Original Paper

Psychopathology 2015;48:324–331 Received: February 23, 2015

Accepted after revision: May 15, 2015
DOI: 10.1159/000432404
Published online: September 9, 2015

From Self-Disorders to Ego Disorders

Thomas Fuchs
Clinic for General Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany

Key Words contributed subtle analyses of the patients’ basic self- and
Schizophrenia · Self-disorders · Ego disorders · world experience which is fundamentally altered fre-
Intentionality · Phenomenology quently many years before the onset of acute psychosis
[1–5]. This has led to a phenomenological reconceptual-
ization of the illness, focusing not on the productive
Abstract symptoms of the acute phase (i.e. delusions and halluci-
While the concept of disorders of basic self-experience as the nations), nor on higher-level cognitive processes such as
clinical core of schizophrenia spectrum disorders has gained ‘theory of mind’ or ‘meta-representation’, but instead on
increasing significance and empirical support, several ques- the insidious erosion of embodied self-awareness, per-
tions remain still unresolved. One major problem is to under- ception and action which may date back even to the pa-
stand how the basic and prodromal self-disturbances are re- tients’ childhood. The prereflexive, practical immersion
lated to Schneider’s first rank symptoms, in particular to the of the self in the world normally mediated by the lived
so-called ‘ego disorders’ found in acute psychotic episodes. body is impaired or lost. This ‘disembodiment’ results in
The study of the transition from prodromal to first rank functional psychopathology that includes
symptoms, for example from alienated thoughts to thoughts (a) a diminishment of the basic, prereflexive sense of
aloud or thought insertions, is of particular importance for self or self-affection, also termed disturbance of ipseity [3],
understanding the nature and course of schizophrenia. The (b) a corresponding tendency towards self-objectifi-
paper analyses the emergence of ego disorders from basic cation or hyperreflexivity [6, 7],
self-disorders in phenomenological terms, taking the exam- (c) a disruption of implicit bodily functioning in
ples of motor passivity experiences and thought insertion. It both perception and action,
is argued that full-blown delusions of alien control are ulti- (d) disturbances of ‘common sense’ and the habitual
mately based on a disturbance of the intentionality of think- interbodily relations with others, with subsequent dis-
ing, feeling and acting. This disturbance, for its part, may be connection from the social environment [8, 9].
traced back to anomalies of self-experience in prodromal Despite increasing consensus within phenomenologi-
stages of schizophrenia. © 2015 S. Karger AG, Basel cal psychopathology and growing empirical support for
this reconceptualization [10–12], several questions still
remain unresolved. One major problem is to understand
how the basic and prodromal self-disorders are related to
Introduction Schneider’s first rank symptoms which are far more spe-
cific and therefore still crucial for the diagnosis of schizo-
Since the beginning of this century, there has been a phrenia in acute psychotic episodes. Among them, the
growing interest into disorders of self-awareness in so-called ‘ego disorders’ (Ich-Störungen), that means dis-
schizophrenia. Phenomenological psychopathology has turbances of ego demarcation or self-other boundaries,
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© 2015 S. Karger AG, Basel Prof. Dr. med. Dr. phil. Thomas Fuchs
0254–4962/15/0485–0324$39.50/0 Department of General Psychiatry, University of Heidelberg
Voss-Strasse 4
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E-Mail [email protected]
DE–69115 Heidelberg (Germany)
www.karger.com/psp
E-Mail thomas.fuchs @ med.uni-heidelberg.de
are of particular interest. As is well known, Schneider [13] schizophrenia could then lead to a loss of ego demarca-
coined this term for the peculiar experience of one’s tion and to the full-blown passivity experiences or ego
thoughts, actions, feelings or bodily sensations being disorders as conceived by Schneider.
