From self disorders

to the schizophrenic self

Riccardo Piero Dalle Luche

Dir. SPDC ASL 1 Massa and Carrara
Tuscany Italy
kraepelin@alice.it
 DSM concepts of
schizophrenia

DSM series from DSM-III to DSM -V considers as

diagnostic criteria for schizophrenia,
delusions, hallucinations (without awareness),
disorganized speech and behaviour and
catatonic behaviour for at least six months.
They do not quote self disorders as fundamental
symptoms. Depersonalization and dissociative
disorders are classified elsewhere.
 Schizophrenia in european
psychopathological tradition
In eurpoean tradition schizophrenia is not only a
psychotic disorder characterized by delusions,
hallucinations and disorganized speech and
behaviour. It is a chronic condition which can start
with not psychotic disorders and even show only
transient psychotic symptoms in its complete course,
but is primarily a disturbance of the Self, that is
to say the illness directly and primarily destroys
the self organization from within. In its early
phases, but also in post psychotic and chronic
stages, the subject can perceive and describe the
sense and feelings of alineation that is to say the
loss of the quality of “mine” of his/her feelings,
bodily sensations, thoughts and perceptions.
 Symptoms structure according to Bleuler
Dementia praecox oder die Gruppe der Schizophrneien, 1911

Sintomi fondamentali accessori

(invariabilmente presenti) (non necessariamente presenti)
Dist. Associazioni, affettività, Allucinazioni, deliri, illusioni
Ambivalenza, Autismo Dist. Memoria, Stati crepuscolari
Dist. Attenzione, volontà Depersonalizzazione

Tendenza alla scissione Dist. Linguaggio e della scrittura

Demenza Sintomi catatonici
Dist. Attività e del comportamento

Sintomi primari secondari

Dist. Associazioni Deliri e allucinazioni

Autismo, ambivalenza Dist. Memoria e orientamento
Deterioramento, demenza
Distorsione percettiva e cognitiva della realtà
Sint. catatonici
 The most important european psychopathologic
concepts of schizophrenia

Kraepelin: loss of internal unity of emotion, volition and cognition

Bleuler: self disorders as fundamental symptoms

Berze: primary insufficiency

Gruhle: disordered selfhood as specificic of schizophrenic existenc

Minkowski: loss of contact with reality and lack of drive toward the
future (“elan vital”)

Schneider K.: Loss of mineness higly specific for schizophrenia

Binswanger L.: loss of personation; complete loss of pure ego functions;

Blankenburg: loss of naturalness, of the evidence of the reality

Laing: divided Self, false self as a defence

Tatossian: subjects without an I; lack of an inner looker or spectator

Huber and G.Gross: aspecific basic symptoms are the true marker of the
schizophrenic process

Parnas: loss of I-ness; disorder of ipseity

 Klaus Conrad's psychopathological differentiation
of schizophrenic psychoses on the base of the inner
experience

Pre-post-scyhcotic
stages, hebephrenic
(disorganized) forms

Paranoid, productive forms

Hyperacute, catatonic froms

• The “Whatness” of schizophrenia is
particularly evident in hebephrenia
that is actually poorly diagnosed at
vantage of other labels such as
borderline and schizotypal PD, OCD,
feeding behaviour disorders and even
anxiety disorders

• (J. Parnas, 2011)

 Lack of awareness, insight

Psychotic symptoms

Symptoms prevalence in schizophrenic psychoses

Gerd Huber's Bonn Scale for the Assessment of Basic Symptoms (1987)
The psychopathological model of schizophrenia according to
basic symptoms theory (Huber, Gross, 1987)

PRE-SCHIZOPHRENIA
3°
BS 2°
1°
Outpost
Syndromes Prodroms Schizophrenia

ONSET OF ONSET OF
SCHIZOPHRENIA SCHIZOPHRENIA
Schultze-Lutter's Schizophrenia Proneness
Scale for Adults and Child and Youth
SPI-A (2007) and SPI C&Y (2012)
Assesment of basic symptoms at high risk for
the
Develpment of psychosis (Schultze-Lutter 2012)

Cognitive-Perceptive Basic Symptoms (COPER, early prodromal

state)

Thought interference, thought pressure, disturbance of

receptive speech, thought perseveration, thought blockages,
decreased ability to discriminate between ideas and perception,
fantasy and true memories, unstable ideas of reference, visual
perceptive disturbances, acoustic perception disturbances,
derealization

High risk criterion Cognitive Disturbances (CODGIS, highly

predictive of the development of a first psychotic episode)

Disturbances of abstract thinking, inability to divide

attention, thought interference, thought pressure, disturbance
of receptive speech, disturbance of expressive speech, thought
blockages, unstable ideas of reference, captivation of
attention by details of the visual field
 EASE: Examination
of anomalous Self Experiences
(J.Parnas et al., 2005 )
 EASE Items
• Self disorders: diminished self.presence,
disturbed first person perspective,
disembodiment, spatialization of mental life,
disorders of the stream of thought, lack of
basic sense of ispeity, sense of unclairyt of
consciousness, anhedonia, devitalizationm
sopipsim/grandiosity
• Other symptoms: perplexity, ambivalence,
sense of loss of meaning, hyper-reflexivitym
mirror phenomnon, ontological insecurity,
fear of dissolution, fear of existence,
disorders of attention and perception,
anomalous bodily sensations
The question of the structure of the SELF
 “Splitting”
The Selfnormale (nevrotico)
and the I
Human identity always refers to a relational
context:everyman is someone in a peculiar
situation but his/her different identities are
always linked one another for adaptative
(economic) purposes inside the Self that assure
their “mineness”:

I1 f(S1)

I2 f(S2)

In f(Sn)
The Self
 The function of ipseity

A normal (or neurotic) individual is

able to adapt to every changing
situation mantaining the feeeling of
having an I and of being oneself

Situations
The function of
Ipseity let the I Sn 1
to keep the sense of S1
Mineness of experiences 2
in front of the SELF S 4

biographical or
S2 3
time-conditioned
changes S3 4
n
 “PERSONATION”

The evolutive process with which an human being acquires

and keeps in time the tacit feeling of oneself
as an individual entity (Racamier)

This process allows oneself to perceive his/her

own mind and body as “his” or her”
and to feel the self as “one own self” (Basaglia)

It is a basic, prereflexive property of human mind

RDL 2002
Schizophrenia and the Self
 Arthur Tatoassian's early observations
(“Analyses phenomenologiques de la conscience
délirante”, 1962-1965) I

• The psychotic patient suffers for a

fundamental inability to feel his mental
states as his own because of the lack of a
reflexive control of the costitution of
experience of reality

• His experience oscillates between the

opposite poles of solipsism (there is not a
reality) and mondification (Verweltlichung)
in which there is only the reality that
controls and gives order to the subject.
 Arthur Tatossian's early observations
(“Analyses phenomenologiques de la conscience
délirante”, 1962-1965) II

• There is no more an empirical ego and the

subject reduces to be a pure gramatical
• signifier (that does not refer to someone):

“I” is no more “The subject” identified

with his/her personality

“Psychotic statements are pseudo-utterances

expressed by a pseudo-subject and addressed
to a pseudo-other” (de Waelhens)
 Last Arthur Tatossian's ideas on
identity referring to Paul Ricoeur's
model

• In normals, identity is composed by a

dialectic between “ipseitè” (to be oneself)
and memeté (to be the same) that constitutes
the narrative identity.

• Melancholic individuals remain identical to

themselves because they cannot change their
empirical and role identity.

• Psychotic individuals cannot assume any role

and empirical identity, so that their
ipseitè remains pure and solipsistic
Ronald Laings's schema of Self-transformation
in schizophrenic psychoses
 A neurobiological model of the
A Schizophrenic Self

• Very recently the question of the alteration

of the schizophrenic self has transformed
from a philosophical question to a
mathematic-cybernetic question. In a paper
published on Scizophrenia Bulletin, Taylor
(2011) has transformed in a cognitive neural
model the ideas of Parnas and Sass,
hypothesizing the CODAM (Corollary Discharge
of Attention Movement), according to which
the disturbance of reflexivity in
schizpophrenia springs out from a primary
defect in attention and in the creation of a
copy of the stimulus, available for mnemonic
and other topside process.
 “Je est un autre”

« Car JE est un autre. Si le cuivre s'éveille clairon, il n'y a rien

de sa faute.[6] »

« Io è un altro. Se l'ottone si desta tromba, non è certo per

colpa sua.[4] »
 What happens to Self identity
if some experience devoid of the sense of
mineness introduces in the mind?

Observing ego Awareness of illness, realization that

something is wrong (perception of basic symptoms or self disorders
experiences)

Feeling of being no more Feeling of being

Master in our house both observing and
(paranoid ideation) observed in one own mind
(delusion of influence)

Loss of the sense of agency, loss of subjectivity,

The Self become an object
What happens in the schizophrenic Self: a synoptic schema

“Double rail” functioning

Normal Self
Being oneself out of reality
(normal self monitoring)

Rebuilding of a
reversible psychotic Self with
an observing ego but
Splitting with a False identity,
between oberving generally megalomanic
and observed Self
(original Splitting) No more
Armonic and reversible
Spontaneous reversible
Adaptation to
Oneself (body Loss of an
and mind) and Observing self
to the external in acute phases
World

Perception of basic
Symptoms; partial
Loss of mineness;
hyperreflexivity
Self centrality,
Schneiderian first
Rank symptoms
 The changes in the Self in the
schizophrenic process

SB3
S5 Sn
S3 S
S4 S1 SB 2 Delusional
S2 S
self
S22
S1 SB1 S
SB
1 Post-psychotic
stages
Cohesion of Self Acute Psychosis
Normal ipseity Primary splitting
Pre-psychotic stages
 What makes and individual
schizophrenic even if he/she is not
delusional or hallucinated?

Lack of a centre of experience

Lack of an inner spectator and of insight

(in certain phases)

Lack of the sense of agency Subjective

experience
Lack of ipseity (of Mineness or I-ness tacit,
pre-reflexive feelings)(in certain phases)

Incoherence, lack of reliability,

consequentiality and predictability

Lack of adaptation and of the ability to keep a Behaviour

social role
 Conclusion
• The assessment of Self-Disorders and the
phenomenological attention to the
schizophrenic Self are dockyards ever in
progress for the study of Ego-
consciousness and self-awareness in
schizophrenia that heLp us to establish
early the diagnosis of this severe and
chronically acute clinical condition and
differentiate it from most of the other
psychoses.
• Moreover it is a natural model for the
study of the structure of human mind in
general.

• Thanks you for the attention