Affinities in the phenomenological perspective of schizophrenia and recent cognitive research: Towards mutual enrichment

The phenomenological approach

As expected in any approach including broad, complex phenomena, there is no single phenomenological perspective of schizophrenia (Rulf, 2003). In general, it might be pointed out that all the various different phenomenological viewpoints share the idea that schizophrenia is first and foremost a disorder affecting the relationship between the person and his/her world, either because it means a loss of common sense (Blankenburg & Mishara, 2001; Schwartz et al., 2005; Stanghellini, 2001, 2004), or because it represents a detachment or threat to his sense of self (Lysaker, Johannesen, & Lysaker, 2005; Parnas & Handest, 2003; Sass & Parnas, 2003; Stanghellini, 2005; Stanghellini & Lysaker, 2007). In a certain sense, this loss of the sense of things given by facts and detachment from oneself might be considered two forms of the same loss of ontological security (Laing, 1960/1993; Schwartz et al., 2005).

In any case, in this article, we use the proposal of Sass and Parnas (2003) as a model for the different phenomenological viewpoints of schizophrenia, as it offers a unitary theory of the different symptoms of schizophrenia and its prodromes, and has clearly formulated related theoretical concepts. Furthermore, the authors of this proposal see their approach as consistent with other classic phenomenological viewpoints, such as those of Minkowski (1927), Blankenburg (1971), and Kimura (1992), and offer a possible synthesis of these points of view (Sass, 2001; Sass & Parnas, 2001).

According to Sass and Parnas (2003), the core abnormality in schizophrenia is a particular kind of disturbance of consciousness and, especially, of the sense of self that is normally implicit in each act of awareness. In this sense, Sass and Parnas (2003) argue that this “ipseity disturbance” has two main aspects, an enhanced sense of awareness or hyperreflexivity, and diminished self-affection. Hyperreflexivity refers to a kind of exaggerated self-consciousness, a tendency for focal, objectifying attention to be directed toward processes and phenomena that would normally go unnoticed or, at least, remain in the background of a person’s experience. Diminished self-affection refers to an alteration of own experience often consisting of a sense of passivity or automatism. It is a diminished intensity or vitality of one’s own subjective self-presence. Actions can become alienated or appear to be performed without the person’s willing them. In this model, these two characteristics are clearly interrelated. To put it in the words of the authors:

Thus, whereas the notion of hyperreflexivity emphasizes the way in which something normally tacit becomes focal and explicit, the notion of diminished self-affection emphasizes a complementary aspect of this very same process –the fact that what once was tacit is no longer being inhabited as a medium of taken-for-granted selfhood. (Sass & Parnas, 2003, p. 430)

Sass and Parnas (2003) understand that the cause leading to a person developing certain schizophrenic symptoms should not be considered emanations of a supposed malfunctioning of some type of substrate. To the contrary, according to these authors, symptoms would have to be considered an attempt to create a new organization of consciousness, better adjusted to the situation that the patient is going through. In this respect, certain “developmental transitions” are alluded to that may make some sense of psychological phenomena apparently difficult to understand such as those present in schizophrenia.

It may be a good idea to clarify that, in our opinion, this proposal is in no way contradictory to the findings of neurocognitive or neurobiological models of schizophrenia, since, as Nelson, Yung, Bechdolf, and McGorry (2008) point out, they are on different explanatory planes, informed by different principles, and not seeking to displace each other.

On the contrary, the phenomenological and cognitive approaches do meet, from our viewpoint, on the same explanatory plane. And this is because both are attempts to reach a psychological understanding of schizophrenia. Thus, both theoretical approaches may be dealing with similar concepts of schizophrenia, but using different languages to do so. This article attempts to show how several different models and data related to the cognitive processes of schizophrenia patients may be interpreted in harmony with this phenomenological view of schizophrenia as a disturbance of self-consciousness.

Hyperreflexivity and attention

One of the most outstanding affinities is the role that both the phenomenological and cognitive views attribute to the schizophrenic subject’s attention to certain processes and phenomena with regard to the self. Hyperreflexivity, which has already been mentioned, can be understood as attention focusing on the subject himself and, basically, on his mental life (thoughts, feelings, emotions, memories, etc.). Along a very similar line, from a cognitive position, Frith (1979) suggested a long time ago that “the basic cognitive defect associated with schizophrenia is an awareness of automatic processes which are normally carried out below the level of consciousness” (1979, p. 233).

