Introspection and Schizophrenia:

A Comparative Investigation of Anomalous Self Experiences

(Running Title: Introspection and Schizophrenia)

Louis Sass1
Department of Clinical Psychology
Graduate School of Applied and Professional Psychology
Rutgers University
152 Frelinghuysen Road
Piscataway, NJ 08854-8020
Phone: 732/445-2000
Fax: 732/445-4888

Elizabeth Pienkos
same as above

Barnaby Nelson
Orygen Youth Health Research Centre
Centre for Youth Mental Health
University of Melbourne
Parkville, Victoria 3052, Australia

Abstract word count: 149

Text body word count (main text only): 10,480

1Corresponding author

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 Introspection and Schizophrenia:
A Comparative Investigation of Anomalous Self Experiences

ABSTRACT
This paper offers a comparative investigation of anomalous self-experiences common in
schizophrenia (as defined in Examination of Anomalous Self Experiences (EASE)
instrument) and those of normal individuals in an intensely introspective orientation
(from early 20th-century “introspectionist” psychology). The latter represent a relatively
pure manifestation of certain forms of “hyperreflexivity,” one facet of the minimal-self or
“ipseity” disturbance postulated as central in schizophrenia. Significant similarities with
schizophrenia-like experience were found but important differences also emerged.
Affinities included feelings of passivity, fading of self or world, and alienation from
thoughts, feelings, or lived-body. Differences involved fundamental confusion between
self and world and severe dislocation or erosion of first-person perspective, qualities
unique to schizophrenia. The purpose is threefold: to 1, place the putatively
schizophrenic experiences of self-disorder in a broader, comparative context; 2, evaluate
hypotheses concerning core processes in schizophrenia; 3, orient investigation of possible
pathogenetic pathways as well as psychotherapeutic interventions.

KEYWORDS: schizophrenia, introspectionism, depersonalization, psychosis,

anomalous self-experience, ipseity, hyperreflexivity, psychiatric phenomenology.

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1. INTRODUCTION
Schizophrenia has traditionally been seen as involving certain profound
disturbances of consciousness, specifically, anomalies or disruptions in the experience of
subjectivity or of subjecthood itself. Such characteristics, while not mentioned in the
schizophrenia criteria of the Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition, Text Revision (DSM IV-TR) or the International Statistical Classification
of Diseases and Related Health Problems, Tenth Edition (ICD-10), are strongly
emphasized in classical accounts of the disorder. Bleuler (1911, p. 58) stated that in
schizophrenia, there is always a certain affliction (“Spaltung”) of the self, that the self is
never intact. In describing the “ununderstandability” he saw as defining schizophrenia,
Karl Jaspers (1923/1963) focused on disturbances of the basic sense of either ownership
or agency in relationship to one’s own experiences, thoughts, or actions.
The key role of altered self-experience in schizophrenia has come to the fore in
the past decade or more. Sass and Parnas (2003) hypothesized that the key disturbance in
schizophrenia is a particular disturbance of consciousness and, especially, of the sense of
“minimal self,” “core self,” or ipseity that is normally implicit in each act of awareness.
(Ipseity derives from ipse, Latin for “self” or “itself”; it refers to a crucial sense of self-
sameness, of existing as a vital and self-identical subject of experience that exists at any
given moment (Ricoeur, 1992; Zahavi, 1999).) This self or ipseity disturbance is
hypothesized to have two main aspects that may sound mutually contradictory but are in
fact complementary. “Hyperreflexivity” refers to a kind of exaggerated self-
consciousness, a tendency (fundamentally non-volitional in nature) for focal, objectifying
attention to be directed toward processes and phenomena that would normally be
“inhabited” or experienced as part of oneself. “Diminished self-affection” refers to a
decline in the (passively or automatically) experienced sense of existing as a living
subject of awareness or agent of action.
Hyperreflexivity and diminished self-affection are best conceptualized not as
separate processes but as mutually implicative aspects or facets of the intentional activity
of awareness: whereas the notion of “hyperreflexivity” emphasizes the way in which
something normally tacit becomes focal and explicit, “diminished self-affection”

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emphasizes a complementary aspect of this very same process—the fact that what once
was “tacit is no longer being inhabited as a medium of taken-for-granted selfhood” (Sass,
2003, p. 170). This two-faceted disturbance of ipseity disrupts the normal, pre-reflective
sense of existing as a self-presence that is the “I-center,” “central point of psychic life,”
or vital “source-point of the rays of attention” (Bernet, Kern, & Marbach, 1993, pp.
209ff). Related papers (Sass, 2003, 2010; Sass & Parnas, 2007) explore how such a
disturbance might play a central explanatory or generative role in schizophrenia. This
includes distinguishing between more primary, basal, or “operative” forms of ipseity
disturbance, and sequelae that may play a more consequential or defensive but
nevertheless crucial role in pathogenesis.
This notion has been operationalized in a semi-structured interview format, the
Examination of Anomalous Self Experience (EASE) (Parnas, Moller, et al., 2005), which
targets a variety of experiences found to be highly characteristic of schizophrenia
spectrum disorders. Several studies using the EASE or related measures have
demonstrated that such self-disturbances discriminate schizophrenia patients from
patients with psychotic bipolar illness (Parnas, Handest, Saebye, & Jansson, 2003) and
from several rather heterogeneous samples: namely, non-schizophrenia-spectrum
psychiatric patients, non-schizophrenic psychotic syndromes, non-schizotypal personality
disorders, and heterogeneous groups of non-schizophrenia-spectrum psychiatric patients
diagnosed with varying personality disorders and affective disorders (Haug et al., in
press; Nelson, Thompson, & Yung, in press-b; Parnas, Handest, Jansson, & Saebye, 2005;
Raballo & Parnas, 2010; Raballo, Saebye, & Parnas, 2011). Studies have further shown
that self-disorders aggregate selectively in portions of an at-risk population that go on to
develop schizophrenia-spectrum disorders (Nelson, Thompson, & Yung, in press-a;
Parnas, Raballo, Handest, Vollmer-Larsen, & Saebye, 2011). Several neurobiological
hypotheses concerning the neural or neuro-cognitive correlates of these ipseity-
disturbances have been put forward recently (Hecht, 2010; Hemsley, 1998, 2005;
Legrand & Ruby, 2009; Nelson, Fornito, et al., 2009; Sass, 1992; Taylor, In press). The
existence of self-disturbances in schizophrenia is clear on theoretical, clinical and
empirical grounds. More controversial is the claim that these index the key element, i.e.,

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the most distinctive feature of the illness or central factor that might account for or
generate its characteristic signs and symptoms. More insight will likely emerge from
future empirical work using the EASE: viz., from closer statistical analysis of the
discriminative qualities and inter-correlations of individual items of the EASE, from
longitudinal studies tracking changes in self-disturbance over the course of illness, and
from applying the EASE to additional diagnostic groups, including certain disorders that
may involve disturbances of related though distinct aspects of self-experience, such as
Depersonalization Disorder, PTSD, and Borderline Personality Disorder. One preliminary
study comparing Depersonalization Disorder and schizophrenia has been completed
(Sass, Pienkos, Nelson, & Medford, submitted); its findings and implications are
considered below.
It is also important to go beyond examining the discriminative and predictive
power of self-disturbances and to take a closer look at these anomalous experiences that
are common in schizophrenia and captured in the EASE. Otherwise there is little hope of
understanding the underlying nature of these anomalies or the functional role they might
play in the pathogenesis of this complex illness. One strategy involves adopting a
comparative approach, in order to determine whether, and to what extent, certain
conditions, outside the schizophrenia spectrum, may bring about or otherwise be
associated with certain anomalies of consciousness or self-experience highly
characteristic of schizophrenia. The EASE, with its operationalized descriptions, makes
it possible to consider these comparisons in a detailed and rigorous fashion.
It can be argued that schizophrenic self­disturbance is best understood as a kind of

overall Gestalt factor.  It can be argued as well that one should not focus on individual 

EASE items but understand them, rather, as potentially indicating, when taken en masse, 

the presence of this Gestalt (Henriksen & Parnas, 2012; Parnas, 2012).  Given the subtle 

and holistic nature of consciousness or self­experience, whether normal or abnormal, 

there is certainly something to be said for this holistic view, which we accept in part. We 

do not believe, however, that this should preclude any closer consideration of the EASE 

