In recent years, several authors have defended a stratified or hierarchical account of the self and self-experience. Some of these accounts have proved to play an important role in the interpretation of psychiatric diseases. In this paper, I addressed the cases of dementia and of schizophrenia in light of the hierarchical model of self and self-experience. Thereby, I set myself two main aims: first, to investigate the potentialities and the limits of applying the hierarchical understanding of the self to dementia and schizophrenia; secondly, to reassess the model itself on the basis of some characteristic traits of both pathologies and possibly to propose some modifications.
The paper begins with a discussion of how the hierarchical model presupposes a formal-ontological law of foundation, which becomes visible in many texts written, for instance, on the distinction between minimal self and narrative self. Simplifying a rather complex debate, we can say that the concept of the minimal self generally refers to the basic, pre-reflective form of self-awareness, i.e., to the sense of mineness implied in all active and passive experiences.
The concept of the narrative self, instead, designates a higher and richer layer of self-experience, which presupposes language, self-reflection, and the possibility of recognizing oneself throughout one’s own life history. I argued that such a relation is generally understood as a univocal foundational relation, according to which the more complex layers cannot exist if the most basic layer does not exist. I further suggested that, if we go beyond purely formal ontology, the dependence relation is not limited to existence. Rather, in several works we can find the suggestion that the modification of the basic layers inevitably affect the higher, whereas the opposite does not seem to be the case.
Applying such a distinction between basic and higher layers of the self to psychopathology has certainly helped to highlight how different diseases affect particular layers of the self, leaving others untouched. However, a closer investigation of both dementia and schizophrenia shows that such a model needs to be theoretically refined, particularly in what concerns the implicit assumption concerning the foundation between layers of experience.
I accomplished this investigation under the assumption that dementia and schizophrenia are diseased that entail two different kinds of disorientation. The two pathologies, indeed, appear to be paradigmatic insofar as they affect, respectively, the higher and the basic layers of self-experience. Indeed, the experience of disorientation in demented patients appears to be connected with a disturbance of the higher faculty of reflective self-distancing. In schizophrenic patients, by contrast, such an experience is grounded upon a more basic self-disturbance. However, considering both diseases, I indicated some limits of the model.
Discussing the case of dementia, I have shown that, in this illness, we find instances of both quasi-implicit and quasi-explicit self-awareness that does not cleanly fit into the model, since it seems to involve a kind of self-awareness that is neither fully minimal nor truly reflective (e.g., when dementia patients evince a sense of shame, or pride). (This aspect has been more thoroughly developed in Summa and Fuchs (2015
).) This observation suggests that there are not just two, highly distinct levels, and it can be taken as a confirmation or the ideal-typical character of the distinction.
In schizophrenia, the case is even more complex. For the disease is not only characterized as a disturbance of ipseity or primal self-affection. Rather, it is often emphasized that such a basic self-disturbance is compensated by hyper-reflexivity. And if, on the one hand, hyper-reflexivity is certainly not a voluntary and controlled form of self-reflection, on the other hand, it clearly entails some higher-order form of self-experience or disposition. Accordingly, if hyper-reflexivity can and does exist even when there is a profound disruption of minimal self (or ipseity), then the postulated strict hierarchical dependency is put into question.
In the conclusions, I suggested that the model should be revised in two ways. On the one hand, a clearer distinction between the formal-ontological structure that concerns the existence or the persistence of layers of self and self experience should be more clearly (phenomenologically and conceptually) distinguished from the ‘quasi-causal’ dependence relations that concern the specific disturbances. In the latter case, the univocal foundational relation needs to be substituted with an account that takes the complex unity of experience as a whole, thereby also emphasizing how higher layers may also have an influence on what happens in lower layers (in this case, we should account for a reciprocal foundational relation).
On the other hand, I suggested that the vertical model might be strengthened in we consider it as complementary with a horizontal account of how, at different levels, cognitive, dispositional, volitional, and emotional aspects are intertwined.