schizophasic shtuff

Aspects of action or interaction that would normally be tacit emerge from the background of awareness. The subject describes difficulty engaging with the world in a natural, prereflective way, largely because of a hyperreflexive tendency to become aware of implicit rules, common-sense assumptions, or automatic aspects of action (e.g., becoming fixated or “hung up” on why an action is done in one way rather than another). NB: This may be found alongside 3.1, Lack of social understanding or interpersonal attunement (hypoattunement).

“[The patient] felt paralysed... his hands could no longer grasp, for who was it that gave them the right to take things? His feet could no longer walk, for who could ensure ground for their steps?”

The person may feel that the world in general is losing its internal order and coherence and has become meaningless and puzzling. This may be associated with feeling of having no stable point of orientation or point of view.

“I... sought some fixed point, but found none...The muchness and the motion were too much and too fast. Everyone withdrew from everyone. There was a running as of something liquefied, a constant going forth, as of evaporation. Everything was schematic, ghostlike, even myself.” (consider also 1.8.3, Loss of spatial integrity or structure, and 5.1.2, Decreased intensity or substantiality*)

The subject’s ability to appreciate or function in everyday reality is disrupted by her preoccupation with or distraction by an imaginary, delusional, or solipsistic world (with or without clear understanding of the distinction between real and imaginary).

The subject experiences a merger or confusion between different realms or universes associated with different experiential modalities; that is: difficulty distinguishing between, e.g., perception and imagination, memory and imagination, or memory and perception.

“I don’t know, when I talk to you [his therapist] whether I’m having a hallucination, or a fantasy about a memory, or a memory about a fantasy.”

“I have a really difficult time distinguishing between dreams and reality... I’ll have dreamed about something, and then it happens, and it’s this really weird doubling of the experience because I feel like I’ve already had the experience. Sometimes when you first wake up from a dream [normally] you’re a little uncertain, but this just endures.”

1           — Space and Objects

1.1        — Abnormal intensity or persistence of visual perceptions 1.1.1     — Increase in intensity of visual perceptions* 1.1.2     — Decrease in intensity of visual perceptions* 1.1.3     — Recurrence or prolongation of visual stimuli

1.2.       — Blindness or partial blindness 1.2.1     — Blurred vision* 1.2.2     — Partial seeing 1.2.3     — Transitory blindness

1.3        — Disturbances involving veridicality (accuracy) of visual perceptions* 1.3.1     — Visual illusions* 1.3.2     — Visual hallucinations* 1.3.3     — Visual pseudohallucinations*

1.4.       — Visual fragmentation 1.4.1     — Object fragmentation 1.4.2     — Break-up of a scene 1.4.3     — Captivation of attention by isolated details

1.5        — Disorganisation or disturbed object stability 1.5.1     — Disorganised object contours 1.5.2     — Loss of perceptual stability

1.6        — Changes in quality, size, or shape of visual perceptions 1.6.1     — Changes in colour of visual perceptions 1.6.2     — Micropsia/macropsia 1.6.3     — Dysmegalopsia 1.6.4     — Metamorphopsia 1.6.5     — Other distortions

1.7        — Disturbances of perceptual distance or object juxtaposition 1.7.1     — Objects seem closer or farther away* 1.7.2     — Disturbance of relative spatial relationship (juxtaposition) of objects 1.7.3     — General disturbances in estimation of distance

1.8        — Distorted experiences of space 1.8.1     — Diminished perspectival orientation 1.8.2     — Loss of topographical orientation 1.8.3     — Loss of spatial integrity or structure 1.8.4     — Loss of dimensionality 1.8.5     — Experience of infinite space 1.8.6     — Figure/ground reversal 1.8.7     — Affective experience of space*

1.9        — Abnormal intensity or persistence of auditory perceptions 1.9.1     — Increases in intensity of auditory perceptions 1.9.2     — Decreases in intensity of auditory perceptions* 1.9.3     — Heightened awareness of background auditory sensations 1.9.4     — Recurrence or prolongation of auditory stimuli

1.10      — Disturbances involving veridicality (accuracy) of auditory perceptions* 1.10.1   — Auditory illusions* 1.10.2   — Auditory hallucinations* 1.10.3   — Auditory pseudohallucinations*

1.11      — Other changes in quality of auditory perceptions

1.12.     — Problems localising sounds

1.13      — Disturbances of other senses* 1.13.1   — Tactile disturbance* 1.13.2   — Gustatory disturbance* 1.13.3   — Olfactory disturbance*