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items and their potential significance.  Gestalts can be compared one with another and 

thereby come to be better understood; indeed, only thus can we progress in understanding

them (Nordgaard, Sass, & Parnas, in press). One way to proceed is to compare what can 

be understood as different aspects of the Gestalts in question.  We believe that the EASE 

items, considered judiciously, can provide one way of doing this.  This issue is discussed 

further in the Methodological Limitations section.
In this paper we employed descriptions from the EASE to assess the presence of
the anomalies at issue in a non-schizophrenic condition, “introspection.” The
“introspection” at issue refers not to just any self-examination or introversion, but to a
specific form of detached self-consciousness used as a research technique by early 20th
century psychologists of the “introspectionist” school, notably E. B. Titchener (see
below). It involves specific alterations in, or manipulations of, the attitude or orientation
of conscious experience, imposed upon non-clinical subjects.
Introspection was selected here because it represents perhaps the clearest and
purest, non-schizophrenic manifestation of hyperreflexivity, one of the two facets of the
ipseity or minimal-self disturbance mentioned above. (Other analogues of interest can be
found in various forms of meditative practice, and in depersonalization, which represents
a non-psychotic instance that foregrounds the other facet of ipseity disturbance:
diminished self-affection; see Sass et al., in press.) Basically, introspection involves
specific techniques that encourage forms of acute self-awareness of one’s own mind,
body, or feelings. We explore how these techniques can transform basic or minimal self-
experience or ipseity in ways that do, and do not, mimic the basic self-anomalies in
schizophrenia.
Our hypothesis is that many of the self-anomalies associated with schizophrenia
will also be prominent in the condition of introspection. We are aware that reports of
analogous experiences cannot, by themselves, establish that either the experiences or the
underlying processes are the same. Similar-sounding descriptions could be masking
significant differences, perhaps because available language is too blunt to capture subtle
subjective differences. Also, if the experiences truly are akin, they might represent only a

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final common pathway having distinct causes or sources. Even if a more proximal
condition were the same in introspection and schizophrenia (say, a passive and detached
experiential orientation), this condition may have been influenced by underlying factors
that are heterogeneous (e.g., conscious choice in introspection, versus neuro-cognitive
dysfunction in schizophrenia; see below re “operative” versus “reflective” forms of
hyperreflexivity). Still, with appropriate caution, consideration of the presence and
patterning of anomalous experiences associated with this normal analogue to
schizophrenic self-anomalies is of interest for several reasons.
A first reason is to put the items of the EASE into a comparative context, thereby
yielding a better sense both of how unusual and of how intrinsically pathological they
may be. To feel that one does not exist (“It is as if I am not a part of this world … I am
almost nonexistent,” EASE item 2.1, p. 245), or that one is not the person performing
one’s own actions (EASE item 2.2, p. 246) may at first seem exceedingly odd, even
bizarre or ununderstandable. This is cast in a different light, however, if one discovers
virtually identical reports among practitioners of introspectionist psychology.
A second reason for considering introspection as a possible analogue is that it may
help to illuminate the internal structure of ipseity disturbance and to suggest proximal
psychological factors that may underlie many key experiences in schizophrenia and
related disorders. If altering one’s orientation or stance toward experience, a process
frequently bound up with motivational and affective issues, can, even in normal or clearly
non-psychotic individuals, generate experiences highly reminiscent of schizophrenia
(akin even to the “first rank symptoms” of schizophrenia (Mellor, 1970)), this may
suggest that some important anomalies found in schizophrenia may derive, to some
extent, from similar alterations—in this case from a hyper-self-conscious orientation
rather than from a more static or focal cognitive deficit (such as a defect of some
component of executive functioning, working memory, attention, motor or efferent
feedback, or perceptual organization, as is frequently assumed). Equally important,
however, is the fact that there may also be schizophrenic anomalies for which analogues
from normal experiences seem absent or very rare. These should invite special scrutiny,
as potential indicators of a more specifically schizophrenic factor. The pattern of

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similarities and differences may, then, help to tease apart different possible sources of
schizophrenic symptomatology and, in particular, to distinguish some of the more
dynamic factors from deficit-like features that are more static and persistent.
A third reason for being interested in introspection as a possible analogue is the
potential relevance for psychotherapy or other psychological interventions. Recognition
of these analogies may help the therapist to see that certain key schizophrenic symptoms
do not, in fact, lie beyond the pale of any possible empathic comprehension.i A related
point concerns therapeutic techniques. Introspection involves reasonably well-understood
methods both for transforming experience and for returning it to normalcy. Even very
partial analogies to schizophrenia may therefore suggest some useful techniques that
could be adapted to help patients reverse or otherwise transcend some of the abnormal
experiences at issue, thereby providing at least some symptomatic relief (consistent,
perhaps, with recent work on treatment of psychosis using “third wave” CBT approaches
such as Acceptance and Commitment Therapy (ACT) or Mindfulness (Bach & Hayes,
2002; Gaudiano & Herbert, 2006; Perez-Alvarez, Garcia-Montes, Perona-Garcela, &
Vallina-Fernandez, 2008)).
There are, at present, no controlled studies offering precise quantitative
comparisons across groups composed of schizophrenia patients and introspectors.
Published reports of introspectionist research do, however, provide sufficient information
to allow for empirical comparisons of a rigorous but more informal kind. In our study,
we collected a sample of reports from introspectionist experiments, then examined these
reports for accounts that fulfilled EASE criteria that are already known to characterize
schizophrenia. We noted the similarities in reports of anomalous experience, as assessed
using the EASE, while also paying attention to instances where the similarity is absent or
less apparent.

2. METHODS
2.1 Instruments
As a tool for assessing introspective experiences, we selected the
phenomenologically-oriented Examination of Anomalous Self-Experience (EASE)

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(Parnas, Moller, et al., 2005). The items of the EASE were taken from the
psychopathological literature on schizophrenia as well as from the Bonn Scale for the
Assessment of Basic Symptoms (BSABS) (Gross, Huber, Klosterkotter, & Linz, 2008), a
validated interview format designed to capture the pervasive experiential anomalies
found in schizophrenia. As noted, the EASE (and closely related proxies) has been
shown to differentiate schizophrenia (and schizophrenia spectrum disorders) from other
psychiatric disorders. The EASE demonstrates very good inter-rater reliability, with
Cohen’s kappa coefficients for single items ranging between 0.6 to 1.0 (Parnas, Moller, et
al., 2005).
2.2 Introspection - Description
The term “introspection” can be used to describe various phenomena; here we are
interested in Edward Bradford Titchener’s use of a method that he considered the truly
scientific procedure for investigating the basic processes of human cognition and
experience. In Titchener's perspective, the way to study such core psychological
processes was to observe one’s own mental functions within the constraints of a
controlled experimental setting (Titchener, 1910).
As an experimental method, introspectionism required much of its practitioners;
many of introspectionism’s rules acknowledge the difficulties of observing one's own
thought or experience. These rules include avoiding distractions, both external and
internal (emotional states, tiredness, etc.); noting mental events as soon as possible after
they occurred; and maintaining an “equable frame of mind” (Titchener, 1898, p. 31), or
the “right mood toward the experiment, … the attitude of passive, impartial indifference”
(Geissler, 1910, p. 597). Also important were avoiding “general terms and stock phrases”
while being held “strictly to the definite and concrete” (Titchener, 1902, p. xiv); and
breaking mental processes or experiences down into their supposedly most fundamental
processes or parts. Perhaps most crucial was what Titchener famously called “avoiding
the stimulus error.” This required focusing solely on mental events and avoiding any
"common-sense attitude" or reference to the external world.
Psychologists have long recognized the inherent difficulties of observing one's
own mind and, in particular, how the act of observing may alter that which is observed.

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Even before Titchener, William James had pointed out the difficulty of observing the
more dynamic or “transitive parts of thought's stream," comparing such introspective
observation to "seizing a spinning top to catch its motion, or trying to turn up the gas
quickly enough to see how the darkness looks" (James, 1890, p. 237). Ultimately,
introspectionism was crippled by doubts about the reliability of its methods, by
controversies over "imageless thought" (is it possible to conceive of completely abstract
ideas?), and finally by the rise of behaviorism. The school died out shortly after
Titchener's death in 1927.
It is crucial to recognize that our use of introspectionist reports in this paper does
not imply acceptance of Titchener’s scientific methods and claims. Indeed, we differ
sharply from Titchener by viewing these reports (of introspected experiences) not
primarily as descriptions of previously unnoticed aspects of normal experience, but rather
as (in large measure) experimental artifacts—that is, accounts of abnormal forms of
experience that may well be created by the act of introspection itself, which is an explicit
and extreme form of reflexive or reflective self-consciousness. The stance of Titchenerian
introspection is, of course, a willful choice, at least at the moment of entry into it (though,
like any mood or mode of attention, it can develop its own independent momentum or
inertia). In this sense it is likely to be distinct from some (though not all) of the modes of
hyperreflexivity that may occur in schizophrenia. The stance itself, however, involves a
focusing on (and potential objectification of) “inner” aspects of the observer’s own self or
experiencing, and in this sense may constitute a useful albeit imperfect analogue to the
hyperreflexive aspect of schizophrenic ipseity disturbance.

