Abstract
Background: Although it has been suggested that disturbances in emotion experience and regulation play a central role in the aetiology and psychopathology of schizophrenia spectrum disorders, the phenomenology of emotion experience in schizophrenia remains under-researched. Sampling and Methods: In-depth interviews were conducted twice with each of the 20 participants (firstly at admission and secondly 6 months later). Data collection and analysis were guided by the principles of phenomenological study of lived experience. Results: The emotion experiences described by our participants vary greatly in both quality and intensity, but appear to have a common phenomenology. Anxiety is reported as the basic emotion which buffers, transforms and sometimes supplants all others. Emotions in general are experienced as foreign, unstable and perturbing, thereby contributing greatly to feelings of ambivalence, perplexity and an unstable sense of self in general. Conclusions: The findings of this study have important therapeutic and theoretical implications because they suggest that emotion experiences in schizophrenia spectrum disorders may underlie a wide range of psychopathological phenomena in both the cognitive and social functioning domains. Due to the relatively small sample size and its selection from psychotherapeutic units, the results may not be generalizable to all schizophrenia patients.
References
1.
Sass LA: Self and world in schizophrenia: three classic approaches. Philos Psychiatr Psychol 2001;8:251-270.
2.
Sass LA, Parnas J: Schizophrenia, consciousness, and the self. Schizophr Bull 2003;29:427-444.
3.
Sass LA, Parnas J, Zahavi D: Phenomenological psychopathology and schizophrenia: contemporary approaches and misunderstandings. Philos Psychiatr Psychol 2011;18:1-23.
4.
Fuchs T: Corporealized and disembodied minds: a phenomenological view of the body in melancholia and schizophrenia. Philos Psychiatr Psychol 2005;12:95-107.
5.
Gibson J: The Ecological Approach to Visual Perception. Boston, Houghton Mifflin, 1979.
6.
De Sousa R: Truth, authenticity, and rationality. Dialectica 2007;61:323-345.
7.
Lambie J, Marcel A: Consciousness and emotion experience: a theoretical framework. Psychol Rev 2002;109:219-259.
8.
Sartre JP: Esquisse d'une théorie phénomenologique des émotions. Paris, Hermann, 1939.
9.
Merleau-Ponty M: The Phenomenology of Perception. New York, Routledge & Kegan Paul, 1962.
10.
Frijda NH: Emotion experience. Cogn Emot 2005;19:473-497.
11.
Lake CR: Hypothesis: grandiosity and guilt cause paranoia; paranoid schizophrenia is a psychotic mood disorder; a review. Schizophr Bull 2008;34:1151-1162.
12.
Ciompi L: The concept of affect logic: an integrative psycho-socio-biological approach to understanding and treatment of schizophrenia. Psychiatry 1997;60:158-170.
13.
Bouricius JK: Negative symptoms and emotions in schizophrenia. Schizophr Bull 1989;15:201-208.
14.
Sweet LH, Primeau M, Fichtner CG, Lutz G: Dissociation of affect recognition and mood state from blunting in patients with schizophrenia. Psychiatry Res 1998;81:301-308.
15.
Kring AM, Kerr SL, Smith DA, Neale JM: Flat affect in schizophrenia does not reflect diminished subjective experience of emotion. J Abnorm Psychol 1993;102:507-517.
16.
Sass LA: Contradictions of emotion in schizophrenia. Cogn Emot 2007;21:351-390.
17.
Sass LA: Affectivity in schizophrenia: a phenomenological view. J Conscious Stud 2004;11:127-147.
18.
Trémeau F: A review of emotion deficits in schizophrenia. Dialogues Clin Neurosci 2006;8:59-70.
19.
Phillips LK, Seidman LJ: Emotion processing in persons at risk for schizophrenia. Schizophr Bull 2008;34:888-903.
20.
Docherty NM, Evans IM, Sledge WH, Seibyl JP, Krystal JH: Affective reactivity of language in schizophrenia. J Nerv Ment Dis 1994;182:98-102.
21.
