smith. New York:

Routledge & Kegan Paul.

Minkowski, E. 1927. La schizophrénie. Paris: Payot.

Minkowski, E. (1933/2005). Le temps vecu : Etudes phenomenologiques et

psychopathologiques. Paris : P.U.F.

Mishara, A. 2001. On Wolfgang Blankenburg, common sense, and schizophrenia.

Philosophy, Psychiatry, Psychology 8: 317-322.

Mishara, A. 2004. Disconnection of external and internal in the conscious

experience of schizophrenia. Philosophica 73: 87-126.

Mishara, A. 2007a. Missing links in phenomenological clinical neuroscience:

Why we still are not there yet. Current Opinion in Psychiatry 20: 559-569.

Mishara, A. 2007b. Is minimal self preserved in schizophrenia: A subcomponents

view. Consciousness and Cognition 16: 715-721.

Mishara, A., Parnas, J. and Naudin, J. 1998. Forging the links between

phenomenology, cognitive neuroscience and psychopathology. Current Opinion in

Psychiatry 3: 209-223.

Møller , P. and Husby, R. (2000). The initial prodrome in schizophrenia:

Searching for naturalistic core dimensions of experience and behavior. Schizophrenia

Bulletin, 26: 217-232.

Mullen P.E. 2007. A modest proposal for another phenomenological approach to

psychopathology. Schizophrenia Bulletin. 33(1):113-21.

Nagel, E. 1979. Mortal questions. Cambridge, U.K.: Cambridge University

Press.

Naudin, J. (1997). Phenomenologie et psychiatrie. Presses Universitaires du

Mirail.

38

Nelson, B. and Sass, L. (2008). The phenomenology of the psychotic break and

Huxley’s trip: Substance use and the onset of psychosis. Psychopathology, 41: 346-355.

Nelson, B.; Sass, L.A. & Skodlar, B. (in press). The phenomenological model of

psychotic vulnerability and its possible implications for psychological interventions in the ultra-

high risk (prodromal) population. Psychopathology.

Nelson, B., Sass, L.A., Thompson, A., Yung, A.R., Francey, S.M., Amminger,

G.P., and McGorry, P.D. in press. Does disturbance of self underlie social cognition

deficits in schizophrenia and other psychotic disorders? Early Intervention in Psychiatry.

Nelson B., Yung A.R., Bechdolf A. and McGorry P.D. 2008. The

phenomenological critique and self-disturbance: Implications for ultra-high risk

(‘prodrome’) research. Schizophrenia Bulletin, 34: 381-392. Parnas, J. 2000. The

self and intentionality in the pre-psychotic stages of schizophrenia. In: Exploring the self:

Philosophical and psychopathological perspectives on self-experience. ed. D. Zahavi,

pp. 115-147. Amsterdam: John Benjamins.

Parnas, J. 2003. Self and schizophrenia: A phenomenological perspective. In The

self in neuroscience and psychiatry, eds. T. Kircher and A. David. Cambridge University

Press, pp. 217-241.

Parnas, J. 2005. Clinical detection of schizophrenia-prone individuals: Critical

appraisal. British Journal of Psychiatry, 187: s111-s112.

Parnas, J. and Bovet, P. 1991. Autism in schizophrenia revisited. Comprehensive

Psychiatry, 32: 7-21.

Parnas J., Bovet P. and Innocenti G. 1996. Schizophrenic trait features, binding

and cortico-corticalconnectivity: a neurodevelopmental pathogenetic hypothesis.

Neurology, Psychiatry and Brain Research, 4: 185-196.

Parnas J., Bovet P. and Zahavi D. 2002. Schizophrenic autism: clinical

phenomenology and pathogenetic implications. World Psychiatry, 1/3: 131-136.

Parnas J. and Handest P. 2003. Phenomenology of anomalous self-experience in

early schizophrenia. Comprehensive Psychiatry, 44: 121-134.

Parnas J., Handest P., Jansson L. and Sæbye D. 2005. Anomalous subjective

experience among first admitted schizophrenia spectrum patients: Empirical

investigation. Psychopathology. 38 (5): 259-267.

39

Parnas J, Handest P, Sæbye D. and Jansson L. 2003. Anomalies of subjective

experience in schizophrenia and psychotic bipolar illness. Acta Psychiatrica

Scandinavica, 108:126-133.

Parnas, J.; Jansson, L.; Sass, L. A. and Handest, P. 1998. Self-experience in the

prodromal phases of schizophrenia: A pilot study of first admissions. Neurology,

Psychiatry, and Brain Research, 6: 107-116.

Parnas J., Moeller P., Kircher T., Thalbitzer J., Jansson L., Handest P. and Zahavi

D. 2005. EASE: Examination of Anomalous Self-experience. Psychopathology. 38 (5):

236-258.