More recently, the self-referent executive function (S-REF) model (Wells & Matthews, 1994) has been proposed as a framework for understanding psychotic experiences. This model postulates that emotional disorders, or vulnerability to emotional disorders, are associated with a particular cognitive-attentional syndrome consisting of heightened self-focused attention, ruminative processing (rumination/worry), attentional bias, and the activation of dysfunctional self-beliefs and self-appraisal. The S-REF model, which was first developed to explain the relationship between attention and emotion from a cognitive viewpoint, has been extended to the field of psychotic symptoms, and is a fruitful line of research (Ensum & Morrison, 2003; Lobban, Haddock, Kinderman, & Wells, 2002; Morrison, 2001; Morrison & Wells, 2007; Morrison, Wells, & Nothard, 2000). The S-REF model deals with a variety of concepts (self-focused attention, ruminative processes, worry, attention bias, dysfunctional beliefs, and so on), whose relationships, in our opinion, have not been explained with sufficient theoretical rigor. From an empirical viewpoint, and with regard to the field of schizophrenia, the concepts that have most awakened interest among researchers have been related to “self-focused attention” and “meta-worry.” Insofar as it refers specifically to psychotic symptoms, the empirical work of Ensum and Morrison (2003) could be mentioned, in which, in a sample of 30 schizophrenia patients with auditory hallucinations, it was found that decreasing levels of self-focused attention appears to reduce the extent of an external attributional bias traditionally associated with auditory hallucinations. This seems to confirm, from an experimental paradigm, that an excess of self-focused attention (or hyperreflexivity) may be playing a relevant role in the aetiology or in maintaining auditory hallucinations. So if the attentional resources of a person are directed mainly toward his own thoughts, memories, or other private events to the detriment of the attention he is giving to what is going on around him, from the cognitive viewpoint, he would be characterized by self-focused attention, increasing the probability under certain circumstances for experiences such as auditory hallucinations to appear or be maintained.

Delving into the role of self-focused attention in schizophrenia, Perona-Garcelán et al. (2008) found, using a cross-sectional design, that high levels of “self-focused attention” are not exclusive in patients with auditory hallucinations, but that, in general, they characterize all patients with positive psychotic symptoms. In this respect, some empirical research would also have to analyze whether “self-focused attention” has some role in “negative symptoms.” In principle, from the phenomenological viewpoint we are taking as a reference, it could be given an outstanding role, as hyperreflexivity is also involved in some way in what are called “negative symptoms” (Sass, 2003; Sass & Parnas, 2003). We will come back to this when we discuss the contributions that phenomenology can make to cognitive research on schizophrenia.

Morrison and Wells (2007) also found with regard to the role of attention in schizophrenia, that measurements of worry are associated with some dimensions of delusional ideation and with general measures of psychotic experiences. In harmony with this line of discussion, the same authors found that meta-worry (worry about worry) was the only dimension associated with emotional responses to hallucinations and with negative symptoms. In the S-REF model, worry is seen as perseverative processing, that is, a way of coping with certain emotions or thoughts that maintain them. We believe that meta-worry may be understood as a form of hyperreflexivity in which the person directs his attention to his own worry. As Cartwright-Hatton and Wells (1997) say, “there is empirical evidence to support a distinction between worry about worry and worry focused on concerns about noncognitive events” (1997, p. 280).

Thus, while worry is a condition of life, worry about worry itself seems to be a form of psychological (hyper)consciousness which the subject has converted into something problematic for himself, similar to what is postulated from the phenomenological approach for hyperreflexivity.

To the considerations described above we could add the various studies done on the role of metacognitions (cognitions on cognitions themselves) in auditory hallucinations and delusions (see, e.g., Baker & Morrison, 1998; García-Montes, Pérez-Álvarez, Soto-Balbuena, Perona-Garcelán, & Cangas, 2006; Lobban et al., 2002; Morrison & Wells, 2003). Although these studies vary with regard to which beliefs and metacognitive processes in particular are related most closely to the appearance of positive psychotic symptoms, all of them suggest that this type of variable has a significant relationship to suffering from this psychotic symptomology. In this respect, it could be argued that the thoughts that one has on his own cognitions, e.g., whether he is sure of them or not; whether he believes they are uncontrollable or dangerous in some way, etc., can also be understood as a form of hyperreflexivity. In fact, when a person pays too much attention to his own cognitions, considering them dangerous or uncontrollable, it seems that this is given the defining characteristic of hyperreflexivity, that is, an exaggerated self-consciousness in which a subject or agent experiences itself, or what would normally be inhabited as an aspect or feature of itself (worries, cognitions, etc.), as a kind of external object (Sass & Parnas, 2003). In any case, since everyone has the ability to pay more or less attention to his own psychological states, it would have to be specified more in detail what relationship this self-focused attention has with “hyperreflexivity,” considered as a defining characteristic of the schizophrenic consciousness.

