Self-disturbance in
dissociation in relation to psychosis
I would like to discuss briefly a comparison
between dissociation and schizophrenia in terms of the ego disturbance. To summarize
my point beforehand, self-disturbance in schizophrenia is considered as
representing a disturbance within a single dynamic core as a putative neural
correlate of consciousness whereas in DID, such disturbance does not seem to
exist within a dynamic core, but existence of multiple dynamic cores can be a
problem. The model of division of consciousness fits better to the pathology of
schizophrenia rather than to DID which is more a pathology of the multiplicity
of the consciousness.
The
paramount disturbance of schizophrenia is considered to be social dysfunction
based on the disturbance of function of self. Karl Jaspers (1997/1913) delineated
the basic sense of self in our conscious live as a self-present,
single, temporally persistent, bodily and demarcated (bounded) subject of
experience and action (Italics added) and indicated that there are
serious disturbances in thse basic sense of self in schizophrenia. Recently,
from his perspective on neuro-biological standpoint, Ebisch (1916) found that the
disturbance of self-function is found to be correlated with that of neural
network, especially its disintegration．Along with our
context, this can be described as some type of fragmentation (apparently more serious
than just “division” within a single dynamic core which is responsible
for schizophrenic symptom manifestation.
Jaspers K; Hoenig J, Hamilton MW,(1997/1913) trans. General psychopathology. London: John
Hopkins University Press, 1997 [1913].
S.Ebisch,S
(2016) The social self in schizophrenia: A neural network perspective on
integrative external and internal information processing European
Psychiatry
Volume 33, Supplement, S45
In
comparison, in the individuals with DID, the dynamic core representing each PP
is basically intact, as any PP appears to have self-disturbance in any level
across self-present, single, temporally persistent, bodily, and demarcated
(bounded) subject of experience and action.
We can
check on this issue one by one by taking up an example that we saw at the
beginning of this article, Ms.A, Mr.B and Mr. C.
As
for the sense of self-presence, it is certainly Ms.A who knows that she
is behind the wheel, attempting to start the car in her own timing. It is
because of her sense of agency that Mr. B’s “remark” came across as abrupt and made
her think of him in a critical way, such as “can’t he be more patient?”. As for
her sense of singleness, certainly she feels she is on her own and is distinct
from Mr.B. As for her sense of temporal continuity, she would still
claim that even if she is amnestic about events of yesterday when Mr.B was mainly
out and active, she would give us her own “alibi”, such as perhaps she was
inside and deep asleep, or was vaguely watching what Mr.B was doing as a
bystander somewhere inside, through a video screen (as several of my DID
patients describe). The sense of demarcation of Ms.A certainly exists
although he might feel it in a different location compared with other non-DID
individual. She might feel that Mr.B very close, even inside of her head, such
as the back of her head, which however, is still outside of the limit of her
control.
In
a case of schizophrenic patients, disturbance of self is seen in at least three
out of four areas. Let me give a case where a patient with schizophrenia is
heavily influenced by hearing voices of what he calls “a high-power”. Mr.D was
walking on the street and saw a stranger waiting for a traffic light to turn. He
then heard a voice telling him “that is the man who is spying on you” which became
revelatory for him. Mr.D walked up to him and yelled at him for having
shadowing him, although he never met that man. The stranger was totally taken
aback and fled in order to avoid any trouble.
In
this case, Mr. D’s self-presence is
seriously compromised as he is acting on his own and at the same time on behalf
of the high-power, that he probably cannot distinguish himself from. In that
sense, Mr. D’s sense of singleness is impaired at the same time as his idea and
that of the high-power is inseparable. Mr. D’s sense of demarcation is also
very precarious as the high-power, who is supposedly outside existence communicating
to him via hearing voices, becomes him suddenly.
