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Altered bodily experience and basic self-disturbance in multimodal hallucinations View project
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Introduction tions in the person’s experience of or subjective perspec-
tive on the lived world. Taken together, the six domains
The Examination of Anomalous World Experience of the EAWE are intended to cover all major domains of
(EAWE) is a semi-structured interview designed to explore world experience.
subjective anomalies in a person’s experience of the external Although it is likely to have some diagnostic signifi-
world, language, and other people, i.e., his or her “lived cance, the EAWE is not intended to be used alone as a
world.” It is primarily but not exclusively based on experi- diagnostic instrument; the symptoms or experiential fea-
ential and clinical accounts offered by and about individu- tures it focuses on are mostly peripheral to or absent from
als with schizophrenia spectrum disorders, and should have standard diagnostic systems such as the DSM (Diagnostic
significant descriptive, differential, diagnostic, and perhaps and Statistical Manual of Mental Disorders) and ICD (In-
prognostic relevance for these and other disorders. This ternational Classification of Diseases) (though perhaps
presentation contains: (1) an introduction treating theoret- relevant for a future, more phenomenological system). It
ical and practical issues; (2) a sequence of EAWE items cov- can be used for evaluation, for research, and for insight
ering 6 domains of experience (Space and objects, Time and into the texture, structure, and aspects of the dynamics of
events, Other persons, Language, Atmosphere, and Exis- subjective life, as well as for developing and communicat-
tential orientation); and (3) Appendix A: a listing of all ing deeper understanding about the interviewee’s illness
EAWE items and subtypes for use during the interview. A and personal perspective, which can be helpful in psycho-
version of Appendix A, formatted for use as a scoring sheet, therapy and for other clinical purposes.
is available online as supplementary material. Appendix B, The EAWE is a complement to the EASE [2], a semi-
a list comparing EAWE items with similar items from the structured, phenomenologically oriented interview that
EASE (Examination of Anomalous Self-Experience) and focuses on disturbances of basic, minimal, or core self-
the BSABS or Bonn Scale (Bonn Scale for the Assessment awareness (“ipseity”). The EAWE was developed to cap-
of Basic Symptoms/Bonner Skala für die Beurteilung von ture those aspects of schizophrenia that pertain more di-
Basissymptomen), is also available as online supplementary rectly to the experience of and orientation to the external
material. (See www.karger.com/doi/10.1159/000454928 world. Self-experience and world experience are, howev-
for all online suppl. material.) er, closely intertwined and sometimes overlapping: virtu-
ally all phenomenologists have emphasized the intimate
Goals and Theoretical Considerations relationship between subjective and objective aspects or
Disorders of the lived world – including anomalies in poles of the act of consciousness (for further discussion,
experience of space and objects, time and events, persons, see Sass et al. [3]). Accordingly, distortions of “ipseity” or
language, overall atmosphere, and attitudes toward exis- basic self-experience might be expected to be correlated
tence – have long been recognized as key features of and interconnected with a loosening or other distortion
schizophrenia spectrum disorders. They are prominent of what might be termed the “grip,” “hold,” or “grasp”
in autobiographical accounts and other first-person re- that the subject has on the world [4, 5].
ports as well as in clinical and psychopathological de- In this sense, no absolute distinctions are possible; in-
scriptions, both classic and contemporary. Some of these deed, the distinction between the EASE and EAWE is
anomalies are collected and described in the BSABS [1]. necessarily somewhat arbitrary. Consider the EAWE do-
The anomalies at issue have not, however, been organized mains of Time and events, Other persons, and Language
and brought together in a single, synoptic list that is both (Domains 2, 3, and 4). Time is obviously a basic dimen-
comprehensive and richly detailed, and suited to the pur- sion of worldly experience; yet basic or implicit temporal-
pose of a general, empirical-phenomenological explora- ity [6], what William James [7] termed the “specious pres-
tion of qualitative abnormalities of the lived world. ent,” is also the very medium of basic self-experience.
