Public Defence of Mads Gram Henriksen's PhD Thesis "Understanding Schizophrenia. Investigations in Phenomenological Psychopathology".

Date: 13 February 2012
Time: 10:00 (precisely)
Venue: University of Copenhagen, Njalsgade 136, room 27.0.09, 2300 Copenhagen S

Abstract

In biological psychiatry, schizophrenic symptoms such as bizarre delusions and verbal hallucinations are considered causal outcomes of genetically inherited biological abnormalities. This predominant, monocausal theory of schizophrenia reflects a widespread ambition to reclaim the foundation of psychiatry within the domain of the natural sciences. The guiding presumption is that schizophrenia is a disease comparable to other medical diseases. Despite notable advances in the search for schizophrenia-specific biological abnormalities, the emerging picture suggests that biological factors form a necessary but not sufficient condition for the development of schizophrenia. Other contributing factors and their interactions must be taken into account if we are to reach a more proper understanding of the multifactorial aetiology of this complex mental disorder.

This thesis presents a phenomenological approach to the psychopathology of schizophrenia with emphasis on certain non-psychotic anomalies of self-experience. An increasing number of empirical studies support the hypothesis that such experiential anomalies are characteristic of the schizophrenia spectrum. However, many classic psychopathologists also shared the basic idea that such anomalies are essential to schizophrenia and the idea is therefore not entirely new. The thesis's overall aim is to enrich our understanding of the psychopathological Gestalt of schizophrenia and some of its symptoms, in particular, autistic traits, auditory verbal hallucinations, and bizarre delusions.

The thesis is divided into four studies. The first study seeks to portray the psychopathological Gestalt of schizophrenia. An increasing amount of empirical studies have documented that the score of anomalies of self-experience is significant between spectrum and non- spectrum individuals, but these studies have not provided an account of the coherence in the clinical picture. This is the aim of the first study. The second study seeks to illuminate experiential correlates of schizophrenic autism. In a qualitative, single-case study, we applied a phenomenological model of the self-world relation to examining a paranoid schizophrenia patient's subjective experiences and we found a distinct disturbance in the patient's self-world relation characterized by pervasive and enduring experiences of estrangement, anxiety, and exposure. The third study strives to provide a clinically grounded phenomenological account of the pathogenesis of auditory verbal hallucinations in schizophrenia. It argues that verbal hallucinations tend to arise from spatialization of experience and morbid objectification of inner speech, which reflect a fundamental disturbance of primordial presence. Finally, the fourth study discusses the supposed incomprehensibility of bizarre schizophrenic delusions. It engages in recent debates in the philosophy of psychiatry and argues that if we instead of focusing exclusively on the content of delusional beliefs also take their form (i.e. the structural alterations of self-consciousness) into account, then it is possible to understand them to a considerable extent.

Besides providing an understanding of schizophrenic symptoms that previously were considered incomprehensible, the results from this thesis can play a role in diagnostic and differential diagnostic procedures as well as in psychotherapy for schizophrenia. Moreover, the intention is to familiarize clinicians with experiential precursors to hallucinations and delusions, thereby enriching the psychopathological resources to recognize impending psychotic states before their full-blown manifestation and improve the possibility of early intervention.