Elizabeth Pienkos

EAWE: Examination of Anomalous World Experience

The “EAWE: Examination of Anomalous World Experience” is a detailed semi-structured interview format whose aim is to elicit description and discussion of a persons experience of various aspects of their lived world. The instrument is grounded in the tradition of phenomenological psychopathology and aims to explore, in a qualitatively rich manner, six key dimensions of subjectivity - namely, a persons experience of: (1) Space and objects, (2) Time and events, (3) Other persons, (4) Language (whether spoken or written), (5) Atmosphere (overall sense of reality, familiarity, vitality, meaning, or relevance), and (6) Existential orientation (values, attitudes, and worldviews). The EAWE is based on and primarily directed toward experiences thought to be common in, and sometimes distinctive of, schizophrenia spectrum conditions. It can, however, also be used to investigate anomalies of world experience in other populations. After a theoretical and methodological introduction, the EAWE lists 75 specific items, often with subtypes, in its six domains, together with illustrative quotations from patients. The EAWE appears in a special issue of Psychopathology that also contains an orienting preface (where the difficulty as well as necessity of studying subjective life is acknowledged) and a brief reliability report. Also included are six ancillary or background articles, which survey phenomenologically oriented theory, research, and clinical lore relevant to the six experiential domains.

Faces of Intersubjectivity

Here we consider interpersonal experience in schizophrenia, melancholia, and mania. Our goal is to improve understanding of similarities and differences in how other people can be experienced in these disorders, through a review of first-person accounts and case examples and of contemporary and classic literature on the phenomenology of these disorders. We adopt a tripartite/dialectical structure: first we explore main differences as traditionally described; next we consider how the disorders may resemble each other; finally we discuss more subtle but perhaps foundational ways in which the phenomenology of these disorders may nonetheless be differentiated. These involve disruptions of common sense and conventionality, abnormalities of empathy, distinct forms of paranoia and the sense of personal centrality, and altered perceptions of intentionality, deadness, and artificiality. We end by considering some neurocognitive research relevant to these abnormal forms of subjectivity, including work on theory of mind, experience of human movement, and perception of faces.

Examination of Anomalous World Experience: A Report on Reliability

Background: The EAWE (Examination of Anomalous World Experience) is a newly developed, semi-structured interview that aims to capture anomalies of subjectivity, common in schizophrenia spectrum disorders, that pertain to experiences of the lived world, including space, time, people, language, atmosphere, and certain existential attitudes. By contrast, previous empirical studies of subjective experience in schizophrenia have focused largely on disturbances in self-experience. Aim: To assess the reliability of the EAWE, including internal consistency and interrater reliability. Sampling and Methods: In the course of developing the EAWE, two distinct studies were conducted, one in the United States and the other in Slovenia. Thirteen patients diagnosed with schizophrenia spectrum or mood disorders were recruited for the US study. Fifteen such patients were recruited for the Slovenian study. Two live interviewers conducted the EAWE in the US. The Slovenian interviews were completed by one live interviewer with a second rater reviewing audiorecordings of the interview. Internal consistency and interrater reliability were calculated independently for each study, utilizing Cronbachs α, Spearmans ρ, and Cohens κ. Results: Each study yielded high internal consistency (Cronbachs α >0.82) and high interrater reliability for total EAWE scores (ρ > 0.83; average κ values were at least 0.78 for each study, with EAWE domain-specific κ not lower than 0.73). Conclusion: The EAWE, containing world-oriented inquiries into anomalies in subjective experience, has adequate reliability for use in a clinical or research setting.

Intersubjectivity and Its Role in Schizophrenic Experience

Social disturbances are common in schizophrenia and can be quite severe, significantly affecting functioning in a variety of ways. Yet the kinds of social disruptions experienced by persons with schizophrenia show a great deal of variability and are difficult to explain with available data. This article considers the variety of intersubjective disturbances that can occur in schizophrenia from a phenomenological perspective, focusing in particular on perceptual disorganization, opacity, loss of common sense, and forms of self-other confusion (petrification and totalization). To explain how these sorts of anomalous experiences might be related to other core disturbances in schizophrenia, the article draws on several prominent phenomenological theories of intersubjectivity, especially Schelers (1954/1973) “expressive unity” and Steins (1916/1989) and Ratcliffes (2012) characterizations of empathy. Finally, the article suggests how these interpersonal disruptions may also play a role in paranoia, solipsism...

Existential Orientation: On the Phenomenology of Values, Attitudes, and Worldviews in Schizophrenia (Ancillary Article to EAWE Domain 6)

Since the appearance of schizophrenia as a distinct diagnosis, various researchers and clinicians, particularly those in the phenomenological and existential tradition, have noted the unique contribution of attitudinal and characterological factors to the illness. There has been a notable lack of attention paid to these features in most recent research on the disorder; still, understanding the values, attitudes, and worldviews - what might be termed the “existential orientation” - of persons with schizophrenia may be essential for comprehending the illness and developing effective approaches to treatment. Domain 6, Existential orientation, of the Examination of Anomalous World Experience (EAWE) includes descriptions related to unusual worldviews and values that may be especially common in schizophrenia. The current paper provides a summary of classic and contemporary phenomenological literature on values and existential orientation in schizophrenia, with the goal of providing a context for and further explanation of the items in EAWE Domain 6. These characterizations generally suggest that persons with schizophrenia may more likely value being faithful to idiosyncratic, often eccentric ways of thinking and acting, questioning or rejecting conventions and common sense, refusing or avoiding relationships and intimacy with others, and living according to intellectual and idealistic rules (in contrast to a more immediate or spontaneous approach to life). Possible factors contributing to the development of these values are also discussed.

