Subjectivity and schizophrenia: another look at incomprehensibility and treatment nonadherence

Psychopathology. 2013;46(5):320-9. doi: 10.1159/000351837. Epub 2013 Jul 11.


Psychiatry is in a time of crisis. The absence of significant breakthroughs to actionable etiological knowledge has left the discipline in a state of uncertainty and worries are being voiced about its status and future. In our view, the stagnation can be, at least in part, ascribed to an excessive, behaviorist-oriented, epistemological, and ontological simplification of psychopathology. The aim of this phenomenological study is to articulate the notion of the 'disordered self' in schizophrenia, a notion that we believe constitutes an important step forward in grasping its essential pathogenetic structures. Through the framework of self-disorders, we analyze two domains of the psychopathology of schizophrenia, seeking to recast their puzzling nature into more useful clinical and scientific terms. First, we examine the so-called schizophrenic incomprehensibility (bizarre gestalt, bizarre delusions, and 'crazy actions') and argue that grasping the altered framework for experiencing, associated with the disordered self, makes these phenomena appear comprehensible to a considerable extent. Second, we explore the issue of treatment noncompliance and provide a novel account of 'poor insight' into illness. We propose that poor insight into schizophrenia is not simply a problem of insufficient self- reflection due to psychological defenses or impaired metacognition, but rather that it is intrinsically expressive of the severity and nature of self-disorders. The instabilities of the first-person perspective throw the patient into a different, often quasisolipsistic, ontological-existential framework. We argue that interventions seeking to optimize the patients' compliance might prove more efficient if they take the alterations of the patients' ontological-existential framework into account.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antipsychotic Agents / administration & dosage*
  • Cognition*
  • Delusions
  • Humans
  • Judgment*
  • Patient Compliance*
  • Problem Solving
  • Psychopathology
  • Schizophrenia / drug therapy*
  • Schizophrenia / therapy
  • Schizophrenic Psychology*


  • Antipsychotic Agents