[[🏠 030 Language and Psychology]] [[Books Index]] #language #schizophrenia #book Phenomenological psychiatry --- Note to self. Read this, what did i gain? - Some interesting perspective about the philosophical view on language and about the view of "Self-evidence" - I think this book just offering some possibility to interprete the language use, but nothing i can can bring into clinical practice immediately. # Book - Language & Schizophrenia Perspectives from Psychology and Philosophy by Valentina Cardella ## Chapter 1 - The Enigma of Schizophrenia ## Chapter 2 - Language in Schizophrenia ## Chapter 3 - The Cognitive Perspective on Schizophrenic Language ## Chapter 4 - The Philosophical Perspective on Schizophrenic Language ### Having schizophrenia or being schizophrenic? - **Maybe we shouldn't try to explain schizophrenia experience, perhaps being able to describe it is enough?** - Interacting with schizophrenic people is like being in touch with a different form of life. The way they speak, their actions and beliefs, and the experiences they live all seems to give birth to a different world too difficult to explain. Yet, maybe the problem here is the word ‘explain’. Are we supposed to explain schizophrenic experience? - **Jaspers think that as a helper, we should move beyond classifying symptoms, to empathetically understand the patient's experience. To see patient as human being.** - For Jaspers, one of the most important authors that phenomenological psy- chiatrists refer to, the answer to this question is no. In his General Psychopathology (1959), Jaspers claims that no objective explanation of human behaviour can be achieved. He thinks that when dealing with psychic life, we should abandon any attempt to explain and move to a possible comprehension. The psychiatrist has to identify with the patient, and thus he will be able to get in touch with mental illness in an empathic way and finally understand it. The perspective radically changes. Until this moment, the traditional way to approach schizophrenia was through classification: the psychiatrist’s aim was to recognise a number of symp- toms that make the diagnosis easy to arrive upon. The single patient, with a way of being and experiencing, was regarded as unnecessary for the purpose of an objective and medical analysis. With Jaspers, the individual becomes the pro- tagonist, and the new aim is to empathically understand the changes caused by madness to each patient’s life. - **Psychopathology is challenging because it is in the space between what we understand and what we will never comprehend.** - This is a real challenge, because psychopathology finds itself in that boundary between what we can easily understand, because it is crystal clear, and what we will never comprehend, because it goes beyond our capacity of understanding. - **The schizophrenic world is subjectively different from where we live. It is hard to understand by outsiders. Patients find meaning, at times create their own subjective and private use of language to make sense of those experiences.** - The schizophrenic world is radically subjective, because schizophrenic people are forced to live experiences that are very far away from what we usually live and share. Hearing voices shouting inside my head and not succeeding in controlling them, believing to be mastered by a robot, claiming to have some animals living in my stomach, and being sure that my thoughts are not mine: all of these experiences are very hard to understand from the outside. Nevertheless, the psycho- pathologist must find a meaning beyond the nonsensical, starting from the words used by schizophrenics that sometimes form a subjective and private language. - **Delusion-like ideas stems from traumatic experiences, or are connected to other psychological processes such as delusions of jealousy, thus makes them understandable.** - Jaspers focuses on the existential difference between who suffers from mental disorders and who does not (and Binswanger, 1954; Blankenburg, 1971 will do the same, as we will see); it is as if a schizophrenic literally does not live in the same world as ours, and when we try to enter this world, we have to know that sometimes we will not be able to go ahead and we will have to stop. It happens when we deal with delusions, for example. For Jaspers, delusions are the key symptom of mental illness, showing the inner conflict between comprehensibility and incomprehensibility. The German author divides delusion-like ideas and primary delusions. The ideas stem from traumatic experiences or are connected to other psychological processes that make them understandable, as in delusions of jealousy or depressive delusions. - **Primary delusions on the other hand, which is a feature of schizophrenia, is incomprehensible.** - Primary delusions, on the other hand, are the halting point of phenomenological research in the psychopathologic field: they usually feature schizophrenia and their core characteristic is incomprehensibility. - **Even though we may not understand the patients' delusions, there is still room to empathically attune to them.