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Paradoxes in a prism: Reflections on the omnipotent passivity and omniscient oblivion of schizophrenia

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Clara Humpston discusses ‘omnipotent passivity and omniscient oblivion’ which are some of the key paradoxes within schizophrenia.

Image courtesy of interviewee. May 30, 2024

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The speaker reflects on their 15 years of experience in schizophrenia research, focusing on the patients' experiences and the concept of "self-disturbance" that often accompanies the condition. They discuss how individuals with schizophrenia may feel a disconnection from their thoughts, sometimes perceiving them as influenced or controlled by external forces. This video results in a paradoxical experience where patients acknowledge their thoughts yet feel disconnected from them.

The speaker emphasizes that schizophrenia should not be viewed as a higher or lower level of consciousness but rather as a distinct type of consciousness with unique insights that can arise when common perceptions of reality fade. They argue that individuals with schizophrenia construct reality similarly to others, but their perception may be influenced more significantly by idiosyncratic experiences.

The speaker criticizes the clinical approach, noting that many clinicians fail to see patients as individuals beyond their diagnosis. Instead, there is a tendency to treat symptoms through a checklist approach, neglecting the patient's unique needs and experiences. They advocate for a more integrated, interdisciplinary understanding of schizophrenia that takes into account personal, social, and biological factors, moving away from singular explanatory frameworks.

Ultimately, the speaker calls for treating patients with the same humanity and individual consideration as anyone else while fostering collaboration and involvement from patients and their families in the treatment process. Their reflections highlight the importance of seeing beyond the label of schizophrenia to recognize the person behind it.

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Mostly my own reflections.

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I've been in the field of schizophrenia research

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for the last 15 years now.

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So I've spoken with a lot of patients.

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I've, worked with them.

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I've, spoken with some of their carers as well.

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And a lot of the things they've told me seem

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to focus on the sense of self that's been disturbed

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or somehow distorted by their condition.

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So it's not strictly speaking the empirical piece

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of work, but it's my kind of reflections on working

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with people with schizophrenia

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and their, their own experiences of

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what's called a self disturbance.

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So by that I mean a sense of self that has been,

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disrupted or distorted.

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For example, in people with schizophrenia,

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people sometimes feel their thoughts not there anymore.

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Instead, they've been put into their heads by some sort

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of external force or agency that may

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or may not sometimes command them

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or direct them to do things they don't usually want to do.

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And that's part of the self-service mode I'm speaking of,

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and which I wrote about is that,

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the kind of omniscient passivity

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and omnipotent oblivion all the other way round that

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people often speak of.

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Maybe not in those terms because that's my fancy terms,

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but they tend to say that my reality, my sense of self,

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they're very much mine,

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but they're not mine at the same time.

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That's where the paradoxical aspect comes from,

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and that's what I based my, reflections upon.

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I think neither

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or both, which is, again, paradoxical by

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its own kind of definition.

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It, it, well that's like a bit

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of like a nature nurture story, isn't it,

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that there's no particular answer to,

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but I think it's a combination of genetics, of biochemistry,

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of brain structure and function

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and of their environment, their interpersonal relationships

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and society's attitude towards the patients.

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So I think it's a combination of all of these things

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that constitutes somebody's sense of self

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and it's disturbances from talking to people

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with schizophrenia

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and from, their own first person narratives.

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I think, I mean, I've been asked this time

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and time again about whether schizophrenia is like a higher

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level of consciousness.

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Personally, I wouldn't necessarily say it's a higher level

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of consciousness, but instead I would say it's very

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different if not almost a separated level of consciousness.

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I often say that the insights

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gained when the common sense reality retreats

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can be really, really profound

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and in some way almost mystical, the transform

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a person's view of themselves and of the world.

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So it is very much a distinct type inside.

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I mean, people treat people other, others with schizophrenia

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and they think it's a lack of insight into, for example,

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the illness that they're suffering from

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or the very fact that something is as is wrong with them

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or different about them.

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But bearing in mind they're undergoing a whole

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transformation of their sense of reality and sense self.

