The Bracketing of Presence: Dematerialization and Disembodiment in Times of Pandemic and of Social Distancing Biopolitics.

The purpose of this paper is to help us understand how and why the COVID pandemic, and its associated biopolitics of social distancing, may have affected our relationships with our own bodies and other persons, thus helping to accelerate what might be termed a bracketing of presence that was already well underway in our modern and contemporary social practices. We focus on 3 historical vectors, all rooted in specific technologies, that have profound implications at the levels of our social imaginary and prereflective ways of being: architecture, social media, and medicine. Architecture has progressively eliminated "porosity" between spaces by establishing clear borders between public and private spaces (also within the private ones), thereby contributing to our drive for social distancing. Social media have provided apparatuses that replace intercorporeal encounters with disembodied, virtual interactions mediated by images. Visual experiences that are more embodied, participatory, and "immersed" are replaced by passive forms of "seeing": the other becomes an image for me, and I for the other. The object of medicine has also recently dematerialized with the advent of the new "optical" and "digital" machines of modern medicine, which can operate remotely thanks to an increasingly powerful interface reliant on computational power and the resources of artificial intelligence, thereby dispensing with body-to-body interactions. We offer these reflections as routes to a better understanding of changes that have occurred and are occurring on the planes of both culture and individual psychological existence.

Three Dangers: Phenomenological Reflections on the Psychotherapy of Psychosis.

BACKGROUND/AIMS: This paper offers a hermeneutic-phenomenological perspective on three dangers relevant to the psychotherapy of an underserved and often poorly understood population: persons with schizophrenia and other psychotic conditions. METHODS: The discussion offered relies on analyses offered by Heidegger (on the "forgetting of the ontological difference"), Husserl (on the nature and importance of intersubjectivity), and Levinas (on appreciating the "infinitude" of human experience, versus adopting a "totalizing" attitude). RESULTS: The three dangers are: (1) that of neglecting the ontological horizon or overall framework dimension of altered experience in favor of a preoccupation with more obvious, content elements of experience (e.g., by focusing overly much on specific delusional beliefs and their apparent falsehood, rather than on how delusions may be experienced and how literally they may, or may not, be taken); (2) the danger of overemphasizing the relevance and need for direct interpersonal interaction at the expense of appreciating issues concerning the implicit, intersubjective sense of sharing (or not sharing) perspectives with other persons; and finally (3) the error of being overconfident of one's ability to grasp the patient's subjectivity. CONCLUSION: The paper explores how phenomenology's general perspective may offer a helpful alternative or supplement to some widespread attitudes and practices.

Anomalous Experience of Self and World: Administration of the EASE and EAWE Scales to Four Subjects with Schizophrenia.

The aim of this paper was to study anomalies of self- and world experience in schizophrenia from a phenomenological perspective through the use of the Examination of Anomalous Self-Experience (EASE) and Examination of Anomalous World Experience (EAWE) interviews. Four patients with diagnoses of schizophrenia were interviewed with both the EASE and the EAWE. A qualitative analysis of these interviews was carried out on all the data; quantitative scores were also assigned, based on the frequency and intensity of the items endorsed by the subjects. In the EASE, the subjects endorsed an average frequency of 45% of all items. In the EAWE, the subjects endorsed an average frequency of 26% of all items. Furthermore, the EAWE data indicated more heterogeneous profiles of experience than the EASE data. This heterogeneity is not surprising, given that the EAWE was designed to be a more broad-based or less targeted exploration of various changes likely to be associated with the schizophrenia spectrum (but also with certain other conditions). Our data suggest that although disturbances of world experience may always be present in schizophrenia, they may take numerous and varied forms. Because the experience of the world occurs across many different modalities, disturbances of this experience would be fundamentally less unitary, whereas the experience of the self presents a more coherent and unitary gestalt. These results show a certain overlapping between the scales while also indicating the potential value of a combined use of the two instruments. Finally, we discuss the relationship between experiential description and behavioral observation, and their potentially complementary value in exploring the first-person perspective, particularly in the case of experiences that occur at a more prereflective level.

