Schizophrenia and the Scaffolded Self

A family of recent externalist approaches in philosophy of mind argues that our psychological capacities are synchronically and diachronically “scaffolded” by external resources. I consider how these “scaffolded” approaches might inform debates in phenomenological psychopathology. I first introduce the idea of “affective scaffolding” and make some taxonomic distinctions. Next, I use schizophrenia as a case study to argue—along with others in phenomenological psychopathology—that schizophrenia is fundamentally a self-disturbance. However, I offer a subtle reconfiguration of these approaches. I argue that schizophrenia is not simply a disruption of ipseity or minimal self-consciousness but rather a disruption of the scaffolded self, established and regulated via its ongoing engagement with the world and others. I conclude by considering how this scaffolded framework indicates the need to consider new forms of intervention and treatment

Motor deficits in schizophrenia quantified by nonlinear analysis of postural sway.

Motor dysfunction is a consistently reported but understudied aspect of schizophrenia. Postural sway area was examined in individuals with schizophrenia under four conditions with different amounts of visual and proprioceptive feedback: eyes open or closed and feet together or shoulder width apart. The nonlinear complexity of postural sway was assessed by detrended fluctuation analysis (DFA). The schizophrenia group (n = 27) exhibited greater sway area compared to controls (n = 37). Participants with schizophrenia showed increased sway area following the removal of visual input, while this pattern was absent in controls. Examination of DFA revealed decreased complexity of postural sway and abnormal changes in complexity upon removal of visual input in individuals with schizophrenia. Additionally, less complex postural sway was associated with increased symptom severity in participants with schizophrenia. Given the critical involvement of the cerebellum and related circuits in postural stability and sensorimotor integration, these results are consistent with growing evidence of motor, cerebellar, and sensory integration dysfunction in the disorder, and with theoretical models that implicate cerebellar deficits and more general disconnection of function in schizophrenia

Affective affordances and psychopathology

Self-disorders in depression and schizophrenia have been the focus of much recent work in phenomenological psychopathology. But little has been said about the role the material environment plays in shaping the affective character of these disorders. In this paper, we argue that enjoying reliable (i.e., trustworthy) access to the things and spaces around us — the constituents of our material environment — is crucial for our ability to stabilize and regulate our affective life on a day-today basis. These things and spaces often play an ineliminable role in shaping what we feel and how we feel it; when we interact with them, they contribute ongoing feedback that " scaffolds " the character and temporal development of our affective experiences. However, in some psychopathological conditions, the ability to access to these things and spaces becomes disturbed. Individuals not only lose certain forms of access to the practical significance of the built environment but also to its ​ regulative​ significance, too — and the stability and organization of their affective life is compromised. In developing this view, we discuss core concepts like " affordance spaces " , " scaffolding " , and " incorporation ". We apply these concepts to two case studies, severe depression and schizophrenia, and we show why these cases support our main claim. We conclude by briefly considering implications of this view for developing intervention and treatment strategies

Schizophrenia, social practices and cultural values: A conceptual introduction

Schizophrenia is usually described as a fragmentation of subjective experience and the impossibility to engage in meaningful cultural and intersubjective practices. Although the term schizophrenia is less than 100 years old, madness is generally believed to have accompanied mankind through its historical and cultural ontogeny. What does it mean to be “mad”? The failure to adopt social practices or to internalize cultural values of common sense? Despite the vast amount of literature and research, it seems that the study of schizophrenia and of the psychoses is suffering from a generic disintegration. In this introduction, we offer an historical overview of the variety of theories and approaches to schizophrenia. We also provide an overview of how the authors in this volume attempt an integrative account where training, practice, theory and research are considered as parts of a larger whole. This is a varied and pluralistic volume, and it is up to the readers to make use of different chapters according to their own needs

Lost in the socially extended mind: Genuine intersubjectivity and disturbed self-other demarcation in schizophrenia

Much of the characteristic symptomatology of schizophrenia can be understood as resulting from a pervasive sense of disembodiment. The body is experienced as an external machine that needs to be controlled with explicit intentional commands, which in turn leads to severe difficulties in interacting with the world in a fluid and intuitive manner. In consequence, there is a characteristic dissociality: Others become problems to be solved by intellectual effort and no longer present opportunities for spontaneous interpersonal alignment. This dissociality goes hand in hand with a progressive loss of the socially extended mind, which normally affords opportunities for co-regulation of cognitive and affective processes. However, at times people with schizophrenia report that they are confronted by the opposite of this dissociality, namely an unusual fluidity of the self-other boundary as expressed in experiences of ambiguous body boundaries, intrusions, and even merging with others. Here the person has not lost access to the socially extended mind but has instead become lost in it, possibly due to a weakened sense of self. We argue that this neglected aspect of schizophrenic social dysfunction can be usefully approached via the concept of genuine intersubjectivity: We normally participate in a shared experience with another person by implicitly co-regulating how our interaction unfolds. This co-regulation integrates our respective experience’s dynamical bases into one interpersonal process and gives the interaction an ambiguous second-person character. The upshot is that reports of abnormal self-other fluidity are not indicative of hallucinations without any basis in reality, but of a heightened sensitivity and vulnerability to processes of interpersonal alignment and mutual incorporation that form the normal basis of social life. We conclude by discussing implications of this view for both the science of consciousness as well as approaches to intervention and therapy