‘made’, influenced or manipulated by others. It may be Remarkably, neither the term ‘self-disorder’ nor ‘ego
assumed that these phenomena of profound self-alien- disorder’ appears in the latest editions of the Internation-
ation are somehow related to the basic disturbances of al Classification of Diseases (ICD-10) or the Diagnostic
self-awareness. Thus, the study of the transition from and Statistical Manual of Mental Disorders (DSM-5). In-
prodromal to first rank symptoms, for example, from stead, thought insertion, thought withdrawal, made ac-
merely alienated thinking to thoughts aloud or thought tions or feelings are regarded as bizarre delusions, com-
insertions, is of particular importance for understanding monly referred to as delusions of influence, control or
the nature and course of schizophrenia. passivity. However, this conception of ego disorders as
However, the difference between self-disorders and mere delusions arguably misses their core disturbance,
ego disorders is far from clear. For further analysis, a pri- which consists not in a cognitive distortion of reality but
or distinction between ‘self’ and ‘ego’ seems necessary. In in a more fundamental alteration of self-awareness and
its most basic sense, ‘self’ refers to the implicit, prereflex- self-demarcation [21, 22]. Only secondarily do these dis-
ive self-awareness that is present in every experience with- turbances of self-experience give rise to corresponding
out requiring introspection or reflection. Thus, any sensa- delusional beliefs. The concept of ego disorders therefore
tion, any perception or action directed towards an object characterizes a group of core schizophrenic symptoms
implies a tacit self-awareness; it is immediately, non-infer- which may not be ranged on the same level as, for exam-
entially given as mine. The basic subjectivity of experience ple, simple delusions of persecution.
constitutes a general medium in which specific modes of In what follows I will analyse the emergence of ego dis-
intentional consciousness are articulated; it may also be orders from basic self-disorders in phenomenological
called ‘mineness’ or ipseity [14, 15]. Ipseity is bound to the terms. Introducing a bridging concept, I will argue that
background feeling of the body, including interoceptive, full-blown delusions of alien control are based on a dis-
proprioceptive and kinaesthetic awareness, and implies a turbance of the intentionality of thinking, feeling and act-
basic auto-affection or the ‘feeling of being alive’ [16]. ing. This disturbance, for its part, may then be traced back
Whereas basic self-awareness characterizes subjectiv- to anomalies of self-experience found in early stages of
ity already in the earliest stages of life, ‘ego’ usually refers schizophrenia. I draw from clinical observations in our
to the higher-level, reflexive self-consciousness which own studies of self-disorders, from investigations based
emerges in the course of early socialization, depending on on the Examination of Anomalous Self Experience devel-
the development of perspective-taking and autobio- oped by Parnas and his group [23–25] and finally from
graphical memory from the 2nd year of life on. Its funda- research into the transition from basic symptoms (‘Basis-
mental structure is intersubjective and reciprocal, for it symptome’ [26, 27]) to full-blown psychosis carried out
includes seeing oneself ‘in others’ eyes’ [17] and an un- by Klosterkoetter [28, 29]. Although the concept of basic
derstanding of oneself and others as intentional agents. symptoms is not grounded on a phenomenology of self-
The ‘ego’ then results from the self-identification among awareness but rather on a medical symptom model, there
others, implying the ability to explicitly distinguish one- is nevertheless a considerable overlap of the interviews
self from them [18]. What Schneider called the lack of ego with phenomenological assessments, thus allowing for a
demarcation or the permeability of ego boundaries in synoptic analysis.
schizophrenia is therefore only possible on the level of
reflexive self-consciousness.
In his General Psychopathology [19], Jaspers distin- The Lack of Basic Self-Awareness and Its Impact on
guished what he called ego consciousness (Ich-Bewusst- Intentionality
sein) from object-directed consciousness and character-
ized it by (1) ego demarcation in contrast to the external According to recent phenomenological approaches [3,
world and to others, (2) sense of activity, (3) identity over 7], schizophrenia at its core implies a diminishment of the
time and (4) unity. The second corresponds to what is basic self-awareness or self-affection which permeates all
termed agency today, meaning the sense of being the ini- dimensions of experience. Patients frequently describe
tiator or author of one’s thoughts or actions [20]. A dis- feelings of a pervasive inner void or lack of presence. They
turbance of this component of self-consciousness in may complain about a certain numbness or opacity of con-
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 directedness of consciousness towards its contents and
objects. This intentional relation is mediated through sin-
Medium
gle sensations, movements, perceptions or thoughts that
sensations, are combined and synthesized to form meaningful pat-
movements,
thoughts terns or gestalten. When reading this sentence, for exam-
etc.
