Here however we are specifically interested in these manic experiences themselves, rather than in the diagnostic entity as a whole. This reminds us that the structure and pathogenesis of schizophrenia, like all forms of psychopathology, will involve some psychological mechanisms found elsewhere as well—e. The comparative phenomenological method is, we believe, an indispensable tool in isolating this core that, without explaining the totality of schizophrenic pathology, may well contribute to giving schizophrenia a unique, Gestalt-like essence.
And perhaps it can make a similar contribution in the cases of melancholia and mania. As noted, our study is exploratory, an exercise in generating hypotheses for further investigation. It has several weaknesses that are perhaps inevitable in this sort of project.
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Although some of our generalizations are corroborated by controlled empirical research e. These would need to be tested in various ways, not only with in-depth qualitative interviews with carefully diagnosed patients, but also through various forms of experimental research. We are aware of the inherent difficulty of operationalizing some of our more speculative claims, which can refer to subtle features of experience that are not likely to be spontaneously or readily described by individuals untrained in phenomenology, and that may, in some instances, even verge on ineffability. We believe, however, that an empiricist-oriented restriction of theoretical speculation would not be appropriate at this stage of research, when it is difficult to know precisely what can and what cannot be operationalized.
Perhaps the major lesson of the modern philosophy of science, since the rejection of the logical-positivist program, is the complexity of the relationship between theory and observation. Work that is highly theoretical, speculative, clinically oriented, and anecdotal — such as ours — is certainly not opposed to empirical study, but should play a role in the formulation of its hypotheses and particular methods.
For as we know from Kant, experience without theory is blind, just as theory without experience would be mere intellectual play. Items in this domain—which are thought to be characteristic of schizophrenia- spectrum disorders in particular—generally involve disturbances of the normal process of thinking or related processes such as memory, attention, and language.
So-called formal thought disorder is largely manifest in verbal output, but can clearly be suggestive of cognitive and experiential anomalies as well. Such disturbances seem to contrast sharply with the cognitive disturbances typically noted in affective disorders, viz. Although schizophrenia patients may also experience change in the speed or quantity of their thoughts, what is more distinctive is the qualitative change such as described in EASE items Loss of Thought Ipseity and Spatialization of Experience. II: However, in more severe forms of affective disturbance, some of these distinctions may not be so clear.
Indeed, formal thought disorder has been noted in both psychotic and non- psychotic patients with mania. A study by Holzman et al. Common factors among the various diagnoses included vagueness, loss of set, inappropriate distance, and incongruous ideas. I can call the jolly folks or the sad folks.
I have one church on Madison Avenue, another in downtown. These utterances seem to demonstrate a lack of common meaning or theme similar to what can characterize schizophrenic thinking. A study by Silber et al. Sarah Kane, a British playwright known to be severely and psychotically depressed, described her experiences in the play 4.
In addition, Piguet et al. III: However, a review of the concept of first-rank symptoms by Koehler provides one way again to differentiate schizophrenic from severe affective symptoms; he suggests that many of the afore-mentioned overlaps may stem from ambiguities in the definitions of the FRSs. According to some experts, only the more narrowly defined symptoms are specific to schizophrenia as opposed to affective psychosis. Thus for Taylor and Heiser , Mellor , and Wing et al. Such a view is consistent with that of Alfred Kraus , who states that although the I- sense may indeed be weakened in melancholia, such patients do not experience the frank loss of mineness Meinhaftigkeit that does occur in schizophrenia p.
By contrast, this disturbance of the core or minimal dimension of selfhood, or ipseity, seems to be a key aspect of a disturbed experience of thoughts and cognition for many schizophrenia patients. Clear instances of what the EASE p. This may be related to a difference in the kind of confusion that is felt in schizophrenia versus mania. It is all a matter of mattering, we might say, or rather of how things matter.
Whereas for the individual with mania, with his intensified emotional reactivity, there are too many things that matter, and that come to matter too quickly and fleetingly, for the individual with schizophrenia, it is rather that nothing may matter, or at least matter in a normal fashion. This may be related to a certain emotional flattening that can occur in schizophrenia. This is not a dimming-down but a qualitative transformation of subjective life.
Distinguishing schizophrenic perplexity from melancholic confusion is somewhat more difficult, however. In the latter condition we encounter, if not a loss of minimal self, at least an ebbing of its vital dynamism and orienting appetites—all of which obviously diminish the significance things can be felt to have in subjective life, often resulting in a general sense of confusion. The subjective experience of depressive inadequacy and schizophrenic perplexity may in fact approach each other very closely, at least in some instances.