1.14      — Synaesthesia or abnormal concomitant perception*

1.15      — Splitting-off or isolation of sensory perceptions

1.16      — Disturbances in recognising or identifying an object of perception

1.17      — Loss of boundaries with, or demarcation from, the physical world

2           — Time and Events

2.1        — Time or movements appear to change speed 2.1.1     — Time or movements seem speeded up* 2.1.2     — Time or movements seem slowed down* 2.1.3     — Time or movements seem (somehow) both speeded up and slowed down

2.2        — Discrepancy between internal and external time* 2.2.1     — Internal time seems slower than world time* 2.2.2     — Internal time seems faster than world time*

2.3        — Disruption of dynamic organisation of time 2.3.1     — Time feels as though completely stopped, static, infinite, disappeared 2.3.2     — Time as disjointed or fragmented 2.3.4     — Disorientation in time 2.3.5     — Feeling limited to or isolated within the present moment 2.3.6     — Various bizarre experiences of time

2.4        — Disturbed anticipation 2.4.1     — Perpetual anticipation 2.4.2     — Constant surprise due to the inability to anticipate future events 2.4.3     — Feeling that “anything could happen” 2.4.4     — Protention (future directedness) collapses

2.5        — Disturbed awareness of the expected future* 2.5.1     — Future seems nonexistent* 2.5.2     — Future seems unimportant or irrelevant* 2.5.3     — Future seems threatening* 2.5.4     — Premonitions*

2.6        — Disturbed experience of memories or of the past 2.6.1     — Past seems cut off* 2.6.2     — Past seems vague or obscure* 2.6.3     — Past disappears or seems nonexistent* 2.6.4     — Past seems accelerated* 2.6.5     — Past seems slower* 2.6.6     — Intrusiveness of the past* 2.6.7     — Erosion of distinction between past and present* 2.6.8     — Past seems disjointed

3           — Other Person

3.1        — Lack of social understanding or interpersonal attunement (hypoattunement) 3.1.1     — Loss of social common sense 3.1.2     — Bodily/proprioceptive loss of attunement 3.1.3     — Specific difficulty understanding nonverbal communication

3.2        — Sense of remoteness from others*

3.3        — Alienated/intellectual strategies for understanding others 3.3.1     — Alienated scrutinising of others’ behaviour 3.3.2     — Algorithmic approach to social understanding/interaction

3.4        — Sense of inferiority, criticism, or mistrust in relation to others* 3.4.1     — Feelings of self-consciousness or self-criticism* 3.4.2     — Feelings of social paranoia or social anxiety* 3.4.3     — Pervasive mistrust of others*

3.5        — Torment or distress due to generalised social insecurity

3.6        — Interference by voices*

3.7        — Disturbance of self-other demarcation 3.7.1     — Hyperattunement 3.7.2     — Unusual influence over others 3.7.3     — Pathological openness 3.7.4     — Experiences of being controlled 3.7.5     — Merging or fluid psychological boundaries 3.7.6     — Universal merging with others* 3.7.7     — Uncertain personal identity/attitudes* 3.7.8     — Uncertain physical boundaries 3.7.9     — Experience of being imitated

3.8        — Difficulties with the gaze 3.8.1     — Intrusiveness of the gaze of the other 3.8.2     — Feeling of exposure through one’s own eyes 3.8.3     — Intrusiveness of one’s own gaze 3.8.4     — Dehumanisation of the eyes of others 3.8.5     — Eyes as cosmic portals 3.8.6     — Unspecific uneasiness with the gaze

3.9        — Depersonalisation of others 3.9.1     — People seem dead* 3.9.2     — People seem unreal/false/illusory 3.9.3     — People seem mechanical

3.10      — Persons dominated by a single characteristic

3.11      — Heightened intensity, aliveness, or reality of others*

3.12      — Changes in quality or tone of others’ appearance 3.12.1   — People seem familiar in a strange way 3.12.2   — People seem unfamiliar in a strange way 3.12.3   — People seem disguised* 3.12.4   — People seem threatening in a strange way* 3.12.5   — General/unspecified changes in physical appearance of others

3.13      — People seem as if communicating something special or unusual (beyond the obvious) 3.13.1   — Paranoid significance* 3.13.2   — Grandiose significance* 3.13.3   — Metaphysical significance 3.13.4   — Unknown/unstatable significance

3.14      — Anomalous behavioural/attitudinal responses to others 3.14.1   — Active withdrawal* 3.14.2   — Oppositional/rebellious behaviour* 3.14.3   — Social disinhibition* 3.14.4   — Compulsive interpersonal harmony* 3.14.5   — Extreme compliance 3.14.6   — Compulsive clownery/entertainment of others*

4           — Language

4.1        — Basic disruptions of standard verbal comprehension 4.1.1     — Meaning/sound dissociation 4.1.2     — Distraction via semantic possibilities 4.1.3     — Distraction by individual words 4.1.4     — Unspecified difficulty understanding