In previous work mentioned here, the paradigm for the phenomenological approach to schizophrenia, Sass (1992, pp. 368–369), stated that the ability for “thinking about thinking” (metacognitive ability) is both a personal and cultural requirement for developing hyperreflexivity and the detachment that characterizes the schizophrenic condition. In our opinion, a key factor for delving into the relationships between the above mentioned cognitive concepts and hyperreflexivity as a characteristic of the schizophrenic condition would be the value given attention to one’s own cognitive processes. In fact, there are psychological treatments for patients diagnosed with psychosis that are based on mindfulness, that is, on a type of voluntary, nonjudgmental self-focused attention (see, e.g., Chadwick, Taylor, & Abba, 2005). This type of attention seems to improve the patient’s general psychological functioning and therefore would not be problematic. What, in our viewpoint would characterize attentional processes in schizophrenia patients (whether called “self-focused attention,” “metaworry,” or “metacognition”) would be a negative type of self-evaluation. Thus the patient with schizophrenia not only pays strong attention to his psychological functioning, but also values it negatively, as an aspect that, in one way or another, could become harmful.

These hypotheses and examples are intended to illustrate how concepts—such as self-focused attention or metaworry or metacognitions—are being studied from the cognitive perspective with noticeable parallelisms with hyperreflexivity (Pérez-Álvarez, 2008), which Sass and Parnas (2003) propose, from a phenomenological point of view, as one of the basic alterations of the sense of self in schizophrenia.

Diminished self-affection, superstition, and dissociation

The other characteristic which, according to this phenomenological approach, would characterize schizophrenia is “diminished self-affection,” which is a loss of the sense of inhabiting one’s own actions, thoughts, feelings, impulses, bodily sensations, or perceptions, often to the point of feeling that these are actually in the possession or under the control of some alien being or force. Stanghellini (2004) has identified two forms of diminished self-affection, which he calls “bodies-without-soul” (cyborgs) and “spirits-without-body” (scanner). As an example of the experience of “bodies-without-soul,” we could take the person who feels that his/her body has become mechanical and robotic, or someone who feels that his/her actions are controlled by some outside agent, like a chip, an implant, etc. On the other hand, an example of “spirit-without-body” might be someone who feels a “Cotard delusion,” which involves the belief that one is dead or unreal in some way.

In our opinion, certain variables studied by the cognitive perspective could be understood as concepts very close to “diminished self-affection.” For example, “superstition and responsibility beliefs about one’s own thoughts” would be in this direction (García-Montes et al., 2006; Morrison & Wells, 2003). According to research by Morrison and Wells (2003) and García-Montes et al. (2006), it seems that schizophrenia patients with auditory hallucinations are characterized by thinking that their thoughts are able to exert some kind of direct effect on the world and, to a certain extent, feel responsible for having them. Compared to other people and to other groups of patients who think that the mediation of the body is necessary for an action to have an effect on things, patients with auditory hallucinations tend to believe that their thoughts are able to act on the world by themselves. Patients with voices could thus be considered “spirits-without-body” or “scanners” (Stanghellini, 2004). In fact, when asked, such patients tend to answer affirmatively with statements such as, “If I did not control a worrying thought, and then it happened, it would be my fault,” or “If I could not control my thoughts, I might end up by embarrassing myself,” or “If a bad thing happens which I have not worried about, I feel responsible.” If this type of item is examined carefully, a sort of “solipsistic power” (Sass, 1992) can be read in it by which the patient understands that he is able to affect the world only through thought. For comparison, an extract of some of the statements that Sass (1992) himself gives as a paradigm of this solipsist power as assumed by a schizophrenic patient called Lawrence are given below:

I could create the events of my universe by just thinking them, believing them to be true… What really terrified me was when I realized that I could conceive of wrenching the world from its axis. Do you know how it would feel to have that kind of power? (1992, p. 335)