2.3 Data Sources

In the present study, selected reports of introspection experiences (see below)
were examined, and statements that demonstrated a core similarity to an EASE item were
selected and retained for inclusion in our data set. On a few occasions a statement fit
more than one EASE item and was therefore used more than once (consistent with
standard EASE practices). In all cases the classification of experiential descriptions as
instances of a particular EASE item was agreed upon by all three authors. All three co-

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authors have attended EASE workshops. In addition, one of us is a co-author of the
ipseity-disturbance hypothesis (LAS), one has extensive training and experience in using
the EASE in clinical and research settings (BN), one has moderate experience in its use
(EP). In many cases, the statements selected were obvious examples of the EASE item at
issue—as is clear from examination of Table 2. On some occasions, the fit seemed
debatable but nonetheless reasonable enough for the item to be included (as agreed by all
3 authors); these instances are marked in the data table as “no clear analogue found” and
given special attention in the discussion of results.
We note that the EASE was designed for use in detailed psychiatric interviews
involving extended probing of the patient’s experience. Here, however, we have applied
it to published descriptions of introspection experiences, as noted above. Since the
introspectors were not actually interviewed with the EASE, we cannot offer direct
quantitative comparisons of the incidence of particular anomalies in introspection versus
schizophrenia spectrum conditions. This obviously limits our ability to draw firm
conclusions. It does not, however, undermine the main goals of this exploratory study,
which are to discover whether (not how frequently) certain experiences seem to be
associated with introspection, and to use this information to develop and refine
hypotheses about the nature, onset, and maintenance of schizophrenic symptoms.
Furthermore, we did not apply the EASE to new case examples of schizophrenia; rather,
we accepted the EASE as providing a compendium of items highly characteristic of the
schizophrenia spectrum. Limitations of this approach are discussed below.

2.4 Selection of Literature

In selecting the reports, we generally preferred first-person phenomenological
descriptions over third-person summaries or interpretations, since these offered richer
experiential accounts. All sources are listed in Table 1. Eight studies employing the
technique of introspectionism were selected from the American Journal of Psychology
and British Journal of Psychology from the early 20th century, the heyday of
introspectionist psychology; six had been cited in recent works on introspectionism
(Coon, 1993; Hunt, 1986). Among these were a report describing the effects of

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introspection on word meaning (Don & Weld, 1924), a study on affective (pleasant or
unpleasant) qualities of sensory stimuli (Nafe, 1924), and a dissertation investigating the
subjective nature of consciousness (Cattell, 1930). Five more general works on the
theory and methodology of introspectionism were also chosen, including several by E.B.
Titchener (Titchener, 1912a, 1912b, 1912c) and one by William James (James, 1892), an
early proponent (but also critic, as noted above) of introspective method in psychology.
Also included was a more recent study (Hunt & Chefurka, 1976), modeled on classic
introspectionism, that required subjects to introspect in a room empty of sensory stimuli,
with the object of observing the emergence of changes in subjective experience.

3. RESULTS
3.1 Overview of Results
Our findings are reported in Table 2 and described in the following Results
sections. Table 2 lists all the items of the EASE; where introspection experiences match
specific EASE items, examples of this are given. The literature we examined often
yielded multiple examples of a given EASE item; to conserve space, our tables typically
display but one, unless a second example significantly enriches the first. In the narrative
of the Results sections below, only a sampling of specific reports are quoted; other EASE
items are merely listed, but discrepancies are noted in more detail. Limitations and
implications are treated in the Discussion that follows.
In the Results sections below, definitions or descriptions of EASE items are
always given in italics. Quotations following a colon are taken from introspectionist
reports (either statements by a particular introspector or a generalization by the
psychologist). On occasion, analogous quotations from schizophrenia patients, taken
from the EASE, are presented for comparative purposes; these latter always appear
within parentheses and in italics, and are always preceded by the label “EASE.”
Examining the accounts of introspection yielded clear endorsements of 44 of the
57 EASE items (77.2%) (“affinities”). This included 15 of the 17 items (88.2%) in
Domain 1, Cognition and Stream of Consciousness; 14 of 18 items (77.8%) in Domain 2,
Self-Awareness and Presence; 6 of 9 items (66.7%) in Domain 3, Bodily Experience; 3 of

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5 items (60%) in Domain 4, Demarcation/Transitivism; and 6 of 8 (75%) items in
Domain 5, Existential Reorientation. The nature of this study argues against use of
statistical-significance analysis: however the generally high level of affinity clearly
suggests some major similarities in experiences of disturbed ipseity (especially
considering the fact that nonpsychiatric subjects typically endorse few or no EASE items,
as described in the Discussion section below). We also note that some of the
“discrepancies” might be merely artifactual: certain experiences in the EASE simply
could not occur in introspectionist experiments, for trivial reasons (e.g., no “Mirror-
related phenomena” if no reflecting surface present in the experimental setup); also, the
short-term nature of introspectionist experiments make it unlikely for introspectors to
develop the major intellectual or existential changes, or sense of superiority over others,
reflected by some EASE items. Other discrepancies may, however, be worthy of careful
consideration as potential indicators of underlying psychological differences.

3.2 Results by Domain (See Table 2)

Domain 1 of the EASE, Cognition and Stream of Consciousness, includes
features that are defined as indicating disruption of a “normal sense of consciousness as
continuous over time, flowing, inhabited by one subject and introspectively transparent
(immediately or directly given) in a non spatial way" (p. 240). In this domain, clear
affinities were found for 15 of the 17 items, with probable discrepancies in two items
(1.16 and 1.17).
Some examples of affinities are the following: Introspectors described
Perceptualization of inner speech or thought (EASE item 1.7): “I saw [the spoken or
thought word] written out in typed letters.” They reported Spatialization of experience
(1.8): “The smell quality lay a little off to one side”; “my consciousness … was aware of
itself as located only in my thumbs … another piece of consciousness between shoulders
and chest” (EASE: “thoughts were in the right side of [patient’s] head”; “thoughts
always pass down obliquely into the very same spot”). Introspectors also described
Inability to discriminate modalities of intentionality (1.10): “Then it became as if I was
dreaming and the sensation lost its objective reality so that I thought I was fancying it”;

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and Discontinuous awareness of one’s own actions (1.15): “I was scarcely aware whether
I had touched the plate or not.”
Other EASE items reported by introspectors include: Thought interference, Loss
of thought ipseity, Thought pressure, Thought block, Silent thought echo, Ruminations-
obsessions, Ambivalence, Disturbance of thought initiative/intentionality, Attentional
disturbances, Disorder of short-term memory, and Disturbance in experience of time.
The two discrepant items were #s 1.16 and 1.17, Discordance between the
intended expression and the expressed and Disturbance of expressive language function;
neither was directly described by the introspectionists whose reports we examined. We
are uncertain as to how to interpret these discrepancies, which seem closely related. They
may be artifactual—whether because introspectors are trained to get on with the task of
describing (without complaint) or because such statements were edited out by the
experimenter as being irrelevant to the focus on the ongoing experiment. We say this
because introspectionist psychologists themselves often emphasize the difficulty of
describing vague and fleeting mental or sensory states in the terminology of conventional
language (see Burnett and Dallenbach (1927, p. 423); Cattell (1930, p. 75); James
(1890)). Still, it is of interest that these two EASE items were not directly reported in the
introspectionist literature we examined.
Domain 2, Self-Awareness and Presence, refers to disruptions of a “normal
sense of being (existence) [that] involves automatic unreflected self-presence and
immersion in the world” (EASE p. 243). Clear or reasonably clear affinities were found
for 14 of the 18 items listed in this domain.
EASE item 2.1, Diminished sense of basic self, is indicated by an introspector's
statement: "I seem to be dissociated from the experience [of perceiving a stimulus]...as a
conscious organism I'm not even there" (EASE: "It is as if I am not a part of this world...I
am almost nonexistent"). Introspectors described Distorted first-person perspective (2.2):
"It was like I'd taken a step back from myself" and "all my consciousness [was] located
only in my thumbs." Diminished presence (2.4) was observed: "[A] thin curtain hung in
front [of the sensation of a needle prick] that blurred it and deadened it slightly," as was
I-Split (2.7): "I was really conscious of three different areas—my head, my heart, and my

