sass et al 2011 copy

8/14/2019 Sass et al 2011 copy

1/34

Sass, Parnas,and Zahavi / Phenomenological Psychopathology and Schizophrenia 1

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)

Phenomenologys 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 em-pirical science, including neuroscience; (3) The

nature of self-experience, especially in its pre-reflective form (ipseityinvolving

operative intentiona lity), and its possible disturbance in schizophrenia (hyper-

reflexivity and diminished self-affection);(4) The relationshipbetween self-

disturbance in schizophrenia and disorders of both temporality and (what Husserltermed) passive syntheses;(5) The role of intentional or quasi-volitionalprocesses in

the perceptual (and other) disorders in schizophrenia; (6) The nature and diversity of

phenomenologys potential contribution to the enterprise of explanation;and (7)

The meaning of several concepts: hermeneuticor existentialap-proach,

phenomenological reflection,and negative symptoms.

Keywords: self-disorder, pre-reflective self-awareness, ipseity, hyperreflexivity, self-

affection, phenomenological reflection, phenomenological explanation

in recent years. There has been aproliferation 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 and Parnas 2003), temporal experience (Fuchs2005),delusions and delusional mood (Parnas and Sass 2001; Fuchs 2005), and psychiatric

classification and diagnosis (Parnas & Zahavi2002), as well as of values and

disturbances of common-sense (Stanghellini 2001, 2004; Stang- hellini and Ballerini 2007),

affect or emotion (Ratcliffe 2008; Sass 2007a), negative sympt(Sass 2003a),perception

(Nelson and Sass 2008; Sass 2004c; Schwartz et al. 2005), and personhood and autonomy

(Sass 2007b, 2011). 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 (Mller and Husby 2000;

Parnas et al. 1998; Parnas et al. 2003; Parnas, Handest, et al. 2005; Parnas, Mller, et al.


2/34

2 PPP / Vol.18, No. 1 / March 2011

2005).

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

schizophrenia, nor is it the first time that the continentalphenomenological tradition has

been introduced. Both Mayer-Grosss famous textbook ofpsychia- try (1954) and FishsSchizophrenia (Hamilton 1984, originally1962) attemptednobly but with limited

successto bring phenomenological psychopathology into the mainstream of English-

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

Symp- toms of schizophrenia, was clearly Jaspersian on the methodological plane, but

unfortunately was interpreted more in an operational than a truly phenomenological

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, Klosterktter, and colleagues in Germany

(Klosterktter 1988, 1992; Klosterktter et al. 1997, 2001).

The most prominent Anglophone attempt to emphasize the importance of the subjective

dimension of schizophrenia was R. D. Laings first and finest book, The Divided Self

(1959), a work admired by many who remain skeptical of Laings later contributions. The

Divided Self, which uses ideas from Sartre, Heidegger, Minkowski, and Binswanger,

was something of a bolt from theblue. Laings own interests and influence were soon

diverted in an anti-psychiatric and sometimes ro- manticizing or otherwise anti-scientific

direction.

25 years between thepublication of Laingsbook and the appearance, starting in the

mid 1980s, of articles by several authors. These include Sass (1985, 1987, 1988a, 1990a,

1990b, 1992b)cul- minating in his books, Madness and Modernism:Insanity in the

Light of Modern Art, Literature, and Thought (1992a), and The Paradoxes of Delusion

(1994)Schwartz and Wiggins (1987; also Wiggins et al. 1990), Cutting and Dunne

(1989), and Parnas and Bovet (1991; Bovet and Parnas 1993) . A superb anthology of

classical European contributions on schizophrenia, editedby John Cutting and Michael

Shepherd, appeared in 1987. Cuttings (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

clinicalpsychology.

These recent developments inphenomeno- logicalpsychopathology coincide with

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

trend is a growing disillusionment, within mainstreampsychiatry, with the extreme

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

1982. A number of recent editorials by key figures inNorth American and European

psychiatry (Andreasen 2007; Maj 2005; see also Mullen 2007; Parnas et al. 2008) have

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


3/34


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 clinicalpsychologists, who are frustrated with the increas- ingly

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

demands, and doubtful about a scientific world dominatedby empirical methodologies

that can seem divorced from significant theoretical issues.

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

cognitiv- ist, 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 et al.

(1991), Clark (1997), Gallagher (2005), Zahavi (2005), Thompson (2007), and Gallagher

and Zahavi (2008), who all in various ways have criticized the standardpicture 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 and Shear 1999; Kircher and David 2003; Sass et al.

