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Phenomenological Psychopathology and Schizophrenia: Contemporary

Approaches and Misunderstandings

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 Phenomenological
Psychopathology
and Schizophrenia:
Contemporary
Approaches and
Misunderstandings
Abstract: The present paper clarifies key issues in
phenomenology and phenomenological psychopathol-
ogy (especially of schizophrenia) through a critique
of a recent article that addresses these topics. Topics
include (1) Phenomenology’s role in clarifying issues
not amenable to purely empirical methods; (2) The
relationship between a phenomenological approach
(focusing on the subjective life of the patient) and em-
pirical science, including neuroscience; (3) The nature
of self-experience, especially in its pre-reflective form
(“ipseity”—involving “operative intentionality”),
and its possible disturbance in schizophrenia (“hyper-
reflexivity” and “diminished self-affection”); (4) The
relationship between self-disturbance in schizophrenia
and disorders of both temporality and (what Husserl
termed) “passive syntheses”; (5) The role of intentional
or quasi-volitional processes in the perceptual (and
other) disorders in schizophrenia; (6) The nature and
diversity of phenomenology’s potential contribution to
the enterprise of “explanation”; and (7) The meaning
of several concepts: “hermeneutic” or “existential” ap-
proach, phenomenological “reflection,” and “negative
symptoms.”
Keywords: self-disorder, pre-reflective self-awareness,
ipseity, hyperreflexivity, self-affection, phenomenologi-
cal reflection, phenomenological explanation
© 2011 by The Johns Hopkins University Press
Louis Sass, Josef Parnas, and
Dan Zahavi
T
he phenomenological approach to
schizophrenia has undergone something
of a renaissance in Anglophone psychiatry
in recent years. There has been a proliferation of
works that focus on the nature of subjectivity in
schizophrenia and related disorders, and that take
inspiration from the work of such German and
French philosophers as Husserl, Heidegger, and
Merleau-Ponty, and such classical psychiatrists
as Minkowski, Blankenburg, and Binswanger
(Rulf 2003; Sass 2001a, 2001b). This trend in-
cludes predominantly theoretical articles, which
typically incorporate clinical material as well as
reviews of empirical and experimental findings
in psychopathology. Some very recent examples
(since 2000) are studies of self-experience (Sass
and Parnas 2003), temporal experience (Fuchs
2005), delusions and delusional mood (Parnas
and Sass 2001; Fuchs 2005), and psychiatric
classification and diagnosis (Parnas & Zahavi
2002), as well as of values and disturbances of
common-sense (Stanghellini 2001, 2004; Stang-
hellini and Ballerini 2007), affect or emotion
(Ratcliffe 2008; Sass 2007a), negative symptoms
2  ■  PPP / Vol. 18, No. 1 / March 2011
(Sass 2003a), perception (Nelson and Sass 2008;
Sass 2004c; Schwartz et al. 2005), and personhood
and autonomy (Sass 2007b, 2011). A major event
of recent years is the appearance of a series of
empirical studies that demonstrate the reality of
clinical-phenomenal disorders of self-experience
as a core factor in early schizophrenia and that
differentiate diagnosis of schizophrenia-spectrum
from other forms of psychosis or psychopathol-
ogy (Møller and Husby 2000; Parnas et al. 1998;
Parnas et al. 2003; Parnas, Handest, et al. 2005;
Parnas, Møller, et al. 2005).
This trend does not, of course, represent the
first attempt to study subjectivity in schizophre-
nia, nor is it the first time that the continental
phenomenological tradition has been introduced.
Both Mayer-Gross’s famous textbook of psychia-
try (1954) and Fish’s Schizophrenia (Hamilton
1984, originally1962) attempted—nobly but
with limited success—to bring phenomenological
psychopathology into the mainstream of English-
language psychiatry. The work of Karl Jaspers’
disciple, Kurt Schneider, on the “First Rank Symp-
toms” of schizophrenia, was clearly Jaspersian on
the methodological plane, but unfortunately was
interpreted more in an operational than a truly
phenomenological sense. Existence, an anthol-
ogy edited by Rollo May, Ernst Angel, and Henri
Ellenberger (1958), influenced humanistic trends
in American clinical psychology. An important
precursor to the above-mentioned empirical
work is the research on schizophrenia-patients’
experience of the so-called “basic symptoms” of
schizophrenia, carried out since the end of the
1960s by Huber, Klosterkötter, and colleagues in
Germany (Klosterkötter 1988, 1992; Klosterkötter
et al. 1997, 2001).
The most prominent Anglophone attempt to
emphasize the importance of the subjective di-
mension of schizophrenia was R. D. Laing’s first
and finest book, The Divided Self (1959), a work
admired by many who remain skeptical of Laing’s
later contributions. The Divided Self, which uses
ideas from Sartre, Heidegger, Minkowski, and
Binswanger, was something of a bolt from the
blue. Laing’s own interests and influence were soon
diverted in an anti-psychiatric and sometimes ro-
manticizing or otherwise anti-scientific direction.
There was, in fact, very little writing—at least in
English (for French and German contributions, see
Tatossian 1979; Naudin 1997)—specifically treat-
ing the phenomenology of schizophrenia in the
25 years between the publication of Laing’s book
and the appearance, starting in the mid 1980s,
of articles by several authors. These include Sass
(1985, 1987, 1988a, 1990a, 1990b, 1992b)—cul-
minating in his books, Madness and Modernism:
Insanity in the Light of Modern Art, Literature,
and Thought (1992a), and The Paradoxes of
Delusion (1994)—Schwartz and Wiggins (1987;
also Wiggins et al. 1990), Cutting and Dunne
(1989), and Parnas and Bovet (1991; Bovet and
Parnas 1993) . A superb anthology of classical
European contributions on schizophrenia, edited
by John Cutting and Michael Shepherd, appeared
in 1987. Cutting’s (1997) book on brain laterality
had a strong phenomenological component. Now,
however, we are seeing a reasonably broad-based
attempt to bring phenomenological perspectives
to bear on scientific psychiatry, particularly on
schizophrenia, in the now-dominant world of
Anglophone psychiatry and clinical psychology.
These recent developments in phenomeno-
logical psychopathology coincide with significant
trends in both the mental health professions and
the mind sciences. One such trend is a growing
disillusionment, within mainstream psychiatry,
with the extreme emphasis on operationalizable
concepts that began with the advent of DSM
III in 1982. A number of recent editorials by
key figures in North American and European
psychiatry (Andreasen 2007; Maj 2005; see also
Mullen 2007; Parnas et al. 2008) have noted the
relative lack of real scientific progress in the study
of schizophrenia and many other disorders, and
have related this to the loss of validity that can
occur when there is an over-focus on reliability
(operational concepts). These editorials have re-
lated this lack of progress to the loss, which they
lament, of the rich, psychopathological tradition
of European psychiatry, which is strongly (but
not exclusively) rooted in phenomenology. This
disillusionment coincides with a certain malaise,
notable among younger psychiatrists and clinical
psychologists, who are frustrated with the increas-
ingly mechanical role they are expected to play in
 Sass, Parnas, and Zahavi / Phenomenological Psychopathology and Schizophrenia  ■  3
a clinical world defined by bureaucratic demands,
and doubtful about a scientific world dominated
by empirical methodologies that can seem divorced
from significant theoretical issues.
Another, more broad-based trend is the disil-
lusionment with purely neurocentristic, cognitiv-
ist, and computationalist approaches that seems
to be spreading among scholars and scientists
in philosophy and the various sciences of mind,
brain, and behavior. One can find a diverse group
of thinkers including Dreyfus (1979), Varela et al.
(1991), Clark (1997), Gallagher (2005), Zahavi
(2005), Thompson (2007), and Gallagher and
Zahavi (2008), who all in various ways have
criticized the standard picture by insisting on the
need for a renewed focus on subjectivity and on
the embodiment and embeddedness of the human
subject. More recently, the concepts of self and
of self-experience have also gained something of
a renaissance in philosophy, psychology, and the
cognitive sciences (cf. Gallagher and Shear 1999;
Kircher and David 2003; Sass et al. 2000).
The revival of a phenomenological approach
to psychiatry precedes the most recent of these
trends, but fits in comfortably with current de-
velopments. The phenomenological approach
emphasizes the need to delve below superficial
levels of behavioral description or common-sense,
symptomatic descriptions (Parnas and Sass 2008;
Zahavi and Parnas 1998). By offering a richer and
more empirically grounded theoretical approach
to the understanding of abnormal action and
experience, it promises an escape from the opera-
tionalist cul-de-sac that contemporary psychiatry
is in danger of entering. The phenomenological
study of schizophrenia in particular is of signal
importance, not only because of schizophrenia’s
preeminent place in the history of psychiatry,
but also because of the profound, enigmatic, and
potentially revelatory nature of the alterations
of subjectivity and selfhood that it involves. The
increased focus, over the last 15 years, on early
intervention for mental disorders, particularly psy-
chotic disorders, has particularly highlighted the
importance of understanding subjective experience
in pre-schizophrenic and schizophrenic conditions,
which may be relevant for the prediction and
identification of high risk, as well as treatment
efforts (Nelson, Sass, Skodlar et al. 2009; Nelson
et al 2008; Parnas 2005).