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legs. Maybe it was my head being dragged down to my heart level." Subjects further
describe Loss of common sense (2.12), as in one introspector's discovery that "the word
was just there, it didn't mean anything" (EASE: "A patient started to doubt the meaning
of the most ordinary words.").
Introspectors also reported Psychic depersonalization (self-alienation),
Derealization, Hyperreflexivity, Dissociative depersonalization, Diffuse or pervasive
anxiety, Ontological anxiety, Diminished transparency of consciousness, Diminished
initiative, and Hypohedonia.
Three of the four discrepant items were Identity confusion (2.9; EASE: “A feeling
as if the patient is somebody else,” e.g., his mother or a dog), Sense of change in relation
to chronological age (2.10) and Sense of change in relation to gender (2.11). These
discrepancies may well reflect a lack of serious identity disturbances in introspectors,
perhaps associated with a lack of very severe, anomalous experience of the lived-body).
They might also result from the absence of any direct focus on such issues (self-identity,
sexuality, age) in the introspectionist experimental situations. It is not impossible that
prolonged introspection, with more open-ended reporting, might eventually induce, or
reveal, some experiences of this sort. The fourth discrepancy pertains to Diminished
vitality (2.18). Diminishment of the basic sense of aliveness may be less prominent in
introspection than in schizophrenia. Consistent with this interpretation is the fact that
introspectors did not mention such a lack in two (non-discrepant) EASE items where lack
of vitality is a possible (though not a necessary) feature (items 1.11, 3.3).
Domain 3, Bodily Experience, describes a disruption of a "normal sense of
psychophysical unity and coherence [or of] a normal interplay or oscillation of the body
as 'lived from within' as a subject or soul...and of the body as an object" (EASE p. 252).
In this domain, clear analogues were found for 6 of 9 items.
EASE item 3.1, Morphological change, is apparent in this observation: "[I]f one
directs attention to the sensations in the arm...one feels as if the arm would considerably
elongate itself." Spatialization of bodily experiences (3.6), which can involve "unusual
introspective access to normally mute...physiological processes," was described:
"Practically the whole of attention was directed toward pressures in the body, mostly

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respiration." (EASE: "I can feel the blood rushing under my skin.") Introspectors also
reported Somatic depersonalization (bodily estrangement), Psychophysical misfit or split,
Cenesthetic experiences, and Motor disturbances (e.g., pseudo-movements of one’s own
body).
The only clear discrepancy in this group was for item 3.2, Mirror-related
phenomena, a possible artifact. A possible but unlikely analogue for item 3.5, Bodily
disintegration (which can involve bodily dissolution) was suggested by the introspector
who described a pleasant affective quality as seeming "bigger than my body, and my
body is in it" (Nafe, 1924, p. 525). We consider this a probable discrepancy: more
explicit reference to corporeal dissolution would be required to qualify this as an
analogue. Another possible but unlikely analogue concerns Mimetic experience (3.9).
An introspector listening to orchestral music said, "my breathing seemed to be sending
the bow [of the violinist in the orchestra] up as if the rise in breath was actually
motivating the music" (Weld, 1912, p. 280). Again, we consider this a probable
discrepancy; the anomalous nature of the experience in question is attenuated by the fact
that it occurred while listening to music—an experience that normally tends to weaken
“ego boundaries” (Hartmann, 1991).
The central disturbance in Domain 4, Demarcation and Transitivism, is "loss or
permeability of self-world boundary" (EASE p. 254). Of the 5 items, 3 clear affinities
were found in the introspectionist literature. EASE item 4.1, Confusion with the other,
was reported by the introspector who stated, "It sounded like someone else breathing. It
must have been my own." Passivity mood (4.4) was described in several general
accounts of the introspective stance, and one subject directly observed, "My attention
seemed to be passively compelled toward the coldness." Other transitivistic phenomena
(4.5) was evident in the statement, "The self receded before [my experience of the
stimulus] flowed in."
Two discrepancies were found in this domain. The discrepancy regarding item
4.2, Confusion with one's own specular image, is a possible artifact due to the absence of
mirrors or reflecting surfaces in the study settings (though we doubt that this experience
would occur with introspection even if such surfaces were present). The failure of

16
introspectors to report item 4.3, Threatening bodily contact and feelings of fusion with
other, is more interesting. While boundary confusion was occasionally reported in the
introspectionist literature, this sort of intense negative emotional response was not.
However, this may also be due to the controlled and formal nature of introspectionist
settings, which make direct bodily contact highly unlikely.
Domain 5, Existential Reorientation, describes the schizophrenic patient's
"fundamental reorientation with respect to his general metaphysical worldview and/or
hierarchy of values, projects and interests" so that "the experiences of anomalies in self-
awareness are here enacted and so existentially expressed" (EASE p. 255). In this
domain, clear and relatively clear affinities were found for 6 of the 8 items, with an
additional item (5.7) suggested by the general attitude toward the world associated with
introspectionism.
Item 5.2, Feelings of centrality, was described by an introspector listening to
music: "I seemed to be responsible for holding the instruments together; I must do my
part or the whole orchestra will break down." (EASE: "A former doctor...sometimes had a
transient 'as if' sentiment that he was the only true doctor in the entire world and the fate
of humanity depended on him.") Item 5.3, Feeling as if the subject's experiential field is
the only extant reality, was apparent into following report: "The whole outside world
seemed to have disappeared...There was only smelling." 'As if' feeling that the
experienced world is not real (5.5) is indicated in the statement: "The sensation lost its
objective reality so that I thought I was fancying it."
Introspectors also reported Primary self reference phenomena, ‘As if’ feelings of
extraordinary creative power or insight, and Magical ideas linked to subject’s way of
experiencing.
Neither of the final two items was described as such in introspectionist reports.
These are: Existential or intellectual change (5.7; “preoccupation with existential,
metaphysical, religious, philosophical, or psychological themes [including] meditation,
psychology … meaning of existence… alternative approaches to science...”) and
Solipsistic grandiosity (5.8; “exhibits a sense of superiority over his fellow humans,
typically associated with his feelings of possessing extraordinary insights or abilities”).

17
The lack of specific reports may well reflect the absence of this sort of overall
transformation of attitude and orientation in introspectors. It may, however, also have
artifactual sources—since the introspectors were typically given specific tasks rather than
being asked to reflect on the general meaning of life, science, or their own self. It is
worth noting, in fact, that something akin to such transformation might sometimes have
been fostered by adopting introspectionism as a general approach to life and
psychological science.ii

4. DISCUSSION
We begin our discussion by assessing the nature and possible significance of the
affinities and differences discovered through use of the EASE. Later we address more
theoretical questions concerning implications for the disturbed-ipseity view and
alternative approaches to schizophrenia.

4.1 Descriptive Psychopathology

4.1.1 Affinities: A key finding of the present study is the sheer extent of EASE
items found in reports of introspection. As shown above, it appears that this condition
can involve or engender the majority of the alterations of self-experience that have been
found (in past studies and clinical descriptions) to be characteristic of schizophrenia and
schizophrenic vulnerability. These include what would appear to involve (at least in the
schizophrenic context) rather extreme distortions of normal qualities of experience or
thought and a diminishment of the sense of ownership or agentic control over one’s
thoughts, feelings, or bodily sensations that is reminiscent of (if not, at times,
indistinguishable from) the “first rank symptoms” of schizophrenia (Mellor, 1970). The
extent of the affinities is remarkable, considering that previous research has shown that
normal individuals will seldom report any of the EASE items, and that patients outside
the schizophrenia spectrum who have been studied (mainly patients with mood and
anxiety disorders) report only very few (Handest, 2003; Huber, 1986; Parnas & Handest,
2003).

