Searching for the lost meaning

Not only defi ning the nature of schizophrenia, but even defi ning schizophrenia as a diagnostic entity is still a challenge for psychiatry. The current diagnostic systems and the related approach to psychopathology are of little aid to this purpose, and have inadvertently resulted in an impoverished clinical practice. There is substantial meaning underlying schizophrenic symptoms that would appear bizarre and senseless from the viewpoint of a purely descriptive method. Psychiatry needs to devise an approach that embraces the complexity of the different perspectives of explanation and understanding of mental illness, examining the interplay of each element in the subjective experience. Symptoms such as delusion and hallucinations cannot merely be conceptualized as false judgment or lacking of external object, respectively, as they refl ect the fact that patients try to make sense of their different, globally altered experience of the self, of others and of the world. This line of reasoning builds on previous work in the phenomenological tradition postulating a disturbance in sensorimotor processes, which bond human beings with one another while remaining imperceptible to consciousness. This suggestion is consistent with a large body of research highlighting impairment in sensory processing in schizophrenia. Other authors underscored the importance of subtle alterations of functions other than sensorimotor processes, such as experiential anomalies of affectivity, cognition-perception and body-motor experience, alterations of self-awareness, and disturbances in reciprocal attunement leading to disconnection from a common register of meanings and loss of common sense. Heidegger refers to a human being as Being intrinsically selfrevelatory in the unity of physis and logos. He refers to the lived experience of being constantly in the everyday situation as being located, “thrown” into the world. The existence is always ‘in the world’, ‘near the things’ and ‘with the others’ for everybody, in the ways of ‘attunement’, ‘understanding’ and ‘discourse’, that are always together, in the unity of the Dasein. This conception of human existence may help understand the subjective experience of a schizophrenic patient and increase diagnostic accuracy and treatment adequacy.