Phenomenology and the Cognitive Sciences

, Volume 12, Issue 1, pp 105–129 | Cite as

On incomprehensibility in schizophrenia

Article

Abstract

This article examines the supposedly incomprehensibility of schizophrenic delusions. According to the contemporary classificatory systems (DSM-IV-TR and ICD-10), some delusions typically found in schizophrenia are considered bizarre and incomprehensible. The aim of this article is to discuss the notion of understanding that deems these delusions incomprehensible and to see if it is possible to comprehend these delusions if we apply another notion of understanding. First, I discuss the contemporary schizophrenia definitions and their inherent problems, and I argue that the notion of incomprehensibility in these definitions rests heavily on Jaspers’ notions of understanding and empathy. Secondly, I discuss two Wittgensteinian attempts to comprehend bizarre delusions: (a) Campbell’s proposal to conceive delusions as framework propositions and (b) Sass’s suggestion to interpret delusions in the light of solipsism. Finally, I discuss the phenomenological conception of schizophrenia, which conceives delusion formation as resulting from alterations of the structure of experiencing and from underlying self-disorders. I argue that although a psychological understanding that seeks to grasp meaning in terms of motivations, desires, and other more straightforward psychological connections between mental states is impossible in schizophrenia, we can in fact have a philosophical understanding of the schizophrenic world and of the emergence of delusions typically found in schizophrenia.

