Psychosis and the disintegration of dialogical self-structure: Problems posed by schizophrenia for the maintenance of dialogue

Researchers and theoreticians across widely varying disciplines have increa singly stressed how sense of self is inherently 'dialogical', or the produc t of ongoing dialogue both within the individual and between the individual and others. This perspective emphasizes that self-awareness is nor an awar eness of an isolated or seamless viewpoint, but a collective of numerous co mplementary, competing, and sometimes contradictory, voices. In this paper we suggest that changes in subjective sense of self in schizophrenia spectr um disorders may represent the collapse of this essential dialogue. We sugg est that this collapse can have the end-result of mentally ill persons eith er coming to embrace a singular, all-incorporating self-position or standin g precariously on the brink of cacophony which is experienced as self-disso lution. We point to two phenomena associated with schizophrenia that could contribute to the derailment of internal and external dialogue: impairments in associative processes and affect dysregulation. Illustrated with a case example, we finally suggest how psychotherapy has the potential to revive internal dialogue through its explicit use of external dialogue helping to restore previous levels of social function.