Existential Orientation: On the Phenomenology of Values, Attitudes, and Worldviews in Schizophrenia (Ancillary Article to EAWE Domain 6).

Since the appearance of schizophrenia as a distinct diagnosis, various researchers and clinicians, particularly those in the phenomenological and existential tradition, have noted the unique contribution of attitudinal and characterological factors to the illness. There has been a notable lack of attention paid to these features in most recent research on the disorder; still, understanding the values, attitudes, and worldviews - what might be termed the "existential orientation" - of persons with schizophrenia may be essential for comprehending the illness and developing effective approaches to treatment. Domain 6, Existential orientation, of the Examination of Anomalous World Experience (EAWE) includes descriptions related to unusual worldviews and values that may be especially common in schizophrenia. The current paper provides a summary of classic and contemporary phenomenological literature on values and existential orientation in schizophrenia, with the goal of providing a context for and further explanation of the items in EAWE Domain 6. These characterizations generally suggest that persons with schizophrenia may more likely value being faithful to idiosyncratic, often eccentric ways of thinking and acting, questioning or rejecting conventions and common sense, refusing or avoiding relationships and intimacy with others, and living according to intellectual and idealistic rules (in contrast to a more immediate or spontaneous approach to life). Possible factors contributing to the development of these values are also discussed.

Language: On the Phenomenology of Linguistic Experience in Schizophrenia (Ancillary Article to EAWE Domain 4).

Anomalies of language use and comprehension are common in schizophrenia. However, they are typically studied only from a diagnostic or behavioral perspective and viewed simply as deficits or disruptions of normal functioning. Such approaches ignore what it is like to experience language, and thus are at risk of missing aspects of these linguistic anomalies that may be crucial for understanding them. The Examination of Anomalous World Experience (EAWE) provides one way to inquire into the experiential changes related to and underlying these disturbances. This paper offers a summary of a number of theoretical and clinical works that informed the development of EAWE Domain 4, Language, to better contextualize and elaborate on the items that make up this domain. The forms of anomalous linguistic experience included in the EAWE can be generally classified into four groups: (1) Diminished interpersonal orientation, (2) Dissociation between language and experience, (3) Shifts of attention and context-relevance, and (4) Unusual attitudes toward language. We suggest that these kinds of experiential changes indicate a far richer and more complex relationship to language than that suggested by standard deficit models and theories. We hope that by considering and inquiring about the subjective experience of language, researchers and clinicians may develop a greater awareness of and appreciation for the variety of language-related experiences in schizophrenia.

Atmosphere: On the Phenomenology of "Atmospheric" Alterations in Schizophrenia - Overall Sense of Reality, Familiarity, Vitality, Meaning, or Relevance (Ancillary Article to EAWE Domain 5).

"Atmospheric" alterations are key aspects of altered subjectivity in mental disorder. Karl Jaspers famously described the "delusional mood": a sense of uncanny salience and ominousness that often precedes the onset of schizophrenic psychosis or of delusions. Such experiences, he writes, involve "a transformation in our total awareness of reality" that often verges on ineffability. In psychiatry, these experiential alterations are often referred to in terms of "derealization." Though derealization most obviously refers to a decline in the sense of objective presence or felt actuality, it can also refer to other unusual experiences in which things seem unlike normal or standard reality, including altered familiarity, vitality, meaning, or relevance. This paper first describes two complementary ways of approaching these phenomena: the notion of an "ontological" dimension (Sass) and that of "existential feeling" (Ratcliffe). It then offers a wider-ranging synopsis of work in phenomenological psychopathology that has sought to address atmospheric alterations believed to be especially characteristic of schizophrenia spectrum conditions, focusing on the themes of a diminished sense of reality, altered sense of meaning, disrupted feeling of familiarity, and diminished vitality and relevance.

EAWE: Examination of Anomalous World Experience.