** - Nevertheless, the possibility to empathically attune has to remain open, all the more so that Jaspers does not agree with Kraepelin’s view of delusion as a defect of intellect (Kraepelin, 1902). As claimed by Jaspers in his General Psychopathology, ‘to say simply that a delusion is a mistaken idea which is firmly held by the patient and which cannot be corrected gives only a superficial and incorrect answer’ (1959: 93; but we can move this critique also to the actual definition of delusion that we find in the DSM-5, as suggested by Ratcliffe, 2013). - **However absurd a delusion may be to us, we must believe that it must make some sense to the patient. We need to put ourselves in their shoes**. - A delusion is not a belief like others, but in order to understand its role in the schizophrenics’ experience, we need to put ourselves in their shoes and fulfil some version of Davidson’s principle of charity (see Davidson, 2001), accord- ing to which what these people are saying, however absurd, must have some sense that we ought to gather. - **A mental disorder symptom does not merely add to the patient (as if like a tissue growth?), but it changes them as a person - how they react to the symptom, make sense of it, view the world through it. Therefore, every patient is unique.** - The distance from the descriptive paradigm we described in the first chapter is huge. One person, however affected by such an enigmatic disease as schizophrenia, will not ever become an object described by neutral medicinal instruments, and the psychopathologist cannot impersonally describe the symptoms shown by a schizophrenic. The symptoms of a mental disorder do not simply add to someone, but they affect them globally, and they react to these symptoms giving some meaning to them and changing their vision of the world. Maybe this is the reason why schizophrenia is such a multiform disease; even if the symptoms can be similar at the exordium, each person has his own way to elaborate them, and so if one wants to investigate schizophrenia’s central core, one has to begin from a first-person perspective in order to get a general comprehension of this disease. - **The author states that "someone does not *have* schizophrenia, someone *is* schizophrenic" - because of how symptoms has affected the patient globally?** - -- *However, this sound not compatible with current "Recovery language", when we rephrase that the "patient diagnosed with schizophrenia", instead of "Schizophrenic patient"* - Someone does not have schizophrenia, someone is schizophrenic. This seems to be one of Jaspers’s most precious lessons. The authors who directly or indirectly refer to him will learn this lesson and consider schizophrenia as a different modality of existence rather than a number of symptoms. As stated by Ballerini (2016: 283): - psychiatric disorders, such as schizophrenia, are not considered a simple collection or a mere checklist of isolated symptoms, but as a structure, that is, a Gestalt [...], a web of signs and symptoms—each one is interconnected with others according to internal links. - **Bingswanger (1954) term "Extravagance" the central core of schizophrenia. Essentially, there is a disconnect between their personal logic to one that is shared societally. They seems to only care about personal aims and needs. However, Their reasoning is not illogical, but is too rationale and lack the human side. Example: A father gives a coffin as Christmas Gift to his daughter who is dying from cancer.** - **The schizophrenia person do not take into account the "shared web of beliefs" (social language) of others. They desperately want to get in touch with others, but their reasoning put more distance between them and others**. (- Is this related to what [[Ludwig Wittgenstein]] talk about language game?) - What does Binswanger mean with the term extravagance? In his famous work, Three Forms of Failed Existence (1954), Binswanger claims that extrava- gance is the key feature of schizophrenia. In the schizophrenic world, some kind of earthquake twists the horizon of meanings and disconnects the behavioural unity, and as a consequence, schizophrenic actions and speeches follow a private logic that does not respect the shared background of beliefs and uses. In order to explain this claim, Binswanger presents some of the most striking examples of schizophrenics’ bizarre behaviours. In one case, a schizophrenic father gives a coffin as a Christmas gift to his daughter who is dying from cancer. In another example, a patient who feels hot uses a piece of meat upon his head to cool down. The common theme of these examples is the fact that these people ignore the shared social web of possibilities that characterise each single situation and bend it to their purposes. That way, a coffin can become a gift because it is something useful for a terminally ill daughter, and a piece of food taken from a plate can help refresh someone’s head. The schizophrenic