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The Experience of Death Anxiety in Individuals with Schizophrenia

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The Experience of Death Anxiety in Individuals with Schizophrenia THE EXPERIENCE OF DEATH ANXIETY IN INDIVIDUALS WITH SCHIZOPHRENIA FROM AN EXISTENTIAL-PHENOMENOLOGICAL PERSPECTIVE A DISSERTATION SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL OF APPLIED AND PROFESSIONAL PSYCHOLOGY OF RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY BY JONATHAN R. CARROLL IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PSYCHOLOGY NEW BRUNSWICK, NEW JERSEY OCTOBER, 2015 APPROVED: ___________________________ Louis A. Sass, Ph.D. ___________________________ James T. Walkup, Ph.D. DEAN: ___________________________ Stanley B. Messer, Ph.D. Copyright 2015 by Jonathan Carroll Abstract This dissertation seeks to advance a theoretical understanding of death anxiety as an existential phenomenon, and to apply this understanding to certain experiences observed and reported by individuals with schizophrenia. Death anxiety as a phenomenon of experience can be understood as a representation of the individual’s relationship between self and world, which is in part defined by one’s existence in the face of the inevitability of death. It is argued that a comprehensive understanding of the experience of death anxiety can be used to contextualize many of the more bizarre utterances, stated beliefs, and experiences of individuals with schizophrenia, which can aid empathic understanding in psychotherapy. In order to do this, contributions from phenomenology, especially components of the ipseity-disturbance model of schizophrenia, are used to describe normal and anomalous experiences of consciousness, temporality, embodiment, and nothingness as features of a lived ontology. After a survey of empirical literature regarding death anxiety and theoretical conceptions of death anxiety from the existential and psychoanalytic traditions, seven key concepts regarding schizophrenia are critically evaluated and compared to relevant aspects of the phenomenon of death anxiety: the concepts discussed are ineffability, hyperreflexivity, diminished presence, disturbed grip, double bookkeeping, solipsism, and engulfment. It is argued that these anomalous experiences of consciousness reflect changes in one’s ontological status, which involve disruptions, reactions, or defenses against a conventional way of relating to one’s own mortality. Phenomenology has done important work to describe the actual experiences of those whose subjectivity is difficult to explain due to psychosis. The present investigation can help to ground our understanding of the subjectivity of such individuals in a context that is common for all human beings, that of Being- towards-death. ii Acknowledgements This dissertation would not have been possible without the loving support of my family, friends, and academic supporters. I must thank my mother, Diane, whose relentless love, admiration, and encouragement have never wavered, even as I have grown in peculiar, obstinate, and sometimes reclusive ways; and my father, Rick, who has made innumerable and often intangible sacrifices for me across the years. Also, my sister, Jenna, for always paving the way for me and leading by example with unparalleled ambition, work ethic, and resilience. Finally, Molly, who has supported me no matter the distance, and shown me how to feel anything and everything. This dissertation, the capstone of my academic career, is a testament to my teachers, athletic coaches, and professors, clinical supervisors, and intellectual peers throughout my life at Blair Academy, Cornell University, and GSAPP at Rutgers University. Each has contributed to my ongoing education as an intellectual, moral, emotional, and empathic pupil in different ways. I would especially like to thank my committee members, Jamie Walkup, who reminds me that I need not sacrifice intellectual rigor for compassion, and Louie Sass, who has taught me how to think, how to think differently, and what it even means to think in the first place; and shown me what it means to be truly accepting of another person. No amount of theory or philosophy can take the place of appreciating the subjectivity of others (but it can often help). Thank you all for helping me in these undertakings of academics and life. iii Table of Contents Page Abstract ........................................................................................................................................ii Acknowledgements ......................................................................................................................iii Introduction ..................................................................................................................................1 Chapter I: Empirical approaches to death anxiety in schizophrenia ............................................11 Part 1: Review of death anxiety in social psychology .....................................................11 Part 2: Review of clinical research connecting schizophrenia with death anxiety ..........26 Part 3: Review of research on suicide in schizophrenia and its application to phenomenology ....................................................................................................31 Chapter II: A theoretical conception of death anxiety .................................................................38 Part 1: Psychoanalytic roots of death anxiety and schizophrenia ....................................38 Part 2: An existential-phenomenological definition and description of death anxiety beyond psychoanalysis.........................................................................................54 Part 3: An existential introduction to schizophrenia and ipseity disturbance ..................74 Chapter III: Representations of death anxiety in the ipseity-disturbance model of schizophrenia ............................................................................................................................89 Part 1: Ineffability as (the lack of) a metaphor for death .................................................89 Part 2: Hyperreflexivity as death anxiety .........................................................................101 Part 3: Diminished presence as the experience of life without life ..................................117 Part 4: Disturbed grip as the tendency of death anxiety to disrupt meaning ...................129 Part 5: Double bookkeeping as the context for the experience of death anxiety .............139 Part 6: Solipsism and world catastrophe as ‘specialness’ and ontological isolation .......151 iv Part 7: Engulfment and ontological insecurity as the experience of death through relationships .........................................................................................................164 Conclusion ...................................................................................................................................172 Notes ............................................................................................................................................182 References ....................................................................................................................................204 v Introduction A prefatory outline of themes and structure We can ask primal questions, but we can never stand near the beginning.—Jaspers1 The realization that life is absurd cannot be seen as an end, but only as a beginning.—Camus Anxiety and fear related to one’s mortality is a universal issue, one that Irvin Yalom (1980, 2008) and others have argued is core to both existentialism and psychopathology. Despite this simple yet far reaching idea, clinical theory and models of psychopathology have not (adequately) systematically incorporated the role of death anxiety into any noteworthy meta- psychology. There are likely a few reasons for this fact, one of which is that the lack of a knowable phenomenology of death precludes a reliable construct that can be readily known. Another is that death anxiety in the abstract is generally unpleasant and prone to avoidance or denial for theoreticians and clients in psychotherapy alike (to say nothing of the antipathy towards abstract and esoteric philosophy in general). In other words, death anxiety is extremely difficult to study for theoretical or epistemological reasons and emotional reasons. Due to the elusive qualities of death anxiety that will be described in this dissertation, an understanding of alternative forms of consciousness may offer the best examples of interpreting this peculiar form of anxiety. Phenomenology and phenomenological psychiatry have already made important contributions to understanding conventional and unconventional forms of consciousness and offer an important entrée into real ways people may experience such a state. This connection should be no surprise, given that existentialism and phenomenology share important theoretical roots, with thinkers like Martin Heidegger and Jean-Paul Sartre having bridged the gap. I seek to argue that death anxiety, when understood existentially, seems to share some important characteristics with the experiences some individuals with schizophrenia have 1 reported. For this reason, I hope to demonstrate how an existential interpretation of death anxiety as a lived phenomenon can aid an understanding of the phenomenology of schizophrenia as a disorder, and also the reverse. What follows is an introduction to a variety of ways death anxiety and schizophrenia are commonly understood in clinical, research, and theoretical psychology and philosophy, followed by an application of death anxiety to
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