Skip to main content
SpringerLink
Log in

Fear and Trembling: A Case Study of Voice Hearing in Schizophrenia as a Self-Disorder

  • Chapter
  • First Online:
An Experiential Approach to Psychopathology

  • 1255 Accesses

Abstract

The case of a young man who had terrible voices from a mental health unit for first psychotic episodes is exposed. After referring the biographical background, we focus on the experiences of voices and attitudes towards them. Next, the case is formulated according to the disturbance-ipseity model. The idea here is that psychotic symptoms represent a more basic alteration at the level of structure of self-experience and way of being in the world. Finally, the implications of phenomenological conception for evaluation, diagnosis, and treatment are emphasized.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Akroyd, M. J. (2013). You can’t spell schizophrenia without an ‘I’: How does the Early Intervention in Psychosis approach relate to the concept of schizophrenia as an ipseity disturbance? Early Intervention in Psychiatry, 7, 238–246.

    Article  PubMed  Google Scholar 

  • Bentall, R. P., de Sousa, P., Varese, F., Wickham, S., Sitko, K., Haarmans, M., et al. (2014). From adversity to psychosis: Pathways and mechanisms from specific adversities to specific symptoms. Social Psychiatry and Psychiatric Epidemiology, 49, 1011–1022.

    Article  PubMed  Google Scholar 

  • Blankenburg, W. (1971/2014). La pérdida de la evidencia natural. Una contribución a la psicopatología de la esquizofrenia. Santiago de Chile: Edicionnes de la Universidad Diego Portales.

    Google Scholar 

  • Bracken, P. (2014). Towards a hermeneutic shift in psychiatry. World Psychiatry, 13, 241–243.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bracken, P., Thomas, P., Timimi, S., Asen, E., Behr, G., Beuster, C., et al. (2012). Psychiatry beyond the current paradigm. British Journal of Psychiatry, 201, 430–434.

    Article  PubMed  Google Scholar 

  • Calton, T., & Spandler, H. (2009). Minimal-medication approaches to treating schizophrenia. Advances in Psychiatric Treatment, 15, 209–217.

    Article  Google Scholar 

  • Doerr-Zegers, O., & Stanghellini, G. (2013). Clinical phenomenology and its psychotherapeutic consequences. Journal of Psychopathology, 19, 228–233.

    Google Scholar 

  • Ellenberger, H. F. (1957/1967). Introducción clínica a la fenomenología psiquiátrica y al análisis existencial [Clinical introduction to psychiatric phenomenology and existential analysis]. In R. May & H. H. Ellenberger (Eds.), Existencia [Existence] (pp. 123–160). Madrid: Gredos.

    Google Scholar 

  • Fuchs, T. (2007). Psychotherapy of the lived space. A phenomenological and ecological concept. American Journal of Psychotherapy, 61, 432–439.

    Google Scholar 

  • Fuchs, T. (2010). Subjectivity and intersubjectivity in psychiatric diagnosis. Psychopathology, 43, 268–274.

    Article  PubMed  Google Scholar 

  • Gumley, A., & Clark, S. (2012). Risk of arrested recovery following first episode psychosis: An integrative approach to psychotherapy. Journal of Psychotherapy Integration, 22, 298–313.

    Article  Google Scholar 

  • Harrow, M., Jobe, T. H., & Faull, R. N. (2014). Does treatment of schizophrenia with antipsychotic medications eliminate or reduce psychosis? A 20-year multi-follow-up study. Psychological Medicine, 44, 3007–3116.

    Article  CAS  PubMed  Google Scholar 

  • Hirjak, D., Breyer, T., Thomann, P. A., & Fuchs, T. (2013). Disturbance of intentionality: A phenomenological study of body-affecting first-rank symptoms in schizophrenia. PLoS One, 8(9), e73662.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hur, J.-W., Kwon, J. S., Lee, T. Y., & Park, S. (2014). The crisis of minimal self-awareness in schizophrenia: A meta-analytic review. Schizophrenia Research, 152, 58–64.