patient does not care for the object he is using or for the other people around him; the patient only cares about personal aims and needs. However, what is worth noting is that the extravagance of these behaviours does not depend on some kind of irrational- ity or on a lack of control over emotions; on the contrary, it descends from a hyper-rationality, from a logic that only a computer could show. For example, this is the way the schizophrenic father reasons: ‘my daughter is dying, a gift should be useful, but the only useful thing for someone who is dying is a coffin. So, I will give her a coffin’ (Binswanger, 1954; see Pennisi, 2004). There is noth- ing wrong in this way of reasoning—it is not illogical. The problem is just the opposite, that it is too rationale and that what is lacking is the human side, the sympathetic one (Gangemi and Cardella, 2015). Also, the fact that schizophrenic people do not take into account the shared web of beliefs and possibilities is what dooms to failure their existence; they desperately want to get in touch with other people, but the way they reason puts more and more distance between them and ‘normal’ people: how is a daughter supposed to react when receiving such a gift from her father? This is the reason why schizophrenic existence is not just different; it is a failed one. - **According to Blankenburg, schizophrenic lack "natural self-evidence" (1971), the real essence of schizophrenia is hidden behind positive symptoms (hallucinations and delusions). For his example, he refer to simple schizophrenia (negative symptoms, and without positive symptoms)** - **He think that the true nature of schizophrenia is the imbalance of the "dialectic relation between evident and non-evident" -- That means, questioning the most obvious and taken-for-granted stuff (which are shared by others) - aka common sense.** (It's interesting to consider how does one develop "common sense" - something to do with language, integration of learning, understanding and how one see the world right?) - According to this author, the essence of schizophrenia is something that the positive symptoms like hallucinations and delusions often hide. For this rea- son, he examines a specific case, that of Anna Rau, a young girl diagnosed with schizophrenia simple, that is, a subtype of schizophrenia characterised by a marked decline of social and occupational functioning and the gradual appearance of negative symptomatology, while psychotic symptoms like hal- lucinations and delusions are absent. In the case of Anna Rau, one can see the true nature of schizophrenic disorder: the imbalance of the dialectic relation between evident and non-evident, which is the reason why schizophrenic peo- ple are forced to question the most obvious and trivial aspects of existence. Actually, schizophrenia is often associated with a number of strange doubts; for example, a schizophrenic can wonder whether people keep on living when he does not look at them (Schreber, 1903), whether people are real or mannequins (Sechehaye, 1950), ask herself if her hand is human or not (Kaysen, 1996), have difficulties in understanding the necessity of changing clothes (like Anna Rau herself), or ask why people have names (as in one case reported by Sass, 1994). The expression ‘loss of natural self-evidence’ comes from one observation of Anna Rau, who says: ‘I simply find that I still need support. In all the simplest things of every-day life I need support. What I miss is natural self-evidence’ (Blankenburg, 1971: 43). In other words, what schizophrenic patients fundamentally lack is common sense. - ==As stated by Fuchs: common sense provides a fluid, automatic and context-sensitive pre-understanding of everyday situations, thus connecting self and world through a basic habituality and familiarity. In schizophrenia, patients ex- perience [...] a lack of tacit attunement to other people and situations. They report feeling isolated and detached, unable to grasp the ‘natural’, everyday meanings of the common world. (Fuchs, 2010: 554)== - **Without this "common sense", patients rely on others for support. "Self-evidence", which is fundamental to living in the world.** - **Both Bingswanger and Blankenburg shows that phenomenological psychopathology reject a descriptive and impersonal approach of mental disorder. They argue that what schizophrenia patients say is not nonsensical, but it's our duty to seek for a meaning beyond the chaotic appearance of schizophrenic language.** - As both Binswanger and Blankenburg show, the phenomenological psychopathology rejects a descriptive and impersonal analysis of mental disor- ders and searches for a basic disturbance in schizophrenia. This disorder, with its enigmatic features, is regarded as an elective one, and schizophrenic language represents a crucial field as well. As we are going to see, the phenomenological perspective fights the idea that what schizophrenics say is nonsensical and states that it is our duty to seek for a meaning beyond the chaotic appearance of schiz- ophrenic language. This search for meaning starts with a symptom that most of all seems to be meaningless: a delusion ### Delusions and Language: A world full of meaning - **Before conversion into full psychosis, patients experience delusional mood, where they start to experience the world in a different way.