Psychosis Risk and Experience of the Self Understanding the Individual Development of Psychosis as a Basic Self-disturbance

A Central Conversation  Use of the term schizophrenia  1. An initial aerial view of the field, then heading for the inside  2. To understand is a universal human need  3. The prodromal phenomena illuminate the core of existence- aiding the understanding of psychosis  4. The problem of defining the prodromal phase  5. The view of science determines the view of psychosis  6. Subjectivity  7. The self and basic self-disturbance  8. Diagnostics, phenomenology and the EASE manual in the field of psychosis risk  9. The five domains of the EASE manual  10. The view of psychosis treatment among professionals and health authorities is changing  11. What about other models of understanding and theraputic approaches to psychosis? Do they use subjectivity, self-experience or self-understanding as explicit concepts?  12. Self-disturbance as part of a wider treatment context  13. Conversation and phenomenology  14. Theraputic effects and obstacles  15. Approaches and settings in treatment directed as basic self-disturbances  16. Outline of a pragmatic seven-step treatment module  17. Implementing the subjectivity model

Biography

Paul Møller, DrMedSci, is a consultant psychiatrist, senior researcher, and former Research Director and Head of Department of Mental Health Research and Development for the Division of Mental Health and Addiction at Vestre Viken Hospital Trust, Norway.His early publications contributed to triggering the re-discovery of the concept basic self-disturbance, and Møller is one of the main authors of the EASE Manual (Examination of Anomalous Self-Experience).

"This marvellous book shows us that going 'back to basics' (the central role in psychiatry of conversation and close listening) can point the way forward for developing a more satisfactory understanding of psychosis and what to address in treatment. The content and writing style will appeal to a broad audience- clinicians, researchers and interested general readers alike. This book is highly recommended"

Professor Barnaby Nelson, Head Ultra High Risk for Psychosis Program, Orygen, The University of Melbourne, Australia.

"This is an amazing cartography of the multiple shades and experiential layers that lie at the core of emerging psychosis, as well as an inspiring map for all those genuinely interested in the psychotherapy of schizophrenia. Over and above the in-depth clinical insights, Paul Møller offers something even more unique and rare in the contemporary literature landscape: a meditated distillate of clinical experience, inter-human curiosity and therapeutic touch"

Professor Andrea Raballo, MD, PHD Professor of Psychiatry and Psychotherapy, Department of Biomedicine, University of Italian Switzerland. Lugano, Italy.

Paul Møller's Psychosis Risk and Experience of the Self: Understanding the Individual Development of Psychosis as a Basic Self-disturbance is the first comprehensive yet humble and sensitive-to-nuances guide to the fascinating clinical and research landscape of the so-called 'subjectivity (and inter-subjectivity) model' of emerging psychosis. Because of its unique blend of scientific rigor together with rich and compassionate clinical insights, it will appeal to a broad audience of clinicians, researchers, and interested laypeople. I certainly plan to recommend it as a must-read to students, colleagues, and loving family members and friends of worry-provoking youth"

Professor Danny Koren, Clinical-Science Program, School of Psychological Sciences, University of Haifa, and ZOHAR Clinic, Rambam Medical Center, Haifa Israel.

"Paul Møller offers here a superb synthesis of clinical acumen with theoretical precision. He lights a path for those seeking both to treat and to understand schizophrenia and related conditions—especially for those who recognize that treatment necessarily relies on understanding. This fine book also serves as a clear and exciting introduction to the phenomenological approach to grasping the lived-world of mental disorders".　

Louis Sass, Ph.D. Distinguished Professor of Clinical Psychology, Rutgers University, State University of New Jersey, USA.Author of Madness and Modernism and The Paradoxes of Delusion.