    Article  PubMed  Google Scholar 

  • Irarrázaval, L., & Sharim, D. (2014). Intersubjectivity in schizophrenia: Life story analysis of three cases. Frontiers in Psychology, 5. doi:10.3389/fpsyg.2014.00100.

    Google Scholar 

  • Kean, C. (2009). Silencing the self: Schizophrenia as a self-disturbance. Schizophrenia Bulletin, 35, 1034–1036.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kraus, A. (2007). Schizophrenic delusions and hallucinations as the expression and consequence of an alteration of the existential a prioris. In M. C. Chung, K. W. M. Fulford, & G. Graham (Eds.), Reconceiving schizophrenia (pp. 97–111). Oxford: Oxford University Press.

    Google Scholar 

  • Maj, M. (2014). Technical and non-technical aspects of psychiatric care: The need for a balanced view. World Psychiatry, 13, 209–210.

    Article  PubMed  PubMed Central  Google Scholar 

  • Morrison, A. P., Hutton, P., Shiers, D., & Turkington, D. (2012). Antipsychotics: Is it time to introduce patient choice? British Journal of Psychiatry, 201, 83–84.

    Article  PubMed  Google Scholar 

  • Nelson, B., Parnas, J., & Sass, L. A. (2014). Disturbance of minimal self (ipseity) in schizophrenia: Clarification and current status [Editorial]. Schizophrenia Bulletin, 40, 479–482.

    Article  PubMed  PubMed Central  Google Scholar 

  • Nelson, B., & Sass, L. A. (2009). Medusa’s stare: A case study of working with self-disturbance in the early phase of schizophrenia. Clinical Case Studies, 8, 489–504.

    Article  Google Scholar 

  • Nelson, B., Sass, L. A., Thompson, A., Yung, A. R., Francey, S. M., Amminger, G. P., et al. (2009). Does disturbance of self underlie social cognition deficits in schizophrenia and other psychotic disorders? Early Intervention of Psychiatry, 3, 83–93.

    Article  Google Scholar 

  • Nelson, B., Yung, A., Bechdolf, A., & McGorry, P. D. (2008). The phenomenological critique and self-disturbance: Implications for ultra-high-risk (“prodromal”) research. Schizophrenia Bulletin, 34, 381–392.

    Article  PubMed  Google Scholar 

  • Parnas, J. (2012a). The core gestalt of schizophrenia. World Psychiatry, 11, 67–69.

    Article  PubMed  PubMed Central  Google Scholar 

  • Parnas, J. (2012b). DSM-IV and the founding prototype of schizophrenia: Are we regressing to a pre-Kraepelinian nosology? In K. S. Kendler & J. Parnas (Eds.), Philosophical issues in psychology II: Nosology (pp. 237–259). Oxford: Oxford University Press.

    Chapter  Google Scholar 

  • Parnas, J., & Henriksen, M. G. (2014). Disordered self in the schizophrenia spectrum: A clinical and research perspective. Harvard Review of Psychiatry, 22, 251–265.

    Article  PubMed  PubMed Central  Google Scholar 

  • Parnas, J., Moller, P., Kircher, T., Thalbitzer, J., Jansson, L., Handest, P., et al. (2005). EASE: Examination of anomalous self-experience. Psychopathology, 38, 236–258.

    Article  PubMed  Google Scholar 

  • Pérez-Álvarez, M., & García-Montes, J. M. (2012). From neurochemistry to interpersonal chemistry: Towards a psychotherapy of schizophrenia. In A. J. Lancaster & O. Sharpe (Eds.), Psychotherapy: New research (pp. 1–21). New York: Nova.

    Google Scholar 

  • Pérez-Álvarez, M., García-Montes, J. M., Perona-Garcelán, S., & Vallina-Fernández, O. (2008). Changing relationship with voices: New therapeutic perspectives for treating hallucinations. Clinical Psychology and Psychotherapy, 15, 75–85.