Given the limitations and general vagueness of much verbal report, one should expect to find many indistinguishable descriptions.
We believe, however, that there are some subtle yet profound differences; and that in depression the experience will be more bound up with issues of vitality or fatigue, whereas in schizophrenia there is an even more fundamental disturbance of ipseity or minimal self, manifest both as an exacerbation of hyperreflexivity exaggerated and dysfunctional forms of self- consciousness and as an undermining of basic self-affection of mine-ness, or first-personhood Sass and Parnas, ; Sass and Parnas, Consider, by contrast, the following account from a depressed patient, which does contain some superficial resemblances: I was seized with an unspeakable physical weariness.
There was a tired feeling in the muscles unlike anything I had ever experienced. A peculiar sensation appeared to travel up my spine to my brain. I had an indescribable nervous feeling. My nerves seemed like live wires changed with electricity…The most trivial duty became a formidable task. Still, these patients describe what they felt: each is always the subject of consciousness, never questioning that her nerves or brain or thoughts are integral parts of her subjectivity.
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I: A particularly clear description of an experience of ipseity disturbance comes from the autobiography of Elyn Saks , who suffers from schizophrenia: And then something odd happens. My awareness of myself, of him, of the room, of the physical reality around and beyond us instantly grows fuzzy. Or wobbly. I think I am dissolving. I feel — my mind feels — like a sand castle with all the sand sliding away in the receding surf. What's happening to me? This is scary, please let it be over! I think maybe if I stand very still and quiet, it will stop.
The understanding of who I am and how I relate to others, and of my continuity over time, will be disturbed, but the person nevertheless preserves the minimal sense of existing as a living, subjective point of view distinct from the external world. II: It should be noted, however, that there are experiences in severe melancholia that can look very similar to schizophrenia. Von Gebsattel in Tatossian, goes even further, speaking of the possibility of a complete loss of feeling in melancholia, and alongside it, loss of the capacity for meaningful action in the world.
In the following quotation from by John Custance , a bipolar patient with psychotic features, we see some of the above themes, together with a suggestion that selfhood simply disappears: …the material world seemed less and less real…the whole universe of space and time, of my own senses, was really an illusion…There I was, shut in my own private universe, as it were, with no contact with real people at all, only with phantasmagoria who could at any moment turn into devils. I and all around me were utterly unreal…My soul was finally turned into nothingness — except unending pain.
McGlashan maintains, however, that there is a fundamental difference between these two. In severe depression, by contrast, even the shutting down of feeling is always permeated with a sense of interpersonal loss, and this gives these experiences a less autistic quality. Silber et al. It would clearly be wrong, however, to portray the schizophrenic condition as one that is devoid of pain. Borrowing this formulation, we might say that the melancholic still possesses a fairly robust, basic sense of ipseity or self-possession; this, in fact, provides the position from which he can recognize his diminished vitality or affective response.
The schizophrenia patient, by contrast, lacks something closer to the core—the sense of inhabiting his own, first-person perspective.
PHENOMENOLOGY OF RELIGION: APPELLATION AND METHODOLOGY
But we should not think that the latter condition is devoid of suffering or any kind of subjective response. This experience of hyperreflexivity described in Sass, might be described as involving a split from within, in which consciousness itself becomes divided and self-aware in unusual ways by virtue of taking itself as its own object.
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Although melancholic patients may at times describe a certain deadness of the self or feeling of void, the latter sort of fragmentation, with all its implications for thought, feeling, and experience of the world, seems to be specific to schizophrenia. As we have seen, the very experience of the minimal self can seem dubious for such persons; yet it often tends to be identified more with a mental or spiritual than with a corporeal presence Laing, Rather, the body may become the object of a kind of alienating or objectifying, hyperreflexive gaze that turns what might have been implicitly experienced sensations into objectified quasi-entities that are witnessed rather than lived.
The body may also be experienced as an alien, controlling entity that subjects the experiential self to its demands or commands. Similarly, other physiological drives like hunger and sexual desire may lose their contextual meaning and come to be experienced as object-like states of tension. In melancholia and mania, bodily experience is also frequently disturbed, though in ways that tend to look different from the more alienated or objectified experiences in schizophrenia. There is a key difference here, though it is easier to state than always to discern: whereas the person with schizophrenia feels detached from his body, the melancholic feels somehow over-identified with it.