‘I remember the first time I reached out to Professor Paul Møller, around 6 years ago about a potential collaboration. Since then, I have had the great pleasure of meeting with him on multiple occasions on my many trips to Norway. I am incredibly glad to have been invited to review his book, Psychosis Risk and Experience of the Self: Understanding the Individual Development of Psychosis as a Basic Self-disturbance and indeed I believe I am the amongst the first readers of this work.

The idea that self-disturbances are at the heart of the experience of psychosis has fascinated me for more than 15 years. I have learnt that self-disturbances can be conceptually diverse; for example, there are different frameworks to the study of self-disturbances, each with its own history, merits and room for improvement. This book focuses on one of the conceptualisations, the Subjectivity Model, with a particular focus on the psychosis prodrome. The Subjectivity Model views basic self-disturbances as generative forces in the psychosis prodrome. Recent meta-analyses have found that self-disturbances possess high levels of predictive power in the conversion from an early stage of psychosis (called the prodrome) to a diagnosable condition and seem to be more specific to the schizophrenia-spectrum as opposed to other mental health conditions. However, practising clinicians in many countries are still not usually familiar with this concept, its historical background, and its significance to the field. Phenomenology and subjectivity have been seen as something esoteric and cannot be understood or treated by clinical intervention, perhaps until quite recently.

The book can be roughly divided into 2 parts, with Chapters 1 to 9 as Part 1 and Chapters 10 to 17 as Part 2. Part 1 lays out the foundation of the concept of self-disturbances according to the Subjectivity Model, their multifaceted clinical presentations, assessment strategies, and their utility in managing the psychosis prodrome and diagnosing a schizophrenia-spectrum condition. The psychosis prodrome for most individuals is an extremely frightening, confusing, uncertain yet oddly revelatory state of mind, distorted by fundamental transformations in one's subjectivity, where new meanings are sought and formed from every tiny stimulus in the external environment and signals from one's own mind. Self-disturbances often arise from "as if" experiences which can sometimes be dismissed by clinicians as a sign of personality (especially "emotionally unstable") pathology rather than a prodromal psychosis, leading to severe underestimations and subsequent undertreatment. To understand is a universal human need, and to understand oneself is perhaps the most pressing of this need. Self-disturbances deprive the individual of this ability to understand themselves. The case studies in this book are particularly illuminating: "I do not understand anything any more" is perhaps one of the most painful conditions that can torment the human mind. I also find the illustrations very helpful, albeit sometimes poignant and disturbing, but that is perhaps because without effective intervention, schizophrenia can be a destructive and terrifying illness for a significant proportion of those affected.

Part 2 explains how self-disturbances may be treated with psychological therapies and antipsychotic medications and outlines a 7-step treatment module nearer the end. I find the cautious acceptance of the usefulness of antipsychotic medications in tackling self-disturbances in the acute phase refreshing. In many of the contemporary debates about antipsychotic medications, the arguments can be unbalanced and biased towards either pure biological psychiatry or a solely psychosocial account. Professor Møller however is able to offer a nuanced view of how antipsychotic medications should not be discounted as completely harmful, but nonetheless should never be the only treatment of benefit. Instead, the individual's unique circumstances (biological, psychological and social) should always be placed centre stage in any clinical intervention, and careful consideration is urgently required at every step of symptom management so that the treatment can be tailored to each person's needs. This is indeed an important insight from phenomenology.

In sum, Professor Møller has made profound contributions to the theory and practice of managing clinically significant self-disturbances, with lasting impact for the growth of the wider field. Most importantly, he has managed to offer an evenly balanced view and added much needed nuance in the debates about schizophrenia as a syndrome, an illness, and a human condition. I have no doubt that self-disturbances will continue to fascinate Professor Møller, myself and many others. But fascination alone is not sufficient – hidden behind the self-disturbances is an individual desperately reaching out to us in the search for meaning, to protect the integrity of the mind and to hold on to what is still active in their subjectivity. As clinicians and researchers, we must never forget the suffering, as well as the determination and resilience, of the individual.’

Clara Humpston, University of York, UK