Keywords

Schizophrenia Delusions Self-disorders Phenomenology Understanding 

References

  1. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders: DSM-III (3rd ed.). Washington, DC: American Psychiatric Association.Google Scholar
  2. American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R. revised (3rd ed.). Washington, DC: American Psychiatric Association.Google Scholar
  3. American Psychiatric Association. (2007). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. text revision (4th ed.). Arlington: American Psychiatric Association.Google Scholar
  4. Andreasen, N. C., & Flaum, M. (1991). Schizophrenia: the characteristic symptoms. Schizophrenia Bulletin, 17, 27–49.CrossRefGoogle Scholar
  5. Bell, V., Halligan, P. W., & Ellis, H. D. (2006). Diagnosing delusions: a review of inter-rater reliability. Schizophrenia Research, 86, 76–79.CrossRefGoogle Scholar
  6. Berrios, G. (1991). Delusions as “wrong beliefs”: a conceptual history. The British Journal of Psychiatry, 159(Supplement 14), 6–13.Google Scholar
  7. Berrios, G. E., & Marková, I. S. (2003). The self and psychiatry: a conceptual history. In T. Kircher & A. David (Eds.), The self in neuroscience and psychiatry (pp. 9–39). New York: Cambridge University Press.CrossRefGoogle Scholar
  8. Berze, J. (1914). Die primäre Insuffizienz der psychischen Aktivität. Ihr Wesen, ihre Erscheinungen und ihre Bedeutung als Grundstörungen der Dementia Praecox und der Hypophrenen überhaupt. Leipzig: Frank Deuticke.Google Scholar
  9. Blankenburg, W. (1971). Der Verlust der natürlichen Selbstverständlichkeit. Ein Beitrag zur Psychopathologie symptomarmer Schizophrenien. Stuttgart: Enke.Google Scholar
  10. Blankenburg, W. (2001). First steps toward a psychopathology of ‘common sense’. Philosophy, Psychiatry, and Psychology, 8(4), 303–315. trans. by A.L. Mishara.CrossRefGoogle Scholar
  11. Bleuler, E. (1950). In J. Zinkin & N. D. C. Lewis (Eds.), Dementia praecox or the group of schizophrenias. New York: International University Press.Google Scholar
  12. Bovet, P., & Parnas, J. (1993). Schizophrenic delusions: a phenomenological approach. Schizophrenia Bulletin, 19(3), 579–597.CrossRefGoogle Scholar
  13. Brice, R. G. (2009). Recognizing targets: Wittgenstein’s exploration of a new kind of foundationalism in on certainty. Philosophical Investigations, 32(1), 1–22.CrossRefGoogle Scholar
  14. Campbell, J. (2001). Rationality, meaning and the analysis of delusions. Philosophy, Psychiatry, and Psychology, 8, 89–100.CrossRefGoogle Scholar
  15. Cermolacce, M., Sass, L. A., & Parnas, J. (2010). What is bizarre in bizarre delusions? A critical review. Schizophrenia Bulletin. doi:10.1093/schbul/sbq001.Google Scholar
  16. Conrad, K. (2002). Die beginnende Schizophrenie. Versuch einer Gestaltanalyse des Wahns. Bonn: Edition Das Narrenschiff im Psychiatrie-Verlag.Google Scholar
  17. Davidson, D. (1967). Truth and meaning. Synthese, 17(3), 304–323.CrossRefGoogle Scholar
  18. Eilan, N. (2000). On understanding schizophrenia. In D. Zahavi (Ed.), Exploring the self (pp. 97–113). Amsterdam: John Benjamins.Google Scholar
  19. Everitt, N., & Fisher, A. (1995). Modern epistemology: a new introduction. New York: McGraw-Hill.Google Scholar
  20. Frith, C. (1987). The positive and negative symptoms of schizophrenia reflect impairments in the perception and initiation of action. Psychological Medicine, 17, 631–648.CrossRefGoogle Scholar
  21. Frith, C. (1992). The cognitive neuropsychology of schizophrenia. Hove: Erlbaum.Google Scholar
  22. Gadamer, H.-G. (1999). In J. Wiensheimer & D. G. Marshall (Eds.), Truth and method (2nd ed.). London: Sheed & Ward.Google Scholar
  23. Gross, G., Huber, G., Klosterkötter, J., & Linz, M. (1987). Bonner Skala für die Beurteilung von Basissymptomen. Berlin: Springer.Google Scholar
  24. Handest, P. (2002). The prodromes of schizophrenia. Dissertation: University of Copenhagen.Google Scholar
  25. Heidegger, M. (2007). In J. Macquarrie & E. Robinson (Eds.), Being and time. Oxford: Blackwell.Google Scholar
  26. Heinimaa, M. (2002). Incomprehensibility: The role of the concept in DSM-IV definition of schizophrenic delusions. Medicine, Health Care and Philosophy, 5, 291–295.CrossRefGoogle Scholar
  27. Henriksen, M. G., Škodlar, B., Sass, L. A., & Parnas, J. (2010). Autism and perplexity: a qualitative and theoretical study of basic subjective experiences in schizophrenia. Psychopathology, 43, 357–368.CrossRefGoogle Scholar
