"Seeing Rain": Integrating phenomenological and Bayesian predictive coding approaches to visual hallucinations and self-disturbances (Ichstörungen) in schizophrenia.

We present a schizophrenia patient who reports "seeing rain" with attendant somatosensory features which separate him from his surroundings. Because visual/multimodal hallucinations are understudied in schizophrenia, we examine a case history to determine the role of these hallucinations in self-disturbances (Ichstörungen). Developed by the early Heidelberg School, self-disturbances comprise two components: 1. The self experiences its own automatic processing as alien to self in a split-off, "doubled-I." 2. In "I-paralysis," the disruption to automatic processing is now outside the self in omnipotent agents. Self-disturbances (as indicated by visual/multimodal hallucinations) involve impairment in the ability to predict moment-to-moment experiences in the ongoing perception-action cycle. The phenomenological approach to subjective experience of self-disturbances complements efforts to model psychosis using the computational framework of hierarchical predictive coding. We conclude that self-disturbances play an adaptive, compensatory role following the uncoupling of perception and action, and possibly, other low-level perceptual anomalies.

Experiential features used by patients with schizophrenia to differentiate 'voices' from ordinary verbal thought.

BACKGROUND: Determining how patients distinguish auditory verbal hallucinations (AVHs) from their everyday thoughts may shed light on neurocognitive processes leading to these symptoms. METHOD: Fifty patients reporting active AVHs ('voices') with a diagnosis of schizophrenia or schizo-affective disorder were surveyed using a structured questionnaire. Data were collected to determine: (a) the degree to which patients distinguished voices from their own thoughts; (b) the degree to which their thoughts had verbal form; and (c) the experiential basis for identifying experiences as voices versus their own verbal thoughts. Six characteristics of acoustic/verbal images were considered: (1) non-self speaking voice, (2) loudness, (3) clarity, (4) verbal content, (5) repetition of verbal content, and (6) sense of control. RESULTS: Four subjects were eliminated from the analysis because they reported absent verbal thought or a total inability to differentiate their own verbal thoughts from voices. For the remaining 46 patients, verbal content and sense of control were rated as most salient in distinguishing voices from everyday thoughts. With regard to sensory/perceptual features, identification of speaking voice as non-self was more important in differentiating voices from thought than either loudness or clarity of sound images. CONCLUSIONS: Most patients with schizophrenia and persistent AVHs clearly distinguish these experiences from their everyday thoughts. An adequate mechanistic model of AVHs should account for distinctive content, recognizable non-self speaking voices, and diminished sense of control relative to ordinary thought. Loudness and clarity of sound images appear to be of secondary importance in demarcating these hallucination experiences.

Schizophrenia and common sense: study of 3 single cases.

There is new interest in subjective experiences of schizophrenia. This kind of analysis emphasizes the subjective stories of patients, and the methods do not pretend to have the objectivity of science. However, the plausibility and the empathetic resonance of the single case may bring subjective confirmation to the validity of an insight and indicate new directions of research. Following this line, the authors present a study of 3 single cases of 'reflexive' residual type of schizophrenia. The methods for selecting the cases and the philosophical groundings of the concept of 'reflexive schizophrenia' are explained. The analysis of the single cases revealed that (1) schizophrenic persons' cognitive deficit is related to the constitution of common sense; (2) some schizophrenics cope with the cognitive deficit by creating a theoretical corpus of axioms stemming from common sense, namely the 'axioms of everyday life'; (3) this mechanism of coping is described as an inflexible attachment to 'axioms of everydayness', and (4) this attachment to common sense releases the patient from all personal investment of self in the process of anchoring in the living world and, on this basis, allows a relatively solid, although distant, attachment to reality. The nature of deficit in schizophrenia is also discussed by confronting the phenomenological point of view and the neuropsychological, that is the so-called 'theory of mind'.

Narrative and psychotherapy--the phenomenology of healing.

In part I, I presented some results of empirical research on mind/body relationship: writing about traumatic experiences brings about improved psychological and physiological health. One important factor of healing in psychotherapy is thereby isolated empirically. In part II, it was shown that the cognitive science explanation of these findings, however, is based on categories deriving from common sense and is insufficient. Phenomenological method can serve as a form of criticism of the assumptions shared by most contemporary approaches to the human mind and brain in psychology, psychiatry, and medicine (e. g. cognitive, psychodynamic, behavioral, and biological). In part III, I presented research and concepts developed in the phenomenological tradition that have bearing on the problem of the healing factor in narrative acts (in writing and speech), including the "talking cure" of psychoanalysis and psychotherapy. I described the problem of the unconscious in narrative acts from the phenomenological point of view and provide an alternative explanation for their healing effects. In short, the way we overcome painful and traumatic experiences is not seen in terms of the cognitive theory in which a painful feeling is "translated" into a cognitive or linguistic representation that organizes it. Such a theory objectifies the human subject. Healing through narration and "opening up," involves an existential act of self-transcendence of an embodied person who organizes his/her experience in time.