restricted access 7. Selfhood, Schizophrenia, and the Interpersonal Regulation of Experience
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7 Selfhood, Schizophrenia, and the Interpersonal Regulation of Experience This paper addresses the view, currently and historically popular in phenomenological psychopathology , that schizophrenia involves disturbance of a person’s most basic sense of self, the minimal self. The concept of “minimal self” is to be understood in wholly phenomenological terms. Zahavi (2014) offers what is perhaps the most detailed characterization to date. All our experiences, he maintains, have a “first-personal character”; their structure incorporates a sense of mineness, of their originating in a singular locus of experience. So the minimal self is neither an object of experience/thought nor an experience of subjectivity that is separate from one’s various experiences. Rather, it pertains to “the distinct manner, or how, of experiencing” (Zahavi 2014, 22). Those who subscribe to this view do not insist that minimal self is the only kind of self. As Zahavi acknowledges, “self” may legitimately refer to a range of different phenomena, all of which need to be carefully distinguished from one another. But the minimal self is the most fundamental of these, a condition for the integrity of experience that all other kinds of self-experience presuppose. Some have further proposed that this basic sense of self is altered (but not entirely lost) in schizophrenia. There is a “disturbance of minimal- or core-self experience,” an “ipseity” disturbance (Sass 2014, 5). What is eroded is a sense of “mineness” or “first-person perspective ,” of a kind that is more usually “automatic” (Parnas et al. 2005, 240). It is in this context that seemingly more localized symptoms such as delusions and hallucinations emerge and are to be understood. A characteristic type of self-disturbance, it is maintained, distinguishes the phenomenology of schizophrenia from that of other psychiatric conditions. The latter either do not involve changes in the minimal self or involve changes that are qualitatively different and less profound than those arising in schizophrenia (Raballo, Sæbye, and Parnas 2009). I think it is plausible to maintain that human experience includes something along the lines of the minimal self and also that diagnoses of schizophrenia are sometimes associated with changes to this aspect of experience. Nevertheless, I argue that the minimal self needs to be reconceptualized in interpersonal terms. Zahavi states that minimal selfhood does not depend on social interaction for its development and/or its sustenance: it is not “a product Matthew Ratcliffe 150 M. Ratcliffe of social interaction or the result of a higher cognitive accomplishment” but “a basic and indispensable experiential feature,” one that is not “constitutively dependent upon social interaction” (Zahavi 2014, 63, 95). When applied to schizophrenia, this view can lend itself to a somewhat individualistic approach. Insofar as schizophrenia originates in disturbance of a presocial self, the social world is perhaps not the place to look for causes. Instead one could seek to identify preexisting “self-disorders” that “antedate the onset of psychosis” and render one susceptible to it (Raballo and Parnas 2011, 1018). It has been further suggested that these disorders have genetic causes. Hence their “primary relevance” is to “etiological research into the genetic architecture of schizophrenia” (Raballo, Sæbye, and Parnas 2009, 348). Then again, it would also be quite consistent to maintain that (a) schizophrenia involves disruption of a presocial, minimal self, and (b) schizophrenia has social and interpersonal causes. Something that did not depend on other people for its development or maintenance could still be disrupted by them. By analogy, having a brain does not depend on a history of social interaction, but brains are not immune to injuries inflicted by other people. However, I argue in what follows that the most basic sense of self is indeed developmentally dependent on interactions with other people. Furthermore, it is interpersonally sustained and continues to depend on other people even in adulthood. I begin by showing why even the most minimal experience of selfhood must include not just the sense that one is in an intentional state (where intentionality is construed in phenomenological terms) but also the sense that one is in an intentional state of one or another kind, such as perceiving or remembering .1 Minimal self, we might say, encompasses an appreciation of the modalities of intentionality . I then offer some remarks on the extent to which experience and thought are interpersonally regulated. These build up to the claims that (a) the modalities of intentionality depend on a certain way of experiencing and relating to other people in general, which involves a primitive, affective...