4.2        — Difficulty understanding emotional/expressive aspects of speech*

4.3        — Specific changes in standard feel or meaning of words 4.3.1     — Focus on sound or appearance of words or phrases* 4.3.2     — Unconventional semantic determination 4.3.3     — Words seems arbitrary/absurd 4.3.4     — Words or language seems alive, quasi-physical, strangely powerful 4.3.5     — Egocentric linguistic reference

4.4        — Unconventional word choice, grammar, tone, or cryptic discourse 4.4.1     — Cryptic, telegraphic, or ungrammatical speech 4.4.2     — Stock words 4.4.3     — Made-up words (neologisms) or unconventional usage 4.4.4     — Mannerisms and stilted speech

4.5        — Disturbed fluency 4.5.1     — Unavailability of words 4.5.2     — Unfocused or disorganised thoughts preclude verbal expression 4.5.3     — General discordance between intended expression and the expressed

4.6        — Disturbed relevance 4.6.1     — Derailment* 4.6.2     — Tangential responding

4.7        — Disturbance of linguistic engagement or purposefulness 4.7.1     — Aprosody (lack of emotional intonation)* 4.7.2     — Echolalia 4.7.3     — Speech feels autonomous

4.8.       — Anomalous experience of the abstract and the concrete 4.8.1     — Difficulty with or dislike of abstract or general concepts 4.8.2     — Abstract rendered in unusually concrete terminology 4.8.3     — Specific or concrete meanings rendered in unusually abstract or general terminology 4.8.4     — Hyperabstract or vague discourse

4.9        — Ineffability: inadequacy of language to describe or express 4.9.1     — Language inadequate to express unusual experiences* 4.9.2     — General feeling of the inadequacy of language

4.10      — Alienation from self-description

5           — Atmosphere

5.1        — Derealisation of the world 5.1.1     — Remoteness or barrier (plate-glass feeling)* 5.1.2     — Decreased intensity or substantiality* 5.1.3     — Deanimation* 5.1.4     — Falseness 5.1.5     — Loss of enticement quality* 5.1.6     — Static quality, stillness, or morbid intellectualism 5.1.7     — Nonspecific/other derealisation*

5.2        — Loss of affordances

5.3        — Inanimate things seem alive or intentional*

5.4        — Heightened intensity/hyperrealisation*

5.5        — Déjà vu experiences

5.6        — Jamais vu experiences

5.7        — Perplexity 5.7.1     — Confusion of realms 5.7.2     — Unreal interferes 5.7.3     — World experienced as incoherent, disoriented 5.7.4     — Perplexing hyperawareness of tacit dimension

5.8        — Anomalous manner of ascribing or perceiving meaning 5.8.1     — Meaning imposed on object by subject 5.8.2     — Meaning inherent in the object itself 5.8.3     — Proliferation of meanings from the object

5.9        — Anomalous forms of meaning 5.9.1     — Physical or literalist instantiation of abstract meaning 5.9.3     — Anomalous classification

5.10      — Intensified awareness of patterns or trends*

5.11      — Anomalous sense of causal relationships 5.11.1   — Actions or events seem controlled by an external force or will 5.11.2   — Actions or events seem predetermined or planned

5.12      — All-inclusive self-consciousness/ontological “paranoia”

5.13      — Diminished ontological independence of experienced world/subjectivism 5.13.1   — Subjectivism/solipsism 5.13.2   — Double bookkeeping 5.13.3   — Influencing physical reality 5.13.4   — Pseudomovements of objects/persons

5.14.     — Revelatory or pseudorevelatory (apophanous) mood 5.14.1   — Uncanny particularity 5.14.2   — Self-referentiality 5.14.2a — Paranoid significance* 5.14.2b — Grandiose significance 5.14.2c — Metaphysical significance 5.14.2d — Unknown/unstatable significance  5.14.3   — Unspecifiable strangeness

5.15      — Quasi-mystical experiences 5.15.1   — Mystic union with the world* 5.15.2   — Mere being

5.16      — Experiences of the end of the world

5.17      — Anomalies of mood or affect 5.17.1   — Emptiness, numbness, indifference, lack of spontaneous response to the world* 5.17.2   — Feeling of emotional/affective blockage* 5.17.3   — Pervasive, nameless anxiety with fear of annihilation* 5.17.4   — Basic irritation, restlessness, anger (nonemotional dysphoria)* 5.17.5   — Detached euphoria 5.17.6   — Despair, demoralisation, hopelessness* 5.17.7   — Abnormalities of mood constancy* 5.17.7a — Mood or emotion is abnormally persistent* 5.17.7b — Mood or emotion is abnormally labile* 5.17.8   — Incongruity of mood or emotion 5.17.8a — Mood or emotion inappropriate to the current situation 5.17.8b — Moods or emotions are mutually contradictory