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 ofbehavioral description or

common-sense, symptomatic descriptions (Parnas and Sass 2008; Zahavi and Parnas 1998).By offering a richer and more empirically grounded theoretical approach to the

understanding of abnormal action and experience, it promises an escape from the opera-

tionalist cul-de-sac that contemporary psychiatry is in danger of entering. The

phenomenological study of schizophrenia in particular is of signal importance, not only

because of schizophrenias preeminent place in the history of psychiatry, but also

because of the profound, enigmatic, andpotentially 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, particularlypsy- chotic disorders, has particularly

highlighted the importance of understanding subjective experience inpre-schizophrenic and

schizophrenic conditions, which may be relevant for the prediction and identification

of high risk, as well as treatmentefforts (Nelson, Sass, Skodlar et al. 2009; Nelson et al

2008; 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 phenomeno-

logical philosophy are presented in a manner that is not only confusing, but highly

inaccurate. Rath- er than clarifying matters, the article in questionblurs key theoretical


4/34

4 PPP / Vol.18, No. 1 / March 2011

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 phenomenologicalclinical neuroscience: Why we still are not there yet. Misharas 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 relationshipbetween 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 Weiz- saecker, Matussek, and Wiggins

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

misleading.1

The publication of Misharas 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 mis- apprehensions and to

explain some basic points about our own approach and the phenomenological

enterprise more generally. In thepresent article, we take hispublication 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 generalinterest (see also Gallagher and Zahavi 2008). The issues treated below are the following:

1. The role ofphenomenology in clarifying issues not amenable to purely empirical

methods.

2. The relationshipbetween a phenomenological ap-proach (focusing on the subjective

life of thepatient) and that of empirical science, including neuroscience. (This

relationship involves what is sometimes referred to as the naturalizingof

phenomenology.)

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

disturbance in schizophrenia.4. The relationshipbetween self-disturbance in schizo-phrenia and disorders both of

temporality and of (what Husserl termed) passive syntheses.

5. The possible, contributing role of intentional or quasi-volitionalprocesses in the

perceptual disorders in schizophrenia.

6. The natureand especially the diversityof phe- nomenologyspotential 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

hermeneuticor an existen- tialapproach; of the nature and role of reflection in

phenomenological accounts; and of the meaning of the concept of negative


5/34


symptoms.

Misharas main justifications for distinguishing between what he calls neo-

phenomenologyand existential/hermeneutic phenomenologyare two. The fact that

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

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

do with the status and role of phenomenology. Ac- cording to Mishara (2007a),

whereas (so-called) neo-phenomenology claims to circumvent experimental

procedures, the (so-called) existentialphenomenologywith which he associates himself

is, by contrast, in an excellent position to supply hypotheses [and testableconstructs]

for further experimental study (pp. 55960). The secondjustification is more substantive:

it pertains to dis- cussions related to the structure of consciousness and the specific nature

of the psychological abnor-mality in schizophrenia. Here Mishara rejects the claim that

consciousness is as such characterizedby a pervasive but tacit dimension ofpre-reflective

self-consciousness, and denies that self-disturbance is a central core feature ofschizophrenia. We consider Misharas claims and criticisms to beboth mistaken and

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

Misharas views on the relevance ofphenomenology, the notion of constraint (a term

we use), and the nature ofphenomenological facts. Later we turn to selfhood and other

topics.

Nature and Role of Phenomenology

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

proposedthatphenomenology is able to constrain neuroscience when applied to

disorders such as schizophrenia (Mishara 2007a, 559, emphasis added). Heexplains this point by stating that, according to Sass, Parnas, and Zahavi,

phenomenologyprovides conclusive knowledge or limits, what Zahavi calls facts,

about the patients subjective experience (Misharas words). We are said tobelieve

that these facts could (in Misharas words once again) be directly incorporated into

clinical neurosciencewithout 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 phenomenologyprovides initial systematic means

for studying subjectivity and seeks only to supplyhypotheses for further

experimental study (p. 560). Misharas account isproblematic.Not only does he not

grasp the standard meaning of constrainas this term is used in recent dis- cussions

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 contemporarypsychiatry orthe project of the

naturalizationof consciousness (the inclusion of consciousness within a

general scientificperspective).


6/34

6 PPP / Vol.18, No. 1 / March 2011

We agree, of course, that a major role forphenomenology is indeed to supply hypotheses

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

shouldbe restricted to this role. Psychiatry, after all, is faced with a host ofphilosophical

questionsfor example, questions concerning the nature of rationality, the definition of

delusion, and thepossibility of empathy with abnormal states of mind. To think that such

questions can be settled by clinical trials or other purely empirical methods would amountto a kind of scientism that would certainly be rejected by all the major theorists of

phenomenology. Phenomenology, together with other phi losophical approaches, has

something to say on these issues.

Mutual Constraints; Phenomenological Facts

To cla rif y ph enomen o logy s rolew i t h i n the mind sciences, we must consider

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

When using the term constrain (Sass and Parnas 2007, 73), we cited a well-known

paper by Gallagher (1997): Mutualenlighten- ment: Recent phenomenology incognitive science. In the next paragraph, we cited another well-known article:

Neurophenomenology, in which (the late) Francesco Varela (1996) speaks of

mutualor reciprocalconstraintsbetween phenomenological accounts of

the structure of experience and their counterparts in cognitive science (p.

