Abnormal Space Experiences in Persons With Schizophrenia

An Empirical Qualitative Study

Giovanni Stanghellini; Anthony Vincent Fernandez; Massimo Ballerini; Stefano Blasi; Erika Belfiore; John Cutting; Milena Mancini

Disclosures

Schizophr Bull. 2020;46(3):530-539. 

In This Article

Abstract and Introduction

Abstract

Abnormal space experience (ASE) is a common feature of schizophrenia, despite its absence from current diagnostic manuals. Phenomenological psychopathologists have investigated this experiential disturbance, but these studies were typically based on anecdotal evidence from limited clinical interactions. To better understand the nature of ASE in schizophrenia and attempt to validate previous phenomenological accounts, we conducted a qualitative study of 301 people with schizophrenia. Clinical files were analyzed by means of Consensual Qualitative Research, an inductive method for analyzing descriptions of lived experience. Our main findings can be summed up as follows: (1) ASEs are a relevant feature in schizophrenia (70.1% of patients reported at least 1 ASE). (2) ASE in schizophrenia are characterized by 5 main categories of phenomena (listed from more represented to less represented): (a) experiences of strangeness and unfamiliarity (eg "Everything appeared weird. Face distorted, world looks terrible, nasty"); (b) experiences of centrality/invasion of peripersonal space (eg "Handkerchief on scaffolding: message telling him something"); (c) alteration of the quality of things (eg "Buildings leaning down"); (d) alteration of the quality of the environment (eg "Person sitting six feet away seemed to be at an infinite distance"); and (e) itemization and perceptive salience (eg "All patients [in ward] have bright eyes"). (3) ASEs are much more frequent in acute (91.9%) than in chronic (28.15%) schizophrenia patients. Moreover, our findings further empirical support for phenomenological accounts of schizophrenia, including those developed by Jaspers, Binswanger, Minkowski, and Conrad, among others and provide the background for translational research.

Introduction

Many empirical studies of schizophrenia leave us with an impoverished view of the experiential disturbances that characterize this condition. In this article, we present the results of a qualitative study of 301 people with schizophrenia, focusing on disturbances in one core structure of their experience: lived space, ie, space as experienced, not as an objective coordinate system[1] but the meaningful, practical space of everyday life. Lived space is centered on the person and characterized by qualities such as vicinity/distance, wideness/narrowness, and connection/separation. In it, things may appear salient, significant, and attractive or meaningless and irrelevant.[2]

A number of studies have confirmed that experiences of space are altered for people with schizophrenia.[3–6] Building on and extending these studies, our aim is to provide a detailed description of what these spatial experiences are like and a nuanced insight into the lived world of people with schizophrenia, focusing on their experience of space, objects, and other human bodies.

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