18
 A noteworthy finding is the number of experiences reported by introspectors that
suggest diminished self-affection. Introspection is, explicitly and by design, a form of
self-consciousness (“hyperreflexivity”), yet it appears to involve or engender experiences
involving a fading of the sense of existing as a self or subject (“diminished self-
affection”). As reported above, one introspector stated that he/she felt dissociated from
the experience of perceiving a stimulus and that “as a conscious organism I’m not even
there.” Such overlaps are consistent with the claim (Sass & Parnas, 2003, 2007) that
hyperreflexivity and diminished self-affection are interdependent or complementary
aspects of anomalous ipseity or self-experience.
4.1.2 Discrepancies: Though fewer, there were also some EASE items that were
either definitely or probably not found in introspection: 11 clear discrepancies (versus 44
clear affinities), as well as 2 possible but unlikely affinities. As noted, some
discrepancies may be artifacts resulting from trivial features of the analogue condition
(e.g., Mirror-related phenomena; Existential or intellectual change; Solipsistic
grandiosity). The remaining discrepancies are of greater theoretical interest and seem
likely to index some deeper fact about schizophrenia in particular. Below we summarize
and then interpret the various discrepancies with the EASE.
Introspectors do not seem to experience (or at least, to report) four types of experience
found in schizophrenia, which we list and then discuss below.
1. Fundamental changes of values and existential orientation: Absent in
introspective reports are statements indicating existential change or solipsistic
grandiosity (EASE 5.7, 5.8). As noted, this may be due to insufficient time or existential
commitment to a different mode of life on the part of introspectors (whose introspecting
experiences are relatively short-lived, and embedded within the conventional social
structure of introspectionism itself). It could also be due to a relative dearth of markedly
alienated or idiosyncratic personality orientations, as might be more common in
schizophrenia-spectrum individuals (Stanghellini & Ballerini, 2006).
2. Disturbances of expression: Introspectors failed to report Discordance between
intended expression and the expressed (EASE 1.16) and Disturbance of expressive
language function (1.17). As already noted, this may be accidental or artifactual. It may,

19
however, also reflect something important about schizophrenia: either a failure to fully
accept or internalize normal linguistic/conceptual categories, which some theorists or
researchers have considered important in schizophrenia (Lacan, 1974; Wahlberg et al.,
1997), or else the presence, in schizophrenia, of underlying feelings so unusual as to defy
any standard descriptors.
3. Profound alterations of the sense of self: It is noteworthy that introspectors
failed to report two items suggestive of a fundamental disturbance of self-identity (or
perhaps of the lived-body): namely, Sense of change in relation to chronological age
(2.10) or gender (2.11). In addition, introspectors failed to report Identity confusion (2.9),
as well as (in all likelihood) Bodily disintegration (3.5), Mimetic experience (3.9), and
Threatening bodily contact and feelings of fusion (4.3), items that seem particularly
suggestive of a very fundamental self disturbance. These items seem to involve
something more severe than feelings of passivity, a fading of self or world, or alienation
from thoughts, feelings, or one’s body—profound as such experiences can be. Here we
find forms of fusion or confusion between self and world or self and other, forms that
suggest disturbance or diminishment of the basic sense of occupying a distinct, subjective
position as an identifiable first-person perspective, that is, of existing at (what Husserl
called) the “zero point” of conscious awareness in relationship to or contrast with others
or the external world.iii In this condition, then, there seems a dearth of reports indicating
some of the most severe forms of ipseity disturbance.iv Perhaps this is an index of the
absence or attenuation of an underlying disruption, probably grounded in neurobiological
dysfunction, that could be specific to schizophrenia and that cannot, perhaps, be
mimicked by processes of a largely volitional nature.
4. Diminishment of basic vitality: The absence of reports of diminished vitality
(2.18) in introspection may suggest the absence of the devitalization and associated “loss
of vital contact” (Minkowski) that seem common in schizophrenia and that may be
closely related to diminished self-affection.
It is noteworthy that these discrepancies between introspection and schizophrenia
resemble the three domains found to characterize early schizophrenic experience by

20
Moller & Husby (2000): namely, 1, ineffability; 2, “disturbance of perception of self”;
and 3, ”extreme preoccupation by and withdrawal to overvalued ideas.”
4.1.3 Descriptive Psychopathology, Summary: Our findings regarding
discrepancies suggest that schizophrenia may involve some disruptions of self-experience
that are distinctive and, perhaps, more foundational than anything to be found in
introspection. These suggest fundamental confusion between self and world or self and
other and loss of the most basic sense of existing as a subject of experience.

4.2 General Implications for the Ipseity-Disturbance View

What are the implications of our findings for the ipseity-disturbance view of
schizophrenia? Here we find both support and challenge, as well as spurs to further
research and theorizing.
At one level, the findings show that what appears to be a pure form of
hyperreflexivity—introspection—is indeed accompanied by (or may bring about) many
of the alterations of self-experience that are highly characteristic of schizophrenia (44 of
the 57 EASE items). This is clearly congruent with the two-faceted self-disturbance
model offered by Sass and Parnas (Sass, 2010; Sass & Parnas, 2003, 2007): It suggests
that schizophrenia itself may well involve, at least in some important respects, similar
forms of distorted ipseity, and that these could play a key role in the pathogenesis of
many symptoms.
A noteworthy point is evidence of the close linkage between the two facets of
ipseity disturbance. Sass and Parnas (2003, 2007) have argued that there is a close
relationship or even complementarity between hyperreflexivity and diminished self-
affection in schizophrenia: “[W]hereas the notion of hyperreflexivity emphasizes the way
in which something normally tacit becomes focal and explicit, diminished self-affection
emphasizes a complementary aspect of the same process—the fact that what once was
tacit is no longer being inhabited as a medium of taken-for-granted selfhood” (Sass &
Parnas, 2003, p. 430). Our data accords with this claim, showing that introspection, an
obvious manifestation of hyperreflexivity, can bring on experiences involving diminished
self-affection (e.g., EASE items 2.4 Diminished Presence, 2.8 Dissociative

21
Depersonalization).v It is noteworthy as well that some EASE items could equally easily
be considered as manifestations either of diminished self-affection or hyperreflexivity
(e.g., 1.7 Perceptualization of Thought; 3.7 Cenesthetic Experiences).
Our finding of analogies call into question the specificity to schizophrenia of at
least many of the manifestations of self-disorders described in the ipseity-disturbance
model and operationalized in items of the EASE. This is not to equate schizophrenia-
spectrum conditions with introspection; obviously, schizophrenia involves additional
factors, or distinctive patterns, not found in introspection. It is probable that, even if some
schizophrenic self-anomalies involve factors that resemble features of introspection, there
are also underlying factors, more specific to schizophrenia, that might give their self-
anomalies a different intensity or perhaps a subtly different cast (more on this below). As
noted, our findings suggest that schizophrenia probably involves certain forms of
neurobiologically based—and more passively engendered—hyperreflexivity that are not
characteristic of “introspection” (operative hyperreflexivity) as well as other forms that
are more similar (reflective hyperreflexivity) (consistent with Sass, 2010; Sass & Parnas,
2007). Though crucial, this point does not vitiate the potential contribution of the
analogue condition to a modeling of aspects of the pathogenesis of schizophrenic
symptoms. It is of great interest that a form of hyperreflexivity having different origins
can be associated with so many of the characteristic features of schizophrenia.
Like any disease, schizophrenia involves multiple factors, many of which are
shared with at least some other conditions. There is no reason to assume that every aspect
of schizophrenic symptomatology derives exclusively from some factor that is unique to
schizophrenia as an illness. It is also the case that processes that may come later in the
causal sequence, and that may involve defensive or quasi-volitional aspects (such as
detachment and self-consciousness), can sometimes play a crucial pathogenetic role—
perhaps as necessary (albeit not sufficient) causal factors. Such factors may also be
important targets of psychotherapeutic intervention. This view is implicit in the widely
accepted diathesis/stress model, as well as in recent research suggesting the possible role
of traumatic experience and perhaps dissociation in the etiology of schizophrenia
(Bleuler, 1911; Read, van Os, Morrison, & Ross, 2005). It conforms with current

22
thinking on the potential efficacy of early intervention (pharmacological and
psychological/behavioral) in preventing onset of schizophrenia, and with recent
speculation concerning possible iatrogenic dangers of therapeutic interventions that might
encourage dysfunctional forms of rumination or self-consciousness (Bach & Hayes,
2002; McGorry et al., 2009; Nelson, Sass, & Skodlar, 2009).
Our findings are also consistent, however, with the notion that certain very basic
abnormalities of consciousness or self experience, abnormalities not brought on by
introspective contemplation and withdrawal, are probably necessary for the development
of full-blown schizophrenic outcomes. The discrepancies in this study (anomalies of self-
experience not reported by introspectors) tend to suggest abnormalities that seem to
involve more severe disturbances of selfhood, especially confusion of bodily-grounded
identity and feelings of fusion with others or with the world. Such experiences would
suggest disturbance or diminishment of the basic sense of occupying a distinct, subjective
position as an identifiable first-person perspective, that is, of existing at the “zero point”
of conscious awareness in relationship to or contrast with others or the external world.
All these findings should be considered in relationship to another, parallel study
recently completed (Sass et al., submitted). The latter study followed a similar
methodology, in this case applying the EASE to published reports of Depersonalization
Disorder, which was chosen as representing a rather pure analogue of the other facet of
ipseity disturbance: diminished self-affection. The findings of this sister study were
similar to the present one in several respects. Here too the majority of EASE items
appeared (41 Of 57 EASE items), thus suggesting that such patients (who were
nonpsychotic and outside the schizophrenia spectrum) could in fact show many of the
key self-anomalies found in schizophrenia. Here too the patients manifested EASE items
suggestive not only of diminished self-affection but also of hyperreflexivity. Here too
there were some interesting discrepancies, namely, certain EASE items not found in the
pure depersonalization cases. These findings support the ipseity-disturbance hypothesis
of schizophrenia in several ways: they show A, that diminished self-affection seems to be
closely bound up with hyperreflexivity, and B, that diminished self-affection can be
accompanied by, or even bring about, many aspects of schizophrenia-like experience.