A Source of
Misunderstandings
In this context, it is surprising that, very re-
cently, an article should have appeared, addressed
to a general psychiatric audience, in which recent
trends in the phenomenological psychopathology
of schizophrenia and key notions of phenomeno-
logical philosophy are presented in a manner that
is not only confusing, but highly inaccurate. Rath-
er than clarifying matters, the article in question
blurs key theoretical issues and leaves the reader
with the impression that much of phenomeno-
logical psychiatry must be, at its core, an obscure
discipline, incomprehensible and somehow deeply
anti-scientific in nature.
The article in question, published in Current
Opinion in Psychiatry in 2007, was authored
by Aaron Mishara and carries the title “Missing
links in phenomenological clinical neuroscience:
Why we still are not there yet.” Mishara’s critique
primarily targets two articles by Sass and Parnas
(2003, 2007), but also criticizes Sass (1992a),
Parnas (2003), and Zahavi (2005). In his contribu-
tion, Mishara strives to offer an ambitious review
of the relationship between phenomenology and
neuroscience, and to construct a stark opposition
between what he calls “neo-phenomenology” ver-
sus “existential or hermeneutic phenomenology.”
Mishara wishes to associate the first term with the
work of Sass, Parnas, and Zahavi, and the second
term with his own work and that of such figures
as Binswanger, Blankenburg, Conrad, von Weiz-
saecker, Matussek, and Wiggins and Schwartz. As
we argue, however, the distinction in question is
confused and misleading.1
The publication of Mishara’s account is not
entirely to be lamented, however: it articulates
certain misunderstandings that may be widespread
enough to be worth addressing in detail, thereby
giving us the opportunity to correct potential mis-
apprehensions and to explain some basic points
about our own approach and the phenomeno-
logical enterprise more generally. In the present
article, we take his publication as an occasion for
4  ■  PPP / Vol. 18, No. 1 / March 2011
clarifying a number of important issues (sometimes
overlapping) concerning phenomenology and its
role in the study of psychopathology in general
and schizophrenia in particular; in this way, we
offer a discussion that should be of general interest
(see also Gallagher and Zahavi 2008). The issues
treated below are the following:
1. The role of phenomenology in clarifying issues not
amenable to purely empirical methods.
2. The relationship between a phenomenological ap-
proach (focusing on the subjective life of the patient)
and that of empirical science, including neurosci-
ence. (This relationship involves what is sometimes
referred to as the “naturalizing” of phenomenology.)
3. The nature of self-experience, especially in its
pre-reflective form, and its possible disturbance in
schizophrenia.
4. The relationship between self-disturbance in schizo-
phrenia and disorders both of temporality and of
(what Husserl termed) “passive syntheses.”
5. The possible, contributing role of intentional or
quasi-volitional processes in the perceptual disorders
in schizophrenia.
6. The nature—and especially the diversity—of phe-
nomenology’s potential contribution to the enterprise
of “explanation” (broadly understood, in contrast
with “mere” description).
7. We also provide a number of necessary clarifications:
of the meaning of a “hermeneutic” or an “existen-
tial” approach; of the nature and role of “reflection”
in phenomenological accounts; and of the meaning
of the concept of “negative symptoms.”
Mishara’s main justifications for distinguishing
between what he calls “neo-phenomenology” and
“existential/hermeneutic phenomenology” are
two. The fact that his article vacillates between
the two justifications, without distinguishing them
clearly, adds to the confusion. One justification
is largely methodological in nature, having to do
with the status and role of phenomenology. Ac-
cording to Mishara (2007a), whereas (so-called)
“neo-phenomenology claims to circumvent experi-
mental procedures,” the (so-called) “existential
phenomenology” with which he associates himself
is, by contrast, “in an excellent position to supply
hypotheses [and “testable constructs”] for further
experimental study” (pp. 559–60). The second
justification is more substantive: it pertains to dis-
cussions related to the structure of consciousness
and the specific nature of the psychological abnor-
mality in schizophrenia. Here Mishara rejects the
claim that consciousness is as such characterized
by a pervasive but tacit dimension of pre-reflective
self-consciousness, and denies that self-disturbance
is a central core feature of schizophrenia. We con-
sider Mishara’s claims and criticisms to be both
mistaken and misleading. We begin with general
methodological and philosophical issues, namely,
with Mishara’s views on the relevance of phenom-
enology, the notion of “constraint” (a term we
use), and the nature of phenomenological “facts.”
Later we turn to selfhood and other topics.
Nature and Role of
Phenomenology
In his article, Mishara states that Sass and
Parnas (2007) and Zahavi (2005) “proposed that
phenomenology is able to constrain neuroscience
when applied to disorders such as schizophre-
nia” (Mishara 2007a, 559, emphasis added).
He explains this point by stating that, according
to Sass, Parnas, and Zahavi, “phenomenology
provides conclusive knowledge or limits, what
Zahavi calls ‘facts’, about the patient’s subjective
experience” (Mishara’s words). We are said to
believe that these facts could (in Mishara’s words
once again) “be directly incorporated into clini-
cal neuroscience” without requiring any kind of
“experimental procedure.” Mishara continues:
“Rather than furnishing hypotheses or testable
constructs to neuroscience, neo-phenomenology
claims to circumvent experimental procedure by
offering constraints about the nature of (human)
subjectivity with a foundation in philosophical
phenomenology.” He contrasts this with what he
calls the “existential-phenomenological . . . view
that phenomenology provides initial systematic
means” for studying subjectivity and seeks only
to “supply hypotheses for further experimental
study” (p. 560). Mishara’s account is problematic.
Not only does he not grasp the standard meaning
of “constrain” as this term is used in recent dis-
cussions on the relation between phenomenology
and cognitive science, he also fails to capture our
own view of the matter, and ultimately provides a
superficial picture of what the phenomenological
tradition has to offer contemporary psychiatry or
 Sass, Parnas, and Zahavi / Phenomenological Psychopathology and Schizophrenia  ■  5
the project of the “naturalization” of conscious-
ness (the inclusion of consciousness within a
general scientific perspective).
We agree, of course, that a major role for
phenomenology is indeed to supply hypotheses
for further empirical study. However, we reject
the idea that phenomenology’s relevance should
be restricted to this role. Psychiatry, after all, is
faced with a host of philosophical questions—for
example, questions concerning the nature of
rationality, the definition of delusion, and the
possibility of empathy with abnormal states of
mind. To think that such questions can be settled
by clinical trials or other purely empirical methods
would amount to a kind of scientism that would
certainly be rejected by all the major theorists of
phenomenology. Phenomenology, together with
other philosophical approaches, has something
to say on these issues.
Mutual “Constraints”;
Phenomenological “Facts”
To clarify phenomenology’s role within the
mind sciences, we must consider precisely what it
means to say that phenomenology can constrain
neuroscience. When using the term “constrain”
(Sass and Parnas 2007, 73), we cited a well-known
paper by Gallagher (1997): “Mutual enlighten-
ment: Recent phenomenology in cognitive sci-
ence.” In the next paragraph, we cited another
well-known article: “Neurophenomenology,” in
which (the late) Francesco Varela (1996) speaks
of “mutual” or “reciprocal constraints” between
“phenomenological accounts of the structure
of experience and their counterparts in cogni-
tive science” (p. 343). Thompson (2007), who
collaborated extensively with Varela, clarifies:
“By ‘reciprocal constraints’ [Varela] means that
phenomenological analyses can help guide and
shape the scientific investigation of consciousness,
and that scientific findings can in turn help guide
and shape the phenomenological investigations”
(p. 329).
The term “constrain” does not, then, mean
anything like “inhibit” or “dictate to in a rigid or
unilateral fashion.” To say that the facts of subjec-
tive life “constrain” neurobiological explanation
is simply to say that these facts are among those
that an adequate neurobiology must ultimately
take into account. It would seem that any person
with a remotely phenomenological bent would
have to accept this latter point; indeed, it should
even be accepted by reductionists who believe that
consciousness is entirely dependent on the biologi-
cal substrate. After all, conscious experience is “an
explanandum in its own right” (Chalmers, 1995,
209). And “without some idea . . . of what the
subjective character of experience is, we cannot
know what is required of physicalistic theory”
(Nagel 1979, 71).
This does not, by the way, rule out the possibil-
ity that cognitive or neurobiological findings might
actually suggest new ways of thinking about and
describing aspects of phenomenal experience. On
the contrary, we (like both Gallagher and Varela)
are precisely arguing that the influence goes both
ways, that is, it would also be a question of letting
phenomenology profit from—and be challenged
by—empirical findings.2
When it comes to cashing out this idea about
mutuality or reciprocity in more concrete detail,
various complementary proposals are currently on
offer. One proposal, entitled neurophenomenol-
ogy, was initially proposed by Varela (1996) and
subsequently developed by Lutz (2002), Lutz and
Thompson (2003), and Thompson (2007). Here,
the basic idea is to train experimental subjects to
gain greater intimacy with their own experiences.