** - Delusion, a held belief not amenable to change, is, as we saw in the first chapter, one of the typical features of schizophrenia. According to phenomenological psy- chiatrists, the appearance of a delusion is preceded by a peculiar phase, a specific atmosphere called Wahnstimmung, or delusional mood (Jaspers, 1959). The classic view of this phenomenon regards it as essentially perceptual; in other words, schizophrenic patients, before entering ‘officially’ into the world of psychosis and showing evident symptoms like delusions and hallucinations, begin to perceive the world in a different way. - **Reality seems abit different to them, they can't put their finger on it.** - Reality acquires a peculiar aspect to them; it seems to have lost its familiarity, and objects, places, and even people start looking un- real, disturbing, strange, or mysterious. - **The objects remain the same, perpetually no difference, what change seems to be the meaning towards those objects.** - However, what happens can be read in a different way with respect to the classic perceptual interpretation. If we focus on the way the same patients describe this phase, we - cannot help thinking that it is not an event that concerns perception, like some sort of pseudo-hallucination. Subjects do not complain that things have changed from a perceptual point of view: they remain the same. It is possible to recognise them, yet it is like they have changed their meaning. What precisely characterises the delusional mood is the fact that the meaning is suspended. - When, for example, I looked at a chair or a jug, I thought not of their use or function – a jug not as something to hold water and milk, a chair not as something to sit in – but as having lost their names, their functions and meanings; they became ‘things’ and began to take on life, to exist.(Sechehaye, 1950: 56) - **Objects become unfamiliar, this is due to a change in semantic, pragmatic and emotional components connected to the objects' recognition. Things become strange and unfamiliar**. - Another patient says: ‘looking around my room, I found that things had lost their emotional meaning. They were larger than life, tense, and suspenseful. They were flat, and coloured as if in artificial light’ (Anon., 1990: 167). The sense of unreality in those examples seems to be due to the semantic, pragmatic, and emotional components connected to the objects’ recognition. The meaning is suspended and things become unfamiliar; amidst the lack of a recognisable function, they seem to convey a feeling of mystery and artificiality. - **People around them start to feel inhuman, as if puppets, androids**. - The suspended meaning does not concern only objects, but people too, who look like puppets, androids provided with artificial mechanisms, or robots. The same anonymous patient cited before says she was afraid of her roommate because she looked inhuman, robot-like, and the majority of the students appeared the same to her (Anon., 1990). Perceiving things and people as unfamiliar leads the schizophrenic to be afraid, to feel that something is terribly wrong in the world and that some bad thing is going to happen: this is the reason why the delusional mood is unbearable for patients. - **Because the delusional mood is unbearable. Patient now compensate by attaching meaning from inner world onto everything.** - However, when reality gets less and less familiar and the world seems to lose its meaning, where is it possible to regain what is getting lost? The answer is only one: in the inner world. It is not accidental that only when the delusion rises schizophrenic subjects succeed to get out from this intolerable situation of suspension. The dawn of delusion comes together with the most severe phase of Wahnstimmung, and it literally reverses the situation, converting the sus- pended meaning into an overflowing meaning. The delusion puts everything in its right place and attaches meaning to every single thing. Before the appearance of a delusion, every possibility of comprehension is suspended, while after it, everything can be understood. - A schizophrenic patient describes this overflowing meaning: Schizophrenia is a disease of information. And undergoing a psychotic break was like turning on a faucet to a torrent of details, which over- whelmed my life. In psychosis, nothing is what it seems. Everything exists to be understood beneath the surface. A bench remained a bench but who sat there became critical. Like irony, the casual exchange of words between a stranger or a friend meant something more than what was being said. The movies, TV, and newspapers were alive with information for those who knew how to read. Without warning my world became suffused with meaning like light. In response, I felt as if I had been only half conscious before, as ignorant of reality as a small child. Although my sense of per- ception remained unaffected, everything I saw and heard took on a halo of meaning that had to be interpreted before I knew how to act. An advertis- ing banner revealed a secret message only I could read. The layout of a store display conveyed a clue. A leaf fell and in its falling spoke: nothing was too small to act as a courier of meaning. (Weiner, 2003: 877) - **Now, everything takes on a special meaning. (Ideas of reference symptoms? delusions start to form.) everything must have happened, for a reason. And patient start to decode and interpret every single gesture and word.