Parnas, J. and Sass, L. 2001. Self, solipsism, and schizophrenic delusions.

Philosophy, Psychiatry, Psychology, 8: 101-120.

Parnas J. and Sass L. 2008. Varieties of “phenomenology”: On description,

understanding, and explanation in psychiatry. In Philosophical Issues in Psychiatry:

Explanation, Nosology and Phenomenology, eds. K. Kendler and J. Parnas. Baltimore

MD: Johns Hopkins University Press.

Parnas, J.; Sass, L. and Zahavi, D. 2008. Recent developments in philosophy and

psychopathology. Current Opinion in Psychiatry. 21 (6): 578-584.

Parnas J, Vianin P, Sæbye D, Jansson L, Larsen AV and Bovet P. 2001. Visual

binding abilities in the initial and advanced stages of schizophrenia. Acta Psychiatrica

Scand, 103; 171-180.

Parnas, J. and Zahavi, D. (2002). The role of phenomenology in psychiatric

classification and diagnosis. In: Psychiatric Diagnosis and Classification (World

Psychiatric Association Series), eds. M. Maj, W. Gaebel, J.J. Lopez- Ibor, and N.

Sartorius, pp.137-162. New York: John Wiley & Sons.

Phillips, W.A. and Silverstein, S.M. 2003. Convergence of biological and

psychological perspectives on cognitive coordination in schizophrenia. Behavioral and

Brain Sciences, 26: 65-82.

Ratcliffe, M. 2008. Feelings of being: Phenomenology, Psychiatry, and the sense

of reality. Oxford UK: Oxford University Press.

Ricoeur, P. 1966. Freedom and nature: The voluntary and the involuntary.

Evanston IL: Northwestern University Press.

40

Ricoeur, P. 1992. Oneself as another, trans. K. Blamey. Chicago: University

Chicago Press.

Rulf, S. 2003. Phenomenological contributions on schizophrenia: A

critical review and commentary on the literature between 1980-2000, Journal of

Phenomenological Psychology, 34.

Sartre, J.-P. 1956. Being and Nothingness, trans. H.E. Barnes. New York:

Philosophical Library.

Sass, L. l985. Time, space, and symbol: A study of narrative form and representational

structure in madness and modernism. Psychoanalysis and Contemporary Thought, 8: 45-85.

Sass, L. l987. Introspection, schizophrenia, and the fragmentation of self.

Representations, 19: l-34.

Sass, L. l988a. The land of unreality: On the phenomenology of the schizophrenic

break. New Ideas in Psychology, 6: 223-242.

Sass, L. l988b. Humanism, hermeneutics, and the concept of the human subject. In

Hermeneutics and psychological theory, eds. S. Messer, L. Sass and R. Woolfolk New

Brunswick, NJ: Rutgers University Press, 222-27l.

Sass, L. 1990a. The truth-taking stare: A Heideggerian interpretation of a schizophrenic

world. Journal of Phenomenological Psychology, 21: 121-149.

Sass, L. 1990b. On delusions. Raritan, Spring: 120-141.

Sass, L. 1992a. Madness and Modernism: Insanity in the Light of Modern Art,

Literature, and Thought. New York: Basic Books. (Harvard paperback 1994.)

Sass, L. 1992b. Heidegger, schizophrenia, and the ontological difference.

Philosophical Psychology, 5: 109-132.

Sass, L. 1994. The Paradoxes of delusion: Wittgenstein, Schreber, and the

schizophrenic mind. Ithaca N.Y.: Cornell University Press.

Sass, L. 1998. “Ambiguity is of the essence”: The relevance of hermeneutics for

psychoanalysis. In Psychoanalytic Versions of the Human Condition and Clinical

Practice, eds. P. Marcus and A. Rosenberg, pp. 257-305. New York: New York

University Press.

Sass, L. (2000). Schizophrenia, self-experience, and the so-called

“negative symptoms.” In Exploring the Self: Philosophical and

41

psychopathological perspectives on self-experience, edited by D. Zahavi.

Amsterdam & Philadelphia: John Benjamins Publishing Co., pp. 149-182.

Sass, L. 2001a, ed. The phenomenology of schizophrenia: Three classic

approaches. Philosophy, Psychiatry, Psychology, Volume 8, #4 (special issue).

Sass, L. 2001b. Self and world in schizophrenia: Three classic approaches.

Philosophy, Psychiatry, Psychology, 8: 251-270.

Sass, L. 2003a. “Negative symptoms, schizophrenia, and the self.

International Journal of Psychology and Psychological Therapy, 3: 153-180.

