Hyper-réflexivité et perspective en première personne : un apport décisif de la psychopathologie phénoménologique contemporaine à la compréhension de la schizophrénie
Schizophrénie; Hyper-réflexivité; Perspective en première personne; EASE; Intersubjectivité; Schizophrenia; Hyperreflexivity; First-person perspective; Intersubjectivity
Abstract :
[en] 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. [fr] Objectifs : Cet article présente l’hypothèse, issue du champ de la psychopathologie phénoménologique, de l’hyper-réflexivité schizophrénique, selon laquelle les patients schizophrènes sont pris dans l’expérimentation d’une conscience qui se retrouve contrainte d’interroger des phénomènes qui devraient aller intuitivement de soi.
Méthodes : La perspective en première personne est une démarche qualitative complétant la lecture, traditionnelle dans le champ de la psychiatrie, en troisième personne – qui consiste en l’attribution depuis une position externe de signes cliniques repérés indépendamment du ressenti exprimé par le patient. Cette perspective en première personne concentre son attention sur l’expérience subjective qu’exprime le sujet. Le discours de plusieurs patients schizophrènes a été recueilli dans le cadre d’un dispositif clinique en utilisant l’échelle EASE (Examination of Anomalous Self-Experience). Cette échelle permet l’exploration semi-structurée, d’orientation phénoménologique, d’une série de difficultés révélatrices d’anomalies de l’expérience subjective.
Résultats : En plus des phénomènes d’hyper-réflexivité, nos analyses mettent en évidence deux grandes caractéristiques de l’être-au-monde schizophrénique. D’abord une problématique du sens commun, qui pose la question de l’intersubjectivité. Ensuite l’existence d’un trouble de l’intercorporéité, les expériences d’hyper-réflexivité schizophrénique s’accompagnant d’une perte du « corps commun ».
Conclusions : L’application d’une perspective en première personne dans la compréhension du vécu des patients schizophrènes, ainsi que l’intérêt porté au phénomène d’hyper-réflexivité, permettent de proposer une vision de la schizophrénie qui n’est plus réduite à une lecture déficitaire de celle-ci (sans nier cette dernière), et qui découvre non pas un affaiblissement, mais une intensification de la conscience.
Englebert, Jérôme ; Université de Liège > Département de Psychologie > Département de Psychologie
Stanghellini, Giovanni
Valentiny, Caroline
Follet, Valérie
Fuchs, Thomas
Sass, Louis
Language :
French
Title :
Hyper-réflexivité et perspective en première personne : un apport décisif de la psychopathologie phénoménologique contemporaine à la compréhension de la schizophrénie
Alternative titles :
[en] Hyperreflexivity and first-person perspective: a decisive contribution of contemporary phenomenological psychopathology to the understanding of schizophrenia
Parnas, J., Bovet, P., Zahavi, D., Schizophrenic autism: clinical phenomenology and pathogenetic implications. World Psychiatry 1:3 (2002), 131–136.
Blankenburg, W., La perte de l’évidence naturelle: une contribution à la psychopathologie des schizophrénies paucisymptomatiques (1971). 1991, PUF, Paris.
Minkowski, E., La schizophrénie (1927). 2002, Petite Bibliothèque Payot, Paris.
Englebert, J., Psychopathologie de l'homme en situation. 2013, Hermann, Paris.
Englebert, J., Valentiny, C., Schizophrénie, conscience de soi, intersubjectivité : essai de psychopathologie phénoménologique en première personne. 2017, De Boeck, Bruxelles.
Sass, L.A., Self-disturbance and schizophrenia: structure, specificity, pathogenesis (current issues, new directions). Schizophr Res 152:1 (2014), 5–11.
Stanghellini, G., Disembodied spirits and deanimated bodies: the psychopathology of common sense. 2004, Oxford University Press, Oxford.
Fuchs, T., Das Gehirn-ein Beziehungsorgan: eine phänomenologisch-ökologische Konzeption. 2009, Kohlhammer, Stuttgart.
Fuchs, T., Embodied cognitive neuroscience and its consequences for psychiatry. Poiesis Praxis 6:3–4 (2009), 219–233.
Fuchs, T., Phenomenology and psychopathology. Schmicking, D., Gallagher, S., (eds.) Handbook of phenomenology and cognitive science., 2010, Springer, Dordrecht, 546–573.
