Schizophrenia, Consciousness, and the Self

In recent years, there has been much focus on the apparent heterogeneity of schizophrenic symptoms. By contrast, this article proposes a unifying account emphasizing basic abnormalities of consciousness that underlie and also antecede a disparate assortment of signs and symptoms. Schizophrenia, we argue, is fun-damentally a self-disorder or ipseity disturbance (ipse is Latin for "self " or "itself) that is characterized by complementary distortions of the act of awareness: hyperreflexivity and diminished self-affection. Hyperreflexivity refers to forms of exaggerated self-consciousness in which aspects of oneself are experi-enced as akin to external objects. Diminished self-affection or self-presence refers to a weakened sense of existing as a vital and self-coinciding source of aware-ness and action. This article integrates recent psychi-atric research and European phenomenological psy-chiatry with some current work in cognitive science and phenomenological philosophy. After introducing the phenomenological approach along with a theoreti-cal account of normal consciousness and self-aware-ness, we turn to a variety of schizophrenic syndromes. We examine positive, then negative, and finally disor-ganization symptoms—attempting in each case to illu-minate shared distortions of consciousness and the sense of self. We conclude by discussing the possible relevance of this approach for identifying early schizo-phrenic symptoms