Subsequently, the subjects are asked to provide
descriptions of these experiences using an open-
question format, thus minimizing the imposition of
predetermined theoretical categories. The ensuing
descriptive categories are subsequently validated
intersubjectively and then used to interpret corre-
lated measurements of behavior and brain activity.
At the same time, however, it is also suggested that,
say, a consideration of insights from neurobiol-
ogy and dynamical systems theory can help us to
improve and refine the classical phenomenological
analyses (see Varela 1996; Thompson 2007). How
is that supposed to happen?
The basic idea is quite simple: let us assume,
for instance, that our initial phenomenological
description presents us with what seems to be a
simple and unified phenomenon. When studying
6  ■  PPP / Vol. 18, No. 1 / March 2011
the neural correlates of this phenomenon (e.g.,
with magnetic resonance imaging), we discover
that two quite distinct mechanisms are involved,
mechanisms that are normally correlated with
distinct experiential phenomena, say, perception
and memory. This discovery might motivate us to
return to our initial phenomenological description
to see whether the phenomenon in question is truly
as simple as we thought. Perhaps a more careful
analysis will reveal that it harbors a concealed
complexity. However, it is important to empha-
size that the discovery of a significant complexity
on the subpersonal level—to stick to this simple
example—cannot by itself force us to refine or
revise our phenomenological description. It can,
however, serve as motivation for further inquiry.
More recently, Gallagher (2003) has made a
slightly different proposal that he has entitled
front-loaded phenomenology. Rather than focus-
ing on training experimental subjects, the idea is
to start with the experimental design, and to allow
insights developed in phenomenological analyses
to inform the way experiments are set up. To take
a concrete example, let us consider the study of
self-consciousness within developmental psychol-
ogy, where the so-called “mirror-recognition task”
has occasionally been heralded as the decisive test
for self-consciousness (Lewis 2003). A phenom-
enological approach suggests moving beyond
reliance on mirror-recognition alone—which phe-
nomenologists would typically consider evidence
for the presence of a rather sophisticated form of
self-consciousness—and attempting to detect the
presence of more primitive forms of propriocep-
tive body awareness (Zahavi 2005). To front-load
phenomenology, however, does not imply that one
simply presupposes or accepts well-rehearsed phe-
nomenological results. Rather, it involves testing
those results and, more generally, incorporates a
dialectical movement between previous insights
gained in phenomenology and preliminary trials
that will specify or extend these insights for pur-
poses of the particular experiment or empirical
investigation (Gallagher and Zahavi 2008).
Once one grasps the actual (and, in this dis-
course, standard) meaning of “constrain,” one
immediately sees that the opposition Mishara
poses—between phenomenology serving as a
“constraint” versus as a generative source of hy-
potheses—is entirely spurious. Indeed, it is only
because experience is implicated in the overall
causal/explanatory nexus (which is to say, that
it serves as a “constraint”—according to the
standard understanding of “constrain”) that it
could possibly be relevant for hypothesizing.
It is precisely this kind of “mutual constraint”
(between empirical data on neurodevelopmental
problems, phenomenological data on initial stages
of the illness, and neurobiological data concern-
ing ontogenesis of cortico-cortical connectivity)
that led one of the present authors to propose,
in 1996, a binding problem associated with the
phenomenological core features of schizophrenia,
within a distributed mis-connectivity model of
neurodevelopmental vulnerability to the illness
(Parnas et al. 1996, 2001, 2002).
Before leaving the issue of methodological
“constraints,” it is interesting to consider the
peculiar way in which Mishara tries to establish
our supposed commitment to the idea that phe-
nomenology can provide conclusive and substan-
tive knowledge about the nature of the mind that
would determine the boundaries of neuroscientific
research in a unidirectional manner. The textual
evidence Mishara offers consists in only three
quotations and references, all to works by Zahavi
(2004, 343; 2005, 136; see Mishara 2007a, 559).
These Zahavi references are quotations taken out
of context or tendentious attempts to paraphrase.
Indeed, Mishara himself seems to recognize this
last point, for he immediately goes on to admit
(quite correctly) that “Zahavi himself does not
endorse this position.” No quotations from Parnas
or Sass are offered. But where, then, is the evidence
that any of the three of us actually adopts the view
Mishara attributes to us?
A closely related misunderstanding concerns
Mishara’s characterization of our understanding
of phenomenological “facts.” Nowhere do we say
that phenomenological methods generate abso-
lutely precise and certain descriptions that cannot
possibly be criticized or improved upon—that is,
that are not defeasible, in the sense of being in prin-
ciple open to revision or valid objection. It is odd,
then, to find Mishara claiming for himself the label
of “hermeneutic phenomenology.” If hermeneutic
 Sass, Parnas, and Zahavi / Phenomenological Psychopathology and Schizophrenia  ■  7
phenomenology means a phenomenology that
rejects aspiration to apodictic certainty in favor of
a more humble understanding of the nature of the
phenomenological enterprise (i.e., as an enterprise
that requires interpretation rather than offering
infallible description), then our work—like that
of many others—certainly falls under the rubric
“hermeneutic.”3 Mishara (2007a) has no basis for
claiming that we believe our phenomenological
accounts to be “immune to error” (p. 561). Nor
does Mishara offer any textual evidence to sustain
his claim that “neo-phenomenology” “claims to
circumvent experimental procedures.” Actually, a
considerable amount of empirical work has been
done and is underway to test the validity and rel-
evance of our phenomenologically inspired model
of schizophrenia (see further below).
The Ipseity- or Self-
Disturbance (IHM) View
The second major way in which Mishara distin-
guishes between what he calls “neo-phenomenolo-
gy” and “existential phenomenology” is by saying
that, whereas the former postulates disorders of
selfhood (ipseity-hyperreflexivity model [IHM])
as the core of psychopathology of schizophrenia,
the latter emphasizes, rather, disorders of “passive
syntheses,” binding, temporalization, and percep-
tual organization. In his article, the IHM becomes
an object of Mishara’s passionate attack.4 Here,
however, Mishara misunderstands most of the key
elements of our ipseity-, self-disturbance, or IHM
view, which are clearly laid out in the two articles
he targets (Sass and Parnas 2003, 2007). Briefly,
this model claims that instability of pre-reflective
self-awareness is a core, generative feature of
schizophrenia; the disorder affects what in cogni-
tive literature is called minimal or core self. Here
are some key passages from our account (Sass and
Parnas, 2007, 68–70, unless otherwise noted).
IPSEITY DISTURBANCE: [T]he core abnormality in
schizophrenia is a particular kind of disturbance of
consciousness and, especially, of the sense of self or
ipseity that is normally implicit in each act of aware-
ness. (Ipseity derives from ipse, Latin for “self” or
“itself.” Ipse-identity or ipseity refers to a crucial sense
of self-sameness, of existing as a subject of experience
that is at one with itself at any given moment [Henry
1973; Ricoeur 1992; Zahavi 1999].) This self or ipseity
disturbance has two main aspects or features that may
at first sound mutually contradictory, but are in fact
complementary. The first is hyper-reflexivity—which re-
fers to a kind of exaggerated self-consciousness, that is,
a tendency to direct focal, objectifying attention toward
processes and phenomena that would normally be “in-
habited” or experienced as part of oneself. The second
is diminished self-affection—which refers to a decline
in the (passively or automatically) experienced sense
of existing as a living and unified subject of awareness.
“Ipseity disturbance” also involves a concomi-
tant disturbance of the field of awareness that we
label “disturbed hold” or “grip” (Sass 2004c; Sass
and Parnas 2003, 436).
HYPERREFLEXIVITY: The notion of hyperreflexivity
includes some fairly volitional, quasi-volitional, or intel-
lectual processes, which we term “hyper-reflectivity.”5
However: the hyperreflexivity in question is not, at
its core, an intellectual, volitional, or “reflective”
kind of self-consciousness; nor is it merely an intensi-
fied awareness of something that would normally be
taken as an object (e.g., in the case of an adolescent’s
self-consciousness about his or her appearance). Most
basic to schizophrenia is a kind of “operative” hyper-
reflexivity that occurs in an automatic fashion. This
has the effect of disrupting awareness and action by
means of an automatic popping-up or popping-out of
phenomena and processes that would normally remain
in the tacit background of awareness (where they serve
as a medium of implicit self-affection), but that now
come to be experienced in an objectified and alienated
manner (see Merleau-Ponty 1962, p. xviii re: “operative
intentionality”—fungierende Intentionalität).
Phenomenally speaking, hyperreflexivity can
be manifest as an emergence or intensification of
experience as such or a prominence of proximal
over distal aspects of stimuli (see e.g. Sass 1994 re:
“phantom concreteness”), or as focal awareness
of kinesthetic bodily sensations, “inner speech,”
or the processes or presuppositions of thinking.
DIMINISHED SELF-AFFECTION involves diminished
sense of being a vital, first-person perspective on the
world. It pertains to a fundamental sense of existing as
an experiencing entity, . . . as a kind of implicit subject-
pole that would normally serve as the vital center-point
of subjective life. . . . [One] patient with schizophrenia
described the condition of lacking this crucial if inef-
fable self-affection that is essential to normal ipseity: “I
was simply there, only in that place, but without being
present.” (Blankenburg 1971, 42; 1991, 77)
8  ■  PPP / Vol. 18, No. 1 / March 2011
The hyperreflexivity and diminished self-
affection central in schizophrenia involve distinc-
tive disruptions of the tacit-focal structure of
experience.
