Autonomy and Schizophrenia: Reflections on an Ideal

  • Louis A. Sass


Here I shall consider an assumption that is widespread in psychoanalysis, psychiatry, and clinical psychology, and that is presented with characteristic subtlety in the writings of David Shapiro. This is the notion that the essential touchstone or ­yardstick of mental health is a person’s capacity for what Shapiro alternatively terms “autonomy,” “agency,” “intentionality,” or “self-directed action.” Corollary ideas are (1) that degrees of psychopathology correlate with a person’s or patient’s distance from this ideal, and (2) that the essential purpose of psychotherapy will be to increase one’s sphere of self-awareness and personal agency. Shapiro’s presentation of this extremely influential notion or assumption is the richest and clearest of which I am aware in clinical psychology or psychiatry. I will criticize the adequacy of this notion in relation to what is perhaps the most severe form of psychopathology: the schizophrenic disorders, a topic Shapiro mentions in Autonomy and Rigid Character (AR, published in 1981) and treats at length in Dynamics of Character (DC 2000). Part of my discussion focuses on the nature of schizophrenic symptoms in particular. The other part concerns the ambiguity of the psychological concepts in question – namely, personal “autonomy” as well as closely related notions including agency, volition, self-direction, and free will.


Strong Evaluation Schizophrenic Symptom Schizoid Personality Catatonic Schizophrenia Defensive Process 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



For helpful comments on drafts of this article, I am grateful to Steven Silverstein, James Walkup, Barnaby Nelson, Shira Nayman, Pierre-Henri Castel, Alain Ehrenberg, Saneke de Haan, and Craig Piers.


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© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.GSAPP—Rutgers UniversityPiscatawayUSA

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