(http://www.ijpsy.com/volumen3/num2/62.html)

Sass, L. 2003b. Schizophrenia and the self: Hyperreflexivity and diminished self-

affection. In The Self in Schizophrenia: Neuropsychological Perspectives, eds. T. Kircher

and A. David. Cambridge UK: Cambridge University Press.

Sass, L. 2004a. “Negative symptoms,” commonsense, and cultural disembedding in the

modern age. In Schizophrenia, Culture, and Subjectivity: The Edge of Experience, eds. J.

Jenkins & R. Barrett. Cambridge UK: Cambridge University Press, pp. 303-328.

Sass, L. 2004b. Affectivity in schizophrenia: A phenomenological

perspective. Journal of Consciousness Studies, 11: 127-147.

Sass, L. 2004c. Schizophrenia: A disturbance of the thematic field. In Gurwitsch’s

Relevancy for the Cognitive Sciences, ed. L. Embree. Dordrecht, Holland: Springer, pp. 59-78.

Sass, L. 2007a. Contradictions of emotion in schizophrenia. Cognition and

Emotion, 21: 351-390.

Sass, L. 2007b. “Person with schizophrenia” or “schizophrenic person”:

Reflections on illness and the self. Theory and Psychology, 17: 395-420.

Sass, L. (in press). Autonomy and schizophrenia: Reflections on an ideal. In C.

Piers, ed., Personality and psychopathology: The influence of David Shapiro. New

York: Springer.

Sass, L. and Parnas, J. 2003. Schizophrenia, consciousness, and the self.

Schizophrenia Bulletin, 29: 427-44.

Sass, L. & Parnas, J. (2007). Explaining schizophrenia: The relevance of

phenomenology. In Reconceiving schizophrenia, eds. M.C. Chung, K.W.M. Fulford, G.

Graham. Oxford UK: Oxford University Press, pp. 63-95.

42

Sass, L.A. and Uhlhaas, P.J. 2003. Phenomenology, context and self-experience

(commentary). Behavioral and Brain Sciences, 26 (3): 102-103

Sass, L.; Whiting, J. and Parnas, J. 2000. Mind, self, and psychopathology:

Reflections on philosophy, theory, and the study of mental illness. Theory and

Psychology, 10: 87-98.

Schmitz, H. 2003. Was ist neue phänomenologie?. Rostock: Koch Verlag.

Schwartz, M.A. and Wiggins, O.P. (1987), Typifications. The first step for

clinical diagnosis in psychiatry. Journal of Nervous and Mental Diseases, 175: 65-77.

Schwartz, M.A., Wiggins, O.P., Naudin, J. and Spitzer, M. (2005). Rebuilding

reality: A phenomenology of aspects of chronic schizophrenia. Phenomenology and the

Cognitive Sciences 4: 91–115.

Skodlar, B., Tomori, M. and Parnas, J. (2008). Subjective experience and suicidal

ideation in schizophrenia. Comprehensive Psychiatry 49 (5): 482-488 E.

Spitzer, M. 1988. Ichstörungen: In Search of a Theory. In Psychopathology and

Philosophy, eds. Spitzer, M.; Uehlein, F.A.; and Oepen, G., pp. 167-183. Berlin:

Springer.

Stanghellini, G. 2001. Psychopathology of common sense. Philosophy,

Psychiatry & Psychology 8: 201-218.

Stanghellini, G. 2004. Disembodied spirits and deanimated bodies: The

Psychopathology of common sense. Oxford UK: Oxford University Press.

Stangehellini, G. & Ballerini, M. 2007. Values in persons with schizophrenia.

Schizophrenia Bulletin 33 (1): 131-141.

Tatossian, A. 1979. La phénomenologie des psychoses. Paris : Masson, 1979.

(reprinted, Paris: L’Art du Comprendre 1997).

Thompson, E. 2007. Mind in life: Biology, phenomenology, and the sciences of

mind. Cambridge MA: Harvard University Press.

Uhlhaas, P.J. and Mishara, A. 2007. Perceptual anomalies in schizophrenia:

Integrating phenomenology and cognitive neuroscience. Schizophrenia Bulletin

33(1):142-156.

Varela, F. 1996. Neurophenomenology. Journal of Consciousness Studies, 3: 330-

349

43

Varela, F.J., Thompson, E., and Rosch, E. 1991. The embodied mind: Cognitive

science and human experience. Cambridge: MIT Press.

Vollmer-Larsen A. 2008. The course and outcome in schizophrenia spectrum

disorders: A 5-year follow-up in Copenhagen prodromal study. University of

Copenhagen, PhD dissertation.

Vollmer-Larsen, A., Handest, P. and Parnas, J. 2007. Reliability of measuring

anomalous experience: the Bonn scale for the assessment of basic symptoms.