** - Once nothing had a clear meaning, now everything takes on a special mean- ing. The situation is turned upside down, and the schizophrenic becomes literally immersed in a world full of meaning. Words always mean more. Each conversation, even among strangers, somehow refers to the subject or drops a hint of something. Eventually, each word assumes a special significance. - When I halfheard a conversation in the distance or the honking of a car, I would think it held special significance for me. I would randomly open a dictionary and find a word (“die”, “liar”, “evil”) and interpret how the word had special meaning for me. (Chapman, 2002: 547) - **When we are distressed by one topic, it is normal to react by connecting/deflecting to the most distant topic (escaping? running from it?) Is this what this passage mean?** - Therefore, things like this will happen: when a schizophrenic is requested to interpret the idiomatic expression ‘a drowning man will clutch a straw’, the reply is: - Duh. Help! Is anyone going to save him. I could say I’m a drowning man right now. Anyone who asks for help. Ask and you shall receive. Seek and you will find it. It all has to do with Christ. (McKenna and Oh, 2005: 14) - As we notice, the delusional idea (with religious content) links in everywhere, and a proverb about a drowning man is interpreted as connected to Christ’s goodness and to the patient’s personal situation. After all, when we are absorbed by a specific thought, when there is one aspect of our life that particularly dis- tresses us or that we particularly care for, there is nothing more normal than connecting the speech or events that are the most distant from this topic we are specially involved in. Delusion is the fundamental theme of the patient’s life, and this is why all seems to refer to it. - **The patient experiences lots of meaning when they are "unwell" though It makes no sense to us, but it gives them lots of meaning. For patient to choose "sanity" mean they may lose that meaning.** (This is important during treatment/psychoeducation, and recovery journey) - The delusional idea, on one hand, is the one idea everything refers to and, on the other, fills with meaning a reality that, in the Wahnstimmung phase, had become obscure and extraneous. The reality of delusion is indeed a private one, which is impossible to share, but in its huge capacity to mean it fascinates who holds it in a compelling way. A patient affirms: - A note about becoming “sane”: medicine did not cause sanity; it only made it possible. Sanity came through a minute-by-minute choice of outer real- ity, which was often without meaning, over inside reality, which was full of meaning. Sanity meant choosing reality that was not real and having faith that someday the choice would be worth the fear involved and that it would someday hold meaning.(Anon., 1992: 335) - This lucid declaration gives us a slice of madness completely different from what we are used to see. The delusion, mental disorder’s symptom par excellence, ac- tually fills people’s lives with meaning, and it is very hard for patients to abandon it, because who will ever choose an insignificant reality while having one full of meaning? ### Language and Forms of Life - Author said that "This is one of the most striking aspects of this perspective: all schizophrenics do and say has some kind of meaning, and if we do not find this meaning it is our fault, not theirs (note that asymmetry between comprehension and production I talked about in Chapter 3)." - Similar to what Anthony Yeo mentioned, it's not about patient being resistance and not being able to build rapport with us. It is us who can't connect with them (i'm paraphrasing) **Start to understand by understanding the person. Their personality. Who they are.** (What Dr George mention about understanding the patient as person) - The person must always be at the centre of the phenomenological analysis, with that person’s irreducible subjective experiences and essential structures that, investigated together, give us the access key to an apparently incomprehensible language. **Neologisms - patient's create new words to communicate the inexpressible.