Elizabeth Pienkos

The self-disorder model provides a phenomenological framework for understanding how the core symptoms of Schizophrenia Spectrum Disorders (SSDs) are rooted in an instability of minimal selfhood. This instability involves a range of “anomalous experiences”: transformations in an individual’s perceptual field and sense of being an agent of action. The explanatory value of this theoretical model can be summarized in two claims about the role of anomalous experiences in self-disorders: (1) anomalous experiences express a common trait-like disturbance that is characteristic of SSDs, and (2) anomalous experiences contribute to explanations regarding how self-disorders progress into SSDs. While hypotheses consistent with the first claim have been substantiated in several studies, hypotheses consistent with the second claim remain underexamined. We argue that attending to this gap in the literature requires considering which methodological strategies are best suited for investigating if and how anomalous experiences contribute to the development of self-disorders into SSDs and psychotic states. Network modeling is discussed as one such strategy suitable for examining the role of anomalies of lived-world in the maintenance of paranoid delusions in SSDs.

In lieu of an abstract, here is a brief excerpt of the content:How Narrative Counts in Phenomenological Models of SchizophreniaThe author reports no conflicts of interest.Rosanna Wannberg (2024) offers an intriguing and novel critique of the predominant phenomenological model of schizophrenia, the ipseity disturbance hypothesis. According to this model, which was initially proposed by Sass and Parnas (2003), schizophrenia is best understood as arising from a disturbance or instability of minimal or basic self-hood, the sense of being present to oneself and one's experiences (Henriksen, 2022). This disturbance appears as various experiential anomalies, sometimes termed "anomalous self (or world) experiences" or "self disorders," which include such phenomena as alienation from subjective processes, doubt in the existence of the world or one's own existence, fluidity of boundaries between self and others or self and world, and many other phenomena. Many of these have been captured in the Examination of Anomalous Self Experience (Parnas et al., 2005) and the Examination of Anomalous World Experience (Sass et al., 2017).At the same time, some research reveals the presence of self disorders in nonpsychotic conditions like panic disorder (Madeira et al., 2017) and depersonalization/derealization disorder (Sass et al., 2013). There are also competing phenomenological models that posit schizophrenia instead as a disturbance of dialogical self (Lysaker & Lysaker, 2002) or as a disruption of automatic perceptual processing (Uhlhaas & Mishara, 2007). Such works contain implicit critiques of the ipseity disturbance hypothesis that focus on the specificity of self disorders, or else on the specific nature of the underlying disturbance in schizophrenia.Wannberg's critique is distinct from these others: by considering the validity and function of recovery narratives, she raises crucial epistemological and ethical questions about the phenomenological approach to psychopathology, asking not only whose narrative counts, but how narrative counts. In particular, Wannberg questions a phenomenology that, she suggests, might find any ongoing symptoms as evidence of continued alterations of subjectivity, and that would then be dismissive of recovery narratives—a phenomenology that would prioritize the authority [End Page 71] of consciousness, as Wannberg puts it, over the authority of the person.It is worth stating here that the standard phenomenological response would not be to distrust or dismiss accounts of recovery. Ideally, phenomenological models, along with their ongoing theoretical developments and empirical work, are based on a deep respect for patients' experience and self-descriptions, striving to attend to experiences as they are lived without imposing pre-defined constructs that would limit or alter the experiences in a fundamental way (Nordgaard et al., 2013).Questions about the nature of recovery might be addressed within phenomenology by considering the difference between minimal (or basic) self and narrative (or extended) self, a more complex self-understanding or self-interpretation that is founded on the more basic, pre-reflective sense of being alive in the world (Gallagher, 2000; Parnas, 2007). According to proponents of the ipseity disturbance hypothesis, disturbances of basic self-hood can contribute to disturbances of narrative self, such as confusion about one's future goals or difficulties making sense of one's life history, though it is unlikely for disruptions that originate in the narrative self to trickle down to the minimal self (Henriksen, 2022). Such a view might similarly suggest that it would be unlikely for work on the level of the narrative self to lead to improvements in minimal self. Recovery, according to this approach, might best be viewed as an understanding of and compensation for alterations in basic self-hood, such that a person can develop a relatively solid narrative self that accounts for and manages disturbances of minimal self—while the minimal self may also grow more solid through various therapeutic interventions (Skodlar & Henriksen, 2019).Wannberg finds a more transformative possibility in Wittgenstein's grammatical approach, which is concerned with the function and rules of discourse. According to her grammar of recovery, recovery narratives are not only the product of a process of meaning-making and self-understanding, but they can create meaning and new realities. Furthermore, this process, according to Wannberg, has an inherently social and normative quality to it: the self-work that occurs in recovery and the recovery narrative involves the development of agency, autonomy, and responsibility in a social world...