6           — Existential Orientation

6.1        — Rejection of society or convention 6.1.1     — Disinclination for human society 6.1.2     — Antagonomia 6.1.3     — Idionomia

6.2        — Extreme indifference or openness 6.2.1     — Attitude of indifference, insouciance, lack of concern 6.2.2     — Conceptual freedom/anything goes

6.3        — Pervasive disbelief, skepticism, curiosity re the obvious/taken-for-granted

6.4        — Absolute certitude

6.5        — Feeling of being special or superior 6.5.1     — Feeling of extraordinary insight* 6.5.2     — Messianic duty* 6.5.3     — Intellectual/spiritual grandiosity

6.6        — Impossible responsibility or guilt*

6.7        — Sense of loss of freedom or individuality

6.8        — Adherence to abstract, intellectualistic, and/or autonomous rules

6.9        — Existential or intellectual change*

6.10      — Feeling of centrality

6.11      — Decentering of the self relative to the universe

The subject doubts his own reality status or that of his immediate world, believing he somehow exists outside or separated from another, “truer” reality. He may feel as though he, or his surroundings, is the figment of someone’s imagination or like a character or scene in someone else’s book.

Fleeting or persistent feelings of being the centre of the universe – which seems to be organised around, controlled by, or dependent on her. NB: This item differs from the more common feelings of being watched, admired, or criticised by other persons of item 3.4.2, Feelings of social paranoia or social anxiety*; for like 5.12, All-inclusive self-consciousness/ontological “paranoia”, this item denotes an all-pervasive or ontological kind of experience. But, in contrast to 5.12, this item involves primarily feelings of one’s own central importance rather than of being watched or criticized. This may also be compared with 5.13.1, Subjectivism/ solipsism, but here in 6.10, the issue is less the subjective or unreal nature of external reality than the subject’s own central role in the world. Item 6.10 can, however, co-occur with any of the above (3.4.2, 5.12, or 5.13.1).

“I have the sense that everything turns around me,” the patient may say. “I am like a little god, time is controlled by me.”

“At a party, everything seemed to originate from him or depend on him.”

“I feel as if I were the ego-centre of society.”

New or unusual preoccupation with existential, metaphysical, religious, philosophical, or psychological themes. Frequently reported themes: supernatural phenomena; religion (especially nonstandard); mystical experience; philosophy; transcendental themes; meditation; psychology; ancient rituals; symbols; reincarnation; the life to come; struggle between good and evil; universal peace and communication; meaning of existence; fate of humanity; salvation; unconventional science; or related ideas about health and nutrition.

“New ideas and interests that gradually overtook my life and thinking absorbed me; they left a mark on my entire life.”

The subject feels compelled to follow a strict set of rules and values that emphasise rationality, an intellectual attitude, abstract or idealistic principles, or a compulsive urge to follow idiosyncratic “rules” or “laws.” This often involves an intellectual, spiritual, moralistic, or utopian ideology detached from the concrete, bodily, individual, or contextual realities of social or practical life.

“[One patient] adopts a pedagogical system, changing its principle once a week: he changes between strict military discipline to a principle of absolute indulgence or ‘a liberal principle of tenderness.’”

The subject experiences herself as a kind of automaton lacking freedom or originality to an extreme degree, as if compelled or utterly determined by outside forces. NB: In contrast to 5.11.1, Actions or events seem controlled by external force, and 5.11.2, Actions or events seem pre- determined or planned, the focus here is less directly on the world as opposed to the self.

One patient declared she “has been under the influence of an electrical machine... being manipulated by someone in a certain manner, and everything that occurs to it happens also to her.”

Feelings of guilt or an overdeveloped sense of responsibility for things the person could not possibly have done or brought about – such as having caused a war or some tragic accident in the news, or otherwise harming others in some impossible way.

(with invidious comparison)

The subject exhibits a marked “sense of superiority over her fellow humans, typically associated with feelings of possessing extraordinary insight or ability.” Others may be seen as less intelligent or evolved, more limited or superficial – as if there were a sharp divide concerning the very capacity for conscious awareness.

The subject feels a sense of extraordinary duty toward others, as though feeling himself to be a messiah or a creative genius who is tasked with helping or saving other people, the planet, extraterrestrial life, etc.

(into hidden dimensions of reality or the mind, with the sense of having special intellectual or creative powers)

These abilities may range from the merely remarkable to the truly supernatural and may include, for example, sensing one’s extraordinary ability to understand or create poetry or mathematical concepts, or having revelations regarding the essence of time, death, or the universe.

“I have come infinitely closer to the truth than human beings who have not received divine revelation.”