23
There is also the fact that the depersonalized patients, like the introspectors, failed to
report several of the EASE items that seem particularly suggestive of a very fundamental
self disturbance: this supports C, the notion that schizophrenia involves something more
basic than anything that can be brought on via either an intentional stance or a defensive
reaction.
Whereas introspectors failed to report Identity confusion (2.9), and Bodily
disintegration (3.5), and (in all likelihood) Mimetic experience (3.9) and Threatening
bodily contact (4.3), depersonalized subjects failed to report Mimetic experience (3.9),
Confusion with the other (4.1), Confusion with one’s own specular image (4.2), and
(possibly) Threatening bodily contact (4.3). (4.2 may also be absent in introspection,
though one cannot exclude the possibility that this is an artifact.) Also, both introspectors
and depersonalized subjects failed to report two items suggestive of a fundamental
disturbance of self-identity: Sense of change in relation to chronological age (2.10) or
gender (2.11). There seems, then, in both analogue conditions, to be a dearth of reports
indicating some of the most severe forms of ipseity disturbance. It is noteworthy, as well,
that both introspectors and depersonalized subjects failed to clearly report Discordance
between intended expression and the expressed (EASE 1.16). As noted above, this may
reflect a fundamental disturbance of either language or experience in schizophrenia.
It is possible that these shared discrepancies might index the absence or
attenuation, in introspection and depersonalization, of an underlying disruption, probably
grounded in neurobiological dysfunction, that could be specific to schizophrenia and that
cannot, perhaps, be mimicked by processes of a largely volitional (introspectionist) or
largely defensive (depersonalization) nature. These findings may point towards a
continuum model of ipseity disturbance, with some states, such as introspection and
depersonalization, existing along a continuum that has schizophrenia at the extreme end.
This ‘endpoint’ of the continuum seems to be characterized not only by a sense of
passivity and an alienation from, or a fading of, aspects of self and experience but also by
a more severe and distinctive dislocation of first-person perspective, such that self and
other or self and world may come to seem fused or confused.

24
4.3 Holistic/Attitudinal Versus Modular/Deficit Views; Modeling Pathogenetic Pathways
But what, more specifically, are the implications of these findings for the
theoretical modeling of psychological processes in the pathogenesis of schizophrenia?
One important implication is the support the analogies may give to the role of
holistic, attitudinal, and varying factors, as opposed to modular or pure-deficit factors, in
accounting for some key aspects of schizophrenia. In our analogue condition, the
essential alteration seems to involve an overall transformation in the orientation, stance,
or ontological “mood” of consciousness—namely, adoption of an attitude of detachment,
non-involvement, and inner-oriented concentration, typically associated with suppression
of motivational or emotional arousal and associated alterations of what might be termed
“existential feelings” (Ratcliffe, 2005). Such transformations can wax and wane over the
course of time, often in relationship to anxiety, defense, action-orientation, and
motivational factors; and, as we have seen, the transformations typically go together. It is
interesting that mere adoption of the stance of introspection is capable of producing
experiences akin to many (not all) of the general self anomalies and even, perhaps, to
some of the First Rank Symptoms (e.g., thoughts aloud, somatic hallucinations, alienated
experiences of one’s own thoughts and emotions) and other mutations in the overall feel
of reality and sense of intersubjectivity typical of schizophrenia. This is consistent with
the ipseity-disturbance theory of schizophrenia, which views the major symptom groups
of schizophrenia (positive, negative, disorganized) as manifestations or products of this
key disturbance (Sass & Parnas, 2003, 2007).
It may be useful to clarify just how such transformations of attitude or orientation
could actually give rise to some of the psychotic or psychotic-like experiences
characteristic of schizophrenia. To illustrate the hypothetical relevance of introspective
hyperreflexivity for modeling pathogenetic pathways, we now explicate just three
potential (psychotic-like) consequences of the experiential transformations at issue.
1, Fragmentation of self: Understanding of one important psychotic development,
fragmentation of the self, can be gleaned from considering the introspective analysis of
self-experience offered in William James’s chapter on “The Consciousness of Self” in his
classic Principles of Psychology (James, 1890). James’s own attempts at introspection

25
show that the introspective demand to locate or specify the experiencing self can result in
a shocking “revelation” of the self’s non-existence. This is because everything that is
discovered by this sort of introspection is necessarily experienced as a kind of external
object: what had previously been experienced (or inhabited) as the tacit medium of
selfhood, necessarily loses its implicit self-like nature when it is turned into an object of
focal awareness. Thus what seemed to be his inner, experiencing self turns out, on James’
account, to be nothing more than the sense of his own breath passing through nose and
throat, or the “fluctuating play of pressures, convergences, divergences, and
accommodations in my eyeballs,” moving in their sockets. Hence, concludes James, “all
that is experienced is, strictly considered, objective,” even including that “imaginary
being denoted by the pronoun ‘I’” (Sass, 1987, 1992).
2, Loss of the interpersonal world: Introspection’s potential contribution to
another aspect of psychotic experience—altered sense of the external and interpersonal
world—is implicit in the phenomenologist Edmund Husserl’s analysis of the
interdependence of the normal sense of reality with the experience of intersubjectivity.
As Husserl (Zahavi, 2003) points out, it is intrinsic to the experience of real-world objects
(and thus of normal perception) that these objects be experienced as having unseen
profiles that are potentially available to other experiencing beings. The introversion
inherent in introspection involves “avoiding the stimulus error” by taking only one’s own
sensations, not external objects, as the object of attention and concern. Husserl’s analysis
shows that this orientation (especially if prolonged, and detached from a shared context)
would be conducive to a sense of derealization together with social isolation or even
solipsistic centrality, experiences common in chronic, withdrawn phases of a
schizophrenic psychosis.
3, Reification of inner experience: An inner-directed contemplation analogous to
introspectionism may also account for a third feature of schizophrenic consciousness,
what has been termed “phantom concreteness” (Laing, 1965; Sass, 1994): namely, the
reified, somehow hyper-concrete quality that “inner” ideas or sensations may take on for
such patients, perhaps as a result of being made the object of an overly attentive stare.
Titchener believed that “avoiding the stimulus error” would enable introspectors to turn

26
their attention back to features that had been there in their experience all along, albeit
unnoticed. According to a different view, introspection does not so much reveal as
transform experience, since experience is crucially altered when it is stripped of its
normal object-orientation or outer-directedness. Introspection clearly involves
withdrawal from the practical, outer-directed, intersubjective world of normal experience
in favor of inner objects that can take on a reified quality when they are placed in the
focus of awareness. (On the remarkable similarities between the psychotic experiences
of Daniel Paul Schreber and the phantom concreteness of Titchenerian introspection, see
Hunt, 1985, pp. 248f; Sass, 1994).
We see, then, that key schizophrenic symptoms (involving alterations of agency
and self-possession, intersubjectivity/sense-of-reality, and altered “inner” experience)
might be understood as, at least in part, being consequences not of simple modular
dysfunctions, but of an altered, overall stance or attitude akin to extreme and prolonged
forms of introspection. Such a view, which ascribes a central though not exclusive role to
set, attitude, or attentional orientation, may be more congruent with the well-known
variability of many schizophrenic symptoms, which typically wax and wane in
correlation with situational, affective, and motivational factors.vi
Indeed, it is possible that some of the neuro-cognitive abnormalities known to be
correlated with such symptoms—e.g., disturbances of motor or efferent feedback,
working memory, comparator function, perceptual organization and cognitive
coordination, or attentional filtering (Frith, Blakemore, & Wolpert, 2000; Goldman-
Rakic, 1994; Hemsley, 2005; Phillips & Silverstein, 2003) – might best be conceived, not
as primary causal factors (a common if often unspoken assumption in modular accounts),
but as neural correlates or products of a more general (and variable) transformation of
attitude or of motivational/affective orientation (Sass, 2004a; Sass & Uhlhaas, 2003).vii
Emphasizing attitudinal or holistic factors does not deny neurobiological factors; it does,
however, foster a more dynamic and multi-leveled approach to these factors.viii
We are not claiming, obviously, that schizophrenia can simply be equated with the
condition of introspection. The introspecting subject is a willing participant who
deliberately adopts or works to achieve the attitude or set in question. Once entered into,