[T]hese two features are best conceptualized not as
separate processes but as mutually implicative aspects
or facets of the intentional activity of awareness. Thus,
whereas the notion of hyperreflexivity emphasizes the
way in which something normally tacit becomes focal
and explicit, the notion of diminished self-affection
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 self-
hood. (Sass and Parnas 2003, 430)
It makes little sense, incidentally, to character-
ize our ipseity or IHM view by using a simple
opposition between “too much” versus “too
little” self-experience—as do Lysaker and Lysaker
(2008a, 32) in their interesting study of dialogical
dimensions of schizophrenia. On our view, there
is a sense in which the person with schizophrenia
has both too little sense of self (diminished self-
affection) and too much self-consciousness (hy-
perreflexivity). Selfhood is too complex an issue
to lend itself to unidimensional characterization
and requires, among other things, sophisticated
phenomenological analysis (Zahavi 2005). Before
elaborating on theoretical issues, we outline recent
empirical work that supports our self-disorder
position.
Empirical Support for the
Ipseity-Disturbance (IHM)
View
Like virtually all scientific work, the IHM is
partly rooted in theoretical work, including such
psychopathological studies as Sass (1987, 1992a,
Chapter 7) and Spitzer (1988), as well as philo-
sophical work including Henry (1973, 1975) and
Zahavi (1999), among many others. It is important
to point out, however, that our phenomenological
claims concerning anomalous self-experience as
a core feature of schizophrenia-spectrum disor-
ders, is not a product of arm-chair theorizing or
anecdotal discussion, as Mishara portrays it, but
derives, in large measure, from years of clinical
experience and considerable empirical research.
This includes descriptive and follow-up studies
of different diagnostic categories (Vollmer-Larsen
2008), predictive work on early psychosis (see
below), and also some experimental work correlat-
ing anomalies of experience with neurocognitive
measures (Parnas et al. 2001).
Thus, in contemporary psychiatry the notion
of self-disorders as the initial, core features of
schizophrenia was almost simultaneously first
reported from a Danish study of 19 first-onset
schizophrenia-spectrum patients (Parnas et al.
1998) and a Norwegian study of 20 first admitted
schizophrenia patients (Møller and Husby 2000).
These findings were subsequently supported in a
longitudinal study of 155 first admitted patients,
of whom about 60% suffered from schizophrenia
or schizotypal disorders (Handest and Parnas
2005; Parnas, Handest, et al. 2005). These pa-
tients have been reassessed at a 5-year follow-up,
showing that self-disorders are predictive of new
incident cases of schizophrenia spectrum disorders
(Vollmer-Larsen 2008). A separate study compar-
ing residual schizophrenia patients with remitted
psychotic bipolar illness patients demonstrated
that self-disorders were characteristic of schizo-
phrenia (Parnas et al. 2003), suggesting a certain
specificity to schizophrenia spectrum disorders.
Currently, several other samples are being studied
(Skodlar et al. 2008), and data analyses are being
conducted on opportunistic samples of high-risk
and genetic research performed in Copenhagen.
Similar research projects and studies on early
identification of schizophrenia are being under-
taken in several European countries, Israel, and
Australia. A phenomenologically oriented, semi-
structured psychiatric interview—the EASE scale
(Parnas, Møller, et al. 2005)—has been developed
and shown to achieve good inter-rater reliability
(Vollmer-Larsen et al. 2007). The EASE scale’s
description of self-disorders seems to have satisfied
a clinical void as testified by the fact that the scale
has so far been translated into seven languages.
In summary, there is now considerable empirical
evidence available that shows “trait-like” presence
of self-disorders in the schizophrenia spectrum
disorders. The measures of self-disorder are now
being included in studies targeting early recogni-
tion and treatment of schizophrenia.
 Sass, Parnas, and Zahavi / Phenomenological Psychopathology and Schizophrenia  ■  9
In his article, Mishara omits all the (then
available) empirical studies mentioned. Oddly,
however, he does mention one vignette from a
conceptual publication by Parnas and Handest
(2003), only to warn his readers that “we must
be careful not to draw conclusions from anecdotal
self-reports” (Mishara 2007a, 565, italics added).
The Notion of Ipseity or Pre-
Reflective Self-Awareness
Mishara (2007a) also gets the central theoreti-
cal features of our view on self-disorder (ipseity
disturbance) wrong in various ways. Consider
his statement that we view “the core deficit in
schizophrenia to be on the level of intentionality
of fully constituted objects and self” (p. 560, italics
added). This is incorrect.
The IHM model claims that a central phenom-
enon of the schizophrenia spectrum disorders is
a disturbance in pre-reflective self-awareness (or
ipseity, from Latin: ipse = self, itself), that is, a
disturbance of the very mineness or first-person
perspective that characterizes any experience.
What do we mean by first-person perspective,
by pre-reflective self-awareness, and what does the
mineness of experience refer to?
When we refer to the mineness of experience,
we are not referring to a specific content of experi-
ence, like yellow, or being salty or spongy. We are
referring to the first-personal presence, givenness-
to-me, or perspectival ownership of experience,
to the fact that experience feels like something
for somebody. For a subject to own something
in a perspectival sense, is for the experience in
question to present itself in a distinctive manner
to the subject whose experience it is. Ipseity could
be defined as the self-presence (the presence to
itself) of the self-as-subject. These pre-reflective
aspects of experience contribute to what we (and
others) call the minimal self (cf. Zahavi 1999,
2005).6 We admit, however, that an analysis of
the minimal self is something of an abstraction
as long as it fails to include the temporal dimen-
sion (more about this in a moment). The basic or
minimal self-experience to which we refer is not
something willed or explicitly assumed, nor does
it involve reference to a full-fledged self, as Mis-
hara seems to think. It is a passive and automatic
process that must be regarded as the diachronic
and synchronic prerequisite or precondition for
any more substantial or elaborate sense of self.
Having or embodying a first-person perspec-
tive does not, incidentally, require being able to
articulate it linguistically. Indeed, it provides an
experiential grounding of the latter possibility
All the major figures in phenomenology—includ-
ing Husserl, Merleau-Ponty, Sartre, and Michel
Henry—considered a minimal form of self-con-
sciousness to be an integral part of experience.
This, for instance, is what Sartre meant when he
declared that self-consciousness constitutes the
mode of being of intentional consciousness (Sartre
1956, liv).
The Issue of Phenomenological
“Reflection”
Mishara (2007a) claims that Zahavi’s (2005)
argument for the existence of a pervasive pre-
reflective self-awareness (ipseity) is tenuous
because of numerous conceptual problems. He
then mentions the following difficulty: there is
no way of knowing whether what I describe in
reflection was truly there before reflection, because
the reflecting itself may have somehow added or
inserted precisely those aspects I was looking for
(Mishara 2007a, 561). As is widely acknowl-
edged, recognition of this methodological or
epistemological problem is an utter commonplace
in phenomenological discussion. It was broached
by Husserl himself (see, e.g., his discussion with
H.J. Watt in §79 of Ideas I [Husserl 1982]) and
was later discussed by numerous authors within
the phenomenological tradition (cf. Chapter 4 in
Zahavi 2005).
All the phenomenologists recognized that,
rather than merely copying or repeating the origi-
nal experience, reflection actually transforms it, or
as Husserl explicitly admitted, it alters it (Husserl
1950, 72; 1987, 89). Husserl spoke of reflection as
a process that discloses, disentangles, explicates,
articulates, and accentuates (herausgehoben) all
those components and structures that were implic-
itly contained in the pre-reflective experience (Hus-
serl 1984, 244; 1966a, 129; 1966b, 205, 236).
10  ■  PPP / Vol. 18, No. 1 / March 2011
One might see the phenomenological position
as being situated between two extremes. On one
hand, we have the view that reflection merely cop-
ies or mirrors pre-reflective experience faithfully;
on the other, the view that reflection distorts lived
experience irredeemably. The middle course is to
recognize that reflection involves both a gain and
a loss. For Husserl, Sartre, and Merleau-Ponty,
reflection is constrained by what is pre-reflectively
lived through; it is answerable to experiential
facts and is not constitutively self-fulfilling. But
at the same time, they recognized that reflection
qua thematic self-experiences does not simply re-
produce the lived experiences unaltered, and that
this may be precisely what makes reflection cogni-
tively valuable. As Husserl put it, in the beginning
we are confronted with a dumb experience that
through reflection must then be made to articulate
its own sense (Husserl 1950, 77; Merleau-Ponty
1945, 207).