This paper offers a comparative investigation of anomalous self-experiences common in schizophrenia instrument) and those of normal individuals in an intensely introspective orientation. The latter represent a relatively pure manifestation of certain forms of exaggerated self-consciousness, one facet of the disturbance of core- or minimal-self postulated as central in schizophrenia. Significant similarities with schizophrenia-like experience were found but important differences also emerged. Affinities included feelings of passivity, fading of self or world, and alienation from thoughts, feelings, or lived-body. Differences involved confusion between self and world and severe dislocation or erosion of first-person perspective, qualities unique to schizophrenia. The purpose is threefold: 1, place the putatively schizophrenic experiences of self-disorder in a broader, comparative context; 2, evaluate hypotheses concerning core processes in schizophrenia; 3, orient investigation of possible pathogenetic pathways as well as psychotherapeutic interventions.

Here we consider interpersonal experience in schizophrenia, melancholia, and mania. Our goal is to improve understanding of similarities and differences in how other people can be experienced in these disorders, through a review of first-person accounts and case examples and of contemporary and classic literature on the phenomenology of these disorders. We adopt a tripartite/dialectical structure: first we explore main differences as traditionally described; next we consider how the disorders may resemble each other; finally we discuss more subtle but perhaps foundational ways in which the phenomenology of these disorders may nonetheless be differentiated. These involve disruptions of common sense and conventionality, abnormalities of empathy, distinct forms of paranoia and the sense of personal centrality, and altered perceptions of intentionality, deadness, and artificiality. We end by considering some neurocognitive research relevant to these abnormal forms of subjectivity, including work on theory of mind, experience of human movement, and perception of faces.

In this paper, we use a phenomenological approach to compare the unusual ways in which language can be experienced by individuals with schizophrenia or severe mood disorders, specifically mania and melancholia. Our discussion follows a tripartite/dialectical format: first we describe traditionally observed distinctions ; then we consider some apparent similarities in the experience of language in these conditions. Finally, we explore more subtle, qualitative differences. These involve: 1, interpersonal orientation, 2, forms of attention and context-relevance, 3, underlying mutations of experience, and 4, meta-attitudes toward language. Such distinctions appear to reflect significant differences in underlying forms of subjectivity; they are broadly consistent with work in phenomenological psychopathology on other aspects of experience, including body, self, and social world. An understanding of such distinctions may assist with difficult cases of differential diagnosis, while also contributing to a better understanding of suffering persons and of psychological factors underlying their disorders

Various forms of anomalous self-experience can be seen as central to schizophrenia and other psychiatric disorders. We examined similarities and differences between anomalous self-experiences common in schizophrenia-spectrum disorders, as listed in the EASE , and those described in published accounts of severe depersonalization. Our aims were to consider anomalous self-experience in schizophrenia in a comparative context, to refine and enlarge upon existing descriptions of experiential disturbances in depersonalization, and to explore hypotheses concerning a possible core process in schizophrenia . Numerous affinities between depersonalization and schizophrenia-spectrum experience were found: these demonstrate that rather pure forms of diminished self-affection can involve many experiences that resemble those of schizophrenia. Important discrepancies also emerged, suggesting that more automatic or deficiency-like factors—probably involving self/world or self/other confusion and erosion of first-person perspective—are more distinctive of schizophrenia-spectrum disorders

This current study is a pilot project designed to clarify changes in the lived world among people with diagnoses within the schizophrenia spectrum. The Examination of Anomalous World Experience was used to interview ten participants with schizophrenia spectrum disorders and a comparison group of three participants with major depressive disorder. Interviews were analyzed using the descriptive phenomenological method. This analysis revealed two complementary forms of experience unique toszparticipants: Destabilization, the experience that reality and the intersubjective world are less comprehensible, less stable, and generally less real; and Subjectivization, the dominance of one’s internal, subjective experiences in the perception or interpretation of the lived world. Persons with depressive disorders, by contrast, did not experience disruptions of the reality or independence of the world or any significant disruptions of appearance or meaning. These results are consistent with contemporary and classic phenomenological views on anomalous world experience in schizophrenia.