** - The neologisms, for example, descend from a specific need of the schizo- phrenic patient: to communicate what seems to be inexpressible. **Paralogisms, words becomes incorrect or imprecise. - Words and language of the patient cannot be interpreted outside the frame of schizophrenia. It must be in the context of the patient's world.** In paralogisms, as the reader will remember, word use becomes incorrect or imprecise. According to the philosophical perspective, this phenomenon has to be understood within the existential frame of schizophrenia, rather than being considered as depending on some defect in the linguistic mechanisms (or in some more basic mechanisms like memory). The reason why the associations among words are so strange and bizarre is that in the schizophrenic world there are no evident and natural links among things; therefore, the words’ meanings can be pulled together according to entirely personal aims and private associations. Coffins and gifts, food and ways to cool down can be put near each other, disre- garding common sense and the web of shared use and habits. In other word, it is the schizophrenic world that is twisted, not language. **Manneristic speech. Patient's speech seems unnatural and contrived because they lack the "solid ground" (make sense of common sense)** Manneristic speech is also explained on the basis of the schizophrenic way of life. Binswanger (1954) regards it as another type of failed existence (together with extravagance, see par. 1 of this chapter) characterised by inauthenticity. Schizophrenic patients lack a solid ground that can guide their actions, and so they grasp a schematic way of life with its typical behaviours, language, and outfits and imitate it. The schizophrenic sounds so unnatural and contrived be- cause he uses a mask in order to somehow elude the chaos of his life. **Space and Time affected. Derailment, Tangentiality or incoherence - because it's impossible to inhibit the irrelevant associations.** **Poverty of content reflect poverty of existence itself.** **Verbigeration and Laconic Speech are consequence of a frozen, suspended existence where nothing new could happen** - Authors like Minkowski (1970) noted that in schizophrenia even the struc- tural categories of space and time are affected. More specifically, a basic dis- turbance in time perception is what affects consciousness in schizophrenia and produces the acceleration and retardation of speech and other phenomena like derailment, tangentiality, or incoherence. The impossibility to inhibit irrele- vant associations is attributed by Minkowski (1970) to some failure in temporal continuity: words intrude into consciousness without being expected, because preparatory processes fail to function (Fuchs, 2013). Finally, if language lessens to an extreme poverty of content, that reflects the vacuity and poverty of the existence itself. Both verbigeration and laconic speech are the consequence of a frozen, suspended existence where nothing new could happen. **Patient repeats the words over and over, or copies what others are saying, may reflect their difficultly to find solid support for their own existence. (if there is no original thoughts or words, that means one does not exist? 'I think therefore I am'? what if I cannot think?)** The case of Anna Rau (Blankenburg, 1971) is significant in that regard, because here language clearly reflects existence. Anna struggles for words, talking in a pol- ished and sometimes stilted manner, making long pauses between one sentence and the other; her speech is a constant battle in order to find words. Yet, this happens be- cause her existence itself is a constant battle, a fight for accessing that level of evidence that other people get for free. Thus, the same topics keep on coming back, since An- na’s completely dominated by the disproportion between evidence and non-evidence and by the search for a safe support; she seeks this support in words as well that she copies from other people, turning out affected and stilted. The pauses, the hard struggle, the loss of the thread, and the inability to sometimes formulate a coherent speech—all of this is due to the impossibility of finding a safe ground to start from. **The way patients uses their language that way also related to social difficulties. I wonder if this related to sense of self, object relations, and attachment theory (identity), without a natural self-evidence, thus they self help by bending language in that manner.** Phenomenological psychiatry is indeed the perspective that probably accounts better for the social difficulties in schizophre- nia. Within this approach, schizophrenics’ social problems are included in the basic disturbance of this disorder, that is, the loss of natural self-evidence, which leads the schizophrenics to ignore the shared web of knowledge and beliefs and to bend it to their aims (see first par. of this chapter). This is the reason for their weirdness, for their detachment from common sense, and not some defect in the cognitive mechanism controlling social life. **Schizophrenia patients have relational deficit that lead to psychotic symptoms? Due to some kind of fracture, gradually, or sudden changing, that lead to patient experiencing depersonalisation or derealisation?