A widely held view, to which we adhere, then,
is that phenomenological reflection does contain
the potential for a kind of iatrogenic error, and
that this is one reason why its results cannot be
considered to have the status of apodictic certi-
tude. This does not, however, preclude the value
of phenomenological reflection so long as this
reflection is imbued with a self-critical awareness
of precisely such dangers. Moreover, as Husserl
argued, any skeptical claim to the effect that reflec-
tion necessarily falsifies the lived experiences and
that they consequently elude it completely is self-
refuting: after all, this very claim must presuppose
knowledge of those very same lived experiences,
and how should one obtain that except through
some kind of reflection (Husserl 1982, §79)?
Thus, rather than adding new, distorting
components and structures to the experience
reflected upon, a reflection might, at best, simply
be accentuating structures already inherent in the
lived experience. But how does this apply to the
specific issue of the first-personal givenness of ex-
perience that we were just discussing? To claim, as
Mishara does, that it is reflection that creates the
distinctive first-personal quality of experience, that
experience lacked such qualities before becoming
the object of a first-person thought, is to attribute
quite exceptional powers to reflection. Such a
view is not, however, unprecedented. Indeed, on
one reading, this is precisely the position adopted
by many “higher-order thought” theorists in
contemporary analytic philosophy of mind. Some
of them have bitten the bullet and accepted the
consequences of their position regarding the as-
cription of phenomenal consciousness to creatures
that lack the capacity for higher-order first-person
thoughts. Carruthers, for instance, holds the view
that animals (and children under the age of three)
are simply blind to the very existence of their own
mental states; and that there is, in fact, nothing at
all that it is like for them to feel pain or pleasure
(Carruthers 1998, 216). Such a position certainly
seems counterintuitive. And as Carruthers himself
notes, it might have profound implications for
our moral attitudes toward animals and animal
suffering (Carruthers 1996, 221). Is this the kind
of position that Mishara is endorsing?
Self-Awareness and
Absorption in the World
Throughout his writings, Husserl, the founder
of phenomenology, is very explicit in arguing that
self-consciousness—rather than being something
that only occurs during exceptional circumstances,
namely, whenever we direct explicit attention to
our conscious life—is a feature characterizing
normal human subjectivity as such, no matter
what worldly entities the subject might otherwise
be conscious of and occupied with. As Husserl
for instance puts it in Zur Phänomenologie der
Intersubjektivität II, “To be a subject is to be in
the mode of being aware of oneself” (Husserl
1973, 151). It is clearly erroneous, then, for Mis-
hara to take Husserl as supporting his claim that
world-absorption and self-awareness are mutually
exclusive (Mishara 2007a, 560–1). When Husserl
talks about Selbstverlorenheit in connection with
our intentional absorption in the world, he does
not refer to a complete loss of self, as Mishara
(2007a) seems to think (p. 561), but to the ab-
sence of a thematic or reflective self-experience
(see Zahavi 1999).
Heidegger—a key figure for “hermeneutic” and
“existential” trends in phenomenology—is also
referring to pre-reflective self-experience when
 Sass, Parnas, and Zahavi / Phenomenological Psychopathology and Schizophrenia  ■  11
he argues that the self is present and implicated
in all of its intentional (world- or object-directed)
comportments; that the co-disclosure of the self
belongs to intentionality as such (Heidegger 1989,
225). Heidegger also wrote that every worldly
experiencing involves a certain component of
self-familiarity, and that every experiencing is
characterized by the fact that “I am always some-
how acquainted with myself” (Heidegger 1993,
251; 1989, 225).
Mishara’s draws a supposed contrast between,
on one hand, Sass and Parnas’s (2003) claim that
“we are self-aware through our practical absorp-
tion in the world of objects” (p. 430), and, on
the other hand, what he calls the “existential
phenomenological” notion that what he terms
“self-awareness” and “absorption in experience”
are “mutually exclusive” (Mishara 2007a, 560).
There is, in fact, no contrast here at all: it is just
that two different notions of self, both clearly
distinguished in much of the phenomenological
tradition, are being conflated by Mishara. As
Sass and Parnas emphasize, the self-awareness
(ipseity) to which they primarily refer is not self-
as-intentional-object-of-experience, but rather
the implicit or pre-reflective self-awareness of the
self-as-subject—which most phenomenologists see
as a concomitant of object awareness and a pre-
requisite of reflective self-awareness (for details see
Zahavi 1999; 2005). Thus, Paul Ricoeur (1966,
60–1), the most prominent synthesizer of phe-
nomenology and hermeneutics, criticizes the view
that “consciousness turned toward the other [is]
unconscious of itself” and that “self-consciousness
[he is referring to pre-reflective self-consciousness
or ipseity] corrod[es] the consciousness which is
directed toward something other than itself.”
It is noteworthy that, here again, there seems to
be slippage in Mishara’s treatment of the issues:
at one point, he seems to acknowledge the non–
object-like and (in a sense) non-representational
nature of ipseity: citing Sass and Parnas (2007), he
notes that the IHM model speaks of a “disruption
of a tacitly functioning operative intentionality
which forms the background of consciousness”
(Mishara 2007a, 560). But then, when he at-
tempts to argue against ipseity’s fundamental role
in experience, he clearly conflates ipseity with
an object-like or representational mode—what
he now calls “self-awareness (in terms of self-
reference)” or an “image-representation of self,
that is, having a self, a “me,” rather than being a
self, an ‘I’” (p. 560). Yet the distinction between
pre-reflective self-experience and the experience
of self-as-object is at the very heart of the articles
by Sass and Parnas (2003; 2007) that Mishara
criticizes and a book by Zahavi that Mishara also
cites (Zahavi 2005; also 1999).
In summary: the IHM does not focus on distur-
bance of a fully constituted self or self-as-object
nor of fully constituted object, nor does it speak
of a focal, thematic intentionality. Rather, we
speak of disturbed or unstable preconditions for
the normal, concordant, and smooth articulation
of the self-object correlation. Once one grasps this
key point, one sees that the dynamic, ever-shifting
qualities of self-experience that Mishara (2007a)
rightly emphasizes (p. 563) are, in fact, perfectly
consistent with what we mean by ipseity. It is
obvious that the pre-reflective self would not be a
static entity, but something more like an ongoing
process that must exist and constantly reconstitute
itself in time.7
“Passive Syntheses” and
“Operative Intentionality”
As a supposedly “existential-phenomenological
response” or alternative view, Mishara (2007a)
proposes that the primary disorder of schizophre-
nia resides in “passive syntheses” of “pre-attentive
binding between subcomponents of the self (e.g.,
I, me, and mine. . .)” (p. 562). (He does not, how-
ever, say much about how this would cash out in
fundamental clinical features of schizophrenia.)
Mishara wants to offer the reader a polarized
choice between ipseity, on one hand, and passive
synthesis or temporality, on the other, as potential
candidates of a generative disorder in schizophre-
nia. In this way, he falsely reifies phenomenological
concepts into mutually exclusive natural-kind–like
categories, while failing to grasp key distinctions
between levels of discourse and of psychological
reality.
Mishara thus fails to grasp that, when we speak
of such phenomena as schizophrenic autism, lack
12  ■  PPP / Vol. 18, No. 1 / March 2011
of self-affection, operative hyperreflexivity, lack
of common sense, loss of natural self-evidence,
diminished feelings of immersion, perplexity, and
other aspects of the ipseity disturbance, we are
also referring to the phenomenal manifestations
of disturbed passive synthetic processes. Our use
of the term “operative intentionality,” coined by
Husserl and elaborated by Merleau-Ponty, refers
precisely to the tacit, pre-objectival, largely “pas-
sive” processes that found the coherence of the
experiential field of the embedded subject (Sass
2003a , 157; Sass and Parnas 2007, 69, 82–85).
Mishara (2007a) does in one passage (p. 560) note
our use of the phrase “operative intentionality,”
but then ignores this key point when he goes on
to criticize our position.
In a recent article by Uhlhaas and Mishara
(2007) our IHM or ipseity-disturbance approach
is described as being essentially a top-down model
that emphasizes “deficits in higher cognitive func-
tions” or “an excess of rationality and reflective-
ness” (pp. 142–3, 150). Uhlhaas and Mishara
describe Sass (1992a) and Sass and Parnas (2003)
as “claim[ing] that fragmentation and destruction
of the self come from above by means of an excess
of rationality or hyper ‘self-consciousness’” (p.
146). As summaries of the IHM or Sass’s current
or earlier writings, these are clearly misreadings.
Hyperreflexivity certainly can involve intel-
lectual or volitional processes, which can indeed
have pathogenetic importance. (The parallel
with modernism makes these processes especially
salient in Sass’s Madness and Modernism.) But
contrary to what Uhlhaas and Mishara imply, both
Sass and Sass and Parnas have stated explicitly
that hyperreflexivity should not be equated with
intellectual or volitional processes of a “higher”
nature—which might better be termed “hyper-
reflectivity”—but also involves the popping out,
in a kind of automatic fashion, of phenomena that
would not normally be in the focus of awareness.