The "EAWE: Examination of Anomalous World Experience" is a detailed semi-structured interview format whose aim is to elicit description and discussion of a person's experience of various aspects of their lived world. The instrument is grounded in the tradition of phenomenological psychopathology and aims to explore, in a qualitatively rich manner, six key dimensions of subjectivity - namely, a person's experience of: (1) Space and objects, (2) Time and events, (3) Other persons, (4) Language (whether spoken or written), (5) Atmosphere (overall sense of reality, familiarity, vitality, meaning, or relevance), and (6) Existential orientation (values, attitudes, and worldviews). The EAWE is based on and primarily directed toward experiences thought to be common in, and sometimes distinctive of, schizophrenia spectrum conditions. It can, however, also be used to investigate anomalies of world experience in other populations. After a theoretical and methodological introduction, the EAWE lists 75 specific items, often with subtypes, in its six domains, together with illustrative quotations from patients. The EAWE appears in a special issue of Psychopathology that also contains an orienting preface (where the difficulty as well as necessity of studying subjective life is acknowledged) and a brief reliability report. Also included are six ancillary or background articles, which survey phenomenologically oriented theory, research, and clinical lore relevant to the six experiential domains.

Examination of Anomalous World Experience: A Report on Reliability.

BACKGROUND: The EAWE (Examination of Anomalous World Experience) is a newly developed, semi-structured interview that aims to capture anomalies of subjectivity, common in schizophrenia spectrum disorders, that pertain to experiences of the lived world, including space, time, people, language, atmosphere, and certain existential attitudes. By contrast, previous empirical studies of subjective experience in schizophrenia have focused largely on disturbances in self-experience. AIM: To assess the reliability of the EAWE, including internal consistency and interrater reliability. SAMPLING AND METHODS: In the course of developing the EAWE, two distinct studies were conducted, one in the United States and the other in Slovenia. Thirteen patients diagnosed with schizophrenia spectrum or mood disorders were recruited for the US study. Fifteen such patients were recruited for the Slovenian study. Two live interviewers conducted the EAWE in the US. The Slovenian interviews were completed by one live interviewer with a second rater reviewing audiorecordings of the interview. Internal consistency and interrater reliability were calculated independently for each study, utilizing Cronbach's α, Spearman's ρ, and Cohen's κ. RESULTS: Each study yielded high internal consistency (Cronbach's α >0.82) and high interrater reliability for total EAWE scores (ρ > 0.83; average κ values were at least 0.78 for each study, with EAWE domain-specific κ not lower than 0.73). CONCLUSION: The EAWE, containing world-oriented inquiries into anomalies in subjective experience, has adequate reliability for use in a clinical or research setting.

Basic Self-Disturbances beyond Schizophrenia: Discrepancies and Affinities in Panic Disorder - An Empirical Clinical Study.

BACKGROUND: Anomalous self-experiences (ASEs), presumably involving alterations in "core" or "minimal self," have been studied as manifest in schizophrenia and its spectrum, in contrast with mood disorder and personality disorder samples. This is the first study to examine ASEs in panic disorder (PD), beginning the exploration of these disturbances of subjectivity in anxiety disorders. We aimed to clarify what might, or might not, be specific to the schizophrenia spectrum domain - which, in turn, could be useful for developing pathogenetic models for various disorders. SAMPLING AND METHODS: 47 hospital outpatients with PD and no other medical and psychiatric comorbidity and 47 healthy control (HC) subjects were assessed with the Examination of Anomalous Self Experiences (EASE) and Cambridge Depersonalization Scale (CDS). RESULTS: All our PD patients had overall ASE and EASE scores significantly higher than our HCs (mean ± SD 17.94 ± 11.88 vs. HC 1.00 ± 1.81), approaching levels found in previous schizophrenia spectrum samples. The distribution of particular EASE items and subitems in the PD sample was heterogeneous, varying from rare (<10%) or absent (termed "discrepancies" with schizophrenia spectrum: 29 items) to being present in >50% of subjects ("affinities" with schizophrenia spectrum: 7 items). EASE and CDS scores were highly correlated (r = 0.756, 95% CI 0.665-0.840). CONCLUSIONS: PD patients scored higher on items suggesting common forms of derealization and depersonalization, perhaps suggesting "secondary" and defensive psychological processes, while lacking indicators of more profound ipseity disturbance. Our study supports the basic-self-disturbance model of schizophrenia, while suggesting the possibility of transnosological "schizophrenia-like phenomena," which might require careful phenomenological exploration to be distinguished from those of true psychotic or schizophrenic conditions.