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It's very difficult to situate that in the common sensical

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or consensual reality that everybody else

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seems to be living in.

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So, so I suppose it is more kind of a different type

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of reality altogether.

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I would say in a sense,

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I would say it's both within the episode,

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the psychosis itself, that gives them a sense of insight

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into these other,

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almost like a dimensional experience

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or as we say, a fundamental restructuring

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of one's consciousness almost.

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But it's not necessarily a higher

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or lower level of consciousness.

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It's just entirely different.

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There are multiple layers of the paradoxes that,

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that we are talking about.

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The first is perhaps more kind of experiential

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sense of paradox.

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As I said, people with schizophrenia experience their

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thoughts even sometimes their behavior

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and actions as both theirs and not this.

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So in a sense they think that their thoughts are not

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there, but in kind of being forced

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or inserted by another force or another agent.

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However, at the same time,

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they still find their thoughts in their heads.

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So it is within developmental space, within,

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within their mind,

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but it's lost the sense of ownership and agency.

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So that's the kind of foundational

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or some sort of sensory layer of paradox.

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But on a higher level though, to able

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to experience this altered sense

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of agency this or even some type of diminishment

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or a lack of agency, one has to

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be somehow responsible, at least in charge of this

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first person perspective in order

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to perceive a different reality.

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In order to experience these alien thoughts.

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It's very much paradoxical to me at least, is that

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how can somebody be both in charge of their behaviors

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with thoughts to be able to think in the first place,

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yet not thinking their own thoughts.

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So I think it's a very deep sense of paradoxical experience

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where people would potentially lose

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themselves in trying to resolve those paradox.

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And that's also why at least in part, I wanted to

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separate suffer from the illness

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because I would say it's very much the illness

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or the condition that kind of compelled

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the patient to think in this paradoxical way is

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because people are very much still aware

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of common sensical reality.

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There's a whole phenomenon in psychopathology called double

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bookkeeping, and by that I mean who are aware

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of the common sensical reality still going around

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around them, happening to them passively.

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Yet they're not an active kind

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of participant in this reality.

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At the same time, they can't completely detach because

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otherwise they wouldn't be able to function at all.

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So people with schizophrenia do function in society

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in very different ways, perhaps by the doctor's kind

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of perspective, in impaired ways or dysfunctional ways.

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However, for the patients, they're desperately trying

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to reintegrate into common sense realities.

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But because of this insight,

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because of this newly open world that's right in their face,

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that as many people will tell me it's more real than

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what we see as reality.

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It's very difficult to detach

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or to participate, especially in the NHS for example.

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Obviously I have very good things to say about NHS

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as a health system, but many clinicians lose sight

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of the individuality if of the very fact that their

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patients are still individuals with their own needs, goals,

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aims, desires, hopes and dreams behind,

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or even beyond this label, this illness of schizophrenia.

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I mean, when people think

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or even see others who have had this label,

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they often just see the illness.

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They don't see the person behind the label,

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behind this whole condition

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that affects them in such profound ways.

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So I would, I wouldn't say every single clinician

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is detached from their patients,

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but I would say perhaps many, if not most fail

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to see the humanity of their patient.

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They only see the differences.

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They only see how they're dysfunctional, impaired,

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or disabled by their conditions.

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They fail to see them as human beings.

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They fail to, to appreciate

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that their individuals at end

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of the day just like condition.

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And, two things I would like to raise is

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that the first is, for example, when people kind

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of assess patient's symptoms

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or for example, hallucinations

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or delusions, they would treat it as a tick box

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clinical exercise that people go down the

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list and go through it.

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And perhaps

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because the resources are so limited in the health services,

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even the most well wishing clinician wouldn't necessarily

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well intentioned clinician would not be able to,

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focus on the patient's subjective experiences,

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wouldn't be able to have the time or the room or resources

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or the personnel to really

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dig into the patient's own kind of needs

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and, hopes and dreams.

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They have no choice

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but to do things in a tick box exercise kind of manner.

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But there are people who do not see patients as,

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individuals or even human beings regardless of

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how much resources, how much kind of investment

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or how many things like,

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how many resources does been put into the process.

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And secondly, I would like to say is that

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patients of, well, patients

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with schizophrenia, at the end of the day,

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they do not necessarily see reality

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or what we call reality in the same way.

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Not because their, I don't know, the

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brain's faulty or their, their broken broken

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or they're completely alienated

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or, like somehow just so different from the rest of us

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that nobody can have any common ground with them.

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I think people construct reality

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or their sense of self in similar, if not the same way,

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regardless whether they're patients or clinicians

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or healthy people in the communities.

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So-called healthy people in the community, the way in which

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we construct a reality follows the same pattern,

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even your biologically.

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It's because of the kind of,

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I wouldn't even say skew a difference in their senses

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in this incoming sensory information

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that skews their perspective towards a

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more idiosyncratic

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or not shared way of perceiving reality.

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I often say it's not fear. Everyone has to go mad.

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Everybody can,

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experience reality in different ways depending on the right

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or wrong circumstances.

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So we're all that different.

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And most, most of all, nobody can

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perceive reality as it is

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just like a brain scanner does not,

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measure brain activity directly.

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We cannot experience reality, the physical world as it is.

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The brain constructs a model of reality

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and that can go wrong, that can go right depending on,

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depending on circumstances and individual.

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It's not that we are the normal ones and the mad ones,

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therefore we'll always be normal ones

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and they always see the mad be the mad ones.

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I would really say it's more of a case of, again,

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seeing individuals as individuals.

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I've had a lot of questions from the general public,

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for example, asking, is it all because of their parents

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or because of the child experience, childhood experiences,

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or because they've had some adverse experiences, child or

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because they've smoked certain drugs

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or they've taken, sometimes brain injuries can even kind

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of physical injuries to the brain can lead

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to psychotic experiences.

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So I think we need to look beyond a singular framework

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to explaining psychotic symptoms

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or schizophrenia as a whole.

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We need to look at firstly the individual,

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their own background, their own experiences, their ways

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of life, their societal influence, their cultural influence,

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their genetics even.

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So I think I'm a massive fan of interdisciplinarity

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and, pluralism in explaining

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or trying to understand anything as complex schizophrenia.

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So I think we need to move away from singular frameworks,

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whether it is biological, medical, social, psychological,

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cognitive or anything, but to combine them

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because as individuals we are the combination

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with the final product of different aspects of our lives

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or biology of our social aspects or whatever.

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But we need to look at patients in the same way as we treat

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our friends and family,

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because I think we have a lot more in common with

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patients than we would realize.

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Often say that people kind of overt the gaze

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of the mad man on the street is just

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because they can see themselves in the gazing back

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of the individual who have been affected by,

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madness or schizophrenia is

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because we can see ourselves in the mad GA

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that we have to look away. But it's also

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Because we can see ourself in the mad gaze

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that we should talk to them.

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We should look at them on equal footings.

14:59.665 --> 15:02.065
I mean treat people as individuals.

15:02.845 --> 15:07.695
And I think even a lot of the research somehow does it

15:08.085 --> 15:09.455
through the patients

15:09.635 --> 15:11.735
or for the patients on behalf

15:11.735 --> 15:14.415
of the patients rather than with the patients.

15:16.655 --> 15:18.175
I think a lot of the things

15:18.565 --> 15:21.495
that can be improved should come from the more kind

15:21.495 --> 15:24.615
of co productive, approaches

15:24.615 --> 15:28.215
and co involvement of patients and their families.

00:00 - Mostly my own reflections. I've been in the field of schizophrenia research for the last 15 years now. So I've spoken with a lot of patients. I've, worked with them. I've, spoken with some of their carers as well.

00:18 - And a lot of the things they've told me seem to focus on the sense of self that's been disturbed or somehow distorted by their condition. So it's not strictly speaking the empirical piece of work, but it's my kind of reflections on working with people with schizophrenia and their, their own experiences of what's called a self disturbance. So by that I mean a sense of self that has been, disrupted or distorted.

00:58 - For example, in people with schizophrenia, people sometimes feel their thoughts not there anymore. Instead, they've been put into their heads by some sort of external force or agency that may or may not sometimes command them or direct them to do things they don't usually want to do. And that's part of the self-service mode I'm speaking of, and which I wrote about is that, the kind of omniscient passivity and omnipotent oblivion all the other way round that

01:35 - people often speak of. Maybe not in those terms because that's my fancy terms, but they tend to say that my reality, my sense of self, they're very much mine, but they're not mine at the same time. That's where the paradoxical aspect comes from, and that's what I based my, reflections upon. I think neither or both, which is, again, paradoxical by its own kind of definition.

02:03 - It, it, well that's like a bit of like a nature nurture story, isn't it, that there's no particular answer to, but I think it's a combination of genetics, of biochemistry, of brain structure and function and of their environment, their interpersonal relationships and society's attitude towards the patients. So I think it's a combination of all of these things that constitutes somebody's sense of self and it's disturbances from talking to people

02:35 - with schizophrenia and from, their own first person narratives. I think, I mean, I've been asked this time and time again about whether schizophrenia is like a higher level of consciousness. Personally, I wouldn't necessarily say it's a higher level of consciousness, but instead I would say it's very different if not almost a separated level of consciousness. I often say that the insights gained when the common sense reality retreats

03:10 - can be really, really profound and in some way almost mystical, the transform a person's view of themselves and of the world. So it is very much a distinct type inside. I mean, people treat people other, others with schizophrenia and they think it's a lack of insight into, for example, the illness that they're suffering from or the very fact that something is as is wrong with them or different about them. But bearing in mind they're undergoing a whole

03:45 - transformation of their sense of reality and sense self. It's very difficult to situate that in the common sensical or consensual reality that everybody else seems to be living in. So, so I suppose it is more kind of a different type of reality altogether. I would say in a sense, I would say it's both within the episode, the psychosis itself, that gives them a sense of insight into these other,

04:17 - almost like a dimensional experience or as we say, a fundamental restructuring of one's consciousness almost. But it's not necessarily a higher or lower level of consciousness. It's just entirely different. There are multiple layers of the paradoxes that, that we are talking about. The first is perhaps more kind of experiential sense of paradox.

04:41 - As I said, people with schizophrenia experience their thoughts even sometimes their behavior and actions as both theirs and not this. So in a sense they think that their thoughts are not there, but in kind of being forced or inserted by another force or another agent. However, at the same time, they still find their thoughts in their heads. So it is within developmental space, within, within their mind,

05:13 - but it's lost the sense of ownership and agency. So that's the kind of foundational or some sort of sensory layer of paradox. But on a higher level though, to able to experience this altered sense of agency this or even some type of diminishment or a lack of agency, one has to be somehow responsible, at least in charge of this first person perspective in order to perceive a different reality.

05:49 - In order to experience these alien thoughts. It's very much paradoxical to me at least, is that how can somebody be both in charge of their behaviors with thoughts to be able to think in the first place, yet not thinking their own thoughts. So I think it's a very deep sense of paradoxical experience where people would potentially lose themselves in trying to resolve those paradox. And that's also why at least in part, I wanted to separate suffer from the illness

06:26 - because I would say it's very much the illness or the condition that kind of compelled the patient to think in this paradoxical way is because people are very much still aware of common sensical reality. There's a whole phenomenon in psychopathology called double bookkeeping, and by that I mean who are aware of the common sensical reality still going around around them, happening to them passively. Yet they're not an active kind

07:04 - of participant in this reality. At the same time, they can't completely detach because otherwise they wouldn't be able to function at all. So people with schizophrenia do function in society in very different ways, perhaps by the doctor's kind of perspective, in impaired ways or dysfunctional ways. However, for the patients, they're desperately trying to reintegrate into common sense realities. But because of this insight, because of this newly open world that's right in their face,

07:42 - that as many people will tell me it's more real than what we see as reality. It's very difficult to detach or to participate, especially in the NHS for example. Obviously I have very good things to say about NHS as a health system, but many clinicians lose sight of the individuality if of the very fact that their patients are still individuals with their own needs, goals, aims, desires, hopes and dreams behind, or even beyond this label, this illness of schizophrenia.