** In line with this perspective, Stanghellini (2000) claims that the relational defi- cit in schizophrenia is not a result of psychotic symptoms, but, on the contrary, is a crucial aspect of schizophrenics’ vulnerability. This detachment from common sense is completely different from the autistic mind-blindness; it reveals itself as some kind of fracture, as a gradual or sudden changing of the natural experience (often associated with depersonalisation or derealisation, so that the subject feels things, persons, and even herself, as unfamiliar). **Patient react to this fracture of relational deficits by switching into observational exercise, by studying how others interact (like outsider looking in?)** The schizophrenic can react in different ways to this fracture, to this world that changes all at once (note that autistic people do not feel this fracture, because they seem to have never had access to this level of evidence in social relationships). The schizophrenic can compensate this lack of common sense through observation, just like Temple Grandin: this is the case of one patient cited by Stanghellini: **Or by active self-marginalisation, by "fighting" or rejecting the rules established by others, which lead to solitude and highly intellectualised style of living. (Since they couldn't fit in)** - Another possible reaction is active self-marginalisation; schizophrenics can feel angry and rebel and behave in an extremely eccentric way, like this young student: V.V. is a 22-year-old university student of the humanities. She plans to get rid of what she herself calls “heteronomia” (i.e., depending on the rules established by others). She has recently started a course on Sumerian language: “Since this was the first written language, I think that in it are expressed parts of the mind that were working by that age and are silent at present.” Exploring parts of the human mind that were active once, and are no longer active now, could help her find that original and eccentric view on the human condition that she is looking for. Her personal fight against the rules established by others results in solitude and a highly intellectual- ized style of living. (Stanghellini, 2000: 778) **The last few paragraph of this chapter, i think the author is reflecting about this approach of philosophical psychiatry. Related to the idea if patient lacking "evidence", as if they do not have any evidence of their existence. And patient may choose suicide to escape this unbearable pain. However, mental illness/suicide is not cancer. It is not destined that patient will have to die from suicide. Intervention wise, what can we do to help patient build this "self-evidence" from support from others?** **Can't take a too pessimistic view.**'' ## Chapter 5 An Alternative View. Schizophrenia as a disease of language ### What's wrong with schizophrenic language, then? **According to some authors, linguistic symptoms is more reliable to diagnose schizophrenia than first-rank symptoms. It is the way those people talk. (wait a min, what language?)** The schizophrenic employs language in a very peculiar way. Schizophrenic language is a specific entity with characteristic features that differ from both ‘normal’ lan- guage and from that of other mental disorders. According to some authors (see e.g., Ceccherini-Nelli and Crow, 2003), linguistic symptoms (collected by the designated scale called CLANG; see Chen et al., 1996) would be more reliable to diagnose schizophrenia than the first-rank symptom of the ICD-10 (the tenth revision of the International Classification of Diseases; WHO, 1992). In other words, language disturbances result more specifically than first-rank symptoms in the diagnosis of schizophrenia. Moreover, it is the way those people talk that directly creates that schizophrenic atmosphere reported by many psychiatrists (see Rümke, 1941) and that reminds us of something bizarre, unnatural, and distant. But what is the "right" way to use language? Actually no one can say. What is "schizophrenic language" is also not defined properly. Let me note a preliminary problem in the assumption of a defective use of language by schizophrenics, the sheer and mutually contradictory variety of “deficits” observed, and the absence of a coherent theory of “normal” usage against which to define deviations. (Frow, 2001: 276). This premise is followed by equally interesting remarks by Lorenz (‘“Schizophrenic language” can be correctly designated as both concrete and as abstract; as restricted, impoverished, and as fluid, overideational; as empty of meaning and as overinclu- sive of meaning; as resembling prelogical thinking and as metaphoric and sym- bolic’ [Lorenz, 1961: 603]) and Bleuler (‘schizophrenic language uses may be intermittent, or not present at all, in many schizophrenics, or present in speech and not in writing, or present with some interlocutors but not others’ [Bleuler, 1982: 591]).