Self-Disturbance and the Bizarre: On Incomprehensibility in Schizophrenic Delusions.

The notion of 'bizarre delusion' has come into question in contemporary anglophone psychopathology. In DSM-5, it no longer serves as a special criterion for diagnosing schizophrenia nor as an exclusion criterion for delusional disorder. Empirical studies influencing this development have, however, been relatively sparse and subject to methodological criticism. Major reviews have concluded that current conceptualizations of bizarre delusions may require rethinking and refinement. Defining bizarreness entails a return to Jaspers, whose influential views on the supposed incomprehensibility of bizarre delusions and schizophrenic experience are more nuanced than is generally recognized. Jaspers insisted we must 'get behind' three 'external characteristics' (extraordinary conviction, imperviousness, impossible content) in order to acknowledge a 'primary experience traceable to the illness' in the 'delusions proper' of schizophrenia. He also denied that one could empathize with or otherwise 'understand' this basis. Here, we focus on three features of bizarre delusions that Jaspers foregrounded as illustrating schizophrenic incomprehensibility: disturbance of the cogito, certitude combined with inconsequentiality, delusional mood. We link these with the contemporary ipseity disturbance model of schizophrenia, arguing that Jaspers' examples of incomprehensibility can be understood as manifestations of the three complementary aspects of ipseity-disturbance: diminished self-presence, hyperreflexivity and disturbed grip/hold. We follow Jaspers' lead in acknowledging a distinctive strangeness that defies ready comprehension, but we challenge the absolutism of Jaspers' skepticism by offering a phenomenological account that comprehends bizarreness in two ways: rendering it psychologically understandable, and fitting the various instances of bizarreness into a comprehensive explanatory framework.

Self-Disorder in Schizophrenia: A Revised View (2. Theoretical Revision-Hyperreflexivity).

A growing body of research supports the role of self-disorders as core phenotypic features of schizophrenia-spectrum conditions. Self-disorders comprise various alterations of conscious experience whose theoretical understanding continues to present a challenge. This is the second of two articles that aim to clarify the nature of self-disorders in schizophrenia by considering the currently most influential, phenomenological model of schizophrenia: the basic-self-disturbance or ipseity-disorder model (IDM). The previous paper (article 1) presented a state-of-the-art overview of this model and critically assessed its descriptive adequacy with respect to the clinical heterogeneity and variability of the alterations in self- and world-awareness characteristic of schizophrenia. This paper (article 2) proposes a theoretical revision by considering how hyperreflexivity might form the crucial common thread or generating factor that unifies the heterogeneous, and sometimes even contradictory features of schizophrenic self-disorders. We outline implications of our revised model (IDMrevised) for explanatory research, therapeutic practice, and our general understanding of the abnormalities in question.

Self-Disorder in Schizophrenia: A Revised View (1. Comprehensive Review-Dualities of Self- and World-Experience).

A growing body of research supports the role of self-disorders as core phenotypic features of schizophrenia-spectrum disorders. Self-disorders comprise various alterations of conscious experience whose theoretical understanding continues to present a challenge. The following 2 articles aim to provide further clarification of the nature of self-disorders in schizophrenia by offering a comprehensive review (article 1) and theoretical revision (article 2) of the currently most influential model of altered selfhood in schizophrenia: the basic-self-disturbance or ipseity-disorder model (IDM). This article presents a state-of-the-art overview of the current self-disturbance model and critically assesses its descriptive adequacy with respect to the clinical variability and heterogeneity of the alterations in self- and world-awareness characteristic of schizophrenia. Special attention is paid to experiences of exaggerated basic self, increased "grip" or "hold" on the world, and paradoxical combinations. The next article proposes a theoretical revision of the self-disturbance model by considering how hyperreflexivity might form the crucial common thread or generating factor that unifies the phenomenologically heterogeneous, and sometimes even contradictory features of schizophrenic self-disorders. We outline the implications of our revised model for explanatory research, therapeutic practice, and our general understanding of the abnormalities in question.