Th.o.m.a.s.: An exploratory assessment of Theory of Mind in schizophrenic subjects

A large body of literature agrees that persons with schizophrenia suffer from a Theory of Mind (ToM) deficit. However, most empirical studies have focused on third-person, egocentric ToM, underestimating other facets of this complex cognitive skill. Aim of this research is to examine the ToM of schizophrenic persons considering its various aspects (first vs. second order, first vs. third person, egocentric vs. allocentric, beliefs vs. desires vs. positive emotions vs. negative emotions and how each of these mental state types may be dealt with), to determine whether some components are more impaired than others. We developed a Theory of Mind Assessment Scale (Th.o.m.a.s.) and administered it to 22 persons with a DSM-IV diagnosis of schizophrenia and a matching control group. Th.o.m.a.s. is a semi-structured interview which allows a multi-component measurement of ToM. Both groups were also administered a few existing ToM tasks and the schizophrenic subjects were administered the Positive and Negative Symptoms Scale and the WAIS-R. The schizophrenic persons performed worse than control at all the ToM measurements; however, these deficits appeared to be differently distributed among different components of ToM. Our conclusion is that ToM deficits are not unitary in schizophrenia, which also testifies to the importance of a complete and articulated investigation of ToM

Hallucinogens: mechanisms and medical complications

Thesis (M.A.)--Boston UniversityHallucinogens are drugs that alter consciousness by distorting primarily auditory and visual perception but they can affect any sensory system. Hallucinogens also affect judgment, orientation, memory, or emotion. Despite the profound alteration in perception, adverse effects are minimal and hallucinogens are not addictive. Hallucinogen use has its roots in shamanic practices of indigenous cultures and is even incorporated in today’s religions like the Native American Church. By putting a person in an altered state of consciousness, many religions believed that the user was able to see beyond the boundaries of reality and reach out to mythical beings. Hallucinogen use in scientific research was not popular until the 1950’s when Albert Hoffman discovered lysergic acid diethylamide (LSD). The discovery of drug encouraged further research into understanding its mechanisms and its relationship with mental diseases like schizophrenia. Unfortunately, the Comprehensive Drug Abuse Prevention and Control Act of 1970 significantly limited hallucinogenic research and human research for the last 42 years. However, animal research in the last 20 years has determined the importance of serotonergic mechanisms and more specifically the 5-HT2A receptors in mediating LSD’s hallucinogenic effects. Researchers continue to identify mechanisms of LSD action. In addition to serotonergic actions, LSD is active with dopaminergic and metabotropic glutamate receptors. PET scans and fMRI’s have also revealed the importance of the prefrontal cortical region and its interaction with other areas during a hallucinogenic state. The relationship between LSD and acute psychosis is also being explored via animal models. Although human clinical research is limited, recent research sees a much deeper relationship by linking LSD brain activity and neurotransmitter levels to psychotic behaviors. This further understanding of hallucinogens on a physiological and psychological level has led to possible psychotherapeutic areas of research in anxiety and substance abuse. This thesis describes a brief history of hallucinogenic research, the pharmacology and neuroanatomy of serotonergic hallucinogens, the acute and chronic adverse effects of serotonergic hallucinogens, the possible treatments for complications of hallucinogens, the epidemiology, the relationship between hallucinogens and schizophrenia, and possible therapeutic uses of serotonergic hallucinogens. With its minimal adverse effects in humans and its powerful influence on the human psyche, serotonergic hallucinogens are invaluable tools for understanding the human mind

Self-reflection as dialectic: How we can follow the Delphian calling to self-knowledge whilst avoiding Narcissus' fate

Self-reflection refers to our ability to think about ourselves and our lives and to ask and answer questions ranging from "Who am I?" to "Why did I do this?". It is thus considered a valuable means to gain self-knowledge. Structurally, reflection involves two elements, a reflecting and a reflected-on, in other words a subject and an object. In the case of self- reflection, subject and object are the same, the reflecting is the reflected-on. As subject and object are traditionally conceived of as radically opposed i.e. mutually exclusive, this situation has led to considering self-reflection problematic: If self-reflection is always reflection on an object, it is thought that self-reflection cannot yield insight into oneself qua subject and might even represent a danger to one’s subjectivity which is characteristic of lived life. Refuting the mutual exclusiveness of subject and object, self-reflection can be regained as a valuable means to gain self-knowledge. It is thereby going to be demonstrated that self-reflection has a dialectical structure. The nature of the self-knowledge yielded by self-reflection conceived of as dialectic is going to be explored. A final part shows how a dialectical account of self- reflection proves useful in clarifying the role which self-reflection plays in schizophrenia