This paper reviews various perspectives regarding the relationship between language and experience, including the challenges of using verbal descriptions to access subjective experience in psychiatric interviews (in both clinical and research settings). Schizophrenia is a specific case in which the experience of language may be altered, posing unique challenges in the context of the interview. The phenomenology of language in schizophrenia is briefly presented, with discussion of related alterations in interpersonal orientation, attention and context, underlying experience, and attitudes toward language. It is suggested that some of the challenges posed by language, particularly in schizophrenia, may be addressed through the use of semi-structured, phenomenologically-informed interviews like the EASE: Examination of Anomalous Self-Experience and the EAWE: Examination of Anomalous World Experience. Guidelines for the administration of these interviews are presented to assist with eliciting descriptions of subjective experience with a higher degree of detail and accuracy.

Depersonalization/derealization disorder is classified as a dissociative disorder in the DSM5. It is noteworthy that the symptoms of depersonalization and derealization are commonly found in many other psychological disorders, including schizophrenia spectrum disorders, while phenomenological features of schizophrenia are commonly found in DPDR. The current study attempts to clarify these apparent similarities via highly detailed phenomenological interviews with four persons diagnosed with DPDR. The data revealed four interrelated facets: 1, Loss of resonance, 2, Detachment from experience, 3, Loss of self, and 4, Commitment to reality. These facets point to a felt loss of immediate and familiar engagement in experience as a basic organizing Gestalt which permeates the various symptoms and signs of our participants with DPDR. Close consideration of this disruption allows their experiences to be more easily distinguished from those of schizophrenia-spectrum disorders.

This paper outlines several of the challenges that are inherent in any attempt to communicate subjective experience to others, particularly in the context of a clinical interview. It presents the phenomenological interview as a way of effectively responding to these challenges, which may be especially important when attempting to understand the profound experiential transformations that take place in schizophrenia. Features of language experience in schizophrenia—including changes in interpersonal orientation, a sense of the arbitrariness of language, and a desire for faithful communication of experience —are described, together with discussion of their relevance for the interview context. Furthermore, the interview presents a unique context in which both intersubjective and interpersonal aspects of experience will be described as well as evoked. It is proposed that phenomenological interviewers should not only be familiar with these and other experiences that can occur in schizophrenia, but also capable of applying the techniques of phenomenological and hermeneutic methods in order to understand the descriptions of interviewees with sensitivity and accuracy.

This special issue presents a Portuguese translation of the EAWE: Examination of Anomalous World Experience (Sass et al., this issue; original publication Sass et al., 2017). The EAWE is a semi-structured, phenomenologically-oriented interview designed to elicit descriptions of changes in the lived world, particularly those that may be more commonly found in schizophrenia spectrum disorders (though it may also be used to study disorders outside the schizophrenia spectrum). The EAWE represents an important trend in psychiatric research and practice: a growing appreciation for the role of subjectivity in understanding, explaining (Sass, 2010), classifying and treating psychiatric disorders, especially complex and heterogeneous disorders such as schizophrenia. The EAWE’s translation into Portuguese reflects several equally important developments. The ability to collect detailed information about the experience of schizophrenia and other psychiatric conditions among Portuguese-speaking participants will make it possible to study the phenomenological characteristics of schizophrenia outside of Anglophone cultures, providing important data about the intersections of individual, interpersonal, and cultural experiences in the development of the disorder. In addition, it occurs at a time of renewed energy and collaboration in phenomenological psychopathology, particularly in Brazil.

Contemporary psychiatric nosology has evolved with a primary goal of reducing the presence and influence of subjectivity by valuing objective symptoms and explanations (e.g. neurobiological models of psychopathology). However, improvements in the reliability and validity of these endeavours have fallen short of expectations, and it has been argued that one reason for these failures is the very omission or neglect of subjectivity in understanding and explaining mental illness. This paper supports the need for a paradigm shift, from researching the “what” of mental symptoms to a focus on “how” patients experience themselves and the world when undergoing a mental disorder. We review past contributions to disturbances of subjectivity, particularly in schizophrenia, which have contributed to the creation of a new bio-pheno-social model. We also discuss available tools for the systematic assessment of subjective anomalies. We pay special attention to the Examination of Anomalous World Experience (EAWE), which considers disturbances in world engagement, including the experience of atmosphere, space and objects, lived time and temporality, interpersonal relations, language, and existential concerns. Ultimately, we stress that the exploration of subjective experiences is essential, promising, and achievable in research on mental disorders.