We believe that the similarities between this expression of disembodied solipsism and the metacognitions on superstition and responsibility related to own thoughts emphasized by patients studied from the (meta)cognitive approach are important. It is also obvious that there are differences between one report and another, although part of these differences could be attributed to the instruments used to collect the data and to the type of patients with whom one tradition and the other usually work. Thus most of the descriptions studied from the phenomenological perspective either have a literary character or are the result of interviews in which the patient is invited to openly narrate his experience. On the other hand, the relative simplicity of the experiences referred to by the patients in the cognitive tradition could be due to the tests and questionnaires used by this approach. Such instruments, in fact, leave too narrow a margin for a person to explain certain complex experiences in any detail. In any case, it should be kept in mind that the study of superstition with regard to schizophrenia has a long history and that in no way is it a subject that cognitive research has created ex novo. Schizophrenia has been considered in this perspective, from Bleuler’s (1916/1934) “omnipotence of thought” to its characterization as “magical psychosis” by Roheim (1955). Cognitive research has thus converged with this line of work, which had been mostly obviated, perhaps because it failed to fit in with accepted conceptualizations (García-Montes, Pérez-Álvarez, Sass, & Cangas, 2008).

Another form of “diminished self-affection” identified by Stanghellini (2004) is “bodies-without-soul” (cyborgs) who are definitely a body that is alive like an independent being (desouled, machine-like). In this regard, from the cognitive tradition, the role of “dissociation” in psychotic experience has begun to be studied, either linking it to past suffering of some type of trauma (see, e.g., Campbell & Morrison, 2007; Kilcommons & Morrison, 2005; Perona-Garcelán et al., 2010); or else relating it to self-focused attention (Perona-Garcelán et al., 2008). Although it may be considered a multidimensional construct (Bernstein & Putnam, 1986), dissociation is defined in the 4th revised edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; APA, 2000) as the process whereby the usually integrated functions of consciousness, memory, identity, or perception of the environment are disrupted. As with the study of superstition in schizophrenia, it should be kept in mind that there is a long history of emphasis on the importance of dissociation in schizophrenia (Gainer, 1994). Thus, for example, Gross (1904) had proposed the name “dementia disjunctiva” for schizophrenia to stress the dissociative component of the disorder. The current term “schizophrenia” (literally “divided mind”) emphasizes the dissociative components of the disorder, and Bleuler himself (1950) already proposed the loss of the ability of association as a basic characteristic of schizophrenia, at the same time he described a variety of dissociative automatisms as the disorder’s primary symptoms. Furthermore, Federn (1952) hypothesized that psychotic symptoms, such as hallucinations, could result from dissociation when thoughts were “object cathected” rather than “ego cathected.” Clearly, dissociation has been a central theme in schizophrenia which cognitive psychology has taken up again from a fundamentally empirical orientation. In a pioneering work, Allen, Coyne, and Console (1997) suggested that severe dissociative detachment—a pervasive form of dissociative disturbance—makes the individual vulnerable to psychosis, not only because it deprives individuals of external anchors, but also because his internal moorings are torn apart (the sense of being connected to one’s body, with its own identity and actions). Persons having this severe dissociative detachment refer to experiences such as, “feeling that the body does not belong,” or “feeling as if looking at the world through a fog,” or “feeling like two different people,” or “feeling as though watching oneself as if it were another person.” In our opinion, this type of item alludes to experiences similar to those that are usually given as an example in phenomenological literature. Below a text taken from Parnas and Handest (2003) about the “sense of corporeality and its alterations” is given to emphasize the analogies between what is studied from the cognitive and phenomenological approaches.

I am no longer myself … I feel strange, I am no longer in my body, it is someone else; I sense my body, but it is far away, some other place. Here are my legs, my hands. I can also feel my head, but cannot find it again. I hear my voice when I speak, but the voice seems to come from somewhere else. (p. 126)

Again, we think that the similarities between the type of items that measure dissociation and the reports of patients which exemplify the sense of corporeality in schizophrenia are considerable.

In view of these parallelisms between the phenomenological and cognitive traditions, it might be of interest to briefly suggest what the main contributions of one approach and the other might be in order to advance in understanding schizophrenia.

Main contributions of the phenomenological approach to cognitive research on schizophrenia

There are several different points in the phenomenological perspective that could enrich cognitive research on psychotic symptoms and, thereby, possible therapeutic applications.

