Elsevier

Consciousness and Cognition

Volume 20, Issue 4, December 2011, Pages 1042-1049
Consciousness and Cognition

Schizophrenia, dissociation, and consciousness☆

https://doi.org/10.1016/j.concog.2011.04.013Get rights and content

Abstract

Current thinking suggests that dissociation could be a significant comorbid diagnosis in a proportion of schizophrenic patients with a history of trauma. This potentially may explain the term “schizophrenia” in its original definition by Bleuler, as influenced by his clinical experience and personal view. Additionally, recent findings suggest a partial overlap between dissociative symptoms and the positive symptoms of schizophrenia, which could be explained by inhibitory deficits. In this context, the process of dissociation could serve as an important conceptual framework for understanding schizophrenia, which is supported by current neuroimaging studies and research of corollary discharges. These data indicate that the original conception of “split mind” may be relevant in an updated context. Finally, recent data suggest that the phenomenal aspects of dissociation and conscious disintegration could be related to underlying disruptions of connectivity patterns and neural integration.

Section snippets

Dissociation, splitting and schizophrenia

In 1911 Eugen Bleuler introduced the term “schizophrenia” as a description of this mental illness in his work Dementia praecox or the group of the schizophrenias, which replaced Kraepelin’s term dementia praecox. In his Textbook of psychiatry he wrote (Bleuler, 1924): “It is not alone in hysteria that one finds an arrangement of different personalities one succeeding the other. Through similar mechanism schizophrenia produces different personalities existing side by side.” (p. 138). The process

Schizophrenia and dissociative disorders

This historical conceptual framework for dissociation and ‘splitting’ in schizophrenia is in agreement with the recent definition of dissociation as a special form of consciousness in which events that would ordinarily be connected are divided from one another (Li & Spiegel, 1992), leading to “a disturbance or alteration in the normally integrative functions of identity, memory, or consciousness” (American Psychiatric Association, 1994). According to recent findings dissociation is closely

Corollary discharges and mental disintegration in schizophrenia

Cognitive and affective representations of one’s identity or the subject of experience form a basis for self-recognition as a specific cognitive process typically involving conscious experience and interpretation activity. Disruptions of these self-interpretation processes likely result in a fragmentation of consciousness because of misattribution of certain inner states that may be interpreted as external objects, because they are “disowned” and dissociated from consciousness (Bob, 2008).

In

Schizophrenia and complexity

The findings reviewed above seem to be in agreement with the idea that disturbed neural integration is an important factor in the development of schizophrenia (Lee et al., 2003, Peled, 1999, Tononi and Edelman, 2000). According to recent evidence, the process of disturbed neural integration leading to increased or decreased functional segregation among groups of neurons might also be quantified using concepts from statistical information theory and in particular by defining a measure of neural

Conclusion

The historical conception of schizophrenia as a “split mind” may be meaningful in the modern investigation of the disease and find support in neurobiology. Furthermore, there are significant overlaps between the symptomatology and experimental data regarding dissociative processes and schizophrenia. Inhibitory deficits or aberrant corollary discharge, among other network abnormalities, may be the neural basis of this interface.

Although direct evidence is lacking, the investigation of

Acknowledgments

This work was supported by research Grants MSM0021620849, MSM0021622404 and support of research project of Center for Neuropsychiatric Research of Traumatic Stress 1M06039 by Czech Ministry of Education.

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    ☆

    This article is part of a special issue of this journal on European Science Foundation EMRC Exploratory Workshop: The Dreaming Mind-Brain, Consciousness and Psychosis (Challand Saint Anselme, Italy, 25th – 28th May 2009).

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