Vivid mental imagery occurs frequently in schizophrenia spectrum disorders (SSDs). Overlapping phenomena, such as obsessions or ruminations, are also frequent in other psychiatric disorders, raising significant diagnostic challenges. Unfortunately, contemporary operational psychopathology lacks the epistemological and phenomenological framework to address such questions. Using the resources of phenomenology and philosophy of mind, we articulate the structure of imagination and describe its distinctive modifications in the SSDs. Drawing on pilot data with patients' self-descriptions, we present the notion of perceptualized imagery. The anomalous imagery acquires spatialization, spatiotemporal constancy, explorability, autonomy and a sense of experiential distance between the subject and the image. As a quasi-perceptual, stable object, such imagery often evokes an intense affective response, whereas the normal sense of ‘irreality' of the fantasy may become compromised. We articulate these anomalies of imagination as being entailed by the underlying generative disorder of schizophrenia, namely the disorder of minimal self (unstable ipseity or first-person perspective). We propose that pathology of imagination is an important psychopathological aspect of the schizophrenia spectrum, with significant relevance for early diagnosis and differential diagnosis.

Keywords:
Imagination, Self-disorders, Schizophrenia spectrum disorders, Mental imagery, Obsessions, Pseudohallucination, Schizophrenia
1.
Parnas J, Sass LA, Zahavi D: Rediscovering psychopathology: the epistemology and phenomenology of the psychiatric object. Schizophr Bull 2013;39:270-277.
2.
Bleuler E: Dementia Praecox or the Group of Schizophrenias. New York, International University Press, 1950.
3.
Jaspers K: General Psychopathology. Chicago, University of Chicago Press, 1963.
4.
Ey H: Traité des hallucinations. Paris, Masson, 1973.
5.
Hoch P, Polatin P: Pseudoneurotic forms of schizophrenia. Psychiatr Q 1949;23:248-276.
6.
Parnas J, Henriksen MG: Disordered self in the schizophrenia spectrum: a clinical and research perspective. Harv Rev Psychiatry 2014;22:251-265.
7.
Nelson B, Parnas J, Sass LA: Disturbance of minimal self (ipseity) in schizophrenia: clarification and current status. Schizophr Bull 2014;40:479-482.
8.
Henriksen MG, Parnas J: Clinical manifestations of self-disorders and the gestalt of schizophrenia. Schizophr Bull 2012;38:657-660.
9.
Parnas J, Jansson L, Sass LA, Handest P: Self-experience in the prodromal phases of schizophrenia: a pilot study of first admissions. Neurol Psychiatry Brain Res 1998;6:107-116.
10.
Parnas J, Moller P, Kircher T, Thalbitzer J, Jansson L, Handest P, et al: EASE: Examination of Anomalous Self-Experience. Psychopathology 2005;38:236-258.
11.
Rasmussen AR, Parnas J: Pathologies of imagination in schizophrenia spectrum disorders. Acta Psychiatr Scand 2015;131:157-161.
12.
Husserl E: Phantasy, Image Consciousness, and Memory, 1898-1925. Dordrecht, Springer, 2005.
13.
Casey ES: Imagination, phantasy, hallucination and memory; in Philips J, Morley J (eds): Imagination and Its Pathologies. Cambridge, MIT Press, 2003, pp 65-92.
14.
Husserl E: Cartesian Meditations. The Hague, Nijhoff, 1965.
15.
Warren ND: Husserl and the Promise of Time: Subjectivity in Transcendental Phenomenology. Cambridge, Cambridge University Press, 2009.
16.
Sartre J-P: The Imaginary: A Phenomenological Psychology of the Imagination. London, Routledge, 2010.
17.
Zahavi D: Subjectivity and Selfhood: Investigating the First-Person Perspective. Cambridge, MIT Press, 2005.
18.
Nordgaard J, Parnas J: Self-disorders and the schizophrenia spectrum: a study of 100 first hospital admissions. Schizophr Bull 2014;40:1300-1307.
19.
Sass LA, Parnas J: Schizophrenia, consciousness, and the self. Schizophr Bull 2003;29:427-444.
20.
Parnas J, Sass L: The structure of self-consciousness in schizophrenia, in Gallagher S (ed): The Oxford Handbook of the Self. Oxford, Oxford University Press, 2011, pp 521-546.
21.
Sass L: Explanation and description in phenomenological psychopathology. J Psychopathol 2014;20:366-376.
22.
Parnas J: A disappearing heritage: the clinical core of schizophrenia. Schizophr Bull 2011;37:1121-1130.
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2015
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