Construction and interpretation of self-related function and dysfunction in Intercultural Psychiatry

Abstract

In several psychiatric disorders, key symptoms are associated with aspects of an individual, which are usually referred to as the "self". For example in schizophrenia, it has been suggested that the activity of the self and the distinction between self and others are impaired. However, such models of the self and its dysfunction have been developed among Western societies and may not easily be transferred into different cultural settings, which can be characterized by alternative concepts of a person's self. This study compares traditional Western concepts of the self and its dysfunction with self-concepts developed in Caribbean, African and South-East-Asian societies. This review demonstrates that "the self" is a fluid concept. Social function and dysfunction of such a self-concepts depend on a given cultural context. We argue that the cursive concept of the self is culturally constructed around cursive experiences which are shared by all human beings. Such universal experiences may include the prereflective access to individual thoughts and feelings, an automatic knowledge that (at least in non-pathological states) these emotions and cognitions belong to my self. Conscious self-reflection and its narrative articulation, on the other hand, is necessarily imbued with social and cultural norms, images and events, often of conflicting nature.

Aberrant Salience Is Related to Dysfunctional Self-Referential Processing in Psychosis

“…Our findings provide experimental evidence for the hypothesis of aberrant salience attribution [1][2][3] and dysfunction of the self 1,[6][7][8][9][10][11] in schizophrenia. We demonstrate reduced neural self-referential processing in the vmPFC, the core region of self-relevance coding, which was associated with increased aberrant salience attribution in schizophrenia patients.…”

“…Indeed, this failure to self-ascribe thoughts, 6 as well as aberrant self-relevance attribution to environmental stimuli 6,7 both point to a dysfunction of the self, which can also be observed in transcultural studies of schizophrenia. 8 The concept of schizophrenia includes the notion of a disturbed basic sense of self as a core mechanism specific to schizophrenia. [9][10][11] Difficulties in differentiating self-relevant from self-irrelevant information may render the perception of neutral environmental stimuli abnormally salient.…”

Shall we really say goodbye to first rank symptoms?

“…Second, it has been suggested that the occurrence of psychotic symptoms per se, including first rank symptoms, is rather frequent even in subjects who do not suffer from any classifiable mental disorder [17–19]. Thirdly, the use of FRS has been questioned within a worldwide context and it has been suggested that the functions impaired in such FRS refer to specific European traditions of self-reflection rather than to a general anthropological trait [20, 21].…”

The Metacognition Assessment Scale (MAS‐A): Results of a pilot study applying a German translation to individuals with schizophrenia spectrum disorders

“…Cognitive and interpersonal problems belong to the most intractable symptoms of patients suffering from psychotic disorders, can contribute to social marginalization, and are not sufficiently alleviated by standard treatments favouring pharmacotherapy (Bellack et al ., ). Moreover, some diagnostic approaches in patients with schizophrenia tend to neglect self‐experience, intersubjectivity, and the human need to make sense of life experiences and to integrate them in the construction of self, identity, and personal history (Fuchs, ; Heinz, Bermpohl, & Frank, ). Therefore, psychotherapeutic and integrative treatment options have attracted increasing attention over the last decades, as they have begun to focus on social cognitive or emotional symptom dimensions (Hogarty & Flesher, ; Kuipers et al ., ; Moritz & Woodward, ; Roberts et al ., ) and foster the overarching capabilities of self‐reflectivity, mentalization, and metacognition (Bargenquast & Schweitzer, ; Brent, ; Lempa, Montag, & von Haebler, ; Lysaker, Buck, et al ., ; Rosenbaum et al ., ; Salvatore et al ., ).…”