  28. Hesnard, A.-L. M. (1909). Les Troubles de la Personalité dans les États d’Asthénie Psychique. Étude de Psychologie Clinique. Thèse de médecine. Bordeaux: Université de Bordeaux.Google Scholar
  29. Huber, G. (1983). Das Konzept substratnaher Basissymptome und seine Bedeutung für Theorie und Therapie schizophrener Erkrankungen. Der Nervenarzt, 54, 23–32.Google Scholar
  30. Huber, G., Gross, G., & Schüttler, R. (1979). Schizophrenie. Eine Verlaufs- und sozialpsychiatrische Langzeitstudie. Berlin: Springer.Google Scholar
  31. Janet, P. (1903). Les Obsessions et la Psychasthénie. Paris: Alcan.Google Scholar
  32. Jaspers, K. (1968). The phenomenological approach in psychopathology. The British Journal of Psychiatry, 114, 1313–1323.CrossRefGoogle Scholar
  33. Jaspers, K. (1997). In J. Hoenig & M. W. Hamilton (Eds.), General psychopathology. London: Johns Hopkins University Press.Google Scholar
  34. Kepinski, A. (1974). Schizofrenia. Warsaw: Panstwowy Zaklad Wydawnictw Lekarskich.Google Scholar
  35. Klee, R. (2004). Why some delusions are necessarily inexplicable beliefs. Philosophy, Psychiatry, and Psychology, 11(1), 25–34.CrossRefGoogle Scholar
  36. Klosterkötter, J. (1988). Basissymptome und Endphänomene der Schizophrenie. Eine empirische Untersuchung der psychopathologischen Übergangsreihen zwischen defizitären und produktiven Schizophreniesymptomen. Berlin: Springer.CrossRefGoogle Scholar
  37. Klosterkötter, J., Hellmich, M., Steinmeyer, E. M., & Schultze-Lutter, F. (2001). Diagnosing schizophrenia in the initial prodromal phase. Archives of General Psychiatry, 58, 158–164.CrossRefGoogle Scholar
  38. Klosterkötter, J., Schultze-Lutter, F., Gross, G., Huber, G., & Steinmeyer, E. M. (1997). Early self-experienced neuropsychological deficits and subsequent schizophrenic diseases: an 8-year average follow-up prospective study. Acta Psychiatrica Scandinavica, 95, 396–404.CrossRefGoogle Scholar
  39. Kraepelin, E. (1913). Psychiatrie. Ein Lehrbuch für Studierende und Ärzte. Aufl 8, vollständig umgearbeitet. Johann Ambrosius Barth: Leipzig.Google Scholar
  40. Maher, B. A. (1988). Anomalous experience and delusional thinking: the logic of explanations. In T. F. Oltmanns & B. A. Maher (Eds.), Delusional beliefs (pp. 15–33). New York: Wiley.Google Scholar
  41. Mishara, A. L. (2010). Klaus Conrad (1905–1961): delusional mood, psychosis, and beginning schizophrenia. Schizophrenia Bulletin, 36(1), 9–13.CrossRefGoogle Scholar
  42. Møller, P., & Husby, R. (2000). The initial prodrome in schizophrenia: searching for naturalistic core dimensions of experience and behavior. Schizophrenia Bulletin, 26, 217–232.CrossRefGoogle Scholar
  43. Moore, G. E. (1925). A defense of common sense. In J. H. Muirhead (Ed.), Contemporary british philosophy (2nd ed., pp. 193–223). London: George Allen and Unwin.Google Scholar
  44. Müller-Suur, H. (1950). Das Gewissheitsbewusstsein beim schizophrenen und beim paranoischen Wahnerleben. Fortschritte der Neurologie, Psychiatrie, und ihrer Grenzgebiete, 18(1), 44–51.Google Scholar
  45. Nakaya, M., Kusumoto, K., Okada, T., & Ohmori, K. (2002). Bizarre delusions and DSM-IV schizophrenia. Psychiatry and Clinical Neurosciences, 56, 391–395.CrossRefGoogle Scholar
  46. Nordgaard, J., Arnfred, S. M., Handest, P., & Parnas, J. (2008). The diagnostic status of first-rank symptoms. Schizophrenia Bulletin, 34(1), 137–154.CrossRefGoogle Scholar
  47. Parnas, J., & Handest, P. (2003). Phenomenology of anomalous experiences in early schizophrenia. Comprehensive Psychiatry, 44(2), 121–134.CrossRefGoogle Scholar
  48. Parnas, J., Jansson, L., Sass, L. A., & Handest, P. (1998). Self-experience in the prodromal phases of schizophrenia: a pilot study of first admissions. Neurology, Psychiatry and Brain Research, 6, 97–106.Google Scholar
  49. Parnas, J., Møller, P., Kircher, T., Thalbitzer, J., Jansson, L., Handest, P., et al. (2005). EASE: Examination of anomalous self-experiences. Psychopathology, 38, 236–258.CrossRefGoogle Scholar
  50. Parnas, J., & Sass, L. A. (2001). Self, solipsism, and schizophrenic delusions. Philosophy, Psychiatry, and Psychology, 8, 101–120.CrossRefGoogle Scholar
  51. Parnas, J., & Sass, L. A. (2008). Varieties of “phenomenology”. On description, understanding, and explanation in psychiatry. In K. S. Kendler & J. Parnas (Eds.), Philosophical Issues in Psychiatry. Explanation, phenomenology, and nosology (pp. 239–285). Baltimore: Johns Hopkins.Google Scholar
  52. Pick, A. (1996). On the pathology of the consciousness of the self. Translation by Viviani, R. & Berrios, G.E. History of Psychiatry, 7, 324–332.CrossRefGoogle Scholar