Subject Object/content ple, you are immediately directed to its meaning through
of feeling, acting, thinking etc. the single letters or words that you are reading – you read
the letters as the meaning you are directed to. One could
Ipseity
also say that the letters and words as such withdraw from
(basic self-affection, mineness) our attention and become transparent for the meaning
they convey [32, 33]. This is also expressed by the notion
of the ‘intentional arc’ coined by Merleau-Ponty [34]:
Fig. 1. Intentional arc. through the medium or vehicle of integrated sensations,
movements or thoughts, the subject is directed towards
the object or content of its conscious acts (fig. 1). The arc
may also be described as a double-layered intentionality:
sciousness (feeling ‘in a fog’), an experiential fissure from a prereflexive, bodily or ‘operative intentionality’ [34],
their own body, a distance to the environment (‘like be- mainly based on habitualized performances, serves as the
hind glass walls’) and a general alienation from the world: medium for the active or explicit intentionality that is di-
It is as if I am not a part of this world; I have a strange ghostly
rected towards the object.
feeling as if I was from another planet. I am almost non-existent This mediation, in turn, is based on ipseity: the inten-
[24]. tional arc is embedded in the subject’s basic self-affection.
It is as if I am not really sitting here. It’s just my body that you Ipseity is what ‘animates’ the mediating vehicles of the in-
see, but somehow I am not in it (own interview). tentional arc and endows them with a sense of mineness.1
Accordingly, Minkowski [30] already conceived of In contrast, a lack of self-affection leads to an opacity of the
schizophrenia as implying a loss of vital contact with real- medium. To take an everyday example: if we temporarily
ity. The fundamental disturbance of immersion in the lose the sensation in our arm because of a nerve compres-
world leads to a hyperreflexive self-observation which, sion, the arm does not only feel numb and somehow alien,
however, cannot compensate for the lacking sense of self: but the hand no longer functions as a medium of touch
I constantly have to ask myself who I actually am. It is hard to
either. Its operative intentionality is disturbed. Instead of
explain … most of the time I have this very strange thing: I watch conveying a sense of the touched surface, the movements
myself closely, like how am I doing now and where are the ‘parts’ of the hand will become awkward or clumsy, and it will
… I think about that so much that I cannot do anything else. It is appear as an alien, thing-like object – an obstacle instead
not easy when you change from day to day. As if you were a to- of a medium. Thus, the mineness of the mediating ele-
tally different person all of a sudden [31].
ments is what makes them transparent, while a loss of
The level of experience that is affected in these patients mineness results in a growing opacity of the medium.
is not that of the ego or reflexive self, but concerns the im- Now we can apply this principle to schizophrenia: if a
plicit, prereflexive self-awareness that is present in every lack of ipseity or basic self-affection extends to the single
experience without requiring introspection. This tacitly bodily sensations, movements, perceptions or thoughts,
felt self-presence is the presupposition for reflexively
identifying myself – but as becomes evident in schizo-
1 Similar concepts of a bodily, affective background consciousness in
phrenia patients, its diminishment may not be compen-
which object-directed intentionality is embedded are proposed in affective
sated by reflexion. On the other hand, despite their perva- neuroscience, for example by Damasio [35] or Solms [36]: ‘The internal type
siveness and highly irritating character, such basic self- of consciousness consists in states rather than objects of consciousness …
disturbances are obviously still very different from the The internal body is not an object of perception unless it is externalized
and presented to the classical senses; it is the subject of perception. It is the
experience of passivity and alien control in acute schizo- background state of being conscious. … We may picture this aspect of con-
phrenic episodes. How can the concept of ipseity disorder sciousness as the page upon which external perceptions are inscribed. The
account for these? relationship between the two aspects of consciousness – the objects and the
subject of perception – is also what binds the components of perception to-
A possible bridge is provided by the phenomenologi- gether; objects are always perceived by an experiencing subject (cf. the ‘‘bind-
cal concept of intentionality which means the inherent ing problem’’)’ [36, p. 7].
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they will no longer serve as implicit media of active inten- Passivity Experiences
tionality but become resistant and opaque. The subject is Alienation of Operative Intentionality
experientially separated from the mediating processes In passivity experiences or delusions of alien control,
which it normally embodies, and these processes will be- schizophrenia patients misattribute self-generated ac-
come increasingly disintegrated or fragmented, resulting tions to an external source (be it an agent or a machine,
finally in what may be called a ‘disembodied mind’ [4, 32]. through hypnosis, rays etc.). A first stage of the trajec-
The relation of the subject to the world is then deprived tory from basic self-disorders to this type of ego disorders
of its ‘mediated immediacy’ (to use Hegel’s term), leading may be seen in an alienation and ‘disautomation’ of ha-
to a fundamental alienation. Sensations, perceptions, bitual motor actions which is found in prodromal phas-
movements or thoughts will increasingly appear in one’s es:
awareness as objects or obstacles that conceal the world There were periods in which I felt extremely badly coordinated,
instead of giving access to it. Consciousness will be like a when I just made a movement with the arm, and the arm had
window that has become stained or blind. moved further than I wanted it to move. But I also found myself to
However, the reciprocal relationship applies as well: a be extremely clumsy, somehow, when walking. I therefore con-
disintegration of habitual patterns of perception, move- stantly observed my walking and my movements … Climbing the
stairs was also very extreme, when you need a bit of concentration
ment or thought may also lead to a sense of alienation and and a feeling of balance. I really thought each step after the other,
loss of mineness. To a certain degree, this is a normal ex- as it were, each movement… [31].
perience: if we repeat a familiar word several times slow- I walk, and I look around … and I’m dizzy and all is like a ma-
ly and aloud it may sound strange to us – the implicit chine. … I just didn’t have much control over myself. … I have this
coupling of syllables and meaning is dissolved. In the robot-like feeling in my head, to be looking through cameras, and
you observe your whole body, and the steps you take towards the
same way, when focusing on a single part of the body, it bench [31].
no longer functions as a tacit component of integrated
habits. If the musician concentrates on his single fingers, These and similar reports [38, 39] may be interpreted
he will stumble in his run, as we also will when running as resulting from a weakened sense of mineness or self-
down the stairs and thinking of the single steps. Hence, affection which normally subserves the smooth flow of
the explication of single elements through focused or hy- coordinated movements. A gap arises between one’s ex-
perreflexive awareness disturbs the former familiarity plicit intentionality (e.g. walking towards a goal) and the
and leads to an alienation and loss of mineness. This may operative intentionality of the body. As a result, the units
also occur in schizophrenia, as a ‘pathological explication’ of meaningful actions become fragmented and must be
caused by the disintegration of habits or gestalten [7, 37]. replaced by targeted attention and action of the will, lead-
In both cases, the fragmentation of the intentional arc ing to a hyperreflexive awareness of normally tacit perfor-
leads to an increasing alienation and finally externaliza- mance [3]. Patients then often experience themselves as
tion of processes that would normally remain tacit, such robots or human machines, becoming the passive specta-
as bodily sensations, single movements or inner speech. tors of their body’s action.

Disintegration of Intentional Arc

From Self-Disorders to Ego Disorders The next step consists in a disintegration of the inten-
tional arc, characterized by fragmented impulses, autom-
On this basis, I will now analyse the transition from atisms or motor blockades which interfere with the course
basic self-disorders to ego disorders in schizophrenia. In of action:
general, four stages may be distinguished: First, she only noticed difficulties in doing her housework. All
1 Alienation of operative intentionality, resulting from the time something interfered, other thoughts, but also disturbing
a lack of mineness or ipseity movements. Thus, right in the midst of cooking, her hand sud-
2 Disintegration of the intentional arc, explication and denly moved to her forehead several times … The movements oc-
objectification of single elements curred on their own accord, she didn’t have control over them. …
From then on, she observed each movement carefully and noticed
3 Externalization, experienced in an ‘as if’ mode that she actually walked around like a robot [28].
4 Breakdown of the ‘as if’ and transition to delusion
I will take a closer look at these stages, using the exam- With the disintegration of overarching action units,
ples of (1) passivity experiences and (2) thought insertion, movement fragments may pop up and attract one’s atten-
and presenting typical case examples for each of the stages. tion – a phenomenon termed ‘pathological explication’
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above. On the other hand, motor blockades can render tually manipulate their movements. Thus, the patient al-
the patients incapable of willfully releasing an action they ready mentioned at the beginning of the section Disinte-
intend to perform: gration of Intentional Arc further reported:
I could no longer do what I wanted. … I wanted to get up, and She was now convinced that extraterrestrial powers were able
then I could no longer move my legs. They were stiff. I was sitting to control her and steer her movements. How this worked and to
somehow, looking at something, then I wanted to stand up and it what purpose she did not know. Yet under these influences, she
did not work. … It was as if I was no longer in control of my move- really had become a marionette [28].
ments, as if my legs … would no longer serve me. … I started to They inserted a computer in my brain. It makes me turn to the
wonder whether I still could move myself. At every step I thought: left or right [41].
‘Are these your own movements, is it you who is moving now?’ I
tried to check that, I walked back and forth, or I ran a bit. That The alteration which has occurred at this stage is two-
worked alright, but I thought: ‘It could still be programmed that fold:
you are now doing this’ [28]. 1 The breakdown of the ‘as if’ implies the loss of the
ability to take an external or intersubjective point of
In this case, the alienation and interruption of the in- view from which what is experienced ‘cannot be
tentional arc already lead to the feeling of external influ- true’. This is the hallmark of delusion and the reason
ence, which announces the next stage. for its incorrigibility: taking another’s perspective
and, thus, a distance from oneself has become im-
Loss of Agency and Externalization possible [9].
At this stage, the alienation of self-generated move- 2 Due to the externalization of agency, passivity experi-
ments reaches the point where they seem to be ‘made’ or ences are characterized by an ‘inverted intentionality’
performed by an alien force, even though this is still ques- [42] or self-centrality: an alien, overwhelming inten-
tioned or expressed with the reserve of an ‘as if’. tionality takes over and causes the patients’ bodily ac-
tions. Instead of acting, they feel acted upon. More-
A schizophrenic patient began to doubt whether it really was
his own arms or somebody else’s that performed a task. While over, in delusional elaboration, the manipulating
working, he had to observe his arms carefully to make sure that agent is not hidden anymore, but gains a concrete,
they were his own, and repeatedly looked behind himself in order often technical shape.
to see if there was not somebody else who moved them [37, 39].
When I ate this morning, I felt as if somebody else’s head would Thought Insertion
also be there and would eat with me. It feels like other people would
stick their head into my head. When I am chewing, it seems that Alienation of Operative Intentionality
another tongue comes and takes the food [40]. The second example for the transition from self- to ego
disorders concerns thought insertions. I start with a his-
In these cases, the unity of the initiative to work or to torical case of hyperreflexive self-observation:
eat and the corresponding bodily action (moving the arm,
If a thought passed quickly through his brain … he was forced
jaw or tongue) is no longer achieved. The intentional arc
to direct back his attention and scrutinize his mind in order to
which normally connects both components is torn apart, know exactly what he had been thinking. In one word, he is preoc-
and they are experienced independently of each other. cupied by the continuity of his thinking. He fears that he may stop
The motor actions are performed, yet without being em- thinking for a while, that there might have been ‘a time when my
bedded in self-affection. Hence, they only convey a sen- imagination had been arrested …’. He wakes up one night and asks
himself: ‘Am I thinking? Since there is nothing that can prove that
sory or kinaesthetic feedback but lack the sense of prere-
I am thinking, I cannot know whether I exist’ [43] (quoted in Par-
flexive bodily agency, thus being experienced as if per- nas and Handest [44, p. 128]).
formed by an alien agent. This is already the stage which
can be termed ‘ego disorder’, since it implies a dissolution In vain, this patient tries to banish his existential fear
of the boundary between self and other. Subsequently, the of losing himself by constantly observing his own
externalization under reservation of ‘as if’ transitions into thoughts. His attempt towards self-assurance fails be-
full-blown delusion. cause reflection cannot compensate for the lacking self-
affection in which the thinking process is normally em-
Delusion bedded. If the intentional act is no longer supported by
At the last stage, the reservation of the ‘as if’ breaks ipseity, it remains unrealized and has to be repeated emp-
down under the pressure of the frightening experiences, tily, resulting in anxious hyperreflexivity.
and the patients gain certainty that others are able to ac-
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 Disintegration of Intentional Arc equivalent to an incipient ego disorder: the thoughts are
On the other hand, the alienation of the thinking pro- no longer experienced as self-generated, but as if they
cess may also arise from a primary disintegration of the were made or inserted from outside. Further externaliza-
intentional arc, as in the case of formal thought disorder: tion combined with sensualization may also turn the au-
While speaking, I suddenly lose the thread and don’t know
dible thoughts into auditory hallucinations or ‘voices’.
what I was going to say. – Sometimes there are strange thoughts in This applies in particular to a type of thoughts that is de-
me that come out of the blue. – I have to pick out thoughts and put rived from normal ‘inner speech’, consisting of running
them together. I can’t control the actual thoughts I want. … I think commentaries or self-criticism:
something but I say it different … (Last time) I could not get the
words that were correct to make up a sentence and I knew I was Each time he does something, smoking a cigarette or eating,
not saying the right thing [38]. then it says: now he smokes, now he eats … these are certainly not
his own thoughts, one could hear them outside, in the next room
In these reports we can notice a ‘lack of tension’ in the [46].
intentional arc which normally keeps the thoughts on the Now the sensualized thoughts are no longer recog-
track and prevents unfitting thoughts or words from in- nized as self-generated but appear as completely foreign
truding. As in the case of motor alienation, fragmented to oneself, in this case as ‘commenting voices’.
thoughts or blockades may interfere with the intended
course of thinking or speaking. Huber et al. [45] spoke of Delusion
a ‘loss of the conductivity of thinking’ which also implies At the last stage, the ‘as if’ breaks down, leading to full-
an increasing awareness of the single elements of thinking blown delusions of thought insertion:
instead of its overall intention. Thus, the fragmented Everybody is able to transmit thoughts onto him. Sometimes
thoughts gain object-like character, as shown in the fol- he tries to defend himself … but then they try to wipe out his own
lowing cases: thoughts by pressure. His own and alien thoughts are intermingled
… This ‘speech in the head’ (Kopfsprache) is constantly present
Each time I think a thought I get a counterthought on the oth- and emanates from his comrades [46].
er side of my brain. – Thoughts always pass down obliquely into
the very same spot [24]. Here the loss of agency for intruding thoughts has re-
Sometimes my own thoughts are audible in my head as if I sulted in the delusion of thought insertion. Again, this
would speak them (own interview). implies a disturbance of both aspects of intersubjectivity:
With the medium of thoughts being alienated, they on the one hand, the patient is no longer able to clearly
lose their transparency for intentional content. Instead, distinguish between himself and others. On the other
thoughts are like material objects localizable somewhere hand, he is unable to take the other’s perspective, that
in the head, or they become audible and the patient listens means to transcend his own point of view and to call his
to his own thinking (thoughts aloud). Nevertheless, there delusional conviction into doubt [9].
is no complete alienation of the thoughts, because they The trajectory of the four stages that I have now de-
are still experienced as one’s own; in other words, the scribed need not be regularly passed through. Frequently,
sense of agency is preserved. one or more stages may be skipped or do not show them-
selves explicitly. In any case, however, there is a dynamics
Loss of Agency and Externalization of increasing alienation from basic over prodromal to
At the next stage, the dissolution of the intentional arc acute stages of psychosis which can be classified according
advances to the point where the fragmented and intrud- to the scheme presented here. Research into these transi-
ing thoughts appear to be imposed on the patient from tional phenomena carried out by Klosterkoetter [28, 29]
the outside: supports such a typical sequence, but more empirical
I could no longer think the way I wanted to … It was as if one
studies are still needed to confirm the phenomenological
could no longer think oneself, as if one were hindered from think- concept of the nature and emergence of ego disorders.
ing. I had the impression that all what I think were no longer my
own ideas at all … as if I wouldn’t be the one who is thinking. I
began to wonder whether I am still myself or an exchanged person Conclusion
[28].
What this patient experiences is not only loss of con- In this paper I started from the concept of schizophre-
ductivity, but a passivity and disempowerment of her nia as a disturbance of basic self-awareness, marked by
thinking process as a whole. Again, this loss of agency is diminished self-affection or ipseity. This can be found in
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its pure form particularly in the prodromal stages, leading experiences are still accompanied by an ‘as if’, this last
to a growing sense of alienation, a ‘disembodiment’ and a reservation finally breaks down, leading to the delusions
separation from the world and others. While the patients of influence, thought insertion and alien control which
are still aware of their personal self and are able to reflect mark the climax of the alienation process.
on themselves, this (hyper-)reflexion always comes too Other ego disorders, such as thought withdrawal,
late and cannot compensate for the lack of basic self-af- thought broadcasting, ‘made’ feelings, somatic hallucina-
fection. tions etc., may be attributed to analogous psychopatho-
As I have further proposed, the relation of these basic logical trajectories. Similarly, an alienation of the inten-
disturbances to ego disorders can be grounded on the tional arc of perception has been shown to lead to delu-
concept of intentionality. The intentional arc of con- sional mood, delusional perception and delusions of
scious thinking, feeling and acting is normally realized reference [42]. Finally, as pointed out above, auditory hal-
through the mediating or tacit function of sensations, lucinations can be conceived as an alienation of thought
perceptions, movements or thoughts which, being con- fragments (thoughts aloud) in which the sensualization is
nected and integrated, become transparent for the sub- predominant so that they are not experienced as inserted
ject’s overarching intentions or goals. This transparency thoughts. Though having the same roots, voices do not
however depends on the basic medium of self-affection count among ego disorders because they do not remain
or ipseity. Hence, the lack of ipseity in schizophrenia re- ‘within the subject’, as it were, but are completely exter-
sults (1) in an alienation and growing opacity of the in- nalized, thus leaving the self-other boundary as such un-
tentional arc. The operative or mediating intentionality affected.
decouples from the active intentionality that it normally To summarize, in ego disorders, the basal schizo-
sustains. (2) Now the otherwise tacit or mediating ele- phrenic self-disorders reach the point of a fundamental
ments appear in the field of awareness as thing-like ob- disturbance of subjectivity, marked by a loss of the bound-
stacles: intruding movements or fragmented thoughts are aries between self and others. Thus, delusions of alien in-
the remnants of the dissolving intentional arc. (3) At the fluence or control are not primarily cognitive misconcep-
next stage, the increasing alienation leads to the external- tions or higher-level meta-representational failures but
ization of the fragments which are no longer embedded rather the final result of a diminishment of self-affection
in an ongoing sense of agency. Now the experiential field and self-presence on the prereflexive level. Hence, one
is characterized by an increasing self-centrality and a cor- can conclude that the absence of the notion of the self and
responding ‘inversion of intentionality’. This results in its disorders in international psychiatric classifications
passivity experiences or ego disorders which involve a means a severe drawback for a differentiated psychopa-
loss of boundaries between self and other. (4) While these thology of schizophrenia.

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