Schizophrenia, the very idea: On self-disorder, hyperreflexivity, and the diagnostic concept.

The purpose of the present article is to consider schizophrenia-the very idea-from the perspective of phenomenological psychopathology, with special attention to the problematic nature of the diagnostic concept as well as to the prospect and challenges inherent in focusing on subjective experience. First, we address historical and philosophical topics relevant to the legitimacy of diagnostic categorization-in general and regarding "schizophrenia" in particular. William James's pragmatist approach to categorization is discussed. Then we offer a version of the well-known basic-self or ipseity-disturbance model (IDM) of schizophrenia, but in a significantly revised form (IDMrevised). The revised model better acknowledges the diverse and even seemingly contradictory nature of schizophrenic symptoms while, at the same time, interpreting these in a more unitary fashion via the key concept of hyperreflexivity-a form of exaggerated self-awareness that tends to undermine normal world-directedness and the stability of self-experience. Particular attention is paid to forms of exaggerated "self-presence" that are sometimes neglected yet imbue classically schizophrenic experiences involving subjectivism or quasi-solipsism and/or all-inclusive or ontological forms of paranoia. We focus on the distinctively paradoxical nature of schizophrenic symptomatology. In concluding we consider precursors in the work of Klaus Conrad, Kimura Bin and Henri Grivois. Finally we defend the concept of schizophrenia by considering its distinctive way of altering certain core aspects of the human condition itself.

The self, neuroscience and psychosis study: Testing a neurophenomenological model of the onset of psychosis.

AIM: Basic self disturbance is a putative core vulnerability marker of schizophrenia spectrum disorders. The primary aims of the Self, Neuroscience and Psychosis (SNAP) study are to: (1) empirically test a previously described neurophenomenological self-disturbance model of psychosis by examining the relationship between specific clinical, neurocognitive, and neurophysiological variables in UHR patients, and (2) develop a prediction model using these neurophenomenological disturbances for persistence or deterioration of UHR symptoms at 12-month follow-up. METHODS: SNAP is a longitudinal observational study. Participants include 400 UHR individuals, 100 clinical controls with no attenuated psychotic symptoms, and 50 healthy controls. All participants complete baseline clinical and neurocognitive assessments and electroencephalography. The UHR sample are followed up for a total of 24 months, with clinical assessment completed every 6 months. RESULTS: This paper presents the protocol of the SNAP study, including background rationale, aims and hypotheses, design, and assessment procedures. CONCLUSIONS: The SNAP study will test whether neurophenomenological disturbances associated with basic self-disturbance predict persistence or intensification of UHR symptomatology over a 2-year follow up period, and how specific these disturbances are to a clinical population with attenuated psychotic symptoms. This may ultimately inform clinical care and pathoaetiological models of psychosis.

The psychiatric interview: validity, structure, and subjectivity.

There is a glaring gap in the psychiatric literature concerning the nature of psychiatric symptoms and signs, and a corresponding lack of epistemological discussion of psycho-diagnostic interviewing. Contemporary clinical neuroscience heavily relies on the use of fully structured interviews that are historically rooted in logical positivism and behaviorism. These theoretical approaches marked decisively the so-called "operational revolution in psychiatry" leading to the creation of DSM-III. This paper attempts to examine the theoretical assumptions that underlie the use of a fully structured psychiatric interview. We address the ontological status of pathological experience, the notions of symptom, sign, prototype and Gestalt, and the necessary second-person processes which are involved in converting the patient's experience (originally lived in the first-person perspective) into an "objective" (third person), actionable format, used for classification, treatment, and research. Our central thesis is that psychiatry targets the phenomena of consciousness, which, unlike somatic symptoms and signs, cannot be grasped on the analogy with material thing-like objects. We claim that in order to perform faithful distinctions in this particular domain, we need a more adequate approach, that is, an approach that is guided by phenomenologically informed considerations. Our theoretical discussion draws upon clinical examples derived from structured and semi-structured interviews. We conclude that fully structured interview is neither theoretically adequate nor practically valid in obtaining psycho-diagnostic information. Failure to address these basic issues may have contributed to the current state of malaise in the study of psychopathology.