The EAWE (pronounced ee wee) focuses primarily on Awareness of persons or other subjectivities is bound up
experiential anomalies common in (though not necessar- with self-consciousness. Language derives (as a system)
ily unique to) the schizophrenia spectrum; it can be used, and arrives (as the speech or writing of others) from the
however, for exploring various disorders. The EAWE fo- social world, yet it is also incorporated by and into the
cuses not on the more florid and overt symptoms crucial subject; only thus does it come to frame our experience of
for standard diagnoses (such as hallucinations, delusions, external objects and events.
and “negative” symptoms) but on assessing an underly- It is, therefore, to be expected that certain EASE items
ing orientation or vulnerability manifest in subtle altera- would be relevant to the domains captured in the EAWE.
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1.3 Disturbances Involving Veridicality (Accuracy) of 1.3.3 Visual Pseudohallucinations* (∼BS C.2.2.2)
Visual Perceptions* As in Visual hallucinations* (1.3.2), the subject experi-
The subject reports having mis-seen visual objects ences visual phenomena not grounded (or only minimally
(e.g., shadow seen as a snake), or seeing things that were grounded) in any external stimulus; but here the subject is
clearly not there. The experience can be quasi-visual, as clearly aware during the experience itself that these phe-
if midway between seeing and imagining. NB: The focus nomena have no basis in external reality.
should be on the nature of the original experience rath- • “[H]e often felt that he saw colorful objects sail through his
er than on a subsequent assessment. Also, the experi- field of vision.” [16]
enced reality status of these experiences (hence the sub-
type) can sometimes be difficult to specify. If the subtype
is not obvious, choose the most appropriate subtype or 1.4 Visual Fragmentation
subtypes, recording any relevant details that might clar- Object or scene typically perceived as coherent whole
ify the nature of the experience. appears to break apart or lose its unity.
1.7.2 Disturbance of Relative Spatial Relationship 1.8.3 Loss of Spatial Integrity or Structure
(Juxtaposition) of Objects The very structure of space seems deceptive, inconsis-
The spatial relationship between, or juxtaposition of, tent, or somehow impossible; like “living in an Escher
objects, or their relative closeness to the perceiver, is dis- drawing,” a space inconsistent with normal geometry. A
organized or perhaps reversed (e.g., a further object subject might, e.g., describe walking upstairs and feeling
seeming less distant than a closer one). It may be diffi- he has arrived somewhere below, or as though a se-
cult to determine what is in the background and what in quence of rooms does not accord with geometric possi-
the foreground, or how objects relate to each other spa- bility.
tially.
• “Again and again I shortly saw things crosswise, confusingly 1.8.4 Loss of Dimensionality
displaced against each other.” [1] Space or the objects it contains may seem flat or two-
dimensional, or otherwise condensed; three-dimensional-
ity itself may seem somehow illusory.
1.7.3 General Disturbances in Estimation of Distance • The subject describes objects as “mere images on canvas” or “as
(=BS C.2.3.9) if they were painted on a window pane.” [21]
The subject has difficulty determining how far away he
is from some object or person.
• “I couldn’t throw things in the waste-paper basket any more, I 1.8.5 Experience of Infinite Space
always aimed too short or too long. I had lost my feeling for the Space seems somehow to go on forever or to be “enor-
distance.” [1] mous” [15].
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7
1.13.3 Olfactory Disturbance* (=BS C.2.6.1)
Both these parenthetical examples might merit an EASE score: consider
EASE 1.2, Loss of thought ipseity for both; also EASE 1.7 Perceptualization Subjective change in experience of smells, as qualitative-
of inner speech or thought, for the second. ly different, more or less intense, or more or less pleasant.
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4.4 Unconventional Word Choice, Grammar, Tone, or 4.5 Disturbed Fluency (∼BS C.1.7, ∼EASE 1.17)
Cryptic Discourse (∼BS C.1.7, ∼EASE 1.17) The subject is aware of finding it hard to express her-
The subject uses, withholds, or strings together words self, due to an impairment in or retardation of word flu-
in anomalous ways that impede understanding by others. ency, precision, or availability, or to some other felt inad-
This can sometimes be willful or quasi-willful; the inter- equacy of her verbal expression (as opposed to the issue
viewer should note details. of ineffability, as with item 4.9.1, Language inadequate
to express unusual experiences*). The subject senses a
4.4.1 Cryptic, Telegraphic, or Ungrammatical diminished ability to use language as a tool to convey
Speech meaning and may experience associated hyperaware-
The subject is aware of adopting, allowing himself to ness of the linguistic medium.
