Research Digest

Sass, L. A. . Self-disturbance and schizophrenia: Structure, specificity, pathogenesis. Schizophrenia Research. Epub ahead of print. doi:10.1016/j.schres.2013.05.017

The nature of the underlying deficit in schizophrenia has been the subject of great debate; some theorists claim that a deficit in certain cognitive skills underlies the varying symptoms of the condition, whereas others argue that there is no one condition that is schizophrenia and it should be considered a label for a group of disorders. This has been a particular hindrance in finding effective treatments for people with schizophrenia, in that it is hard to consider how to combat a condition whose root cause is unknown. An approach growing in popularity in the last few years is to consider the nature of the alterations of subjective experience found in schizophrenia, harkening back to the phenomenological tradition in psychiatry.

In this school, Louis Sass has recently provided an updated account of the ipseity-disturbance model of schizophrenia, which posits a change in the nature of subjective experience to be at the core of the disorder. A disturbance of ipseity refers to a two-part experience: (1) diminished self-affection, which is a disruption of the normal sense of being a subject and taking action; (2) hyper-reflexivity, where the subject is intensely and perhaps even obsessively overly aware of his or her own body, its condition and its movements. These two aspects may appear apparently contradictory, but they are in fact mutually reinforcing—the uncertainty regarding ownership over one's actions leads to paying excessive attention to one's body and movements.

While this model is conceptually compelling, like other phenomenological models it can be difficult to falsify or verify. However, such models can be considered alongside and with reference to scientific findings regarding mind and brain and can be used to generate hypotheses suitable for empirical testing. One such hypothesis is that if di