Danion JM, Cuervo C, Piolino P, Huron C, Riutort M, Peretti CS, et al: Conscious recollection in autobiographical memory: an investigation in schizophrenia. Conscious Cogn 2005;14:535-547.
22.
Neumann A, Blairy S, Lecompte D, Philippot P: Specificity deficit in the recollection of emotional memories in schizophrenia. Conscious Cogn 2007;16:469-484.
23.
Maggini C, Raballo A: Alexithymia and schizophrenic psychopathology. Acta Biomed 2004;75:40-49.
24.
Baslet G, Termini L, Herbener E: Deficits in emotional awareness in schizophrenia and their relationship with other measures of functioning. J Nerv Ment Dis 2009;197:655-660.
25.
Pallanti S, Cantisani A, Grassi G: Anxiety as a core aspect of schizophrenia. Curr Psychiatry Rep 2013;15:354.
26.
Muller JE, Koen L, Soraya S, Emsley RA, Stein DJ: Anxiety disorders and schizophrenia. Curr Psychiatry Rep 2004;6:255-261.
27.
Achim AM, Maziade M, Raymond E, Olivier D, Mérette C, Roy MA: How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association. Schizophr Bull 2011;37:811-821.
28.
Voges M, Addington J: The association between social anxiety and social functioning in first episode psychosis. Schizophr Res 2005;76:287-292.
29.
Michail M, Birchwood M: Social anxiety disorder in first-episode psychosis: incidence, phenomenology and relationship with paranoia. Br J Psychiatry 2009;195:234-241.
30.
Achim AM, Ouellet R, Lavoie MA, Vallières C, Jackson PL, Roy MA: Impact of social anxiety on social cognition and functioning in patients with recent-onset schizophrenia spectrum disorders. Schizophr Res 2013;145:75-81.
31.
Lysaker PH, Erickson M, Ringer J, Buck KD, Semerari A, Carcione A, Dimaggio G: Metacognition in schizophrenia: the relationship of mastery to coping, insight, self-esteem, social anxiety, and various facets of neurocognition. Br J Clin Psychol 2011;50:412-424.
32.
Pallanti S, Quercioli L, Hollander E: Social anxiety in outpatients with schizophrenia: a relevant cause of disability. Am J Psychiatry 2004;161:53-58.
33.
Braga RJ, Mendlowicz MV, Marrocos RP, Figueira IL: Anxiety disorders in outpatients with schizophrenia: prevalence and impact on the subjective quality of life. J Psychiatr Res 2005;39:409-414.
34.
Moustakas C: Phenomenological research methods. Thousand Oaks, Sage, 1994.
35.
Wing JK, Babor T, Brugha T, Burke J, Cooper JE, Giel R, et al: SCAN. Schedules for clinical assessment in neuropsychiatry. Arch Gen Psychiatry 1990;47:589-593.
36.
Whitley R, Crawford M: Qualitative research in psychiatry. Can J Psychiatry 2005;50:108-114.
37.
Handest P, Parnas J: Clinical characteristics of first-admitted patients with ICD-10 schizotypal disorder. Br J Psychiatry Suppl 2005;48:s49-s54.
38.
Parnas J, Licht D, Bovet P: Cluster A personality disorders: a review; in Maj M, Akiskal HS, Mezzich JE, Okasha A (eds): Personality Disorders. WPA Series: Evidence and Experience in Psychiatry. Chichester, Wiley, 2005, pp 1-74.
39.
Møller P, Husby R: The initial prodrome in schizophrenia: searching for naturalistic core dimensions of experience and behavior. Schizophr Bull 2000;26:217-232.
40.
Lysaker PH, Lysaker JT: Narrative structure in psychosis. Theory Psychol 2002;12:207-220.
41.
Smith JA, Osborn M: Interpretative phenomenological analysis; in Smith JA (ed): Qualitative Psychology: a Practical Guide to Research Methods, ed 2. London, Sage, 2008, pp 51-80.
42.
Bovet P, Parnas J: Schizophrenic delusions: a phenomenological approach. Schizophr Bull 1993;19:579-597.
