Double bookkeeping and schizophrenia spectrum: divided unified phenomenal consciousness
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ORIGINAL PAPER
Double bookkeeping and schizophrenia spectrum: divided unified phenomenal consciousness Josef Parnas1,2,3 · Annick Urfer‑Parnas4 · Helene Stephensen1,2 Received: 16 June 2020 / Accepted: 20 August 2020 © The Author(s) 2020
Abstract Eugen Bleuler, the founder of the concept of schizophrenia, pointed out that psychotic patients were able to live in two disjoint worlds (namely, the social, intersubjective world and the delusional world). He termed this phenomenon “double bookkeeping,” but did not provide any conceptual elaboration of this phenomenon or its possible mechanisms. Double bookkeeping has been neglected in mainstream psychiatry, but it has been addressed in recent theoretical work, however mainly concerned with the issue of delusion. In this article, we present clinical material that supports the view that double bookkeeping manifests itself across various psychotic phenomena and its antecedent may be observed in premorbid (pre-onset) phases as well as in the schizotypal disorder. We try to conceptualize double bookkeeping to concretize an often atmospheric perception of paradoxicality in the encounter with the patient. A phenomenological analysis of double bookkeeping suggests an instability in the affective (“auto-affection”) articulation of selfhood. We point to four main implications of our presentation: (1) diagnostic, (2) epistemological, (3) therapeutic and (4) pathogenetic research. Keywords Schizophrenia spectrum · Double bookkeeping · Auto-affection · Self-disorders · Consciousness
Introduction Clinical observations of the phenomenon of double bookkeeping, although not conceptualized with this term, can already be found in the works of Philippe Pinel [1] and JeanÉtienne Esquirol [2]. The notion of double bookkeeping was coined by Eugen Bleuler in his monograph on schizophrenia [3] and his subsequent textbook of psychiatry [4] referring to the patients’ ability to separate their delusional world from the everyday socially shared world. According to Bleuler, this reflects a co-existence of two disjoint ways of orienting oneself to reality. This is well illustrated in the following quote from Bleuler. * Helene Stephensen [email protected] 1
Center for Subjectivity Research, University of Copenhagen, 2300 Copenhagen, Denmark
2
Mental Health Centre Glostrup, University Hospital of Copenhagen, 2605 Brøndby, Denmark
3
Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
4
Mental Health Centre Amager, University Hospital of Copenhagen, 1610 Copenhagen, Denmark
Kings and Emperors, Popes, and Redeemers engage, for the most part, in quite banal work.[…]. None of our generals has ever attempted to act in accordance with his imaginary rank and station [3, p. 129]. As an example, from our own clinical work, we can mention a hospitalized patient, who claims that the nurses are trying to poison him, but he nonetheless gladly consumes the food that he is served by the very same personnel. As in the example from Bleuler, the patient does not act
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