Schizophrenia, Subjectivity, and Mindreading

Abstract

A number of recent articles, many appearing in Schizophrenia Bulletin, signal a renewed interest in phenomenological approaches to our understanding of schizophrenia. These approaches conceptualize schizophrenia as a disorder of altered self-awareness and decreased prereflective social attunement, which may manifest as an impaired understanding of self, others, and the physical world. Phenomenological approaches to psychopathology are sometimes construed as being incompatible with the reductionistic methodology of contemporary neuroscience. In this article, we re-examine findings from the phenomenological investigation of schizophrenia in light of an influential neurocomputational account of mindreading, which postulates that understanding of others is subserved by coherent internal self-models. We argue that the phenomenological approach to schizophrenia is not incompatible with a neurocomputational account of mindreading, and that the 2 approaches should instead be viewed as existing in a relationship of mutual constraint and enlightenment. Our hypothesis, while speculative, is an attempt to marry the phenomenological and neuronal realities of schizophrenia. Furthermore, it has implications for psychotherapeutic interventions and future research.

Psychedelics and the science of self-experience

“…The studies discussed above may shed light on the neuronal mechanisms underlying self-attribution to physical and mental features (approaching the self as an object of attribution), but are not well suited to identify neuronal correlates of minimal self-experience (self as knowing subject). 2 Phenomenological features of minimal self-experience, such as self-ownership and self-agency, are present in the structure of first-person subjective experience itself, 4 suggesting that their neuronal correlates may be found in the very building blocks of neuronal computation.…”

“…Theoretical considerations suggest that the brain is perpetually engaged in generating predictions about the 'state of the world', and testing these predictions against incoming sensory signals. 1,4 Perception and action depend on neuronal mechanisms that minimise the mismatch between predicted and actual incoming signals. This process of mismatch-minimisation would theoretically imbue perception and action with a pre-reflective feeling of familiarity, self-ownership and self-agency, making it a good candidate for the neuronal correlate of minimal self-experience.…”

“…10 A disrupted sense of self was considered to be a core phenomenological feature of early and acute psychosis. 4 Kraepelin, for example, wrote of a 'disunity Psychedelics and the science of self-experience Matthew M. Nour and Robin L. Carhart-Harris…”

“…of consciousness' in schizophrenia and Bleuler wrote of a slackening of the associative links that tie together thoughts, perceptions and affects. 4 More recently, it has been proposed that a central phenomenological alteration in schizophrenia is an instability of 'pre-reflective self-awareness', which has close parallels to conceptions of minimal self-experience, and is related to a feeling of immersion in a social world. 4,11 Recent efforts to operationalise self-disturbance in schizophrenia, using the Examination of Anomalous Self-Experience (EASE) questionnaire, suggest that this feature may predict clinical trajectory of firstepisode psychosis.…”

“…4 More recently, it has been proposed that a central phenomenological alteration in schizophrenia is an instability of 'pre-reflective self-awareness', which has close parallels to conceptions of minimal self-experience, and is related to a feeling of immersion in a social world. 4,11 Recent efforts to operationalise self-disturbance in schizophrenia, using the Examination of Anomalous Self-Experience (EASE) questionnaire, suggest that this feature may predict clinical trajectory of firstepisode psychosis. 11 By contrast, the depressed state is characterised by an increase in self-focus, and an inability to disengage from self-referential ruminative thought.…”