43.
Conrad K: Die beginnende Schizophrenie. Stuttgart, Thieme, 1958.
44.
Heidegger M: What is metaphysics?; in Krell DF (ed): Martin Heidegger: Basic Writings. New York, Harper Collins, 1993, pp 89-110.
45.
Ratcliffe M: Feelings of being: phenomenology, psychiatry and the sense of reality. New York, Oxford University Press, 2008.
46.
Bleuler E: Dementia praecox or the group of schizophrenias. Oxford, International Universities Press, 1950.
47.
Störring G: Perplexity; in Cutting J, Shepherd M (eds): Clinical roots of the schizophrenia concept. Cambridge, Cambridge University Press, 1987, pp 79-82.
48.
Henriksen MG, Škodlar B, Sass, LA, Parnas J: Autism and perplexity: a qualitative and theoretical study of basic subjective experiences in schizophrenia. Psychopathology 2010;43:357-368.
49.
Deutsch H: Some forms of emotional disturbance and their relationship to schizophrenia. Psychoanal Q 1942;11:301-321.
50.
Parnas J, Møller P, Kircher T, Thalbitzer J, Jansson L, Handest P, et al: EASE: Examination of Anomalous Self-Experience. Psychopathology 2005;38:236-258.
51.
Raballo A, Parnas J: Examination of Anomalous Self-Experience: initial study of the structure of self-disorders in schizophrenia spectrum. J Nerv Ment Dis 2012;200:577-583.
52.
Hemsley DR: The development of a cognitive model of schizophrenia: placing it in context. Neurosci Biobehav Rev 2005;29:977-988.
53.
Laing RD: The divided self: an existential study in sanity and madness. London, Tavistock, 1960.
54.
Corin E: The thickness of being: intentional worlds, strategies of identity, and experience among schizophrenics. Psychiatry 1998;61:133-146.
55.
Winnicott DW: The maturational processes and the facilitating environment: studies in the theory of emotional development. London, Carnac, 1990.
56.
Kohut H, Wolf ES: The disorders of the self and their treatment: an outline. Int J Psychoanal 1978;59:413-425.
57.
Wittmann D, Keshavan M: Grief and mourning in schizophrenia. Psychiatry 2007;70:154-166.
58.
Birchwood M, Iqbal Z, Chadwick P, Trower P: Cognitive approach to depression and suicidal thinking in psychosis. 1. Ontogeny of post-psychotic depression. Br J Psychiatry 2000;177:516-521.
59.
Iqbal Z, Birchwood M, Chadwick P, Trower P: Cognitive approach to depression and suicidal thinking in psychosis. 2. Testing the validity of a social ranking model. Br J Psychiatry 2000;177:522-528.
60.
Williams CC: Insight, stigma, and post-diagnosis identities in schizophrenia. Psychiatry 2008;71:246-256.
61.
Rosenbaum B, Harder S: Psychosis and the dynamics of the psychotherapy process. Int Rev Psychiatry 2007;19:13-23.
62.
Stanghellini G, Lysaker PH: The psychotherapy of schizophrenia through the lens of phenomenology: intersubjectivity and the search for the recovery of first- and second-person awareness. Am J Psychother 2007;61:163-179.
63.
Fuchs T: Psychotherapy of the lived space: a phenomenological and ecological concept. Am J Psychother 2007;61:423-439.
64.
Brent B: Mentalization-based psychodynamic psychotherapy for psychosis. J Clin Psychol 2009;65:803-814.
65.
Csikszentmihalyi M: Flow: the psychology of optimal experience. New York, Harper Collins, 1990.
66.
Parnas J, Sass LA: Self, solipsism and schizophrenic delusions. Philos Psychiatr Psychol 2001;8:101-120.
67.
Brett C: Psychotic and mystical states of being: connections and distinctions. Philos Psychiatr Psychol 2002;9:321-341.
68.
Podvoll EM: Psychosis and the mystic path. Psychoanal Rev 1979-1980;66:571-590.
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