use, or finding himself using speech that is telegraphic
(omitting many words, perhaps seeming cryptic to oth- 4.5.1 Unavailability of Words
ers) or somehow lacking usual grammatical structure. The subject describes feeling as though she is unable to
The subject may describe intentionally speaking “non- “find the right words” to describe her experience. NB: In
sense” or going “into his ‘schizy’ mode of speaking” more contrast to 4.9, Ineffability: inadequacy of language to
or less at will just to obscure his meaning or somehow test describe or express, here the person feels that she cannot
other people [22]. manage to find or summon the right words, rather than
that adequate or appropriate words do not exist.
4.4.2 Stock Words
The subject reports fixing on a conventional word to 4.5.2 Unfocused or Disorganized Thoughts Preclude
convey many meanings beyond those it would normally Verbal Expression
signify. Can involve repetitive overreliance on one or a The subject is unable to adequately express himself (or
few words, with the subject’s speech or writing taking on to speak at all) because of difficulty focusing on a particular
a stilted or impoverished quality. theme or line of thought – as if his thoughts were too nu-
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5.1 Derealization of the World (∼BS C.2.11.1, 5.1.4 Falseness (= EASE 5.5)
∼EASE 2.5.1) Everything seems somehow fake, fraudulent or phony,
“A change in the experience of the environment: the illusory, or “shammed” [50], perhaps theatrical or like car-
surrounding world appears somehow transformed, un- toons or mere simulacra. World may be experienced as
real, and strange, and may be compared to an ongoing artificial or as merely “virtual,” reminiscent of such films
movie.” [2] “Derealization” is a broad and ambiguous as “The Truman Show” or “The Matrix.”
term; here, we employ it only regarding experiences in- • A Russian patient in the Burghölzli asylum in Switzerland
volving diminished sense of immediacy, actuality, useful- claimed that “an identical duplicate ‘Russian Burghölzli’ had
ness, relevance, authenticity, vitality, or dynamism. (Ex- been erected.” [50]
periences of hyperrealism or of solipsism are classified • “As a child she experienced that ‘the whole world was built up
just for her,’ like a scene.” [2]
in other items below.) This is distinct from a hallucina-
• “You can’t imagine what it is like to know everything is simu-
tory or delusion-like distortion of reality: not a failure to lated. Having dinner – even at my grandma’s house! – seems
recognize the identity of people or things but an experi- faked!” [59]
ence of subtle but pervasive change in the feeling/sense
or felt reality of the world. The change occurs without
loss of reality testing. It should be noted if it occurs after 5.1.5 Loss of Enticement Quality*
or associated with a panic attack. The subject feels as though objects have no use or ap-
peal to action for him (though he may still recognize their
5.1.1 Remoteness or Barrier (Plate-Glass Feeling)* common sense or practical significance). For example, he
(∼EASE 2.4.2) may have no trouble recognizing something as a hammer
Feeling as though cut off from the world, as if the world (i.e., it does not present itself as a mere geometrical form)
existed at a remote distance or beyond a transparent bar- but is unable to register or conceive of its practical use or
rier. relevance for himself. NB: This may overlap with or ac-
• “Everything appears as through a veil; as if I heard everything company 5.2, Loss of affordances, though it may also oc-
through a wall.” [14] cur with affordances intact.
• “Things do not feel real. There is something between me and • “… more and more, despite my efforts, I lost the feeling of
the things and persons around me; something like a wall of practical things.” [18]
glass between me and everything else.” [58]
6.10 Feeling of Centrality (= EASE 5.2) 6.11 Decentering of the Self Relative to the Universe
Fleeting or persistent feelings of being the center of the The subject doubts his own reality status or that of his
universe – which seems to be organized around, con- immediate world, believing he somehow exists outside or
trolled by, or dependent on her. NB: This item differs separated from another, “truer” reality. He may feel as
from the more common feelings of being watched, ad- though he, or his surroundings, is the figment of some-
mired, or criticized by other persons of item 3.4.2, Feel- one’s imagination or like a character or scene in some-
ings of social paranoia or social anxiety*; for like 5.12, one else’s book.
