Self-Representation in Severe Psychopathology: The Role of Reflexive Self-Awareness

In both normal and abnormal functioning, the self is a complex psychological structure that is constituted and experientially divided by reflexive self-awareness—by the tension that arises from coordinating subjective and objective perspectives on the self. Disturbances in reflexive self-awareness are central to the development of severe psychopathology. Although both schizophrenia and borderline personality disturbances involve difficulties in self-reflexivity, schizophrenia also involves a more fundamental disturbance in the core, embodied self. In a sample of 40 adolescent and young adult psychiatric inpatients, qualitative analyses of spontaneous self-descriptions revealed that, among schizophrenic persons, reflexive self-awareness usually results in confusion and perplexity, as if a sense of identity were lacking altogether. Among borderline patients, who have tenuously established a core self, a sense of identity is present but is unstable and highly reactive to changes in mood. These impairments in self-reflexivity likely result from multiple developmental deviations over the course of childhood and adolescence. Intensive analyses of the spontaneous self-descriptions of two schizophrenic patients and two borderline patients illustrate these findings.