343). Thompson (2007), who collaborated extensively with Varela, clarifies:

By reciprocal constraints[Varela] means thatphenomenological 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 inhibitor dictateto in a rigid

or unilateral fashion. To say that the facts of subjective life constrainneurobiological

explanationis simply to say that these facts are among those that an adequate

neurobiology must ultimately take into account. It would seem that anyperson with a

remotely phenomenologicalbent would have to accept this latter point; indeed, it should

even be accepted by reductionists who believe that consciousness is entirely dependent on

thebiologi- cal substrate. After all, conscious experience is an explanandum in its own

right (Chalmers, 1995, 209). And withoutsome idea . . . of what the subjective

character of experience is, we cannot know what is required of physicalistic theory

(Nagel 1979, 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 ofphenomenal

experience. On the contrary, we (like both Gallagher and Varela) are precisely arguing

that the influence goesboth ways, that is, it would also be a question of letting

phenomenology profit fromand be challengedbyempirical findings.2

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 proposedby Varela (1996) and subsequently


7/34


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 toprovide descriptions of these

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

predetermined 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 to improve and

refine the classicalphenomenological 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 descriptionpresents us with what seems to be a simple and unified

phenomenon. When studyingthe neural correlates of this phenomenon (e.g., with

magnetic resonance imaging), we discover that two quite distinct mechanisms are

involved, mechanisms that are normally correlated with distinct experiential

phenomena, say, perception and memory. This discovery might motivate us to return to

our initialphenomenological description to see whether thephenomenon 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 subpersonal levelto stick to this simple examplecannot

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 that he has

entitledfront-loaded phenomenology. Rather than focusing on training experimentalsubjects, the idea is to start with the experimental design, and to allow insights developed

inphenomenological analyses to inform the way experiments are set up. To take a concrete

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

ogy, where the so-called mirror-recognition task has occasionally been heralded as the

decisive test for self-consciousness (Lewis 2003). Aphenom- enological approach

suggests moving beyond reliance on mirror-recognition alonewhichphe- nomenologists

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

consciousnessand attempting to detect thepresence of more primitive forms of

propriocep- tive body awareness (Zahavi 2005). To front-loadphenomenology, however,

does not imply that one simplypresupposes or accepts well-rehearsedphe- nomenological

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 pur- poses of the particular

experiment or empirical investigation (Gallagher and Zahavi 2008).

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

immediately sees that the opposition Misharaposesbetween phenomenology serving

as aconstraintversus as a generative source of hy-pothesesis 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 constraintaccording to the standard


8/34

8 PPP / Vol.18, No. 1 / March 2011

understanding of constrain)that it could possibly be relevant for hypothesizing. It

is precisely this kind of mutualconstraint (between empirical data on

neurodevelopmentalproblems, phenomenological data on initial stages of the illness, 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 et al. 1996, 2001,

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 theboundaries 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, 343; 2005, 136; see Mishara

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

attempts toparaphrase. 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 Misharas characterization of our

understanding ofphenomenologicalfacts.Nowhere do we say that phenomenological

methods generate abso- lutely precise and certain descriptions that cannotpossibly be

criticized or improved uponthat is, that are not defeasible, in the sense of being inprin-

ciple open to revision or valid objection. It is odd, then, to find Mishara claiming for himselfthe label of hermeneutic phenomenology.If hermeneuticphenomenology means a

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

understanding of the nature of thephenomenological enterprise (i.e., as an enterprise that

requires interpretation rather than offering infallible description), then our worklike

that of many otherscertainly falls under the rubric hermeneutic.3 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-phenomenologyclaims to circumvent experimentalprocedures.Actually, a

considerable amount of empirical work has been done and is 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 distin- guishes between what he calls neo-

phenomenologyand 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


9/34


syntheses,binding, temporalization, and perceptual organization. In his article, the IHM

becomes an object of Misharas passionate attack.4 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 and Parnas 2003, 2007).

Briefly, this model claims that instability ofpre-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 and Parnas,

2007, 6870, unless otherwise noted).

IPSEITY DISTURBANCE: [T]he core abnormality in schizophrenia is aparticular

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

[Henry1973; 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-reflexivitywhich refers to a kind of

exaggerated self-consciousness, that is, a tendency to direct focal, objectifying attention

towardprocesses and phenomena that would normally be in- habitedor experienced

as part of oneself. The second is diminished self-affectionwhich refers to a decline

in the (passively or automatically) experienced sense of existing as a living and

unified subject of awareness.

Ipseity disturbancealso involves a concomitant disturbance of the field of awareness

that we label disturbed hold or grip(Sass 2004c; Sass and Parnas 2003, 436).

HYPERREFLEXIVITY: The notion of hyperreflexivity includes some fairly volitional,

quasi-volitional, or intellectual processes, which we term hyper-reflectivity.5 However:

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

reflective kind of self-consciousness; nor is it merely an intensi- fied awareness of

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

self-consciousness about his or her appearance). Mostbasic to schizophrenia is a kind of

operativehyper- 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 ofphenomena 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 cometo be experienced in an objectified and alienated manner (see Merleau-Ponty 1962, p. xviii

re: operative intentionalityfungierendeIntentionalitt).

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.


