The schizophrenias as disorders of self consciousness

Abstract

There are limitations to the meaningfulness and usefulness of the diagnosis of schizophrenia. These limitations have important treatment implications. A re-evaluation of the phenomenology of the disorder, and in particular the formation of delusions, provides a potentially useful heuristic framework. A disturbance of the experience of the self, and of the self in relation to the external world, may underpin the phenomenology of schizophrenia. Putative biological substrates are described, and an integrative model is proposed, whereby higher centres, or mind, strive to modulate lower biological events, experienced as anomalous, in order to restore a meaningful homeostasis. These distorted representations form the characteristic symptoms of schizophrenia. Analogies are drawn with current strategies for managing chronic pain. Differences in the value accorded to the self across cultures, and the variations in outcome corresponding with these differences, are proposed as evidence and indicate a need for a paradigm shift in the philosophy of treatment of the disorder.