All-inclusive self-consciousness/ontological “para- • “Is this really happening? Is this actually the universe, or just
noia”, this item denotes an all-pervasive or ontological some kind of an amoeba in a Petri dish in some kind of larger
kind of experience [69]. But, in contrast to 5.12, this universe”? [unpublished data]
Appendix A
For their work in field trials including reliability studies, we The EAWE was composed by Louis Sass and Elizabeth Pienkos,
thank Joseph Conerty, Greg Byrom, Steven Silverstein, and Tina in collaboration with the co-authors. Borut Skodlar and Elizabeth
Zadravec. We also thank Luis Madeira, Leonor Irarrázaval, Richard Pienkos were primarily responsible for the field trials in Slovenia
Dub, Erika Butler, and Steven Silverstein for various suggestions. and the USA.
References
1 Gross G, Huber G, Klosterkötter J, Linz M: 19 Matussek P: Studies in delusional perception; 36 Conrad K: Die beginnende Schizophrenie:
Bonn Scale for the Assessment of Basic Symp- in Cutting J, Shepherd M (eds): The Clinical Versuch einer Gestaltanalyse des Wahns.
toms. Aachen, Shaker, 2008. Roots of the Schizophrenia Concept. Cam- Stuttgart, Thieme, 1958.
2 Parnas J, Møller P, Kircher T, Thalbitzer J, bridge, Cambridge University Press, 1987, pp 37 Blankenburg W: Der Verlust der natürlichen
Jansson L, Handest P, Zahavi D: EASE: Ex- 89–103. Selbstverständlichkeit. Ein Beitrag zur Psy-
amination of Anomalous Self-Experience. 20 Wagner P, Spiro CS: Divided Minds: Twin chopathologie symptomarmer Schizophre-
Psychopathology 2005;38:236–258. Sisters and Their Journey through Schizo- nien. Stuttgart, Enke, 1971.
3 Sass L, Pienkos E, Fuchs T: Other worlds: in- phrenia. New York, St. Martin’s Press, 2008. 38 Minkowski E: La schizophrénie. Paris, Payot,
troduction to the special issue on the EAWE: 21 Stanghellini G, Rosfort R: Emotions and Per- 1927.
Examination of Anomalous World Experi- sonhood: Exploring Fragility, Making Sense 39 Stanghellini G, Ballerini M: What is it like to
ence. Psychopathology 2017;50:5–9. of Vulnerability. Oxford, Oxford University be a person with schizophrenia in the social
4 Merleau-Ponty M: Phenomenology of Per- Press, 2013. world? A first-person perspective study on
ception. London, Routledge, 2012. 22 Sass L: Madness and Modernism: Insanity in schizophrenic dissociality. Part 2: method-
5 Sass L, Parnas J: Schizophrenia, conscious- the Light of Modern Art, Literature, and ological issues and empirical findings. Psy-
ness, and the self. Schizophr Bull 2003; 29: Thought. New York, Basic Books, 1992; rev chopathology 2011;44:183–192.
427–444. ed: Oxford, Oxford University Press, 2017. 40 Laing RD: The Divided Self. New York, Pen-
6 Husserl E: The Phenomenology of Internal 23 Jones N, Luhrmann T: Beyond the sensory: guin, 1965.
Time Consciousness. Bloomington, Indiana findings from an in-depth analysis of the phe- 41 Stanghellini G, Ballerini M: Values in persons
University Press, 1964. nomenology of “auditory hallucinations” in with schizophrenia. Schizophr Bull 2007; 33:
7 James W: Principles of Psychology. Cam- schizophrenia. Psychosis 2016;8:191–202. 131–141.
bridge, Harvard University Press, 1890. 24 Hamilton M (ed): Fish’s Schizophrenia, ed 3. 42 Adam: Experiencing suspicious thoughts and
8 Heidegger M: Being and Time. New York, Bristol, Wright, 1984. paranoia: an account. Schizophr Bull 2011;37:
Harper & Row, 1962. 25 Payne R: Night’s end. Schizophr Bull 2012;38: 656–658.
