Self Fragmentation and Position Imbalance: Consciousness Structure Analysis on schizophrenia in Chinese New...

Classic models of schizophrenia posit a complete loss of insight during psychotic episodes. However, clinical observations and recent phenomenological research, especially those on double bookkeeping, suggest that some patients retain partial self-observation capacities. This study explores the consciousness structure of schizophrenia, with particular attention to the partial insight phenomena.

This is a part of a phenomenological research on the lived experience of Chinese new-generation schizophrenia patients, where we conducted in-depth life story interviews with eight schizophrenia patients (four Millennials, four Gen Z). Data were analyzed following Giorgi's five-step approach, with particular attention to participants' metaphorical expressions and self-descriptions during psychotic episodes. The theme of current study emerged from participants' reports of retaining observational capacities despite lacking control, which led us to the analogy of lucid dreams.

We identified that the self fragments into a realistic self (anchored in consensus reality) and a fictional self (generating private intentional worlds), and the two parts of self fall into position imbalance that while the fictional self usurps experiential dominance the realistic self disenfranchises. We further propose that the foundation of self fragmentation is the temporal rupture.

The conceptualization of self fragmentation and position imbalance provides a nuanced framework for understanding partial insight and double bookkeeping in schizophrenia, reframing psychotic experiences as dynamic struggles between coexisting self-poles rather than simple reality disconnection. These findings have important implications for clinical assessment, therapeutic interventions, and future research on the psychopathology of schizophrenia.