In the first place, one of these contributions is a conceptualization of the negative symptoms of schizophrenia far removed from the idea of “deficit.” As Sass (2000, 2003) has pointed out, the so-called negative symptoms are accompanied by a variety of positive experiential alterations.

Basic-symptom research demonstrates that even the most clearly negative symptoms, such as apathy or avolition, are accompanied by a panoply of positive experiential disturbances in the domain of cognition, perception, bodily experience, action and emotion. (Sass & Parnas, 2003, p. 434)

The cognitive approach could make use of this view of negative symptoms to delve into the psychological processes that accompany them. And, in effect, it could be said that the cognitive approach has almost neglected the study of the “negative symptoms” (as an exception, see Rector, Beck, & Stolar, 2005), especially if compared with the very abundant research that has been done by this approach on hallucinations and delusions.

It would also be of interest for research that is being done from the cognitive perspective to give the patient a “turn to speak,” taking the example of the phenomenological methodology. As pointed out by Stanghellini and Lysaker (2007):

Phenomenologically oriented researchers and theoreticians typically use methods that involve in-depth interrogation of patients about subjective experiences, and the questions suspend or “bracket” any presuppositions about the phenomena under investigation, including its normality or abnormality, its putative causes (and explanations for it), or its nosographical attribution. (2007, p. 165)

The use of a methodology such as the one described above might assist the cognitive approach in overcoming some evaluation procedures in which, in the best of cases, the most important role given the patient is selecting a score between 1 and 5 for each one of the items on a test. Moreover, giving patients increased importance in defining their experience may assist in fine-tuning concepts used by the cognitive tradition, usually taken from research in basic psychology or from areas other than clinical psychology, and extrapolated without further ado to the field of schizophrenia.

Surely, both the study of psychological experiences that accompany the “negative symptoms of schizophrenia” and the adoption of a new methodology which has room for the patient’s voice, would have to pass through an epistemological turn of the cognitive approach. In our opinion, this would mean distancing from the “positivist” or “empiricist” view and nearing “hermeneutic” or “narrative” positions. As Bruner (1990) states, the cognitive revolution was born with the intention of establishing “meaning” as a central concept in psychology. However, it soon went from the “construction of meaning” to the “processing of information,” distorting the original intention of making psychology sensitive to culture. It could now attempt to promote a hermeneutic or narrative turn which would again introduce “meaning” as an axis of the cognitive model. Phenomenology, as a discipline that studies the “lived experience” can make, without doubt, important contributions in this respect.

All the above contributions could lead to cognitive psychology’s leaving behind its tendency to reduce symptoms or clinical phenomena to premade concepts and their correlations, and enter in a line of theoretical and philosophically more consistent research, similar to what cognitive neuroscience has done, but avoiding the temptations of brain-centered reductionism (Garza & Fisher Smith, 2009; Pérez-Álvarez, 2011).

Contributions of the cognitive approach to the phenomenological perspective of schizophrenia

On the other hand, the phenomenological view could also benefit from certain aspects of the cognitive approach. Thus, the interest that this approach has shown for individual differences would enrich, in our opinion, phenomenological analyses of experiences that patients with schizophrenia refer to. Given that, in the same sociocultural sphere, there are persons who develop schizophrenia and others who do not, the type of individual factors—types of upbringing, early experiences, sharp role transitions, coping mechanisms, etc.—influence whether one develops schizophrenia or not. In this respect, Morrison and Petersen (2003) have suggested a possible relationship between having some kind of traumatic experience and showing a predisposition to refer to auditory hallucinations. This relationship between trauma and psychotic symptoms (especially auditory hallucinations) is, moreover, strongly backed by studies made from other perspectives (see, e.g., Offen, Waller, & Thomas, 2003; Romme & Escher, 1989; Shevlin, Dorahy, & Adamson, 2007). The phenomenological approach might consider this and other biographical factors that could share in the “construction” of the psychotic experience. It would definitely be going beyond “understanding” to arrive at the “explanation” for the schizophrenic patient’s experience. The explanation that is proposed here would not consist only of postulating “connections between descriptions of experience and structures and events in the brain,” as suggested by Schwartz et al. (2005, p. 93). We understand, in fact, that any disorder (and any experience) occur in a body and, therefore, affect one way or another certain regions or structures in the brain. However, we also believe that any overall explanation for the experience cannot be due only to biological considerations, but must also have biographical causes. Thus, for example, as pointed out by Cantor-Grae (2007), findings such as excessively high risk of schizophrenia in second-generation immigrants are difficult to explain solely in terms of biological or genetic factors. There would have to be a biographical logic in the construction of the experience in which the subject and his world would be harmonious, equally relevant terms.

