Lars Siersbæk Nilsson / A New Look at Schizophrenia and Intersubjectivity

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A certain estrangement from the communal world has always been considered an integral part of disorders belonging to the schizophrenia spectrum. Bleuler who coined the very term “schizophrenia” famously listed autism as one of its fundamental features and described how these patients tended to withdraw from intersubjectivity and encase themselves with their inner life. Such difficulties maneuvering the social realm have transpired through the various descriptions given by the canonical authors of psychopathology since then. It is an integral part of key clinical concepts ranging from Minkowski’s “loss of vital contact with reality” over Blankenburg’s “loss of natural self evidence” to Rümke’s “Praecox Gefühl” and today it is reflected in the diagnostic manuals. Thus the DSM 5 lists impoverished personal relations as a possible criterion B for making the schizophrenia diagnosis and it includes a lack of close friends or confidants and excessive social anxiety as diagnostic criteria for schizotypal personality disorder.

Yet the exact nature of these disturbances remains poorly understood. Most contemporary research addresses these matters by way of instruments assessing social cognition and cashes out the results in various measures of social functioning. While such strategies have produced valuable results, they might not, however, do full justice to the lived experience of the patients in question.

In our current interdisciplinary research project between philosophy and psychiatry, we approach these issues from a different angle. In a 5-year follow up on a cohort of first-admission schizophrenia spectrum patients, we couple a thorough psychopathological investigation (including the EASE scale assessing self disorders) with an existential interview focusing on the social domain. Inspired by the work of Canadian anthropologist Ellen Corin, we do an hour-by-hour reconstruction of the patients’ last two days and address questions of meaning and subjective importance with regard to interpersonal relationships.

The data collection is now nearly complete and interesting findings are starting to emerge. Currently, I am, together with Mads Gram Henriksen, working on a paper in which we try to flesh out some of these patients’ interpersonal difficulties in clinical reality and make sense of their altered intersubjectivity through the conceptual framework offered by Salice and Henriksen in their 2015 article The Disrupted “We”: Schizophrenia and Collective Intentionality[1]. Essentially, we will argue that our main empirical findings seem to corroborate the theoretical claims of the aforementioned paper: Whereas some forms of goal-oriented and predictable intersubjective activities remain relatively unaffected in schizophrenia spectrum disorders, other more loosely orchestrated and improvised interpersonal endeavors can be almost unbearable. Indeed it seems that whereas joint-intentionality is preserved, we-intentionality is more fragile in schizophrenia.

[1] Journal of Consciousness Studies, Vol. 22, Numbers 7-8, 2015, pp. 145-171 (27)

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