No abstract

Clinical observations suggest early self-consciousness disturbances in schizophrenia. A double mirror combining the images of two individuals sitting on each side of the mirror was used to study self–other differentiation in 12 individuals with early onset schizophrenia (EOS) and 15 individuals with adult onset schizophrenia (AOS) compared to 27 typically developing controls (TDC) matched on age and sex. The effects of intermodal sensory perception (visual–tactile and visual–kinesthetic) on self–other recognition were also studied. The results showed that EOS and AOS individuals, independently of age and schizophrenia severity, were centered on their own image compared to TDC, with both significant earlier self-recognition and delayed other-recognition during the visual recognition task. In addition, there was no significant effect of intermodal sensory stimulation on self–other recognition in EOS and AOS patients, whereas self-centered functioning was significantly increased by visual–tactile stimulation and decreased by visual–kinesthetic stimulation in TDC. The findings suggest that self–other recognition impairments might be a possible endophenotypic trait of schizophrenia.

A historical review of the concepts of self-consciousness is presented, highlighting the important role of the body (particularly, body perception but also body action), and the social other in the construction of self-consciousness. More precisely, body perception, especially intermodal sensory perception including kinesthetic perception, is involved in the construction of a sense of self allowing self-other differentiation. Furthermore, the social other , through very early social and emotional interactions, provides meaning to the infant’s perception and contributes to the development of his/her symbolization capacities. This is a necessary condition for body image representation and awareness of a permanent self in a time-space continuum (invariant over time and space). Self-image recognition impairments in the mirror are also discussed regarding a comprehensive developmental theory of self-consciousness. Then, a neuropsychological and neurophysiological approach to self-consciousness reviews the role of complex brain activation/integration pathways and the mirror neuron system in self-consciousness. Finally, this article offers new perspectives on self-consciousness evaluation using a double mirror paradigm to study self- and other- image and body recognition.

Self-experience impairments have been described since many years as part of core features of schizophrenia, but are currently neglected in research and clinical practice. First, a literature review on self-consciousness is developed in this article with regard to definitions (including the concepts of self and self-consciousness) and different approaches (especially cognitive, developmental and neurobiological approaches). Self-consciousness can be divided into three levels: minimal-self with implicit pre-reflexive consciousness, reflexive-self with explicit reflexive consciousness (consciousness of a permanent self as an invariant over time through multiple experiences and actions), and social-self (style, habits, and historical narrativity) with explicit self-consciousness. These levels appear progressively in the child from bodily perception (pre-reflexive consciousness) to identification of the self in the mirror at approximatively two-years old (reflexive consciousness) and appearance of mental representations later (self-consciousness). Second, self-consciousness impairments observed in schizophrenia are described in this article and discussed in light of the literature presented. Converging evidence suggests that exploring self-disorders in schizophrenia could help clinicians to understand daily-life patients difficulties and might be of interest for developing a therapeutic alliance. Finally, this critical literature review opens new perspectives to understand better disorders of the self and social interaction impairments in schizophrenia, and to propose a therapeutic use of the mirror based on cognitive remediation helping individuals with schizophrenia to improve self-other differentiation.