    Article  PubMed  Google Scholar 

  • Pérez-Álvarez, M., García-Montes, J. M., Vallina-Fernández, O., Perona-Garcelán, S., & Cuevas-Yust, C. (2011). New life for psychotherapy in the light of phenomenology. Clinical Psychology and Psychotherapy, 18, 187–201.

    Article  PubMed  Google Scholar 

  • Perona-Garcelán, S., García-Montes, J. M., Rodríguez-Testal, J. F., López-Jiménez, A. M., Ruiz-Veguilla, M., Ductor-Recuerda, M. J., et al. (2014). Relationship between childhood trauma, mindfulness and dissociation in subjects with and without hallucination proneness. Journal of Trauma and Dissociation, 15, 35–51.

    Article  PubMed  Google Scholar 

  • Pienkos, E., & Sass, L. (2012). Empathy and otherness: Humanistic and phenomenological approaches to psychotherapy of severe mental illness. Pragmatic Case Studies in Psychotherapy, 8, 25–35.

    Article  Google Scholar 

  • Ratcliffe, M. (2012). Phenomenology as a form of empathy. Inquire, 55, 473–495.

    Article  Google Scholar 

  • Read, J., van Os, J., Morrison, A. P., & Ross, C. A. (2005). Childhood trauma, psychosis and schizophrenia: A literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112, 330–350.

    Article  CAS  PubMed  Google Scholar 

  • Ricoeur, P. (1992). Oneself as another. Chicago: The University of Chicago Press.

    Google Scholar 

  • Rojcewick, S. J., & Rojcewick, R. (1997). The ‘human’ voices in hallucinations. Journal of Phenomenological Psychology, 28, 1–41.

    Article  Google Scholar 

  • Saks, E. (2007). The center cannot hold. New York: Hyperion.

    Google Scholar 

  • Sass, L. A. (1988). Humanism, hermeneutics, and the concept of human subject. In S. B. Messer, L. A. Sass, & R. L. Woolfolk (Eds.), Hermeneutics and psychological theory (pp. 222–271). New Brunswick, NJ: Rutgers University Press.

    Google Scholar 

  • Sass, L. (1992). Madness and modernism: Insanity in the light of modern art, literature, and thought. New York: Basic Books. [Spanish translation: Sass, L. (1992/2014). Locura y modernismo. La esquizofrenia a la luz del arte, la literatura y el pensamiento modernos. Madrid: Dykinson.]

    Google Scholar 

  • Sass, L. A. (2004). Schizophrenia: A disturbance of the thematic field. In L. Embree (Ed.), Gurwitch’s relevancy for the cognitive sciences (pp. 59–78). Dordrecht: Springer.

    Chapter  Google Scholar 

  • Sass, L. (2013). Jaspers, phenomenology, and the ‘ontological difference’. In G. Stanghellini & T. Fuchs (Eds.), One century of Kal Jaspers’ general psychopathology (pp. 95–106). Oxford: Oxford University Press.

    Google Scholar 

  • Sass, L. (2014). Self-disturbance and schizophrenia: Structure, specificity, pathogenesis (current issues, new directions). Schizophrenia Research, 152, 5–11.

    Article  PubMed  Google Scholar 

  • Sass, L., & Parnas, J. (2003). Schizophrenia, consciousness, and the self. Schizophrenia Bulletin, 29, 427–444.

    Article  PubMed  Google Scholar 

  • Sass, L. A., & Parnas, J. (2007). Explaining schizophrenia: The relevance of phenomenology. In M. Chung, W. Fulford, & G. Graham (Eds.), Reconceiving schizophrenia (pp. 63–96). Oxford: Oxford University Press.

    Google Scholar 

  • Sass, L., Pienkos, E., & Nelson, B. (2013a). Introspection and schizophrenia: A comparative investigation of anomalous self experiences. Consciousness and Cognition, 22, 853–867.

    Article  PubMed  Google Scholar 

  • Sass, L., Pienkos, E., Nelson, B., & Medford, N. (2013b). Anomalous self-experience in depersonalization and schizophrenia: A comparative investigation. Consciousness and Cognition, 22, 430–441.

