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775
Schizophrenia Bulletin, Vol. 26, No. 4, 2000 G. Stanghellini
My thesis is that the common sense issue is crucial for Basic Disorders of Experience. The recognition of sub-
understanding schizophrenic worlds, since the crisis of jective experience provides the basis for psychopathologi-
common sense is probably the main root of the schizo- cal research on psychoses (Schizophrenia Bulletin, 15[2],
phrenia patient's vulnerable condition, and consequently, 1989). Basic disorders of experience in prodromal phases
the origin of full-blown psychotic symptoms. The concept of schizophrenia have been described as depersonalization
of "crisis of common sense" (Blankenburg 1971) is prob- and derealization phenomena (i.e., strange changes in self
ably the most accurate way to characterize the prodromal and world awareness in which patients feel as if they, the
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Schizophrenia Bulletin, Vol. 26, No. 4, 2000 G. Stanghellini
Traditional vulnerability models stress derealization ment without any reflection, commonly felt by a whole
and depersonalization as prime causes of overt symptoms order, a whole people, a whole nation or the whole human
and psychotic breakdowns, and they neglect eccentricity, kind." The 18th-century Scottish philosopher T. Reid
i.e., active positioning at the margins of socially shared (Reid 1997) postulated that the human mind could harmo-
worldviews (vignette 4) and the refusal of social norms nize with common sense because of an innate "instinct."
(vignette 5). The structure of values and beliefs of the per- In contrast to Vico's and Reid's praise for common sense,
son who is vulnerable to schizophrenia is also of central modem scientists and philosophers, with few but signifi-
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At Issue Schizophrenia Bulletin, Vol. 26, No. 4, 2000
accept the teachings of adults at a stage of psychological conceptualized as a stock of knowledge useful at the level
growth that is prior to doubts and uncertainties. In short: of everyday life. Common sense is a set of rules of infer-
we are imprinted with it. ence that is the medium for organizing the everyday expe-
riences of individuals and social groups (Flick 1998). It is
Preservation of Common Sense. The common sense the foundation of people's expectations and of meaning
world enjoys relative stability and consistency among attributions (Moscovici and Hewstone 1983). This process
individuals who belong to the same group. The remark- of inference is mainly automatic in nature—motivations
able stability of common sense is due to the tendency to and meanings are attributed prereflectively.
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Schizophrenia Bulletin, Vol. 26, No. 4, 2000 G. Stanghellini
ire, "to go inside") what is going on in somebody else's These different dimensions of schizophrenic vulnera-
mind. I can attune with a given social situation when I am bility can be outlined as follows:
able to comprehend thoughts and feelings of others by
1. Sensory-level disorders (perception of self, body,
observing their behavior and to explain others' behavior
and world)
in terms of intentional (e.g., "He is looking for an
2. Conceptualization-level disorders (attribution of
aspirin") or nonintentional (e.g., "He has a headache")
meaning and intention)
mental facts. Social cognition is based on a fundamental
2.1 Damaged social knowledge network
feature of the human mind, the urge to establish motiva-
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At Issue Schizophrenia Bulletin, Vol. 26, No. 4, 2000
phrenia, in which the pragmatic use of things is affected Vignette 6. Impaired intuitive attunement
(Minkowski 1927).
M.M. is a 42-year-old woman affected by paranoid
Hypertrophy. Disorders of conceptualization can also schizophrenia. During a therapy session she asked me
be due to a hypertrophied background of knowledge-at- and herself, "What is reasonableness? It is the light that
hand. The phenomenon of "automatic consciousness" allows the interpretation of reality. In me it is switched
experienced by E.B. (vignette 5) is a well-known and off. It is not spontaneous. One must work on it. I feel
fundamental feature of psychotic thinking. Complex switched off here in my forehead. Interpreting reality is
associations are passively triggered by a single word or also saying: 'I don't like him!' It is a subjective interpre-
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Schizophrenia Bulletin, Vol. 26, No. 4, 2000 G. Stanghellini
normal controls (Sarfati et al. 1997a, 1997b). Thought, Vignette 8. Bracketing of common sense1
language, and communication disorders are especially
highly correlated with this inability. People with schizo- F. is now 26 years old. He was once a sensible boy, who
loved to be alone. At the age of fifteen he began feeling
phrenia who fail to appreciate other people's mental states
the pure and romantic desire of having a girl friend. No
do not seem to rely on what is specifically relevant to the
sensual factor was involved. But since he was very shy,
context, but on two competing strategies of decoding: he could not fulfil his desire. This did not trouble him
either they choose the prevailing meaning of an ambigu- very much, nonetheless he thought it was suitable at his
ous stimulus (e.g., a word), thus relying on their back- age to have a sentimental life and so he tried to behave
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At Issue Schizophrenia Bulletin, Vol. 26, No. 4, 2000
Vignette 9. Apoplexia philosophies1 ivity and the tendency to reify abstractions. It is also possi-
ble for an attitude based on the hypertolerance of ambigu-
"We moved to the patient's bedside. The patient had to
ity to generate the refusal of conventional common sense
confine himself to his bed; he was no longer able to
typifications that do not reflect enough of the complexity
perform any of the essential daily actions. He felt para-
lyzed. The rigidity of his stupor had taken control over
of reality and to promote the search for idiosyncratic and
him. His hands could no longer grasp, for who was it esoteric cues to interpret reality itself.
that gave them the right to take things? His feet could
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Schizophrenia Bulletin, Vol. 26, No. 4, 2000 G. Stanghellini
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Schizophrenia Bulletin, Vol. 26, No. 4, 2000 G. Stanghellini
Mundt, C. Das Apathiesyndrom der Schizophrenen. Eine Netherlands: Nijhoff, 1962. pp. 3-27.
psychopathologische und computertomographische Schwartz, M.A.; Wiggins, O.P.; and Spitzer, M. Psychotic
Untersuchung. Berlin, Germany: Springer, 1985. experience and disordered thinking: A reappraisal from
Mundt, C. Constituting reality—its decline and repair in the new perspectives. Journal of Nervous and Mental
long-term course of schizophrenic psychoses: The intention- Disease, 185:176-187, 1997.
ality model. In: Marneros, A.; Andreasen, N.C.; and Tsuang, Searle, J.R. The Construction of Social Reality. New
M.T., eds. Negative Versus Positive Schizophrenia. Berlin, York, NY: Free Press, 1995.
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Acknowledgments
I wish to thank Prof. M. Maj and Prof. L.A. Sass for their
helpful comments on earlier versions of this manuscript.
The Author
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