27
the introspectionist stance can take on its own distinctive momentum, and the
introspector may feel she is a passive witness of transformations occurring in her field of
awareness. Initially, however, she did choose or accept this state, adopting it by dint of
effort and the use of particular strategies; and this is clearly not the case in schizophrenia.
Autobiographical or clinical accounts do show, however, that volitional
maneuvers can play an important role in schizophrenia, sometimes reducing but
sometimes inciting symptomatic manifestations. Patients may, e.g., choose to stare at a
neutral object in order to forget themselves or suppress unpleasant thoughts, or may
willfully adopt abnormal speech patterns precisely in order to avoid or disengage from
social interactions they find threatening (see references in Sass, 1992, pp. 72f, 206-208).
Still, in schizophrenia the role of active strategies, although far from negligible, is likely
to be less primary, in a temporal-etiological sense, than are certain more basal
dysfunctions of neuro-cognitive, neuro-affective, or neuro-motivational systems. It is
possible, however, that these basal dysfunctions are themselves best conceived in terms
of their relevance for self-experience.

4.4 Methodological Limitations

Our study is primarily exploratory, using the EASE interview to compare self-
anomalies in subjects in an experimental condition, introspection, with characteristic
experiences of schizophrenia. The “experimental manipulation” in introspection does
appear to be well-controlled (introspectionists were nothing if not rigorous in defining the
introspective stance). However, in this particular study, some typical experimental
controls were not possible. In sorting reported experiences of introspectors into EASE
categories, we were not blind to the status of the subjects, nor were we able to use a pre-
test measure to determine what self-anomalies such subjects might have experienced
prior to engaging in introspection. In addition, whereas the EASE normally involves
interview questions that probe for each item, here we looked in preexisting reports
gathered for other purposes, and thus were unable to determine the degree of an apparent
EASE item or the frequency of its appearance. These weaknesses are, however, less
problematic than may at first appear.

28
 It should be noted that past users of the EASE with clinical populations (as with
most psychopathology instruments) have also not been blind to the diagnosis of the
individual being interviewed—nor could they be (an experienced clinician giving the
EASE cannot help but come across information relevant to diagnosis). Also, EASE
results have typically been reported without information on the salience or degree of
particular items. Additionally, as noted above, the occurrence of self-disturbances in non-
schizophrenia-spectrum and nonpsychiatric individuals is quite rare (Haug et al., in press;
Nelson et al., in press-a; Raballo et al., 2011), and so the types of anomalous experiences
described in introspection reports were unlikely to have occurred prior to the
experimental conditions.
It is possible that our use of written reports rather than interview data could have
artificially inflated the finding of affinities: deeper probing of apparent affinities might
have shown some of them to lack the distinctive qualities of the related EASE items.
However, most of the reports of affinities are highly specified in terms of the detail
allowing their classification. Also, one could argue that the application of the EASE to
preexisting vignettes could as easily deflate as inflate the number of EASE items
revealed, since probing explicitly for each EASE item could increase the likelihood of
revealing an instance of anomalous self experience that might otherwise have gone
unnoticed, or been dismissed as a more run-of-the-mill experience (see Nordgaard et al.,
in press; Shorvon, 1946, p. 784). This may make our findings all the more remarkable.
It should be remembered as well that the EASE targets aspects of the form or
structure of subjectivity, namely, how self and world are experienced, rather than mere
issues of “content.” Any affinities in introspection, then, would similarly suggest
anomalies of experience at the level of structure, rather than content. Although we would
certainly not claim that the overall form or “Gestalt” of introspection is identical to that
of schizophrenia, our findings indicate that there are some important parallels at the level
of certain structural aspects of experience.
It would be of great interest to have controlled studies comparing ratings on the
EASE across various groups, including not only schizophrenia and introspectionist
subjects, but also a variety of other groups, both psychopathological and otherwise.

29
Nevertheless, the present study, with all its flaws, is adequate for its main purpose. This
was to see whether certain conditions other than schizophrenia, but involving certain
analogous processes, can involve or generate prominent manifestations of the self-
anomalies that seem characteristic of schizophrenia and have been found to differentiate
schizophrenia from other disorders (including affective or bipolar psychosis as well as
mixed groups of psychiatric disorders). This, we believe, has been demonstrated beyond
much doubt. We would note as well that there are also certain advantages to the use of
these published reports, given that the introspectionist stance is not easily inculcated (as
the Titchenerians well knew) and may even represent a kind of subculture that cannot be
easily replicated yet is of considerable theoretical interest in this context.
Inspection of Table 2 shows that classification of introspectionist experiences into
particular EASE categories is fairly obvious and we think, non-controversial. Further,
anyone who peruses the literature on introspectionism will quickly recognize that
anomalies such as those we have identified are prominent or even dominant aspects of
such conditions. However, as already noted, it is equally important to emphasize the
differences between schizophrenia and introspection, for these suggest the presence of
some basic level of self disturbance not found in a condition like introspection. The
current study was a preliminary investigation of the comparative phenomenologies of
schizophrenia and introspection, which future studies can attempt to replicate and extend
in a more controlled fashion.

4.5 Implications for Treatment and Research

This is not the place for in-depth discussion of treatment implications. We note
the need to beware, however, for patients with schizophrenia spectrum disorders or
considered at risk of such disorders, of interventions that might encourage introspection,
as this could exacerbate core pathological tendencies of such individuals. Also,
interventions targeted at reducing such experiences could be useful, as could be
interventions that might enhance the sense of minimal self. This may require fostering a
stronger orientation outward toward the world as well as an increase in the experience of

30
motivation and emotional involvement (consistent with recommendations in several
recent articles (Bach & Hayes, 2002; Nelson, Sass, et al., 2009; Perez-Alvarez et al.,
2008; Skodlar, Henriksen, Sass, Nelson, & Parnas, Submitted)). Three lines of future
research have already been mentioned:
1, More rigorous, interview research using the EASE re introspection, with
special focus on discrepant items, in order to corroborate our findings.
2, Closer examination of the structure of self-disturbances as manifest on the
EASE in schizophrenia (and other disorders). What, e.g., would statistical re-analysis of
past research show to be the most discriminating items on the EASE? How do these
compare to the items we found to be significant discrepancies?
3, More empirical and theoretical work is needed to explore the nature and
specificity of anomalous self-experience in schizophrenia. This will require comparison
of schizophrenia not just with affective psychosis or a mixture of psychiatric disorders (as
in past studies) but specifically with disorders or conditions involving forms of self-
transformation that may be similar, yet presumably not identical, to what occurs in
schizophrenia. Depersonalization Disorder, as a relatively pure reflection of diminished
self-affection, is an obvious candidate whic3h we have examined in a preliminary study,
as discussed above (Sass et al., submitted). Studies of PTSD, Borderline Personality
Disorder, Paranoid Psychosis, and other disorders (including such neurological disorders
as Cotard and Capgras; also meditation) would be useful as well. More precise analyses
of EASE results might help to ascertain which specific items or domains are most clearly
associated with schizophrenia as opposed to other comparison groups.
Three additional lines of research would be useful as well:
4, Experimental research focusing on the impact of various manipulations of
experiential modality (inducing introspective and depersonalized orientations), both with
normal individuals and persons with schizophrenia (and certain other diagnoses). To
what extent can analogues of key symptoms of schizophrenia be brought about by
experimentally manipulating attitude/orientation and sense-of-being in normal
individuals? To what extent can certain tendencies be exacerbated or attenuated in
psychiatric patients through such manipulations? The effects of these experimental

31
inductions could be measured with EASE interviews, but also by examining possible
effects on schizophrenic cognition (e.g., is there increase in the fragmentation of the
Gestalt or patterned quality of visual stimuli (Phillips & Silverstein, 2003), in
disorganization of verbal discourse patterns, in “fluidity” or “contamination” responses
on the Rorschach). Such research would help to generate hypotheses re possible
pathogenetic pathways (involving basal, consequential, and compensatory/defensive
processes) whereby schizophrenic symptoms develop and transform over time.
5, Use of brain imaging techniques to investigate neural correlates of the above
manipulations (e.g., of prolonged states of introspection or depersonalization); and to
compare these with neural correlates of certain schizophrenia symptoms.
6, Finally, development and empirical testing of psychotherapeutic interventions
that target hyperreflexivity and diminished self-affection in schizophrenia.