10/34

10 PPP / Vol.18, No. 1 / March 2011

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 inef- fable self-affection that is essential to normal ipseity: I was

simply there, only in that place, but without beingpresent.(Blankenburg 1971, 42;

1991, 77)

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

processthe fact that what once was tacit is no longerbeing inhabited as a medium of

taken-for-granted selfhood. (Sass and Parnas 2003, 430)

It makes little sense, incidentally, to character- ize our ipseity or IHM view by using a

simple opposition between too much versus too littleself-experienceas do

Lysaker and Lysaker (2008a, 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

(hy-perreflexivity). Selfhood is too complex an issue to lend itself to unidimensional

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-disorderposition.

Empirical Supportfor 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, 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

aproduct of arm-chair theorizing or anecdotal discussion, as Mishara portrays it,but

derives, in large measure, from years of clinical experience and considerable empirical

research.This includes descriptive and follow-up studies of different diagnosticcategories (Vollmer-Larsen

2008), predictive work on early psychosis (see below), and also some experimental work

correlat- ing 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 (Mller and

Husby 2000). These findings were subsequently supported in a longitudinal study of

155 first admitted patients, of whom about 60% suffered from schizophrenia or


11/34


schizotypal disorders (Handest and Parnas 2005; Parnas, Handest, et al. 2005).

These patients have been reassessed at a 5-year follow-up, showing that self-disorders

are predictive of new incident cases of schizophrenia spectrum disorders (Vollmer-Larsen

2008). A separate study compar- ing residual schizophrenia patients with remitted

psychotic bipolar illness patients demonstrated that self-disorders were characteristic

of schizo-phrenia (Parnas et al. 2003), suggesting a certain specificity to schizophreniaspectrum 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 under- taken in several European countries,

Israel, and Australia. A phenomenologically oriented, semi- structured psychiatric

interviewthe EASE scale (Parnas, Mller, et al. 2005)hasbeen developed and shown

to achieve good inter-rater reliability (Vollmer-Larsen et al. 2007). The EASE scales

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-likepresence of self-disordersin 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.

Oddly, however, he does mention one vignette from a conceptual publicationby Parnas

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

conclusions from anecdotalself-reports(Mishara 2007a, 565, italics added).

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 inschizophrenia 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), that is, a disturbance of the very

mineness or first-personperspective 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 ofexperi- ence, 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 couldbe defined as the self-presence

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

contribute to what we (and others) call the minimal self (cf. Zahavi 1999,2005).6 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


12/34

12 PPP / Vol.18, No. 1 / March 2011

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

is a passive and automaticprocess that must be regarded as the diachronic and

synchronic prerequisite or precondition for any more substantial or elaborate sense of

self.

Having or embodying a first-person perspective does not, incidentally, require beingable to articulate it linguistically. Indeed, it provides an experiential grounding of the

latter possibility All the major figures inphenomenologyinclud- ing Husserl, Merleau-

Ponty, Sartre, and Michel Henryconsidered a minimal form of self-consciousness to

be an integral part of experience. This, for instance, is what Sartre 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 Zahavis (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 before reflection,because the reflecting

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

(Mishara 2007a, 561). As is widely acknowledged, recognition of this methodological

or epistemologicalproblem is an utter commonplace inphenomenological discussion. It

wasbroachedby 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

origi- nal experience, reflection actually transforms it, or as Husserl explicitly admitted, it

alters it (Husserl1950, 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 implic- itly contained in the pre-reflective experience

(Hus- serl 1984, 244; 1966a, 129; 1966b, 205, 236).

One might see the phenomenologicalposition as being situated between two extremes.

On one hand, we have the view that reflection merely cop- ies or mirrors pre-reflective

experience faithfully; on the other, the view that reflection distorts lived experienceirredeemably. The middle course is to recognize that reflection involves both a gain and a

loss. For Husserl, Sartre, and Merleau-Ponty, reflection is constrainedby what ispre-

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 re-produce the lived experiences unaltered, and

that this may be precisely what makes reflection cogni- tively valuable. As Husserl put it, in

thebeginning we are confronted with a dumb experience that through reflection must

then be made to articulate its own sense (Husserl 1950, 77; Merleau-Ponty

1945, 207).


13/34


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 certi- tude. This does not,

however, preclude the value ofphenomenological 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 mustpresuppose 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, simplybe accentuating structures already

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

personal givenness of ex-perience 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 before 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 adoptedby 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

as- cription ofphenomenal 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, 216). Such a position certainly seems counterintuitive. And asCarruthers himself notes, it might have profound implications for our moral attitudes

toward animals and animal suffering (Carruthers 1996, 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-consciousnessrather than being something that only occurs during

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

conscious lifeis a feature characterizing normal human subjectivity as such, nomatter what worldly entities the subject might otherwisebe conscious of and occupied

with. As Husserl for instance puts it in Zur Phnomenologie der Intersubjektivitt II,

To be a subject is to be in the mode of being aware of oneself (Husserl

1973, 151). It is clearly erroneous, then, for Mis- hara to take Husserl as supporting his

claim that world-absorption and self-awareness are mutually exclusive (Mishara 2007a,

5601). 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 ab- sence of a thematic or reflective self-experience

(see Zahavi 1999).