Introspection and schizophrenia: a comparative investigation of anomalous self experiences.

This paper offers a comparative investigation of anomalous self-experiences common in schizophrenia (defined in Examination of Anomalous Self Experiences (EASE) instrument) and those of normal individuals in an intensely introspective orientation (early 20th-century "introspectionist" psychology). The latter represent a relatively pure manifestation of certain forms of exaggerated self-consciousness ("hyperreflexivity"), one facet of the disturbance of core- or minimal-self ("ipseity" disturbance) postulated as central in schizophrenia. Significant similarities with schizophrenia-like experience were found but important differences also emerged. Affinities included feelings of passivity, fading of self or world, and alienation from thoughts, feelings, or lived-body. Differences involved confusion between self and world and severe dislocation or erosion of first-person perspective, qualities unique to schizophrenia. The purpose is threefold: 1, place the putatively schizophrenic experiences of self-disorder in a broader, comparative context; 2, evaluate hypotheses concerning core processes in schizophrenia; 3, orient investigation of possible pathogenetic pathways as well as psychotherapeutic interventions.

Anomalous self-experience in depersonalization and schizophrenia: a comparative investigation.

Various forms of anomalous self-experience can be seen as central to schizophrenia and other psychiatric disorders. We examined similarities and differences between anomalous self-experiences common in schizophrenia-spectrum disorders, as listed in the EASE (Examination of Anomalous Self Experiences), and those described in published accounts of severe depersonalization. Our aims were to consider anomalous self-experience in schizophrenia in a comparative context, to refine and enlarge upon existing descriptions of experiential disturbances in depersonalization, and to explore hypotheses concerning a possible core process in schizophrenia (diminished self-affection, an aspect of "ipseity" or minimal self). Numerous affinities between depersonalization and schizophrenia-spectrum experience were found: these demonstrate that rather pure forms of diminished self-affection (depersonalization) can involve many experiences that resemble those of schizophrenia. Important discrepancies also emerged, suggesting that more automatic or deficiency-like factors--probably involving self/world or self/other confusion and erosion of first-person perspective--are more distinctive of schizophrenia-spectrum disorders.

Metaphor, magic, and mental disorder: Poetics and ontology in Mexican (Purépecha) curanderismo.

This article offers an epistemological, poetic, and ontological reading of the ways of knowing regarding mental disorders that are characteristic of the traditional healers (curanderas and curanderos) of an Indigenous group in Mexico. The study is based on ethnographic interviews with traditional Purépecha (Tarascan) healers in rural Michoacan. Interviews focused on local conceptions of emotional and mental illness, especially Nervios, Susto, and Locura (nerves, fright, and madness). We discuss the conceptual structure of these Indigenous illness notions, the nature of the associated imagery and notions of the soul, as well as the general sense of meaningfulness and reality implicit in Purépecha curanderismo. The highly metaphorical modes of understanding characteristic of these healers defy analysis in purely structuralist terms. They do, however, have strong affinities with the Renaissance "episteme" or implicit framework of understanding described in The Order of Things, Michel Foucault's classic study of modes of knowing and experiences of reality in Western thought-a work profoundly influenced by Heidegger's interest in the historical and cultural constitution of what Heidegger termed "Being." After examining the individual illness concepts, we explore both the poetic and the ontological dimension (the foundational sense of reality or of Being) that they involve, with special emphasis on supernatural concerns.