Sass (2003b, 249) and Sass and Parnas (2007, 69,
82–85) term this latter process “operative hyper-
reflexivity.” They state that the operative type is
likely in fact to be more primary in a pathogenetic
sense than is the reflective type of hyperreflexivity
(p. 83),8 “affecting what Blankenburg (following
Husserl) calls the ‘fundamental receptivity’ of the
automatic or ‘passive syntheses’ that structure
the basic act of consciousness and constitute a
person’s most immediate and fundamental rela-
tionship to self and to world” (Sass 2003a, 167,
157). Earlier Sass (1992a) noted the possibility of
neurophysiological “disturbance of those ‘lower’
and more automatic processes that normally al-
low for spontaneity while providing a sense of
natural embeddedness in the practical and social
world” (p. 396).
Mishara’s characterization of our position as
one that views schizophrenia as essentially deter-
mined by “higher” or volitional processes is thus
a misrepresentation of what is, in fact, an attempt
to demonstrate the complexity of the interaction
of intentional/reflective and non-intentional or
“operative” factors.
In a recent article, Lysaker and Lysaker (2008b)
adopt this mistaken view, portraying Sass as plac-
ing exclusive emphasis on the “withering” effect
of an “inward gaze of radical intensity” (p. 335).
As their citations and phrasings indicate, their
discussion of Sass’s views derives largely from a
single, second-hand source: a paper by Mishara
(2004). They cite only one paper by Sass (2000),
while ignoring passages from that paper that
contradict theirs and Mishara’s portrayal. The
Lysakers’ uncritical acceptance of Mishara’s inter-
pretation mars the treatment of phenomenology in
their otherwise useful review article, and seems to
have lead them into absurdities of which they are
perhaps unaware. Thus, they portray Parnas and
Sass as having incompatible views when, in reality,
Parnas and Sass have been close collaborators for
ten years, with congruent views as co-authors of
papers on self-disorder and the phenomenology
of schizophrenia.
Also misleading is the Lysakers’ (2008b, 335)
reference to what they call “Mishara’s suggestion”
(emphasis added) regarding the core pathogenetic
role of disruption of “bodily systems that allow
persons, without self-conscious effort, to suddenly
attend to novel information.” In fact, the pathoge-
netic significance (for schizophrenic cognition) of
disruption of automatic processes that normally
orient attention toward the novel, is perfectly
explicit in work by Hemsley and Gray, who em-
phasize disorders of the hippocampus-based
 Sass, Parnas, and Zahavi / Phenomenological Psychopathology and Schizophrenia  ■  13
“comparator system” (Hemsley 1987, 2005). Also
mistaken is the Lysakers’ presentation of this view
as somehow antithetical to Sass’s position (also
implied by Uhlhaas and Mishara 2007, 150, who
cite Hemsley). Indeed, this view is perhaps the
main neurocognitive hypothesis Sass singles out
for its compatibility with his own position (see
references in Sass 1992a; 2007a, 83, and other ar-
ticles).9 In Madness and Modernism, Sass (1992a,
228) discusses the role such factors might play
in self-fragmentation and bodily alienation—the
very point the Lysakers ascribe to a 2005 publica-
tion by Mishara. The compatibility of Hemsley’s
comparator approach with Sass is acknowledged
in Hemsley (1998).10
Temporality and Self-
Experience
Here we will not attempt to discuss, in any
detail, the relationship between temporality and
self-experience. Clearly, however, there is some-
thing absurd, from a phenomenological stand-
point, about treating self-experience and temporal
experience as if these were distinct faculties of
the mind—as Mishara (2007a, 565) seems to do
when arguing that temporality is more basic than
self in the schizophrenia disturbance. Indeed the
central point of Zahavi’s influential interpretation
of Husserl’s writings on time was precisely that
the latter’s notion of inner time-consciousness
amounts to a form of pre-reflective self-awareness
(Zahavi 1999, 2003a, 2003b).
The temporal distortions of schizophrenia have
long been recognized, in both the experimental
and phenomenological literature on schizophrenia
(e.g., Bovet and Parnas 1993; Minkowski 1927;
1933/2005). Before being convinced that tempo-
rality in particular is playing a foundational role
in the pathogenesis of schizophrenia, it would be
necessary to show (at least) that (A) the disorder is
reasonably specific to schizophrenia in particular
and (B) the temporal abnormality is more striking
than other abnormalities in schizophrenia (thereby
addressing some of the concerns raised long ago
by Chapman and Chapman 1973). Mishara has
not addressed either of these concerns.
By now it should be clear that in his article,
“Missing links in phenomenological clinical
neuroscience,” Mishara tends to oversimplify,
misrepresent, and offer misleading polarization
of alternatives. So far we have focused primar-
ily on his polemical treatment of our own work.
Oversimplification and polarization are also
characteristic of his conceptualizations of the
possible underlying psychopathology of schizo-
phrenia. Both tendencies emerge with clarity if
we compare Mishara’s with Sass’s discussion of
the German Gestalt psychiatrist Matussek’s ideas
about prodromal features (including the so-called
Wahrnehmungstarre) and of the relevance of
Wolfgang Blankenburg’s work for understanding
negative symptoms, and also Mishara’s attack on
Sass and Parnas’s (2007) exploration of the pos-
sible explanatory relevance of phenomenology.
Die Wahrnehmungstarre and
the Existential Complexity of
Schizophrenic Symptoms
In Madness and Modernism (1992a, Chapter
2), Sass uses the phrase “Truth-taking stare” to
capture the phenomenon described in German
psychiatry by the term Wahrnehmungstarre. Wah-
rnehmungstarre refers to the fixed gaze that can be
especially common in early phases of schizophre-
nia; it would typically be translated as “rigidity
of perception” (as both Sass 1992a, 423, n4 and
Mishara 2007a, 564n note). In his article, Mishara
claims that Sass’s use of the phrase “truth-taking”
is a “fanciful but apocryphal” (p. 564) mistransla-
tion, which suggests that Sass misunderstands the
meaning of the German term Wahrnehmungstarre,
which means “perceptual rigidity”; and that this is
one indication of what Mishara calls a gross lapse
of “textual/philological accuracy” that should
call Sass’s scholarly reliability and hermeneutic
competence into question. Mishara goes so far as
to accuse Sass of “overlook[ing] the fundamental
hermeneutic principles” by “granting [himself]
the license to slip at these basic levels of textual-
philological accuracy (e.g., translation, historical
context, or careful and correct citing of sources)”
(p. 564f).
It is not difficult to show that the misunder-
standings and textual/philological “lapses” are
entirely Mishara’s. This should be apparent from
14  ■  PPP / Vol. 18, No. 1 / March 2011
Mishara’s apparent failure to take into account the
following endnote, which is appended to Sass’s first
mention of the term Wahrnehmungstarre: “War-
hrnehmung means ‘perception’ or ‘observation’
in German. I have chosen to translate this in an
unusually literal way—as ‘truth-taking’—because
this seems better to capture the schizophrenic
experience in question” (Sass 1992a, 44, 423).
Wahr in German means “true,” as in the
term “Wahrheit,” meaning “truth.” Nehmung is
derived from “nehmen” as in “to take.” (Starre
means “stiffness” or “rigidity.”) The above-quoted
note makes it perfectly obvious that Sass was de-
liberately and overtly using a kind of poetic license
(in accordance with the etymology of the parts of
the word, and with full knowledge of the standard
meaning of Wahrnehmung) to convey a sense of
the patient’s experience of a kind of revelation that
can accompany the fixed or rigid stare common
in prodromal schizophrenia. There is, incidentally,
something of a tradition of this kind of creative
etymology within phenomenology, especially in
the later Heidegger.
Mishara commits other “textual/philological
lapses” against both Sass and Matussek. At one
point, Mishara (2007a, 564) criticizes Sass for
not following Matussek’s lead more closely, and
thereby failing to appreciate the role of “rigidity
or attentional capture” while overemphasizing
instead what Sass calls a “mode of deliberateness
and hyperawareness.” In fact, Sass (1992a, 72,
427f, notes 43, 44) criticizes Matussek’s (Gestalt)
theoretical account for downplaying the role of
intentionality, while noting that, in his clinical de-
scriptions, Matussek emphasizes both intentional
and non-intentional aspects. Matussek (1987)
does say that the schizophrenic “is held captive by
the object”; but he also writes, “The schizophrenic
. . . is capable, to a much greater degree, of fixing
his attention on an isolated object,” noting the
patient’s “ability” and “pleasure” in doing so (p.
93–4, emphasis added).
Mishara’s characterization of Sass displays a
lack of familiarity with the arguments put forward
in the works he criticizes. In writing on schizo-
phrenia, Sass never denies the role of deficien-
cies, dysfunctions, or other forms of “affliction.”
Indeed, Sass (1992a, 73) states that it would be
“absurd” to claim that schizophrenic states are
entirely under the patient’s control, and “foolish
to view schizophrenia as purely volitional and
entirely self-aware” (p. 114).
Mishara’s attempt to appropriate for himself
the label “existential phenomenology” is peculiar.