4.6 Conclusions
Our findings regarding introspection experiences are consistent with the ipseity-
disturbance view of schizophrenia in several ways. They demonstrate that alteration of
self-experience involving pure instances of hyperreflexivity do indeed engender
experiences resembling those of schizophrenia, which is consistent with the ipseity-
disturbance hypothesis. They also demonstrate the interweaving of hyperreflexivity and
diminished self-affection postulated for schizophrenia. A third point concerns the
discrepancies. Here we find support for our suggestion that more automatic, “operative,”
or deficiency-like factors (Sass, 2003; Sass & Parnas, 2007)—probably involving
self/world or self/other confusion and erosion of first-person perspective—are likely to
play a key role in schizophrenia; this implies that certain core features of schizophrenia
cannot be mimicked by engaging volitionally in an attentional stance. However, such
“operative” factors, in our view, are likely to motivate the more reflective and defensive
forms of experience, those that do have parallels to anomalies in introspection, with
which they will soon become inextricably entwined.
Obviously we do not propose that schizophrenia just is a kind of hyper-
introspection. That would be absurd. But we see that many phenomena, including

32
perhaps the First Rank Symptoms, can result from shifts in attention or orientation, and
that these may be related to issues pertaining to detachment and motivation and
underlying experiences of basic selfhood. All this suggests the potential power of an
account of schizophrenic symptoms that places main emphasis, not on modular deficits of
cognition, but on attitude, orientation, and the sense of being—namely, on diminished
“vital contact” (Minkowski, 1927) as well as on introversion and diminished
intersubjective framing of a shared, objective world.

END OF ARTICLE

33
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Table 1. Sources – Introspectionist literature

1. James, W. 2 1892 Text Book of Psychology (or briefer course).

2. Geissler, L.R. 1 1910 A preliminary introspective study of the association-reaction
consciousness.
3. Weld, H.P. 1 1912 An experimental study of musical enjoyment.
4. Titchener, E.B. 2 1912a Description vs. statement of meaning.
5. Titchener, E.B. 2 1912b Prolegomena to a study of introspection.
6. Titchener, E.B. 2 1912c The schema of introspection.
7. George, S.S. 1 1917 Attitude in relation to the psycho-physical judgment.
8. English, H.B.2 1921 In aid of introspection.
9. Nafe, J. 1 1924 An experimental study of the affective qualities.
10. Don, V. and Weld, H. 1 1924 Lapse of meaning with visual fixation.
11. Burnett, N.C. and Dallenbach, 1927 The experience of heat.
K.M.1
12. Cattell, R. 1 1930 The subjective character of cognition and the pre-sensational
development of perception.
13. Heidbreder, E. 3 1933 Seven Psychologies.
14. Ponzo, M. and Angyal, A. (cited 1933 Toward a systematology of weight sensations.
in Angyal)
15. Hunt, H. and Chefurka, C. 4 1976 A test of the psychedelic model of altered states of consciousness.

1. Original introspectionist experiment

2. Description of introspectionism and methodology
3. Historical review of introspectionism
4. Modern experiment using introspectionist methods

40
ENDNOTES 41

41
iOther useful analogies may be found in some extreme products of modernist and postmodernist culture
(Sass, 1992).

iiConsider that Titchener encouraged his students to "practice [introspection] at all times and in all
places...presently, very likely when you are least expecting it, you will come face to face with a
concrete process [in daily life] and find yourself observing it..." He described introspection loftily as
“the most important means of psychological knowledge” and the one and only scientific psychology in
light of which all data must be interpreted (Titchener, 1912b, p. 433).

iiiThe absence of certain of these EASE items (sense of change in gender/age, sense of others being threatening) in
introspection may have something to do with the typical settings/conditions of introspection ‘experiments’, i.e. being
isolated, detached from all but very controlled interaction with other people. Perhaps these particular anomalous
experiences could only emerge in the context of dynamic interaction with the world/others (not the typical setting for the
accounts of introspection).

ivSeveral additional EASE items where we did find affinities in introspectionist reports might also
seem to imply quite severe disturbances of fundamental selfhood, for example, Diminished sense of
basic self (2.1), Distorted first-person perspective (2.2), Psychic depersonalization (2.3), and
Dissociative depersonalization (2.8). These, however, seem to involve a pure fading of or alienation
from self-experience, without necessarily implying a concomitant confusion, disorganization, or loss of
boundaries suggestive of a fundamental loss of orientation. The feeling of being less fully present
seems less severe than the sense of dissolution or fusion with the other. Perhaps this is also the case
with the particular introspectionist report we offer for Confusion with the other (4.1); the example we
quote does not, in any case, suggest a very extreme form of confusion.

vSimeon and Abugel’s book on depersonalization describes “… a somewhat paradoxical state

of mind. On one hand, selfhood … seems to deteriorate, leaving the sensation of ‘no-self.’ Conversely
… a distant heightened consciousness of the self” in the form of a self-conscious monitoring of the
thoughts in one’s head” (Simeon & Abugel, 2006, p. 9). Sass & Parnas (2003, 2007) have suggested
that diminished self-affection and hyperreflexivity may not best be conceived as two distinct processes
in interaction but rather as complementary aspects of a single process—of the very same distortion of
the consciousness that is being described in different words and from a different angle. On this view,
the two phenomena are equiprimordial aspects of a fundamental alteration of the act of awareness. It
may, however, be useful to retain both theoretical perspectives (interacting processes and
complementary-aspects), not unlike light being conceived as both particle and wave. It does seem that
the focus can be placed on one aspect in particular, as when an introspector voluntarily focuses on her
own consciousness; this possibility may be relevant in the formulation of therapeutic interventions.

viInterestingly enough, it is also congruent with Eugen Bleuler’s speculations, namely, that “the
fundamental nature of the schizophrenic affect disturbance (whose “distinctive character” Bleuler
associates above all with “indifference”) is independent of the thinking disturbance [and] that many
disturbances of thinking are consequences of the affect-anomalies” rather than the reverse (Bleuler,
1911, pp. 40f, 365).

viiA holistic and dynamic view may, e.g., offer a more plausible account of many schizophrenic
symptoms than does the well-known, diminished-efferent-feedback theory offered by Frith (Frith et al.,
2000). The efferent-feedback theory applies reasonably well to first-rank symptoms involving alienated
bodily actions. It does not, however, offer a very plausible account of the alienation from thoughts and
emotions that is also common in schizophrenia, since neither thought nor emotion seems likely to
involve the intentions or efferent feedback found in motoric action (Gallagher, 2004; Sass, 2004b). A
more plausible and parsimonious explanation might view the various forms of motoric, thinking, and
emotional alienation as manifestations or sequelae of a generalized disengagement, rather than being
consequences of dysfunction primarily located in the motor-control system (Sass & Parnas, 2003) .

viiiIn recent years various neurobiological hypotheses relevant to disturbances of ipseity or minimal self have been
proposed. Both Hemsley (1987, 1998, 2005) and Sass (1992) have drawn on the notion of malfunction in the hippocampus-
based, “comparator” system in schizophrenia, proposing that such dysfunction results in an automatic, hyperreflexive
awareness and disturbed forms of salience that disrupt the tacit/focal structure essential to normal self-experience. Taylor (In
press) focusing on attentional processes, has proposed a neural-network model of corollary discharge and applied it to
schizophrenic self-disturbance. Nelson et al. (submitted) discuss the relevance for self-disorder of various neurocognitive
theories emphasizing either source-monitoring deficits (including corrollary discharge) or aberrant salience and associated
disturbances of memory, prediction, and attention. Legrand and Ruby (2009, p. 278) have pointed to “perturbed
sensorimotor integration”: disturbance of the integration that normally relates “efferent information to its reafference and
allow[s] any represented object to be related to the representing subject.” Hecht (2010) suggested that dysfunctions in right-
hemisphere circuits subserving “self-corporeal awareness” could be associated with self-disintegration experiences in
schizophrenia (on the role of the right hemisphere, see McGilchrist, 2010).