The Self-Experience of Schizophrenics

Empirical studies of the ego/self in schizophrenia, borderline disorders and depression

This book reviews my psychopathological research on the self-experience of schizophrenics and their functionally correlated behaviour. Its aim is to achieve a better understanding of the way in which schizophrenics experience their self and their works, and of their struggle to survive and to overcome their suffering. It is hoped that this will help us to improve our strategies of treatment and rehabilitation. Schizophrenic illnesses are conceived of as severe "ego-disorders" (Heinroth 1818), or in modern terms "certain mutations of selfhood — of the ego’s unity" (Sass 1992), the common experiential denominator being disordered ego-consciousness. This is studied systematically by means of an ego-pathology inventory, which investigates the ego-disorder in five basic dimensions: vitality, activity, consistency and coherence, demarcation, identity. It is shown that the respective disorders can be reliably empirically assessed. Positive arguments are advanced in favour of accepting this concept of ego pathology as valid in various aspects.
 
These explorations of self-experiences are, as a matter of fact, language dependent in the process of concept forming and studying, on the interviewer’s as well as on the proband side. The patient’s self and world experience is conveyed by what he/she tells us and also the speachless signs of his/her behaviour. I am aware of the fallaciousness of words which are yet unevadable. Goethe already said: "Where we do not have concepts based on sufficient knowledge, there immediately a word will fill the gap". Nietzsche called our attention to the seduction of language. Wittgenstein and analytical philosophy followed with the view that: "The limit of my language is the limit of my world". One must not necessarily interpret this as a disregard of the "purest" trans-language experience of the ineffable and inexpressible of which mystics of all religions witness and which so much constitutes the individual, experiential "world".
 
This study will resign itself cautiously and modestly to this word-communicated world of mental patients. The psychiatrist in sympathy and empathy can share with the patient part of his/her world, i.e. his/her self and its world created by the individual consciousness. The mutual exchange of the respective worlds, the ídios kósmos of the individual, join with the koinós kósmos, may further a wholesome metamorphosis in the ill subject. Thus it is hoped that this study will make a small contribution to psychiatry’s effort to understand and to help the suffering fellow human being. Part I presents the concept of "empirical ego" in philosophy, psychology, evolution, ontogenesis and in various cultures. Part II covers the construct of ego pathology, its origins in clinical observations and in the history of psychiatry and its clinical elaboration in the theoretical framework of functional psychopathology. Part III describes the methods of inquiry, reliability tests, arguments for validation and the study population of 664 probands: 552 schizophrenics, 25 borderline inpatients and 87 depressives. The results reported cover (1) comparison of the three diagnostic groups; (2) data analysis of schizophrenics; (3) correlation of ego pathology to external variables: speech characteristics, traditional descriptive psychopathology (documented my AMDP), Ego-Function-Assessment-Scales (Bellak 1976), "basic disorders" (Süllwold, Huber 1986), self-help-strategies of schizophrenics, (4) ego pathology in borderline-inpatients and depressives and in altered states of consciousness.

Zürich (ISBN 3-9520832-1-6)