  53. Raballo, A., Sæbye, D., & Parnas, J. (2009). Looking at the schizophrenia spectrum through the prism of self-disorders: an empirical study. Schizophrenia Bulletin. doi:10.1093/schbul/sbp056.Google Scholar
  54. Read, R. (2001). On approaching schizophrenia through Wittgenstein. Philosophical Psychology, 14(4), 449–475.CrossRefGoogle Scholar
  55. Rümke, H. C. (1990). The nuclear symptom of schizophrenia and the preacoxfeeling. Translation by Neeleman, J. History of Psychiatry, 1(3), 334–341.CrossRefGoogle Scholar
  56. Saks, E. R. (2007). The center cannot hold. New York: Hyperion.Google Scholar
  57. Sass, L. A. (1990). The truth-taking-stare: a Heideggerian interpretation of a schizophrenic world. Journal of Phenomenological Psychology, 21(2), 121–149.CrossRefGoogle Scholar
  58. Sass, L. A. (1992a). Heidegger, schizophrenia, and the ontological difference. Philosophical Psychology, 5(2), 109–132.CrossRefGoogle Scholar
  59. Sass, L. A. (1992b). Madness and modernism. Insanity in the light of modern art, literature, and thought. Harvard: Harvard University Press.Google Scholar
  60. Sass, L. A. (1994). The paradoxes of delusion: Wittgenstein, Schreber, and the schizophrenic mind. New York: Cornell.Google Scholar
  61. Sass, L. A. (2003a). Incomprehensibility and understanding: on the interpretation of severe mental illness. Philosophy, Psychiatry, and Psychology, 10, 125–132.CrossRefGoogle Scholar
  62. Sass, L. A. (2003b). Self-disturbance in schizophrenia: hyperreflexivity and diminished self-affection. In T. Kircher & A. David (Eds.), The self in schizophrenia: neuropsychological perspectives (pp. 242–271). Cambridge: Cambridge University Press.Google Scholar
  63. Sass, L. A. (2004). Some reflections on the (analytical) philosophical approach to delusion. Philosophy, Psychiatry, and Psychology, 11(1), 71–80.CrossRefGoogle Scholar
  64. Sass, L. A., & Parnas, J. (2003). Self, consciousness, and schizophrenia. Schizophrenia Bulletin, 29(3), 427–444.CrossRefGoogle Scholar
  65. Sass, L. A., & Parnas, J. (2007). Explaining schizophrenia: the relevance of phenomenology. In M. C. Chung, K. W. M. Fulford, & G. Graham (Eds.), Reconceiving schizophrenia. International perspectives in philosophy and psychiatry (pp. 63–95). Oxford: Oxford University Press.Google Scholar
  66. Schneider, K. (1959). In M. W. Hamilton (Ed.), Clinical psychopathology. New York: Grune & Stratton.Google Scholar
  67. Schreber, P. D. (1988). In I. Malcapine & R. A. Hunter (Eds.), Memoirs of my nervous illness. Cambridge: Harvard University Press.Google Scholar
  68. Searle, J. R. (1992). The rediscovery of the mind. Cambridge: MIT Press.Google Scholar
  69. Spitzer, M. (1988). Ichstörungen: in search of a theory. In M. Spitzer, F. A. Uehlein, & G. Oepen (Eds.), Psychopathology and philosophy (pp. 167–183). Springer: Berlin/Heidelberg.CrossRefGoogle Scholar
  70. Spitzer, M. (1990). On defining delusions. Comprehensive Psychiatry, 31, 377–397.CrossRefGoogle Scholar
  71. Störring, G. (1900). Vorlesungen über Psychopathologie in irher Bedeutung für die normale Psychologie. Leipzig: Engelmann.Google Scholar
  72. Tanenberg-Karant, M., Fennig, S., Ram, R., Krishna, J., Jandorf, L., & Bromet, E. J. (1995). Bizarre delusions and first-rank symptoms in a first-admission sample: a preliminary analysis of prevalence and correlates. Comprehensive Psychiatry, 36(6), 428–434.CrossRefGoogle Scholar
  73. Thornton, T. (2004). Wittgenstein and the limits of empathic understanding in psychopathology. International Review of Psychiatry, 16(3), 216–224.CrossRefGoogle Scholar
  74. Thornton, T. (2008). Why the idea of framework propositions cannot contribute to an understanding of delusions. Phenomenology and the Cognitive Sciences, 7, 157–175.CrossRefGoogle Scholar
  75. Wernicke, C. (1900). Grundriss der Psychiatrie in klinischen Vorlesungen. Leipzig: Thieme.Google Scholar
  76. Wittgenstein, L. (1972). In D. Paul & G. E. M. Anscombe (Eds.), On certainty. New York: Harper & Row.Google Scholar
  77. Wittgenstein, L. (1997). In G. E. M. Anscombe (Ed.), Philosophical investigations. Oxford: Blackwell.Google Scholar
  78. World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: clinical description and diagnostic guidelines. Geneva: World Health Organization.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Danish National Research Foundation, Centre for Subjectivity ResearchUniversity of CopenhagenCopenhagenDenmark
  2. 2.Psychiatric Center HvidovreUniversity of CopenhagenCopenhagenDenmark

Personalised recommendations