Rather than being disembodied, the melancholic individual is overly embodied or corporealized Fuchs, One has come to feel incapable of the animated activity whereby the healthy lived body, without leaving itself behind, nevertheless transcends itself toward the external world. The melancholic body has become Solid and heavy; it resists any attempt at reaching out to touch the external world [and] closes itself up, thus taking on the aspect of a corpse. Such a body turns inflexible, heavy, and burdensome, taking on aspects of a corpse. II: In practice, however, the boundary between schizophrenic and melancholic experiences of the body can seem to blur.
Although melancholic patients may most frequently experience a kind of debilitating fatigue, stasis, heaviness, and lack of motivation, they sometimes undergo stranger experiences that suggest something more like a basic disturbance of ipseity. Another depressed patient recalls, There in the parking lot I was standing at attention. I was being made to move; there was nothing for it but to move.
My legs snapped out stiffly, one by one, in sidelong kicks…My arms traced long stiff arcs through the sky; my elbows dropped woodenly into my ribs. Then, apparently, it was time for some choreography. My arms and legs began to move together, then alternately. I must have resembled some short-circuited windshield wiper, or some marionette gone awry. But who — where — was the puppeteer? Who was in control of this body? Smith, Here we see how the body in melancholia can be an obstacle, preventing the person from engaging meaningfully in the world. With its suggestion that someone else is controlling the body, this report takes us beyond typical melancholic corporealization and appears to overlap with schizophrenic disembodiment.
III: Still, we suggest that these experiences can be differentiated. The intense feeling of guilt and inability to transcend the past that Fuchs relates to melancholic corporealization does not appear so prominent in the types of descriptions provided by schizophrenia patients. Also, the melancholic experiences are perhaps more closely related to an implicit sense of disturbed relationship to others: it is other people who will see me as guilty; other people to whom I am no longer able to relate as I feel stuck in my own body.
Schizophrenic disembodiment, by contrast, seems to involve—at least in many cases—a disturbance of self-experience that is somewhat less related to others or the actual external world.
Comparative Studies in Phenomenology
We combine discussion of these domains because of an overlap in themes. Both these domains seem largely to involve a diminution of the usual sense of separation between inner and outer or between subjective and objective reality. I: Regarding transitivism, experiences of actual confusion between self and other do not seem to be characteristic of patients with mood disorders, whether depressed or manic.
But there also seem to be some subtle difference that may distinguish the merger experiences typical of mania versus schizophrenia. III: One difference is that patients with mania do not seem to report any sense of confusion about their own point of view, in the sense of losing track of who one is. Perhaps associated with this is the presence of a mood-tone that is ecstatic or benign, or at least not frightening or unpleasant. There is little indication of a disorganization of fundamental selfhood, and these patients do not seem at all confused about who they are.
By contrast, the feeling of uncertainty about boundaries often has a dysphoric quality in schizophrenia patients. An additional difference seems to be that the schizophrenic experience of union frequently has a more distinctively solipsistic tone, with the world felt to be merely an extension of the self and have no separate reality of its own.
The psychiatrist Hilfiker describes experiences in his schizophrenia patients that are congruent with this item of the EASE: e. Such quotes strongly suggest the solipsistic quality that can lie behind schizophrenic feelings of union. His own life is experienced as the life of whole world, his strength is world-sustaining and world-vitalizing. In mania, by contrast, the dominant experience seems more a feeling of resonating or being at one with the All.
If in mania there is a sense of merging with the Godhead, in schizophrenic solipsism it is more a matter of being the only Godhead, the creator of all things in the experiential field. The following report, from a grandiose patient with mania, does put some pressure on the distinction just drawn. But we have also attempted to show how, on closer examination, the two can probably be distinguished, albeit in some ways that are more subtle and elusive than those traditionally proposed.
Abrams, R. Akiskal, H. Allerdyce, J. Binswanger, L. In Straus, E. Bleuler, E. Carpenter, W. Dutta, R. Fuchs, T. Hamilton, M. Handest, P. Haug, E. Holzman, P. Millions of books are added to our site everyday and when we find one that matches your search, we'll send you an e-mail. Best of all, it's free. Did you know that since , Biblio has used its profits to build 12 public libraries in rural villages of South America? Biblio is a marketplace for book collectors comprised of thousands of independent, professional booksellers, located all over the world, who list their books for sale online so that customers like you can find them!
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