Psychosis and the disintegration of dialogical self-structure: problems posed by schizophrenia for the maintenance of...

Researchers and theoreticians across widely varying disciplines have increasingly stressed how sense of self is inherently 'dialogical', or the product of ongoing dialogue both within the individual and between the individual and others. This perspective emphasizes that self-awareness is not an awareness of an isolated or seamless viewpoint, but a collective of numerous complementary, competing, and sometimes contradictory, voices. In this paper we suggest that changes in subjective sense of self in schizophrenia spectrum disorders may represent the collapse of this essential dialogue. We suggest that this collapse can have the end-result of mentally ill persons either coming to embrace a singular, all-incorporating self-position or standing precariously on the brink of cacophony which is experienced as self-dissolution. We point to two phenomena associated with schizophrenia that could contribute to the derailment of internal and external dialogue: impairments in associative processes and affect dysregulation. Illustrated with a case example, we finally suggest how psychotherapy has the potential to revive internal dialogue through its explicit use of external dialogue helping to restore previous levels of social function.