14/34

14 PPP / Vol.18, No. 1 / March 2011

Heideggera key figure for hermeneuticand 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 characterizedby the fact that Iam always

somehow acquainted with myself (Heidegger 1993,251; 1989, 225).

Misharas draws a supposed contrast between, on one hand, Sass and Parnass (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 existentialphenomenological notion

that what he terms self-awareness and absorption in experience are mutually

exclusive (Mishara 2007a, 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 pre-

requisite of reflective self-awareness (for details see Zahavi 1999; 2005). Thus, Paul

Ricoeur (1966, 601), the most prominent synthesizer of phenomenology and

hermeneutics, criticizes the view that consciousness turned toward 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 toward something

other than itself.

It is noteworthy that, here again, there seems tobe slippage in Misharas treatment of theissues: at one point, he seems to acknowledge the nonobject-like and (in a sense) non-

representational nature of ipseity: citing Sass and 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, 560). But then, when he

attempts to argue against ipseitys fundamental role in experience, he clearly conflates

ipseity with an object-like or representational modewhat 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

betweenpre-reflective self-experience and the experience of self-as-object is at the very

heart of the articlesby 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 preconditions 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 ongoingprocess that must exist and constantly reconstitute itself


15/34


in time.7

Passive Synthesesand

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

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

polarized choice between ipseity, on one hand, andpassive 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-kindlike

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, lackof 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 (Sass2003a , 157; Sass and Parnas 2007, 69, 8285). 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 func- tions or an excess of rationality and reflective- ness (pp. 1423,

150). Uhlhaas and Mishara describe Sass (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 Sasss current or earlier writings, these are clearly

misreadings.

Hyperreflexivity certainly can involve intellectual or volitional processes, which can indeedhave pathogenetic importance. (The parallel with modernism makes these processes

especially salient in Sasss Madness and Modernism.) But contrary to what Uhlhaas and

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- reflectivitybut also involves the popping out, in

a kind of automatic fashion, of phenomena that would not normally be in the focus of

awareness. Sass (2003b, 249) and Sass and Parnas (2007, 69,

8285) term this latter process operative hyperreflexivity. They state that the operative

type is likely in fact to be more primary in apathogenetic sense than is the reflective type of

hyperreflexivity (p. 83),8 affecting what Blankenburg (following Husserl) calls the


16/34

16 PPP / Vol.18, No. 1 / March 2011

fundamental receptivity of the automatic or passive syntheses that structure the

basic act of consciousness and constitute a persons most immediate and fundamental

relationship to self and to world(Sass 2003a, 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).

Misharas characterization of our position as one that views schizophrenia as

essentially deter- mined by higheror 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 operativefactors.

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

Sass as plac- ing exclusive emphasis on the withering effect of an inward gaze of

radical intensity(p. 335). As their citations and phrasings indicate, their discussion of

Sasss 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 Misharas portrayal. The Lysakers uncritical acceptance of

Misharas inter-pretation mars the treatment ofphenomenology 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, 335) reference to what they call Misharas

suggestion (emphasis added) regarding the core pathogenetic role of disruption of

bodily systems that allowpersons, 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

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

hippocampus-based comparator system (Hemsley 1987, 2005). Also mistaken is the

Lysakerspresentation of this view as somehow antithetical to Sasss position (also

implied by Uhlhaas and Mishara 2007, 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, 83, and other articles).9

InMadness andModernism, Sass (1992a, 228) discusses the role such factors might play

in self-fragmentation and bodily alienationthe very point the Lysakers ascribe to a

2005 publication by Mishara. The compatibility of Hemsleys comparator approach

with Sass is acknowledged in Hemsley (1998).10

Temporality and Self- Experience

Here we will not attempt to discuss, in any detail, the relationshipbetween temporality

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


17/34


phenomenological stand-point, about treating self-experience and temporal experience as

if these were distinct faculties of the mindas Mishara (2007a, 565) seems to do when

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

the central point of Zahavis influential interpretation of Husserls writings on time was

precisely that the latters 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., Bovet and Parnas 1993; Minkowski

1927;1933/2005). Before being convinced that temporality in particular is playing a

foundational role in thepathogenesis of schizophrenia, it would be necessary to show (at

least) that (A) the disorder is reasonablyspecific to schizophrenia inparticular and (B) the

temporal abnormality is more striking than other abnormalities in schizophrenia (thereby

addressing some of the concerns raised long agoby Chapman and 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 polarization of alternatives. So far we have focused primarily on his

polemical treatment of our own work. Oversimplification and polarization are also

characteristic of his conceptualizations of the possible underlying psychopathology of

schizo-phrenia. Both tendencies emerge with clarity if we compare Misharas with

Sasss discussion of the German Gestalt psychiatrist Matusseks ideas about prodromal

features (including the so-called Wahrnehmungstarre) and of the relevance of Wolfgang

Blankenburgs work for understanding negative symptoms, and also Misharas attack on

Sass and Parnass (2007) exploration of the possible explanatory relevance ofphenomenology.