The approach Mishara offers in his article fails, in
fact, to go beyond a rather mechanical or passive
vision of the nature of schizophrenia, in which
the patient’s role is simply to be afflicted with
disturbances of passive synthesis; little if anything
is said about broader human or “existential”
consequences or about the patient’s conscious and
self-conscious project of “being-in-the-world.” By
contrast, much of the work that Mishara criticizes
does explore these aspects in considerable depth
(see especially Sass 1992a, 2003a, 2004a; Sass and
Parnas 2007). Recently, Sass has focused on the
nature of both personhood (2007b) and autonomy
(2011) in schizophrenia, noting, for example, that
schizophrenia, a heterogeneous condition, can
sometimes involve not simple diminishment of
autonomy, but more complex disruptions of the
normal balance between independence and de-
pendence or between autonomy and heteronomy
Mishara’s overly mechanical portrayal of
passive syntheses seems particularly unsuited
to accounting for the remarkable variability of
schizophrenic symptoms and cognitive/affective
abnormalities, which as often noted (e.g., Bleuler
1950, 72) may vary with context, motivation,
and attitude. It is noteworthy, for example, that
cognitive and perceptual disorganization is by
no means constant, and often disappears in the
presence of a strong motivation toward practical
activity (for references see Sass 1992a, Chapter
1, p. 24 and notes 47, 48, 49; Chapter 2, p. 71
and notes 105, 112). In this sense it seems to be
linked up with particular orientations of the self
(including forms of reflexivity and self-affection).
An understanding of ipseity disturbances is also
relevant for conceptualizing psychotherapeutic
interventions. It suggests the potential danger in
overemphasizing certain forms of confrontation
and self-reflection in the therapeutic process. It
may also help to illuminate the potentially agen-
tive role of the patient, and thereby suggest more
subtle ways of helping patients both to identify
 Sass, Parnas, and Zahavi / Phenomenological Psychopathology and Schizophrenia  ■  15
with their experiences and to engage in the thera-
peutic encounter (Nelson, Sass, and Skodlar 2009).
Negative Symptoms
In the same paragraph in which Mishara ques-
tions Sass’s translation of Wahrnehmungstarre, he
accuses Sass of another scholarly error; but once
again, it is Mishara who commits errors of both
fact and logic. Mishara (2007a, 565) says that the
phrase “negative symptoms” had not been applied
to schizophrenia at the time that the phenomeno-
logical psychiatrist Blankenburg published his
book, The loss of natural self-evidence, in 1971,
and that for this reason it is inappropriate for Sass
to consider the book to be relevant to what we
now call “negative symptoms.”
As it happens, Mishara is wrong on the histori-
cal point: several French psychiatrists, including
De Clerambault, Nayrac, and Ey, spoke of negative
symptoms in schizophrenia quite early in the twen-
tieth century (Berrios 1985, 1991). This historical
error is almost beside the point, however. Even
if Mishara had been factually correct, his point
would amount to a non sequitur that, if taken
seriously, would preclude our finding much of
contemporary relevance in older works of psycho-
pathology, which often apply somewhat different
terminology to recognizable conditions that now
have different labels. (Often, of course, the over-
lapping of categories is only partial, and this com-
plicates the comparisons.) Mishara (2007a) also
states that what Blankenburg calls “schizophrenia
simplex” is a “very different diagnostic category”
from that of negative-symptom schizophrenia (p.
565). The concept “negative symptom” is not,
however, a diagnostic category at all, but part of
a currently popular way of subtyping symptoms of
schizophrenia (and some other conditions); nega-
tive symptoms are typically distinguished from
positive and disorganization symptoms.
It is obvious, in any case, that “schizophrenia
simplex,” which lacks both positive and dis-
organized symptoms, exemplifies at least one,
particularly clear type of the negative syndrome.
Indeed Mishara’s own description of schizophrenia
simplex, in the article of his own that he cites here
(his only relevant citation on the issue; Mishara
2001, 319–20), actually describes schizophrenia
simplex (following ICD-10) in clear negative-
symptom terms, namely, as “exhibit[ing] the basic
but not the accessory symptoms of schizophrenia,”
as being “fairly undramatic and inconspicuous in
its own right,” as manifesting “decline in total
performance,” and as having the “characteristic
‘negative’ features of residual schizophrenia (e.g.,
blunting of affect, loss of volition) [which] develop
without being preceded by any overt psychotic
symptoms.” If this is not a negative-symptom
syndrome, what is?
Phenomenological
Explanation
We end by considering the important but
complex topic of phenomenology’s relevance for
explanation. We approach this issue by discussing
the inaccuracies in Mishara’s characterization of
Sass and Parnas (2007), “Explaining schizophre-
nia: The relevance of phenomenology.” Mishara
describes Sass and Parnas as offering a “proposal
to conflate explanation and understanding” in
their 2007 article, and as somehow suggesting
that phenomenological explanation need “not
rely on experimental procedure.” He also states
that “Sass and Parnas opt to associate their phe-
nomenology with everyday explanation” (p. 563).
Each of these three statements is flatly mistaken.
It is not surprising, then, that in the paragraphs
containing these statements, Mishara offers virtu-
ally no quotations from Sass and Parnas (2007)
(except a single phrase, and even that turns out
to be inaccurate; on page 87, the phrase used is
not “explanatory power” but “explanatory sig-
nificance”; see Mishara 2007a, 563).
The first point to be realized is that the Sass
and Parnas article from 2007 does not in any way
deny the crucial role of neurobiological factors in
the explanation of schizophrenia (nor does Sass
1992a, which in fact contains a lengthy appendix
discussing “Neurobiological Considerations”).
The article focuses, rather, on the distinct yet of-
ten complementary role that an understanding of
subjectivity can play. The second point is that the
article does not focus primarily on the distinction
between understanding and explanation, but on
16  ■  PPP / Vol. 18, No. 1 / March 2011
that between description and explanation. Sass
and Parnas (2007) attempt to show that a com-
monly held view—namely, that phenomenology
is relevant only to description and not to expla-
nation—is inaccurate. It then proceeds to differ-
entiate a variety of senses of the word “explana-
tion.” The paper explicitly offers a “preliminary
taxonomy of six forms of phenomenological
explanation” (p. 67) divided into two groups,
the first involving a kind of “phenomenological
implication,” the second a kind of “at least quasi-
causal significance.” The diversity of these modes
of explanation is central to the argument.
The point, then, in Sass and Parnas (2007),
is to show that phenomenological accounts are
not merely descriptive. But this in no way implies
that all that is nondescriptive, or “explanatory”
in some sense of the latter term, is somehow the
same—as Mishara’s accusation regarding “con-
flating” would seem to imply. (If A = not-x and B
= not-x, this does not imply that A = B.) On the
contrary, the whole point of the article is to make it
very clear that not only the general term “explana-
tion.” but also the forms of explanation to which
phenomenology is relevant. are extremely various,
ranging from the demonstration of meaningful
unities to the clarification of causal sequences and
interactions.
In the article, Sass and Parnas (2007) note that
phenomenology (namely, the description of forms
of experience or of subjective life) can help to
“explain,” in one sense of that term, by showing,
for example, how seemingly distinct features of
conscious experience may actually be mutually
interdependent in the sense of being different as-
pects of the same experiential whole (this is called
a kind of “implicative” relationship). In another
sense of the term “explanation,” phenomenology
can help one to understand (and also to explain)
how one form of experience might lead into an-
other, as when unusual features of the subjectively
experienced perceptual field (e.g., perceptual frag-
mentation) can inspire or motivate certain forms
of (over-focused) attention, which can in turn
lead to further transformations of the perceptual
field (eventually involving, say, “delusional per-
cept”—as discussed by Matussek, 1987, and also
Sass 1992a, Chapter 2). The understanding of
such sequences has “explanatory significance” in
the sense that it clarifies forms of causal or quasi-
causal relationship that link one phase to another
(viz., it is because the visual world has a certain
kind of peculiar look—a feature of subjectivity—
that the patient is motivated to scrutinize what
is before him, and this in turn leads to certain
consequences). Sass and Parnas take the view
that mental patients are conscious human beings;
and that, in addition to manifesting the relatively
direct consequences of neurobiological abnormali-
ties, they will also react to their abnormalities in
all kinds of ways that may sometimes require the
categories of meaning and experience in order to
be understood or explained.
There is something surprisingly mechanistic
about the proposal Mishara (2007a) makes. Al-
though he does not say this in so many words, he
discusses the patient as if he or she were exclusively
the victim of brain events—as if intentional activ-
ity were irrelevant and subjective experience no
more than epiphenomenal. Mishara’s characteriza-
tion of natural science as generally “seeking out
explanatory relationships between ever-smaller
parts” (p. 563) represents a highly reductionistic
vision of science that runs counter to mainstream
views in both modern and contemporary philoso-
phy of science (re the latter, see articles in Kendler
and Parnas, 2008)
Sass and Parnas do not dispute that neural
abnormalities play a crucial role, nor indeed that
they may often play the most fundamental role
in terms of kicking off the sequence of events.
“In its most primary form, then, this ‘irritation’
may well occur in a largely passive manner, and
therefore represents an ‘operative’ rather than
‘reflective’ kind of hyper-reflexivity,” write Sass
and Parnas (2007, 83; also Sass 1992a, 68–73,
374–97). “This ‘irritation’ may, in fact, be a rather
direct consequence of a neurally based cognitive
dysfunction.” As examples of the latter dysfunc-
tion, Sass and Parnas mention disturbances of
the hippocampus-based comparator system or of
‘cognitive coordination’ (citing Gray et al. 1991;
Phillips and Silverstein, 2003).
