This paper takes a fresh look at Sass & Parnas’ Ipseity Disturbance Hypothesis about Schizophrenia. It asks how well the current theorization in terms of hyperreflexivity, disturbed self-presence and diminished grip really explain the phenomenology of schizophrenia. It then turns to a detailed discussion of the way the various elements of ipseity disturbance are supposed to be explained finding there are certain gaps in that explanation. The second part discusses how the new Hierarchical Predictive Processing (HPP) framework can do a good job explaining and inter-relating the three factors in ipseity disturbance: first, distortions of presence; second, hyperreflexivity; and third, why some distortions of presence progress to the positive symptoms of schizophrenia, namely hallucination and especially delusions. The paper argues that really moving toward a deep understanding of schizophrenia requires grounding the theory in a mechanistic explanation. HPP is well-poised to play this role by explaining why distortions of presence might lead to hallucination and global changes in the structure of a patient’s beliefs.
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NB. It’s important to notice that hyperreflectivity is not identical hyperreflexivity but is rather supposed to be a sort of quasi-agentive form and secondary form of the latter.
A discussion of Henry’s influence and the notion of self-affection can be found in Chapter 3, Section 4 of Zahavi (2005).
From Gurwitsch’s The Field of Consciousness, cited in Sass (2004).
This accords with Metzinger’s (2004) claim that the sense of mineness in pre-reflexive self-consciousness, while typically present, is not actually necessary for consciousness.
Seth et al.’s (2011) paper is a case here where the presence category is rightly problematized albeit the problem not resolved. The question of whether or not the structural dimension of presence only shows up when consciousness is disturbed requires more attention in the research literature (but see Clowes, 2015).
It should be remembered that we are not quite comparing like with like. The schizophrenia subjects were patients interviewed using the EASE scale whereas – as just noted – the DPD patients were drawn from historical literature. It is possible that affinities might be even stronger if the EASE scale was used to interview contemporary subjects.
A phrase Clark uses time and again in (Clark, 2015) to signal that perception is not understood on this model as being a shallow appearance but as a highly nuanced and detailed world model. Perception reveals the world.
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Writing this article was possible thanks to the Portuguese Government Ciência e Tecnologia grants (SFRH/BPD/70440/2010) and the IFILNOVA research fellowship (FCSH/NOVA UID/FIL/00183/2013). Thanks to Inês Hipolito, Klaus Gaertner & Dina Mendonca, João Gama Marques, Anil Seth, Marinos Kyriakopoulos and members of the Lisbon Mind and Reasoning Group for useful discussions and criticisms of the text or presentations which helped develop the ideas.
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Clowes, R.W. (2018). Rethinking the Ipseity Disturbance Theory of Schizophrenia Through Predictive Processing. In: Hipólito, I., Gonçalves, J., Pereira, J. (eds) Schizophrenia and Common Sense. Studies in Brain and Mind, vol 12. Springer, Cham. https://doi.org/10.1007/978-3-319-73993-9_7
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