Nelson, B., Whitford, T.J., Lavoie, S., Sass, L.A., What are the neurocognitive correlates of basic self-disturbance in schizophrenia? Integrating phenomenology and neurocognition. Part 1 (Source monitoring deficits). Schizophr Res 152:1 (2014), 12–19.
Nelson, B., Whitford, T.J., Lavoie, S., Sass, L.A., What are the neurocognitive correlates of basic self-disturbance in schizophrenia? Integrating phenomenology and neurocognition: part 2 (aberrant salience). Schizophr Res 152:1 (2014), 20–27.
Borda, J.P., Sass, L.A., Phenomenology and neurobiology of self disorder in schizophrenia: primary factors. Schizophr Res 169 (2015), 464–473.
Sass, L.A., Borda, J.P., Phenomenology and neurobiology of self disorder in schizophrenia: Secondary factors. Schizophr Res 169 (2015), 474–482.
Fuchs, T., The psychopathology of hyperreflexivity. J Speculative Philos 24:3 (2010), 239–255.
Nelson, B., Parnas, J., Sass, L., Disturbance of minimal self (ipseity) in schizophrenia: clarification and current status. Schizophr Bull 40:3 (2014), 479–482.
Stanghellini, G., Rossi, R., Pheno-phenotypes: a holistic approach to the psychopathology of schizophrenia. Curr Opin Psychiatry 27:3 (2014), 236–241.
Martin, B., Giersch, A., Cermolacce, M., Berna, F., Dubreucq, J., Franck, N., Self minimal et schizophrénie. EMC Psychiatr, 2016, 1–12.
Martin, B., Piot, M.A., Approche phénoménologique de la schizophrénie. Info Psychiatr 87 (2011), 781–790.
Basso, E., Où va la philosophie de la psychiatrie ?. Rev Synth 137:1–2 (2016), 153–175.
Sass, L.A., Pienkos, E., Nelson, B., Introspection and schizophrenia: a comparative investigation of anomalous self-experiences. Conscious Cogn 22 (2013), 853–867.
Sass, L.A., Pienkos, E., Nelson, B., Medford, N., Anomalous self-experience in depersonalization and schizophrenia: a comparative investigation. Conscious Cogn 22 (2013), 430–431.
Sass, L.A., Preface to revised edition. Madness and Modernism: insanity in the light of modern art, literature and thought, 2017, Oxford University Press, Oxford [s.p].
Stanghellini, G., At issue: vulnerability to schizophrenia and lack of common sense. Schizophr Bull 26:4 (2000), 775–787.
Sass, L.A., Madness and modernism: insanity in the light of modern art, literature. and thought, 1992, BasicBooks, New York [nouv. ed. rév. Oxford: Oxford University Press; 2017].
Sass, L.A., Les paradoxes de la réflexivité. Englebert, J., Cormann, G., (eds.) Psychopathologie et philosophie : nouveaux débats et enjeux contemporains., 2016, Le Cercle Herméneutique, Paris, 26–27 [p. 185–219].
Foucault, M., Les mots et les choses. 1966, Gallimard, Paris.
Sass, L.A., Foucault et l'autoréflexion moderne. Temps Mod 656:5 (2009), 99–143.
Sass, L.A., Les paradoxes du délire: Wittgenstein, Schreber et l'esprit schizophrénique (1994). 2010, Ithaque, Paris [traduit par P.-H. Castel].
Stanghellini, G., Embodiment schizophrenia. World Psychiatry 8:1 (2009), 56–59.
Merleau-Ponty, M., Phénoménologie de la perception. 1945, Gallimard, Paris.
Englebert, J., Gauthier, J.M., Géographie et psychose : territoire et perte de corps commun. Ann Med Psychol 169 (2011), 559–563.
Englebert, J., Valentiny, C., Le schizophrène comme hyper-philosophe. Englebert, J., Cormann, G., (eds.) Psychopathologie et philosophie : nouveaux débats et enjeux contemporains., 2016, Le Cercle Herméneutique, Paris, 26–27 [p. 221–236].
Parnas, J., Møller, P., Kircher, T., Thalbitzer, J., Jansson, L., Handest, P., et al. EASE : évaluation des anomalies de l'experience de soi. Encephale 38 (2012), S121–S145 [traduit par M. Cermolacce et P. Bovet].
Sass, L.A., Pienkos, E., Skodlar, B., Stanghellini, G., Fuchs, T., Parnas, J., et al. EAWE: Examination of Anomalous World Experience. Psychopathology 50 (2017), 10–54.