Die Wahrnehmungstarre and the Existential Complexity of Schizophrenic

Symptoms


18/34

18 PPP / Vol.18, No. 1 / March 2011

In Madness and Modernism (1992a, Chapter 2),

Sass uses the phrase Truth-taking stare to capture thephenomenon described in

Germanpsychiatry by the term Wahrnehmungstarre. Wah- rnehmungstarre refers to the

fixed gaze that canbe especially common in early phases of schizophrenia; it wouldtypically be translated as rigidity ofperception(as both Sass 1992a, 423, n4 and

Mishara 2007a, 564n note). In his article, Mishara claims that Sasss use of the phrase

truth-taking is a fanciful but apocryphal(p. 564) mistransla- tion, 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 Sasss scholarly reliability and

hermeneutic competence into question. Mishara goes so far as to accuse Sass of

overlook[ing]the fundamental hermeneutic principlesby 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 Misharas. This should be apparent from

Misharas apparent failure to take into account the following endnote, which is appended to

Sasss first mention of the term Wahrnehmungstarre: War- hrnehmung means

perception or observation in German. I have chosen to translate this in an unusually

literal wayas truth-takingbecause this seems better to capture the schizophrenic

experience in question(Sass 1992a, 44, 423).

Wahr in German means true, as in the term Wahrheit,meaning truth.Nehmung is derived from nehmenas in to take.(Starre means stiffnessor

rigidity.) The above-quoted note makes it perfectly obvious that Sass was de- liberately

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

the word, and with full knowledge of thestandard meaning of Wahrnehmung) to convey a

sense of thepatients experience of a kind of revelation that can accompany the fixed or

rigid stare common inprodromal 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. Atonepoint, Mishara (2007a, 564) criticizes Sass for not following Matusseks 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, 72,

427f, notes 43, 44) criticizes Matusseks (Gestalt) theoretical account for downplaying

the role of intentionality, while noting that, in his clinical de-scriptions, Matussek

emphasizes both intentional and non-intentional aspects. Matussek (1987) does say

that the schizophrenic isheld captiveby the object; but he also writes, The schizophrenic

. . . is capable, to a much greater degree, of fixing his attention on an isolated object,


19/34


noting thepatients abilityand pleasurein doing so (p.

934, emphasis added).

Misharas characterization of Sass displays a lack of familiarity with the argumentsput

forward in the works he criticizes. In writing on schizo-phrenia, Sass never denies the

role of deficien- cies, dysfunctions, or other forms of affliction. Indeed, Sass (1992a,

73) states that it would be

absurd to claim that schizophrenic states are entirely under the patients control, and

foolish to view schizophrenia as purely volitional and entirely self-aware(p. 114).

Misharas attempt to appropriate for himself the label existential phenomenology

ispeculiar. The approach Mishara offers in his article fails, in fact, to go beyond a rather

mechanical or passive vision of the nature of schizophrenia, in which the patients

role is simply to be afflicted with disturbances of passive synthesis; little if anything is

said about broader human or existential consequences or about thepatients

conscious and self-conscious project of being-in-the-world.By contrast, much of thework that Mishara criticizes does explore these aspects in considerable depth (see

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

on the nature of both personhood (2007b) and autonomy (2011) in schizophrenia, noting,

for example, that schizophrenia, a heterogeneous condition, can sometimes involve

not simple diminishment of autonomy, but more complex disruptions of the normal

balance between independence and de-pendence or between autonomy and

heteronomy Misharas 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, 72) may vary with context, motivation, and attitude. It is noteworthy, forexample, that cognitive and perceptual disorganization is by no means constant, and

often disappears in the presence of a strong motivation toward practical activity (for

references see Sass 1992a, Chapter

1, p. 24 and notes 47, 48, 49; Chapter 2, p. 71 and notes 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 conceptualizingpsychotherapeutic 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 agen- tive role of the patient, and

thereby suggest more subtle ways of helping patients both to identify

with their experiences and to engage in the thera-peutic encounter (Nelson, Sass, and

Skodlar 2009).

Negative Symptoms

In the sameparagraph in which Mishara questions Sasss 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, 565) says that


20/34

20 PPP / Vol.18, No. 1 / March 2011

thephrase negative symptomshad not been applied to schizophrenia at the time that

thephenomeno- logicalpsychiatrist Blankenburgpublished his book, The loss of

natural self-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 twen- tieth 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 ofpsycho-pathology, 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 com- plicates the comparisons.) Mishara (2007a) also states that what

Blankenburg calls schizophrenia simplexis a verydifferent 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 frompositive and

disorganization symptoms.

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

dis- organized symptoms, exemplifies at least one, particularly clear type of the

negative syndrome. Indeed Misharas own description of schizophrenia simplex, in the

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

2001, 31920), actually describes schizophrenia simplex (following ICD-10) in clear

negative- symptom terms, namely, as exhibit[ing] thebasic but not the accessory symptoms

of schizophrenia, as being fairly undramatic and inconspicuous in its own right, as

manifesting decline in totalperformance,and as having the characteristic

negativefeatures of residual schizophrenia (e.g.,blunting of affect, loss of volition)

[which] develop withoutbeing preceded by any overt psychotic symptoms. If this is not a

negative-symptom syndrome, what is?