This paper returns to a seminal case in the historical of phenomenological psychopathology, Ludwig Binswanger’s discussion of “Ellen West A woman with a long history of melancholia and disordered eating, Ellen West was treated at Binswanger’s Bellevue sanatorium in 1921, a two-and-a-half month-long stay that resulted in a diagnosis of schizophrenia and Ellen West’s suicide. Binswanger relied on West’s personal writings and clinical history to develop and apply an original approach to case analysis, Daseinsanalyse or “existential analysis.” This paper takes up this case and Binswanger’s analysis to explore the origins of contemporary phenomenological psychopathology, the recent progress in this field, and areas for continued growth. The paper argues that new approaches to exploring the embedded or situated quality of psychopathology are needed for advancing clinical phenomenology, and that feminist and critical phenomenology are among the disciplines that can provide important methodological and theoretical foundations for this work. Without this, the field risks repeating Binswanger’s original mistakes and viewing psychiatric illness solely as the expression of a disturbed individual.

This paper proposes a qualitative study exploring anomalous self and world-experiences in individuals with high levels of depersonalization experiences. Depersonalization (DP) is a condition characterized by distressing feelings of being a detached, neutral and disembodied onlooker of one’s mental and bodily processes. Our findings indicate the presence of a wide range of anomalous experiences traditionally understood to be core features of DP, such as disembodiment and disrupted self-awareness. However, our results also indicate experiential features that are less highlighted in previous work, such as faster time perception and blurriness of the self/other boundaries which may play a key role in altering one’s sense of self and sense of presence in the world. Our qualitative study provides an in-depth examination of self-reported disturbances of one’s relatedness to one’s self and the world, thereby shedding further light on the nature of altered subjective experiences in DP. In doing so, this paper draws attention to key aspects yet overlooked that may prove valuable for shedding further light into the phenomenon of depersonalization. We conclude by highlighting limitations of this study and a number of open questions that further work needs to address in the future.

Traditionally, phenomenological theories of schizophrenia have emphasized disturbances in self-experience, with relatively little acknowledgement of the surrounding world. However, epidemiological research consistently demonstrates a strong relationship between traumatic and stressful life events and the development of schizophrenia, suggesting that encounters in the world are highly relevant for many people diagnosed with this disorder. This paper reviews foundational texts in phenomenology and phenomenological psychopathology on the nature of subjectivity and its disturbances, finding support for broadening contemporary phenomenological models of schizophrenia to incorporate world events and their subjective meaning as essential aspects of this disorder. This contextual approach to phenomenology emphasizes the relationship between self and world, one that is especially unstable, unclear, and untrustworthy in schizophrenia. Both epidemiological and phenomenological research can benefit from this approach: in epidemiology, researchers might consider the ways that various risk factors are experienced by persons vulnerable to schizophrenia, while phenomenologists are encouraged to inquire about the environmental and social context in which altered experiences occur and incorporate these considerations into their explanatory models.

This chapter offers an overview of the phenomenological approach to delusions, emphasizing what Karl Jaspers called the "true delusions" of schizophrenia. Phenomenological psychopathology focuses on the experience of delusions and the delusional world. Several features of this approach are surveyed, including emphasis on formal qualities of subjective life and questioning of standard assumptions about delusions as erroneous belief. The altered modalities of world-oriented and self-oriented experience that precede and ground delusions in schizophrenia, especially the experiences of revelation that Klaus Conrad termed the outer and inner apophany, are then discussed. The chapter first considers the famous "delusional mood", then the role of ipseity-disturbance. In both cases it is explained how delusions can develop out of these distinctive alterations of perception and feeling. The classic question of the understandability or comprehensibility of schizophrenic delusion, together with the related issues of wish-fulfillment and rationalizing motives are then considered. The chapter addresses the crucial but neglected issue of the felt reality-status of delusions or the delusional world, discussing derealization, "double bookkeeping", and "double exposure". The chapter concludes by discussing delusions typically found in paranoid and affective psychoses, and monothematic delusions found in certain organic conditions.

It is a Pleasure to comment on Somogy Varga’s intriguing paper, which offers welcome insight into the historical sources, changing uses, and underlying assumptions pertaining to the concept of ‘melancholia,’ especially in relationship to ‘depression.’ We found Varga’s discussion of the relationship between affect and cognition in past discussions of melancholia and depression to be illuminating, especially given the emphasis on cognitive distortions in contemporary psycho-pathology. His explanation of the gradual evolution of the depression concept from melancholia sheds interesting light on current notions. All in all, we find Varga’s arguments persuasive, and are inclined to agree with him (and others whom he ..