Language: On the Phenomenology of Linguistic Experience in Schizophrenia (Ancillary Article to EAWE Domain 4)

Anomalies of language use and comprehension are common in schizophrenia. However, they are typically studied only from a diagnostic or behavioral perspective and viewed simply as deficits or disruptions of normal functioning. Such approaches ignore what it is like to experience language, and thus are at risk of missing aspects of these linguistic anomalies that may be crucial for understanding them. The Examination of Anomalous World Experience (EAWE) provides one way to inquire into the experiential changes related to and underlying these disturbances. This paper offers a summary of a number of theoretical and clinical works that informed the development of EAWE Domain 4, Language, to better contextualize and elaborate on the items that make up this domain. The forms of anomalous linguistic experience included in the EAWE can be generally classified into four groups: (1) Diminished interpersonal orientation, (2) Dissociation between language and experience, (3) Shifts of attention and context-relevance, and (4) Unusual attitudes toward language. We suggest that these kinds of experiential changes indicate a far richer and more complex relationship to language than that suggested by standard deficit models and theories. We hope that by considering and inquiring about the subjective experience of language, researchers and clinicians may develop a greater awareness of and appreciation for the variety of language-related experiences in schizophrenia.

Madness and Melancholia

It is a pleasure to comment on Somogy Varga’s intriguing paper, which offers welcome insight into the historical sources, changing uses, and underlying assumptions pertaining to the concept of ‘melancholia,’ especially in relationship to ‘depression.’ We found Varga’s discussion of the relationship between affect and cognition in past discussions of melancholia and depression to be illuminating, especially given the emphasis on cognitive distortions in contemporary psychopathology. His explanation of the gradual evolution of the depression concept from melancholia sheds interesting light on current notions. All in all, we find Varga’s arguments persuasive, and are inclined to agree with him (and others whom he cites) concerning the considerable affinity and probable continuity between the concepts of depression and of melancholia. We do, however, wish to make a couple of points that, although not exactly contradicting what Varga calls his ‘modest continuity view,’ tend nevertheless to take this comparison in a rather different direction. Our first point concerns the fact that at least some current usages of ‘depression’ seem to have moved this concept somewhat away from what Varga refers to as its core semantic meaning, namely, lowered mood. Indeed it could be argued that, rather like ‘melancholia’ in pre-modern Europe, ‘depression’ in contemporary Western culture has come to serve as a culturally approved and rather all-purpose concept and complaint, one that is deeply grounded in current cultural values and that offers a nonstigmatized alternative to, or avenue for withdrawal from, certain cultural imperatives. Our second point is an attempt to clarify, and in some ways justify, an important current usage of the concept of ‘melancholia,’ one that would foreground its difference from depression proper by emphasizing the melancholic patient’s transcendence of any mere disorder of mood or emotion, no matter how exaggerated the latter may be. We make brief reference to some anecdotal phenomenological evidence supporting the latter point.

Other Worlds: Introduction to the Special Issue on the EAWE: Examination of Anomalous World Experience

The importance of studying the subjective dimension in psychopathology has been stressed at least since the early 20th century work of Karl Jaspers [10] and the Heidelberg school of psychiatry, which was inspired by the phenomenological tradition in philosophy and psychology. This perspective has regained prominence with the revival of phenomenological psychopathology over the last couple of decades [11–17] . Such approaches assert that understanding the subjective experience of various forms of psychopathology is necessary for grasping the crucial features of a disorder and for conceptualizing how these may relate to underlying structures and processes or encompassing forms of experience. Virtually all students of subjectivity have recognized the holistic This special issue of Psychopathology is devoted to a newly developed, semi-structured interview called the “Examination of Anomalous World Experience” or EAWE (pronounced ee wee) [1] . The EAWE has a qualitative and phenomenological orientation, and it is designed to capture changes in or disturbances of the lived world, particularly (though not limited to) those that occur in what have traditionally been considered schizophrenia spectrum disorders. As such, it focuses on eliciting reports concerning six dimensions or domains of an individual’s experience of the world: (1) Space and objects; (2) Time and events; (3) Other persons; (4) Language; (5) Atmosphere (overall “feeling” of experience in general); and (6) Existential orientation (anomalous attitudes or viewpoints toward existence or reality as a whole). The current issue contains, in addition to this introduction, the EAWE itself, an extensive document [1] , followed by a brief report on two reliability studies undertaken during the development of the EAWE [2] . The second part of this issue consists of six “ancillary” articles that provide the clinical/theoretical background to the EAWE domains. Two of these concern the two aspects of “spatiotemporality” [3, 4] (which Gurwitsch [5] , a phenomenologist, has termed “the most general underlying Published online: March 11, 2017

The Phenomenology of Anomalous World Experience in Schizophrenia: A Qualitative Study

This current study is a pilot project designed to clarify changes in the lived world among people with diagnoses within the schizophrenia spectrum. The Examination of Anomalous World Experience ( EAWE ) was used to interview ten participants with schizophrenia spectrum disorders ( SZ ) and a comparison group of three participants with major depressive disorder ( DEP ). Interviews were analyzed using the descriptive phenomenological method. This analysis revealed two complementary forms of experience unique to SZ participants: Destabilization, the experience that reality and the intersubjective world are less comprehensible, less stable, and generally less real; and Subjectivization, the dominance of one’s internal, subjective experiences in the perception or interpretation of the lived world. Persons with depressive disorders, by contrast, did not experience disruptions of the reality or independence of the world or any significant disruptions of appearance or meaning. These results are consistent with contemporary and classic phenomenological views on anomalous world experience in schizophrenia.