9 Husserl E: Cartesian Meditations. Dordrecht, 899–901. 43 Stanghellini G, Ballerini M, Lysaker P: Autism
Kluwer, 1950. 26 Stanghellini G: Schizophrenia and the sixth Rating Scale. J Psychopathol 2014; 20: 273–
10 Koehler K: First rank symptoms of schizo- sense; in Chung M, Fulford K, Graham G 285.
phrenia: questions concerning clinical (eds): Reconceiving Schizophrenia. Oxford, 44 Rossi Monti M, Stanghellini G: Influencing
boundaries. Br J Psychiatry 1979; 134: 236– Oxford University Press, 2007, pp 129–150. and being influenced: the other side of “bi-
248. 27 Cutting J, Silzer H: Psychopathology of time zarre delusions.” 1. Analysis of the concept.
11 Conerty J, Skodlar B, Pienkos E, Byrom G, Sass in brain disease and schizophrenia. Behav Psychopathology 1993;26:159–164.
L: The Examination of Anomalous World Ex- Neurol 1990;3:197–215. 45 Landis C: Varieties of Psychopathological Ex-
perience in schizophrenia and other disorders: 28 Stanghellini G, Ballerini M, Presenza S, Man- perience. New York, Holt, Rinehart & Win-
a report on reliability. Psychopathology 2017; cini M, Raballo A, Blasi S, Cutting J: Psycho- ston, 1964.
50:55–59. pathology of lived time: abnormal time 46 Cutting J: The Living, the Dead, and the Nev-
12 McGhie A, Chapman J: Disorders of attention experience in persons with schizophrenia. er-Alive. Hove, Forest Publishing, 2002.
and perception in early schizophrenia. Br J Schizophr Bull 2016;42:45–55. 47 Reed G: The Psychology of Anomalous
Med Psychol 1961;34:103–116. 29 Minkowski E: Lived Time. Evanston, North- Experience: A Cognitive Approach. London,
13 Cutting J: The Right Cerebral Hemisphere western University Press, 1933/1970. Hutchinson, 1972.
and Psychiatric Disorders. New York, Oxford 30 Silverstein SM: Fragmentary phenomena 48 Sass L: Delusion and double bookkeeping: in
University Press, 1990. scale, unpublished. Fuchs T, Breyer T, Mundt C (eds): Karl Jas-
14 Jaspers K: General Psychopathology. Chica- 31 Fuchs T: The temporal structure of intention- pers’ Philosophy and Psychopathology. New
go, University of Chicago Press, 1963. ality and its disturbance in schizophrenia. York/Heidelberg, Springer, 2014, pp 125–147.
15 Cutting J: Principles of Psychopathology. Ox- Psychopathology 2007;40:229–235. 49 Anonymous: Language games, paranoia, and
ford, Oxford University Press, 1997. 32 Fuchs T: Temporality and psychopathology. psychosis. Schizophr Bull 2011; 37: 1099–
16 Lenzenweger M: Schizotypy and Schizophre- Phenomenol Cogn Sci 2013;12:75–104. 1100.
nia: The View from Experimental Psychopa- 33 Cutting J: The Psychology of Schizophrenia. 50 Bleuler E: Dementia Praecox or the Group
thology. New York, Guilford, 2011. Oxford, Churchill Livingstone, 1985. of Schizophrenias. New York, International
17 Chapman J: The early symptoms of schizo- 34 Northoff G, Stanghellini G: How to link brain Universities Press, 1950.
phrenia. Br J Psychiatry 1966;112:225–251. and experience? Spatiotemporal psychopa- 51 Stanghellini G: The Cratylus effect: a case
18 Sechehaye M: Autobiography of a Schizo- thology of the lived body. Front Hum Neuro- study in semantic deconstruction. J Psycho-
phrenic Girl. New York, Penguin, 1962. sci 2016;10:76. pathol 2016;22:80–89.
35 Kimura B: Écrits de psychopathologie phéno-
ménologique. Paris, Presses Universitaires de
France, 1992.
129.206.31.43 - 4/8/2017 10:14:27 AM
Universitätsbibliothek Heidelberg