Final considerations

This work attempted to show the similarities existing between the phenomenological view of schizophrenia and recent cognitive research. We have shown how it would be possible to reconceptualize part of the data provided by studies made from a cognitive perspective of schizophrenia in terms of “hyperreflexivity” and “diminished self-affection,” the two central characteristics that, according to Sass and Parnas (2003) define schizophrenia as an “ipseity disturbance.” Hyperreflexivity has been studied from certain cognitive positions as “self-focused attention,” “metaworry,” or “metacognitions.” Regardless of the name, it seems to have been proven that excessive attention to one’s own psychological functioning characterizes the population with a schizophrenic disorder (Pérez-Álvarez, 2008).

Furthermore, “diminished self-affection” is therefore referred to, suggesting that this can take two basic forms, “bodies-without-soul” and “spirits-without-body” (Stanghellini, 2004). In this direction, certain studies done from a (meta)cognitive perspective have shown how schizophrenia patients believe that their thoughts are able to produce a direct effect on the world, and therefore, tend to consider themselves responsible for the perceived effect of these thoughts. It has been argued that this type of metacognitive belief involves a disembodied sense of “self” that would coincide with the notion of spirits-without-body. It has also been pointed out that the research on “dissociation” in schizophrenia that is beginning to develop from a cognitive perspective can be understood as paired with the sense of “bodies-without-spirits” which, according to the phenomenological viewpoint, characterizes certain schizophrenia patients.

All of this has led us to conclude that, in fact, there are marked affinities between the phenomenological view of schizophrenia and some cognitive models and studies. Certain points have thus been proposed which, in our opinion, could mean possible mutual enrichment. It has also been suggested that an approach of the cognitive perspective to the phenomenological view should be accompanied by an epistemological turn of the first, in the sense of adopting a “hermeneutic” or “narrative” position. From this new framework, it would be possible to study “negative symptoms” and, at the same time, give the patient a “turn to speak.” Furthermore, the cognitive position could direct the phenomenological view of schizophrenia toward the possibility of giving greater emphasis to the study of individual differences and consideration of biographical factors which, in one way or another, can influence the appearance of the schizophrenic consciousness.

This work has several limitations which we think are worth underlining. In the first place, we have clearly concentrated on a certain line of research within the very broad cognitive perspective of psychotic symptoms. We cannot hide that in our judgment, they are the works that can most easily be linked with the phenomenological view of schizophrenia. Surely there are other models, other symptoms, and other studies in which this fit would not be so simple and even conceptually contradictory with a continental phenomenological view (see, e.g., Thornton, 2002). Moreover, we have also concentrated on a certain model within the broad phenomenological perspective of schizophrenia. Nothing would impede those data from being reexplained according to other phenomenological contributions different from the Sass and Parnas model (2003). So, for example, parallelism could be established between the studies referring to metacognitions on superstition and responsibility related to one’s own thoughts or dissociation and the phenomenological view of the body in schizophrenia proposed by Fuchs (2005). On the other hand, we have preferred to take as our theoretical frame a phenomenological position and integrate data from cognitive research into it and not vice versa. This was because, in our judgment, the phenomenological conception of schizophrenia is theoretically and philosophically more powerful than the existing cognitive models. Note that, in general, cognitive authors do not develop overall or joint views as much as models related to certain symptoms or to certain cognitive processes in schizophrenia.

It would be of interest to be able to find out in future research exactly what the relationships between the various concepts (“hyperreflexivity,” “metacognitions,” “self-focused attention,” “diminished self-affection,” “dissociation,” etc.) dealt with are. Are the concepts handled by the phenomenological and cognitive traditions equivalent? Are they only partially coincident? How do they influence each other until leading to the schizophrenic experience? All of these are questions of great importance that require detailed analysis, as well as a considerable task of conceptual and theoretical purification and precision. In any case, when carrying out this combination between the two approaches, we believe, like Rulf (2003), that a “promising development occurs when different perspectives separately yield correspondent understandings, reach convergent conclusions” (p. 39).

Perhaps from these affinities a dialogue between the two traditions could be opened that in the final analysis could have repercussions for a better comprehension of schizophrenia and on the development of new therapeutic approaches able to situate the patient in his world.