Hyper-réflexivité et perspective en première personne : un apport décisif de la psychopathologie phénoménologique contemporaine à la compréhension de la schizophrénie

Englebert, Jérôme;Stanghellini, Giovanni;Valentiny, Caroline;Follet, Valérie;Sass, Louis;et.al.
(2018) L’évolution psychiatrique - cahiers de psychologie clinique et de psychopathologie générale — Vol. 83, n° 1, p. 77-85 (2018)

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Objectives: This paper aims to summarize the hypothesis, which originates in the field of phenomenological psychopathology, of schizophrenic hyperreflexivity, and to discuss the methodological context enabling these highly subjective manifestations to emerge. Starting from the seminal hypothesis developed by contemporary psychopathology, that the schizophrenic patients appear to experience a consciousness that finds itself being forced to question phenomena which should be intuitively self-evident, the idea of this present paper is to complete the usual interpretation of schizophrenia as deficit by the hypothesis of an excess functioning of consciousness. Methods: First-person perspective is a qualitative approach completing third-person interpretation, traditional in the field of psychiatry – which consists in the attribution, from an external position, of clinical signs noted independently of the perception expressed by the patient. This first-person perspective focuses on the subjective experience expressed by the individual. To understand schizophrenia according to this perspective, the words of several schizophrenic patients have been collected as part of a clinical device. We used the EASE scale (Examination of Anomalous Self-Experience) with this aim in mind. This scale offers a phenomenologically oriented semi-structured exploration of a set of difficulties revealing anomalies of subjective experience, considered as troubles of self-awareness. EASE has been developed on the basis of self-descriptions by patients suffering from schizophrenic spectrum troubles. This tool allows the co-construction of a language between patient and clinician, focused on the patient’s particular experience and the unique phenomena he endures. Results: Besides the hyperreflexivity phenomena, the qualitative analysis of collected descriptions highlight two important features of schizophrenic being-in-the-world. First a problem of common sense, which addresses the issue of intersubjectivity and the opportunity, for schizophrenic patients, to share a social world. Then the existence of an intercorporeality trouble, since the schizophrenic hyperreflexivity experiences are accompanied by a loss of “common body”, body being the scene where intersubjectivity is performed. Employing EASE, and the ensuing first-person perspective, is relevant in a psychotherapeutic approach; on one hand in the process of acknowledgement of the disease (which has to be made by the patient as well as by the clinician), on the other hand in the communication with families of schizophrenic patients. Conclusions: The phenomenological interpretation offered by the application of a first-person perspective in the understanding of schizophrenic patients experience, as well as the interest showed in the hyperreflexivity phenomenon, suggest an outlook of schizophrenia which isn’t reduced to a deficit interpretation anymore (without denying the latter), and which uncovers not a weakening, but a surprising intensification of consciousness.
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Englebert, J., Stanghellini, G., Valentiny, C., Follet, V., Fuchs, T., & Sass, L. (2018). Hyper-réflexivité et perspective en première personne : un apport décisif de la psychopathologie phénoménologique contemporaine à la compréhension de la schizophrénie. L’évolution psychiatrique - cahiers de psychologie clinique et de psychopathologie générale, 83(1), 77-85. https://doi.org/10.1016/j.evopsy.2017.07.004 (Original work published 2018)