    Article  PubMed  Google Scholar 

  • Schwartz, W. E. (2013). Schizophrenia, cultural marginalization, and dissociation of the body: An application of Ernest Becker’s work to psychotherapy. Psychosis, 5, 26–35.

    Article  Google Scholar 

  • Schwartz, M. A., & Wiggins, O. P. (1987). Typifications. The first step for clinical diagnosis in psychiatry. Journal of Nervous and Mental Disorders, 175, 65–77.

    Article  CAS  Google Scholar 

  • Skodlar, B., Henriksen, M. G., Sass, L. A., Nelson, B., & Parnas, J. (2013). Cognitive-behavioral therapy for schizophrenia: A critical evaluation of its theoretical framework from a clinical-phenomenological perspective. Psychopathology, 46, 249–265.

    Article  CAS  PubMed  Google Scholar 

  • Stanghellini, J. (2004). Disembodied spirits and deanimated bodies. The psychopathology of common sense. Oxford: Oxford University Press.

    Book  Google Scholar 

  • Stanghellini, G. (2008). Qualitative analysis. Its use in psychopathological research. Acta Psychiatrica Scandinavica, 117, 161–163.

    Article  PubMed  Google Scholar 

  • Stanghellini, G. (2011). Phenomenological psychopathology, profundity, and schizophrenia. Philosophy, Psychiatry and Psychology, 18, 163–166.

    Article  Google Scholar 

  • Stanghellini, J., & Cutting, J. (2003). Auditory verbal hallucinations—breaking the silence of inner dialogue. Psychopathology, 36, 120–128.

    Article  PubMed  Google Scholar 

  • Stanghellini, G., & Lysaker, P. H. (2007). The psychotherapy of schizophrenia through the lens of phenomenology: Intersubjectivity and the search for the recovery of first- and second-person awareness. American Journal of Psychotherapy, 61, 163–179.

    PubMed  Google Scholar 

  • Vallina-Fernández, O., Pérez-Álvarez, M., Fernández-Iglesias, P., Soto-Balbuena, C., Perona-Garcelán, S., & García-Montes, J. M. (2014). Person-based contextual therapy applied to a complex case of schizophrenia. Psicothema, 26, 299–307.

    PubMed  Google Scholar 

  • Velikonja, T., Fisher, H. L., Mason, O., & Johnson, S. (2015). Childhood trauma and schizotypy: A systematic review. Psychological Medicine, 45(5), 947–963. doi:10.1017/S0033291714002086.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, University of Oviedo, Oviedo, Spain

    Marino Pérez-Álvarez

  2. Hospital Sierrallana, Torrelavega, Spain

    Oscar Vallina-Fernández

  3. Department of Psychology, University of Almeria, Almeria, Spain

    José M. García-Montes

  4. Department of Clinical Psychology, GSAPP—Rutgers University, Piscataway, NJ, USA

    Louis A. Sass

Authors
  1. Marino Pérez-Álvarez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Oscar Vallina-Fernández
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. José M. García-Montes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Louis A. Sass
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Louis A. Sass .

Editor information

Editors and Affiliations

  1. Department of Psycho,Humanis.&Terr. Sci, Uni"D.Portales",Chile,&Uni“G.D’Annunzio”, Chieti, Italy

    Giovanni Stanghellini

  2. Sapienza Univ&Crossing Dialogues Assoc., Rome, Italy

    Massimiliano Aragona

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Pérez-Álvarez, M., Vallina-Fernández, O., García-Montes, J.M., Sass, L.A. (2016). Fear and Trembling: A Case Study of Voice Hearing in Schizophrenia as a Self-Disorder. In: Stanghellini, G., Aragona, M. (eds) An Experiential Approach to Psychopathology. Springer, Cham. https://doi.org/10.1007/978-3-319-29945-7_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-29945-7_17

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-29943-3

  • Online ISBN: 978-3-319-29945-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation