Passive and Active Schizophrenia: Toward a New Descriptive Micropsychopathology

Schizophrenia Bulletin vol. 35 no. 6 pp. 1183–1196, 2009 doi:10.1093/schbul/sbn057 Advance Access publication on June 17, 2008 Passive and Active Schizophrenia: Toward a New Descriptive Micropsychopathology Introduction 2 This article introduces and defines the domain of the ‘‘experiential substrate’’ and the ‘‘passive experiences’’ of schizophrenia. Passive experiences are subjective experiences characterized by passive reception of the experience. The term ‘‘passive,’’ used in reference to the experiences of a disorder, shares the same basic etymology of the term ‘‘patient,’’ and the passive experiences are similar to the simple and immediate experiences of pain described in medicine: an individual may feel, suffer, and undergo the experiential substrate of schizophrenia in the same way that other individuals feel, suffer, and undergo the experiential substrate of physical pain. Therefore, other meanings of the term experience (ie, the action of putting to the test, trial, experiment, to make experiment of, to test, to try) are excluded from the experiential substrate, passive experiences, and ‘‘passive domain’’ of schizophrenia because they do not imply the passive nature of this psychopathology domain. The passive experiences of schizophrenia are here considered a fundamental, independent domain with a precise role in descriptive psychopathology. Passive experiences and active judgments, in particular those judgments formulated in terms of ‘‘conviction’’ or ‘‘doubt’’ about the passive experiences themselves, are distinct domains that need to be analyzed independently. The term ‘‘descriptive micropsychopathology’’ is proposed to describe these independent domains and the architecture of their possible interactions. This article is particularly focused on the definition of passive experiences due to their being currently neglected, omitted, or ignored as an independent domain and their being intermingled and confused with acts of judgment in current descriptive psychopathology. The introduction and definition of the domain of the experiential substrate and the passive experiences of schizophrenia are divided into 3 main sections. The first section starts with key definitions of experiences, symptoms, and the descriptive approach in psychopathology. This general framework is followed by the new operational definition of passive experiences. This new definition is then applied in an analysis of ‘‘thought insertion’’ and Jaspers’ ‘‘delusion proper’’ and discussed in relation to the relevant historical and current approaches in descriptive psychopathology. The second section of the International Center of Mental Health Policy and Economics, Via Daniele Crespi 7, 20123 Milano, Italy The ‘‘experiences’’ reported by individuals affected by schizophrenia are fundamental components of the descriptive approach adopted by current diagnostic systems for mental disorders and by clinical diagnostic interviews and rating scales for the assessment of the symptoms of schizophrenia. However, the technical literature does not rely on a specific definition of experiences in schizophrenia. This article introduces a specific, restrictive, operationalized definition of the ‘‘experiential substrate’’ of schizophrenia, defined by the ‘‘self-giving’’ ‘‘passive experiences’’ of the disorder that break into the consciousness of the affected individual, and are distinguished from the ‘‘active’’ acts of judgment formulation and conviction/belief attainment. The experiential substrate of schizophrenia may be considered similar to the experiential substrate of pain. The operationalization of the definition of passive experiences can enable the experiential substrate of schizophrenia to be acknowledged as an independent domain with a specific role in the assessment of the disorder, a role that is substantially omitted or ignored by current research and practice. The term ‘‘descriptive micropsychopathology’’ is proposed for this new method aimed to describe passive experiences and active judgments as independent domains to enhance the reformulation of criteria for symptom assessment and, consequently, reformulation of the criteria for the assessment of the efficacy and effectiveness of interventions aimed at prevention, care, and rehabilitation in schizophrenia. A new measure focusing on the evaluation of the passive experiences of schizophrenia and on the disturbance they cause to patients is also described. Key words: psychopathology/symptom/experience/ judgment/subjective 1 To whom correspondence should be addressed; tel: þ39-02-8323 882, fax: þ39-02-5810 6901; e-mail: . Ó 2008 The Authors This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 1183 Massimo Moscarelli1,2 M. Moscarelli article analyzes a number of semistructured and structured clinical interviews to clarify how this new descriptive approach applies in practice and how these measures conflate what has been defined here as passive experiences with other phenomena. Finally, the third section discusses some practical issues related to the passive experiences of schizophrenia for the assessment of efficacy, effectiveness and subjective usefulness of treatments, and the implications for adherence to treatment in research and practice. Readers of this article are likely to be familiar with current diagnostic tools and outcome measures. However, they might be less familiar with historical nosology, definitions of psychopathology concepts (Phillips),1 or phenomenology (Andreasen2). The descriptive approach in psychopathology was conceptualized by Jaspers3 at the beginning of the 20th century. Jaspers3 emphasized the importance of the descriptions of the patients’ experiences, a domain of psychopathology which he named ‘‘phenomenology’’: Phenomenology is the study which describes patients’ subjective experiences and everything else that exists or comes to be within the field of their awareness. These subjective data of experience are in contrast with other objective phenomena, obtained by methods of performance-testing, observation of somatic state or assessment of what the patients’ expressions, actions and various productions may mean (p53). .An experience is better described by the person who has undergone it . The patients themselves are the observers and we can only test their credibility and judgment .... Psychotic self-descriptions are not only unique but yield reliable results and through them we have discovered many of our basic concepts. If we compare what patients say we find much that is similar (p55). Jaspers’ concepts focusing on the ‘‘description’’ of the patients’ experiences influenced mainstream psychopathology in the areas of clinical interviews, symptom a (...truncated)