Phenomenological

Explanation

We end by considering the important but complex topic of phenomenologys relevance

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

characterization of Sass and Parnas (2007), Explainingschizophre- nia: 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 andParnas opt to associate theirphe- nomenology

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


21/34


offers virtually no quotations from Sass and Parnas (2007) (except a single phrase, and

even that turns out to be inaccurate; on page 87, the phrase used is not explanatory

powerbut explanatorysignificance; see Mishara 2007a, 563).

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

any way deny the crucial role of neurobiological factors in the explanation ofschizophrenia (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 distinctionbetween understanding and explanation,but on

that between description and explanation. Sass and Parnas (2007) attempt to show that

a com- monly held viewnamely, that phenomenology is relevant only to description

and not to explanationis inaccurate. It then proceeds to differentiate a variety of

senses of the word explanation. The paper explicitly offers a preliminary taxonomy

of six forms ofphenomenological 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 and Parnas (2007), is to show that phenomenological

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

nondescriptive, or explanatory in some sense of the latter term, is somehow the

sameas Misharas accusation regarding con- flatingwould seem to imply. (If A = not-xand B

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

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 thatphenomenology (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 mayactually be mutually interdependent in the sense of being different as-pects 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

per- ceptas discussed by Matussek, 1987, and also Sass 1992a, Chapter 2). The

understanding of


22/34

22 PPP / Vol.18, No. 1 / March 2011

such sequences has explanatorysignificance 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 looka feature of subjectivitythat 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 tobe

understood or explained.

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

Al- though he does not say this in so many words, he discusses the patient as if he or she

were exclusively the victim of brain eventsas if intentional activity were irrelevant and

subjective experience no more than epiphenomenal. Misharas characterization of natural

science as generally seeking out explanatory relationshipsbetween ever-smallerparts

(p. 563) represents a highly reductionistic vision of science that runs counter to

mainstream views in both modern and contemporary philoso-phy of science (re the latter,

see articles in Kendler and Parnas, 2008)

Sass and Parnas do not dispute that neural abnormalitiesplay 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

reflectivekind of hyper-reflexivity, write Sass and Parnas (2007, 83; also Sass 1992a,

6873,

37497). This irritationmay, 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

cognitivecoordination(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 organisms and the persons defensive and com-pensatory

responses to the originating cause. In the case of psychiatric disorders, these

responses are particularly likely to involve reactions (both consequentialand

compensatory;Sass and Parnas 2007) to lived experiences of various kinds. Bleuler

(1950), who firmly believed in thephysical 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.

4053, 36373). Even if something like a neurologicallybased disorder of attention

(see, for example, Hemsley 2005 for an especiallyplausible account) is primary in a


23/34


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

develops aparticular cognitive/perceptual style, way of living, and world

perspectivenone 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. Just onepossible contribution of the former type of analysis, for instance, is

that it may help the neuroscientist topare away features that may not be directly

related to a malfunctioning or abnormal neural substrate (because these features are

psychologically ex-plicable) 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 neuro-biological plane (sometimes termed downward causation).In his

discussion, Mishara shows no sensitivity to these possibilities.

It is also simply false to say that Sass and Par- nas opt to associate their

phenomenology with everyday explanation (Mishara 2007a, 563).

Indeed, in the article Mishara criticizes, Sass and Parnas (2007, 746) explicitly contrast

the distinctive explanatory contribution ofphenomenology with the practical syllogism

and thebelief-desireparadigm of mental causation that is commonlyproposed in analytic

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

Parnas do not deny the relevance of the beliefdesire 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

ones attention in a different direction, namely, towardformal or structural features

that involve more pervasive aspects or in- frastructures of human experience (e.g., modes

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

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

typically not part of everyday ex-planationwhich is one reason whypsychiatrists and

psychologists would do well to be familiar with the phenomenological tradition

precisely to be able to go beyond the resources of everyday or common-sensicalexplanation (Gallagher and Zahavi 2008; Parnas and Sass 2008; Parnas and Zahavi

2002; Zahavi and Parnas 1998).

In several publications, Bovet, Parnas, and Sass

(Bovet and Parnas 1993; Parnas and Sass 2001,

2008; Sass 1990b, 1992a Chapter 9, 1992b,

1994, 2004b) have emphasized, for example, the relevance of such non-everyday,

phenomenological distinctions as Heideggers between the ontological and the ontic

for the understanding and explanation of delusions. They have noted, for example, that

whereas many paranoid delusions do imply fairly straightforward forms of poor re-


24/34

24 PPP / Vol.18, No. 1 / March 2011

ality-testing(the patient believes something false about a world whose structure is largely

analogous to the normal worldonticor empiricaldelu- sions), 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 horizonsofexperience 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, Misharas arguments in Missing linkbetray misunderstanding of the relevant

phenomenological and psychiatric literature as well as failure to grasp the key points of

thepublications he criticizes. In this article, we have addressed most of Misharas errors,

attempting to do so in a way that serves the larger purpose of clarifying general issues

pertainingboth to phenomenological psychopathology and to our own perspective on

schizophrenia. We have concentrated especially on several broad points: these include the

mutuality of the relationshipbetween thephenomenological enterprise and cognitive

(neuro)science; the nature of self-experienceparticularly ipseity or pre-reflective self-

consciousness together with the notions of hyperreflexivity and diminished self-affection

and their possible disturbance in schizophrenia; thepotentially complex interactions of

intentional or quasi-volitional with non-volitional processes in the formation ofsymptomatology; and thepos- sible (and diverse) contribution ofphenomenology to

psychological explanation.

