Double bookkeeping and schizophrenia spectrum: divided unified phenomenal consciousness
Open accessAbstract
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.
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In schizophrenia, it is often the prereflective sense of reality that fails.
“In schizophrenia, it is often the prereflective sense that fails [5,6].”
From Delusional Experiences Emerging From AI Chatbot Interactions or “AI Psychosis” (2025) · cites this paper as [5]
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Delusional Experiences Emerging From AI Chatbot Interactions or “AI Psychosis”
Hudon, A., & Stip, E. (2025) · JMIR Mental Health · doi:10.2196/85799 · Cited by 88 · see citing works
“In schizophrenia, it is often the prereflective sense that fails [5,6].”
- Authors
- Parnas, J., Urfer-Parnas, A., & Stephensen, H.
- Affiliations
- University of Copenhagen (DK)
- Amager Hospital (DK)
- Corresponding author
- Stephensen, Helene
- Venue
- European Archives of Psychiatry and Clinical Neuroscience
- Published
- 2020-09-08
- Volume
- 271
- Issue
- 8
- Pages
- 1513-1523
- ISSN
- 0003-9373 (ISSN-L)
- 0940-1334
- 1433-8491
- PMC
- PMC8563555
- OpenAlex
- W3084151659
- Cited by
- 63
- References
- 62
- Citations by year
- 2026: 14 · 2025: 6 · 2024: 13 · 2023: 14 · 2022: 10 · 2021: 5 · 2020: 1
- FWCI
- 41.44
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- European Archives of Psychiatry and Clinical Neuroscience (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
- Topics
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- double-entry bookkeeping, schizophrenia spectrum, schizotypy, delusions, phenomenology of psychosis, selfhood, auto-affection, neuroticism, Eugen Bleuler, therapeutic implications
- MeSH terms
- Consciousness, Humans, Psychiatry, Schizophrenia, Schizophrenic Psychology
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