The Possibility of Phenomenological Causation in Psychosis
March 4, 2007

Parnas and Carter (2002) noted: “Psychiatric research, notably in schizophrenia, continues to be technology driven and is short of psychopathological theorizing and phenomenological scrutiny, the elements that are indispensable both as points of departure for integrative efforts and as constraints for empirical investigations” (p.78).Parnas and Carter after summarizing the neuroscience research that is incompatible with Weinberger’s NDH (neurodevelopmental hypothesis) of schizophrenia,
concluded:

“A suggestion is emerging from the first-onset studies using in-depth interviews, that vulnerability to schizophrenia may be linked to an unstable sense of selfhood. The sense of selfhood and a correlated,
automatic intentional attunement to the world (disturbed in the schizophrenic autism) are developmentally founded on quite early sensori-motor and cross-modal sensory integrations. Spatio-temporally precise ontogenetic formations of cortico-cortical connections, dependent  on a variety of organism-environment interactions, constitute a neurobiological prerequisite of such integrations. A variety of adversities may be hypothesized to disrupt such connectivity and so result in an unstable functional organization of the CNS, phenotypically manifest, e.g., as perceptual-motor wavering in the HR [high risk] infants. Such instabilities may entail an initiation of subtle distortions of intentionality and selfhood. In this way we can perhaps reformulate the NDH to include the possibility of  henomenological causation: abnormal organization of the structures of consciousness (intentionality and selfhood) may promote and constrain evolutions of symptoms, evolutions that allow for interactions with environmental factors and that do not need to be understood in linear and mechanical terms. If the brain is seen as a self-organizing, ecologically embedded system [something the neuroreductionists minimize in the face of growing research bases detailing the significant impact of experience on gene expression, neural/synaptic connectivity, CNS structure/function, etc] and consciousness as its global emergent property, then psychotic decompensations may be envisaged as progressive organizations of novel coherence patterns with various degrees of stability and temporal constancy, organizations that articulate themselves around fundamental alterations of self-world relatedness” (p. 79).

Sass and Parnas (2003) view schizophrenia from a phenomenological perspective as a disorder “involving subtle but pervasive and persistent aspects of subjective experience” (p.428). They consider schizophrenia to be a disorder of the self, or more specifically, an ipseity disturbance.  The latter refers “to the experiential sense of being a vital and self-coinciding subject of experience or first person perspective on the world” (p. 428). This disturbance, according to Sass and Parnas, has two fundamental and complementary aspects. They noted:

“The first is hyperreflexivity, which refers to forms of exaggerated self-consciousness in which a subject or agent experiences itself, or what would normally be inhabited as an aspect or feature of itself, as a kind of external object. The second is a diminishment of self-affection or auto-affection-that is, of the sense of basic self-presence, the implicit sense of existing as a vital and self-possesed subject of awareness (...self-affection refers to subjectivity affecting itself-that is, manifesting itself to itself in a way that involves no distinction between a subject and an object. This self-manifesting is seen as a necessary condition for consciousness to arise in the first place...)” (p. 428).

Brian Koehler PhD