This does not mean, however, that experi-
ential phenomena, together with responses to
these phenomena, involving different degrees of
 Sass, Parnas, and Zahavi / Phenomenological Psychopathology and Schizophrenia  ■  17
volition, may not also play a key role. After all,
even in the case of major physical illnesses, we
are nearly always confronted with a complex
combination of factors, which include both the
organism’s and the person’s defensive and com-
pensatory responses to the originating cause. In
the case of psychiatric disorders, these responses
are particularly likely to involve reactions (both
“consequential” and “compensatory”; Sass and
Parnas 2007) to lived experiences of various kinds.
Bleuler (1950), who firmly believed in the physical
nature of schizophrenia, nevertheless recognized
the crucial importance of these factors, as can be
seen in his subtle discussion of the precise nature
of the affective disturbance in schizophrenia (see
pp. 40–53, 363–73). Even if something like a
neurologically based disorder of attention (see, for
example, Hemsley 2005 for an especially plausible
account) is primary in a chronological sense, we
are nevertheless presented with a person who, over
time, develops a particular cognitive/perceptual
style, way of living, and world perspective—none
of which can be entirely reduced to the attentional
dysfunction itself (Sass 2007b). Understanding
such styles or perspectives is of obvious relevance
for understanding pathogenetic pathways and also
in the therapeutic encounter and for devising new
forms of psychological intervention.
Consideration of possible psychological,
meaning-driven sequences is not, incidentally,
something that can be separated from the search
for neurobiological causes. Just one possible
contribution of the former type of analysis, for
instance, is that it may help the neuroscientist to
pare away features that may not be directly related
to a malfunctioning or abnormal neural substrate
(because these features are psychologically ex-
plicable) to have a purified understanding of the
more direct cognitive or behavioral consequences
of the substrate condition. But it is also true that
a predilection for particular modes of attention
or experience may have its effect on the neuro-
biological plane (sometimes termed “downward
causation”). In his discussion, Mishara shows no
sensitivity to these possibilities.
It is also simply false to say that Sass and Par-
nas “opt to associate their phenomenology with
everyday explanation” (Mishara 2007a, 563).
Indeed, in the article Mishara criticizes, Sass and
Parnas (2007, 74–6) explicitly contrast the distinc-
tive explanatory contribution of phenomenology
with the practical syllogism and the belief-desire
paradigm of mental causation that is commonly
proposed in analytic philosophy and that is gener-
ally associated with everyday forms of explana-
tion. Sass and Parnas do not deny the relevance of
the belief–desire paradigm for explaining certain
things. However, they note the problems inherent
in applying this unadulterated form of everyday
explanation to many apparently irrational actions
and beliefs (such as found in schizophrenia); and
they argue that phenomenological explanation
typically directs one’s attention in a different
direction, namely, “toward formal or structural
features that involve more pervasive aspects or in-
frastructures of human experience (e.g., modes of
temporal or spatial experience, general qualities of
the object world, forms of self-experience)” (Sass
and Parnas 2007, 76). As Sass and Parnas say, the
latter features are typically not part of everyday ex-
planation—which is one reason why psychiatrists
and psychologists would do well to be familiar
with the phenomenological tradition—precisely
to be able to go beyond the resources of everyday
or common-sensical explanation (Gallagher and
Zahavi 2008; Parnas and Sass 2008; Parnas and
Zahavi 2002; Zahavi and Parnas 1998).
In several publications, Bovet, Parnas, and Sass
(Bovet and Parnas 1993; Parnas and Sass 2001,
2008; Sass 1990b, 1992a Chapter 9, 1992b,
1994, 2004b) have emphasized, for example, the
relevance of such non-everyday, phenomenological
distinctions as Heidegger’s between the “ontologi-
cal” and the “ontic” for the understanding and
explanation of delusions. They have noted, for
example, that whereas many paranoid delusions
do imply fairly straightforward forms of “poor re-
ality-testing” (the patient believes something false
about a world whose structure is largely analogous
to the normal world—“ontic” or “empirical” delu-
sions), this is not so clearly the case with some of
the more bizarre or metaphysical (“ontological”)
delusions in schizophrenia. Recently Sass (2004b,
2007a) has argued that phenomenological notions
about ipseity and the “horizons” of experience
can help to explain some of the anomalies of
18  ■  PPP / Vol. 18, No. 1 / March 2011
emotion and affect in schizophrenia (including
certain neurophysiological findings), notably the
curious possibility that such patients can experi-
ence a heightening of certain forms of affectivity
(awe, ontological anxiety) simultaneous with a
diminishment of the more passionate or standard
forms of emotionality.
Conclusion
Overall, Mishara’s arguments in “Missing link”
betray misunderstanding of the relevant phenom-
enological and psychiatric literature as well as
failure to grasp the key points of the publications
he criticizes. In this article, we have addressed most
of Mishara’s errors, attempting to do so in a way
that serves the larger purpose of clarifying gen-
eral issues pertaining both to phenomenological
psychopathology and to our own perspective on
schizophrenia. We have concentrated especially on
several broad points: these include the mutuality of
the relationship between the phenomenological en-
terprise and cognitive (neuro)science; the nature of
self-experience—particularly ipseity or pre-reflec-
tive self-consciousness together with the notions
of hyperreflexivity and diminished self-affection
and their possible disturbance in schizophrenia;
the potentially complex interactions of intentional
or quasi-volitional with non-volitional processes
in the formation of symptomatology; and the pos-
sible (and diverse) contribution of phenomenology
to psychological explanation.
Notes
1. An additional reason for rejecting Mishara’s use
of the term “neophenomenology”: it has already been
used extensively by Herman Schmitz (2003).
2. Mishara himself quotes the phrases “reciprocal
constraint” and “mutual enlightenment,” even including
them in the abstract, in Mishara et al. (1998).
3. Sass’s Madness and Modernism (1992a, see pp.
9, 10, 27) is perhaps the most extended recent attempt
(together with his The Paradoxes of Delusion [1994])
to offer an explicitly hermeneutic-phenomenological
approach to schizophrenia. For introductions to her-
meneutic phenomenology’s relevance, see Sass 1988b,
1998. (In retrospect, Sass would revise his discussion
of Husserl in these latter articles—along lines inspired
by Zahavi [2003a] and explained in Thompson [2007,
appendix A].)
4. A more accurate (but impossibly unwieldy) label
for the overall model would perhaps be the IHRDSAM,
standing for the Ipseity/HyperReflexivity/Dimished-Self-
Affection Model.
5. Hyper-reflective processes are not always active;
they can, for example, be quasi-automatized. There are
many nuances to the activity/passivity issue.
6. More could be said about this topic (self-aware-
ness vs self), but detailed analysis is beyond the scope
of this paper. See Zahavi (2005, 2009).
7. For discussion of how seeking a static, object-like
entity precludes finding the self-as-subject, see discussion
of William James in chapter 7 of Sass (1992a).
8. Mishara (2007a) misses the relevant point when
he acknowledges that, for the IHM, “hyperreflexiv-
ity (or exaggerated self-reflection) may itself become
automatic in schizophrenia leading to the ‘pop out’ of
irrelevant background stimuli and disruptive bottom
up processes” (560; also in Mishara 2007b, p. 716n).
Sass and Parnas do indeed mention this latter kind of
development (which involves an automatizing of reflec-
tion). It would have been more relevant, however, to
recognize that, according to our IHM view, operative
hyperreflexivity is more fundamental, temporally and
causally, than is hyper-reflection (Sass and Parnas 2007,
69, 82–5)—the latter point directly refutes Mishara’s
critique.
9. Sass (1992a, 228) writes:
[The] mode of exigent introspection . . . could also
reflect some more specific cognitive factor rooted in
neurobiological abnormalities, such as an incapacity
(or a disinclination) to synthesize larger Gestalts or,
perhaps, an inability to desist from paying attention to
stimuli that are habitually experienced and that would
not normally be focused on (kinesthetic and other “in-
ner” sensations would be one important subset of such
sensations). In these latter cases, fragmentation of the
self would be not just a consequence but, in a sense, also
a cause of a certain kind of hyperfocused introspection.
An attached note cites Hemsley as well as Matussek
and Conrad.
10. The “top down-versus-bottom up” or “from
above-versus-from below” distinction misconstrues
the difference between Mishara’s and our view, as
explained. Also erroneous is using Nietzsche’s notion
of the “Dionysian” to describe the view that common
sense fails “because perceptual and automatic meaning
processing are [sic] disrupted ‘from below’” (Lysaker
and Lysaker 2008a, 32; 2008b, 335, citing Mishara).
In Nietzsche’s Birth of Tragedy, Dionysianism refers to
self-dissolution from excess of passion or instinct. This
has nothing in common with the disrupted perceptual/
automatic-processing view and seems antithetical to the
nature of schizophrenia (Sass 1992a, Prologue; 2007a).
 Sass, Parnas, and Zahavi / Phenomenological Psychopathology and Schizophrenia  ■  19

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