08:20 - I mean, when people think or even see others who have had this label, they often just see the illness. They don't see the person behind the label, behind this whole condition that affects them in such profound ways. So I would, I wouldn't say every single clinician is detached from their patients, but I would say perhaps many, if not most fail to see the humanity of their patient.

08:50 - They only see the differences. They only see how they're dysfunctional, impaired, or disabled by their conditions. They fail to see them as human beings. They fail to, to appreciate that their individuals at end of the day just like condition. And, two things I would like to raise is that the first is, for example, when people kind of assess patient's symptoms

09:17 - or for example, hallucinations or delusions, they would treat it as a tick box clinical exercise that people go down the list and go through it. And perhaps because the resources are so limited in the health services, even the most well wishing clinician wouldn't necessarily well intentioned clinician would not be able to, focus on the patient's subjective experiences, wouldn't be able to have the time or the room or resources

09:48 - or the personnel to really dig into the patient's own kind of needs and, hopes and dreams. They have no choice but to do things in a tick box exercise kind of manner. But there are people who do not see patients as, individuals or even human beings regardless of how much resources, how much kind of investment or how many things like, how many resources does been put into the process.

10:22 - And secondly, I would like to say is that patients of, well, patients with schizophrenia, at the end of the day, they do not necessarily see reality or what we call reality in the same way. Not because their, I don't know, the brain's faulty or their, their broken broken or they're completely alienated or, like somehow just so different from the rest of us that nobody can have any common ground with them.

11:04 - I think people construct reality or their sense of self in similar, if not the same way, regardless whether they're patients or clinicians or healthy people in the communities. So-called healthy people in the community, the way in which we construct a reality follows the same pattern, even your biologically. It's because of the kind of, I wouldn't even say skew a difference in their senses in this incoming sensory information

11:37 - that skews their perspective towards a more idiosyncratic or not shared way of perceiving reality. I often say it's not fear. Everyone has to go mad. Everybody can, experience reality in different ways depending on the right or wrong circumstances. So we're all that different. And most, most of all, nobody can perceive reality as it is

12:10 - just like a brain scanner does not, measure brain activity directly. We cannot experience reality, the physical world as it is. The brain constructs a model of reality and that can go wrong, that can go right depending on, depending on circumstances and individual. It's not that we are the normal ones and the mad ones, therefore we'll always be normal ones and they always see the mad be the mad ones. I would really say it's more of a case of, again,

12:42 - seeing individuals as individuals. I've had a lot of questions from the general public, for example, asking, is it all because of their parents or because of the child experience, childhood experiences, or because they've had some adverse experiences, child or because they've smoked certain drugs or they've taken, sometimes brain injuries can even kind of physical injuries to the brain can lead to psychotic experiences. So I think we need to look beyond a singular framework

13:15 - to explaining psychotic symptoms or schizophrenia as a whole. We need to look at firstly the individual, their own background, their own experiences, their ways of life, their societal influence, their cultural influence, their genetics even. So I think I'm a massive fan of interdisciplinarity and, pluralism in explaining or trying to understand anything as complex schizophrenia. So I think we need to move away from singular frameworks,

13:50 - whether it is biological, medical, social, psychological, cognitive or anything, but to combine them because as individuals we are the combination with the final product of different aspects of our lives or biology of our social aspects or whatever. But we need to look at patients in the same way as we treat our friends and family, because I think we have a lot more in common with patients than we would realize. Often say that people kind of overt the gaze

14:28 - of the mad man on the street is just because they can see themselves in the gazing back of the individual who have been affected by, madness or schizophrenia is because we can see ourselves in the mad GA that we have to look away. But it's also Because we can see ourself in the mad gaze that we should talk to them. We should look at them on equal footings. I mean treat people as individuals.

15:02 - And I think even a lot of the research somehow does it through the patients or for the patients on behalf of the patients rather than with the patients. I think a lot of the things that can be improved should come from the more kind of co productive, approaches and co involvement of patients and their families.

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