Psychopathology, 2007, 345-348.

Wiggins, O.P., Schwartz, M.A. and Northof, G. 1990. Toward a Husserlian

description of the initial stages of psychosis, in Philosophy and Psychopathology, eds.

Spitzer, M. and & Maher, B. Berlin, Springer-Verlag.

Zahavi, D. 1999. Self-awareness and alterity: A phenomenological investigation.

Evanston IL: Northwestern University Press.

Zahavi, D. 2003a. Husserl's phenomenology. Stanford: Stanford University Press.

Zahavi, D. 2003b. Inner time-consciousness and pre-reflective selfawareness. In The new

husserl: A critical reader, ed. D. Welton, pp. 157-180. Bloomington: Indiana University

Press.

Zahavi, D. 2004. Phenomenology and the project of naturalization.

Phenomenology and the Cognitive Sciences, 3: 331-347.

Zahavi, D. 2005. Subjectivity and selfhood: Investigating the first-person

perspective. Cambridge MA: MIT Press.

Zahavi, D. 2009. Is the self a social construct? Inquiry, in press.

Zahavi, D. and Parnas, J. 1998. Phenomenal consciousness and self-awareness. A

phenomenological critique of representational theory. Journal of Consciousness Studies

5/5-6: 687-705.

ENDNOTES i An additional reason for rejecting Mishara’s use of the term

“neophenomenology”: it has already been used extensively by Herman Schmitz (2003).

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iii Mishara himself quotes the phrases “reciprocal constraint” and “mutual

enlightenment,” even including them in the abstract, in Mishara, Parnas & Naudin

(1998).

iv Sass’s Madness and Modernism (1992a, see pp. 9, 10, 27) is perhaps the most

extended recent attempt (together with his The Paradoxes of Delusion [1994]) to offer an

explicitly hermeneutic-phenomenological approach to schizophrenia. For introductions

to hermeneutic phenomenology’s relevance, see Sass 1988b, 1998. (In retrospect, Sass

would revise his discussion of Husserl in these latter articles—along lines inspired by

Zahavi [2003a] and explained in Thompson [2007, appendix A].)

v A more accurate (but impossibly unwieldy) label for the overall model would

perhaps be the IHRDSAM: standing for the Ipseity/HyperReflexivity/Dimished-Self-

Affection Model.

vi Hyper-reflective processes are not always active; they can, e.g., be quasi-

automatized. There are many nuances to the activity/passivity issue.

vii More could be said about this topic (self-awareness vs self), but detailed analysis

is beyond the scope of this paper. See Zahavi (2005, 2009).

viii For discussion of how seeking a static, object-like entity precludes finding the

self-as-subject, see discussion of William James in chapter 7 of Sass (1992a).

ix Mishara (2007a) misses the relevant point when he acknowledges that, for the

IHM, “hyperreflexivity (or exaggerated self-reflection) may itself become automatic in

schizophrenia leading to the ‘pop out’ of irrelevant background stimuli and disruptive

bottom up processes” (560; also in Mishara 2007b, p. 716n). Sass and Parnas do indeed

mention this latter kind of development (which involves an automatizing of reflection). It

would have been more relevant, however, to recognize that, according to our IHM view,

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operative hyperreflexivity is more fundamental, temporally and causally, than is hyper-

reflection (Sass & Parnas 2007, pp. 69, 82-85). The latter point directly refutes Mishara’s

critique.

x Sass (1992a p. 228) writes:

“[The] mode of exigent introspection …could also reflect some more specific

cognitive factor rooted in neurobiological abnormalities, such as an incapacity (or

a disinclination) to synthesize larger Gestalts or, perhaps, an inability to desist

from paying attention to stimuli that are habitually experienced and that would not

normally be focused on (kinesthetic and other “inner” sensations would be one

important subset of such sensations). In these latter cases, fragmentation of the

self would be not just a consequence but, in a sense, also a cause of a certain kind

of hyperfocused introspection …”

An attached note cites Hemsley as well as Matussek and Conrad.

xi The “top down-vs-bottom up” or “from above-vs-from below” distinction

misconstrues the difference between Mishara’s and our view, as explained. Also

erroneous is using Nietzsche’s notion of the “Dionysian” to describe the view that

common sense fails “because perceptual and automatic meaning processing are [sic]

disrupted ‘from below’” (Lysaker & Lysaker 2008a, p. 32; 2008b, p. ??*, citing

Mishara). In Nietzsche’s Birth of Tragedy, Dionysianism refers to self-dissolution from

excess of passion or instinct. This has nothing in common with the disrupted

perceptual/automatic-processing view and seems antithetical to the nature of

schizophrenia (Sass 1992a Prologue; 2007a).