Psychosis and the disintegration of dialogical self‐structure: Problems posed by schizophrenia for the maintenance of dialogue

Abstract

Researchers and theoreticians across widely varying disciplines have increasingly stressed how sense of self is inherently 'dialogical', or the product of ongoing dialogue both within the individual and between the individual and others. This perspective emphasizes that self-awareness is not an awareness of an isolated or seamless viewpoint, but a collective of numerous complementary, competing, and sometimes contradictory, voices. In this paper we suggest that changes in subjective sense of self in schizophrenia spectrum disorders may represent the collapse of this essential dialogue. We suggest that this collapse can have the end-result of mentally ill persons either coming to embrace a singular, all-incorporating self-position or standing precariously on the brink of cacophony which is experienced as self-dissolution. We point to two phenomena associated with schizophrenia that could contribute to the derailment of internal and external dialogue: impairments in associative processes and affect dysregulation. Illustrated with a case example, we finally suggest how psychotherapy has the potential to revive internal dialogue through its explicit use of external dialogue helping to restore previous levels of social function.

Addressing Metacognitive Capacity in the Psychotherapy for Schizophrenia: A Case Study

“…Finally, he eventually began to refer to his delusions as "default thinking" and would consistently notice when he was doing it himself. There were also several times when Schubert did not discuss his delusions, but, consistent with older case studies (Lysaker & Lysaker, 2001), would say that without talking about these beliefs he was "blank" or "empty" to which the therapist would respond, "You have no thoughts now" and sit with him in silence with no judgment. When asked to compare how he felt when using "default thinking" rather than thoughts about himself, he replied he felt "angry" with using default thinking versus "relieved" yet also "empty" when talking about himself.…”

From Theory to Clinical Practice: A Phenomenologically Inspired Intervention for Patients with Schizophrenia

“…Rather, we propose that the specific therapeutic format outlined here can be fruitfully complemented by other therapeutic approaches: the use of fluctuating self-disorders as an early warning sign might add to the effectiveness of relapse prevention while trait-like self-disorders could better be approached by strategies that focus on the individual assignment of higher-order meaning [38,39]. All of these theoretical implications and therapeutic applications require further research, both phenomenological and empirical.…”

Sense of self, adaptation and recovery in patients with psychosis in a forensic NHS setting

“…For example, Lysaker, Wickett, Wilke and Lysaker (2003) state that with impoverished narratives, people lose the contextual basis of emotions, imagined futures and sustained intimacy. It has therefore been suggested that the construction/recovery of a coherent narrative plays a significant role in the movement towards mental health (Davidson & Strauss, 1992) and may be considered a potential focus of psychotherapy (Fenton, 2000;Lysaker & Lysaker, 2001). Siegal's (2001) model of interpersonal neurobiology offers an explanation of the development of narratives that lack coherence and integration, stating that coherent narratives may reflect an integrative process within the mind.…”