Notes1. An additional reason for rejecting Misharas use of the term neophenomenology: it

has already been used extensively by Herman Schmitz (2003).

2. Mishara himself quotes the phrases reciprocal constraintand mutual

enlightenment,even including them in the abstract, in Mishara et al. (1998).

3. Sasss 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 phenomenologys relevance, see Sass 1988b,

1998. (In retrospect, Sass would revise his discussion of Husserl in these latter articlesalong

lines inspired by Zahavi [2003a] and explained in Thompson [2007, appendix A].)

4. 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.

5. Hyper-reflective processes are not always active; they can, for example, be quasi-

automatized. There are many nuances to the activity/passivity issue.

6. More could be said about this topic (self-awareness vs self), but detailed analysis is


25/34


beyond the scope of this paper. See Zahavi (2005, 2009).

7. 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).

8. Mishara (2007a) misses the relevant point when he acknowledges that, for the IHM,

hyperreflexivity (or exaggerated self-reflection) may itselfbecome automatic in

schizophrenia leading to the pop outof 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,

operative hyperreflexivity is more fundamental, temporally and causally, than is hyper-

reflection (Sass and Parnas 2007,

69, 825)the latter point directly refutes Misharas critique.

9. Sass (1992a, 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 in-

ner 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.

10. The top down-versus-bottom up or from above-versus-from below distinction

misconstrues the difference between Misharas and our view, as explained. Also

erroneous is using Nietzsches notion of the Dionysianto describe the view that

common sense fails because perceptual and automatic meaning processing are [sic]

disrupted from below (Lysaker and Lysaker 2008a, 32; 2008b, 335, citing Mishara). In

Nietzsches 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).

ReferencesAndreasen, N. C. 2007. DSM and the death of phenomenology in America: An example of

unintended consequences. Schizophrenia Bulletin 33:108112. Berrios, G. E. 1985. Positive and

negative symptoms and Jackson. A conceptual history. Archives of General

Psychiatry 42:958.

. 1991. French views on positive and negative symptoms: A conceptual history.

Comprehensive Psychiatry 32:395403.

Blankenburg, W. 1971. Der Verlust der naturlichen Selb- stverstandlichkeit:Ein Beitrag zur


26/34

26 PPP / Vol.18, No. 1 / March 2011

Psychopathologie symptomarmer Schizophrenien. Stuttgart: Ferdinand Enke Verlag. (The

loss of natural self-evidence.)

. 1991. La Perte de LEvidence Naturelle: Une Contribution a la Psychopathologie des

Schizophr- nies Pauci-Symptomatiques, trans. J.-M. Azorin, and Y. Totoyan. Paris: Presses

Universitaires de France (The loss of natural self-evidence.)

Bleuler, E. 1950. Dementiapraecox or the group of schizophrenias. New York: International

Universi- ties Press.

Bovet, P., and J. Parnas. 1993. Schizophrenic delusions: A phenomenological approach.

Schizophrenia Bul- letin 19:57997.

Carruthers, P. 1996. Language, thoughts and consciousness. An essay in philosophical

psychology. Cambridge: Cambridge University Press.

. 1998. Natural theories of consciousness. Euro- pean Journal of Philosophy 6, no.

2:20322.

Chalmers, D. 1995. Facing up to the problem of consciousness. Journal of Consciousness

Studies

2:20019.

Chapman, L. J., and J. P. Chapman. 1973. Disordered thought in schizophrenia. New York:

Appleton- Century-Crofts.

Clark, A. 1997. Being there: Putting brain, body, and world together again. Cambridge: MIT

Press.

Cutting, J. 1997. Principles of psychopathology: Two worldstwo mindstwo hemispheres.

Oxford, UK: Oxford University Press.

Cutting, J., and F. Dunne. 1989. Subjective experience of schizophrenia. Schizophrenia Bulletin

15:21731. Cutting, J., and M. Shepherd, eds. 1987. Clinical roots of the schizophrenia concept.

Cambridge UK: Cam-

bridge University Press.

Dreyfus, H. 1979. What computers cant do, revised edition. New York: Harper and Row.

Fuchs, T. 2005. Delusional mood and delusional per- ceptionA phenomenological analysis.

Psychopa- thology 38:1339.

. 2007. The temporal structure of intentionality and its disturbance in schizophrenia.

Psychopathol- ogy 40:22935.

Gallagher, S. 1997. Mutual enlightenment: Recent phenomenology in cognitive science.Journal

of Consciousness Studies 4:195214.

. 2003. Phenomenology and experimental de

sass et al 2011 copy

Documents