Hyeon-Seung Lee
Individuals with depression often report their core belief of "I am worthless and unlovable." Individuals with anxiety disorders and OCD often report “what if” statement as a sign of excessive worry that leads to the thoughts of the worst-case scenario. Then, what would be a representative sign of schizophrenia? It is difficult to pick just one phenomenon given the multifaceted nature of the disorder, but I would pick "as if" statements related to the sense of self. Past research points out that self-disturbances are intertwined with the emergence of schizophrenia symptoms such as delusions and hallucinations. People at-risk often describe their experiences like this: “It feels 'as if' I am untuned to my body.” The anomalous feeling of altered self (agency, body ownership, self-boundary, and the experience of sensation, perception, and emotion) is a salient feature in the lives of those with schizophrenia. Bleuler’s original conceptualization of schizophrenia as that of the splitting of the mind and Kraepelin’s analogy of “an orchestra without a conductor” that indicates “a loss of inner unity”, both emphasize aberrations in the basic sense of self. These self-disturbances have been shown to be important for predicting functional outcomes.
Although the Research Domain Criteria (RDoC) of the National Institute of Mental Health (NIMH) and the International Classification of Diseases (ICD-11) include self-related features, self-disorder is not a prominent feature in either approach. Moreover, the sense of self has been ignored in the diagnosis, research, and treatment of schizophrenia due to lack of reliable and valid measures. With new methodological advances, it is now possible to empirically investigate the etiology and nature of self-disorders. As an early career researcher working with Dr. Sohee Park and multidisciplinary collaborators, I have developed and implemented novel experimental paradigms to elucidate and measure aspects of self-disturbances in schizophrenia. For instance, I have used virtual reality (VR) based measures to assess the neurocognitive representation of bodily space (i.e., peripersonal space) and how it is linked to schizophrenia symptoms. I also utilized VR-based social skills training to provide simulation and rehearsal of interpersonal interactions in realistic settings rather than explicitly teaching social cognitive skills to individuals with schizophrenia. In addition, I use computerized tools to visualize embodied emotions, manipulate cortical activities with brain stimulation, and assess the integrity of frontoparietal networks with neuroimaging to fully investigate the self-disturbances, symptoms, and social dysfunctions in schizophrenia.
Specifically, my master’s thesis focused on the abnormal spatial self-consciousness in schizophrenia formed through multisensory processing. As objects or people approach one’s personal space, multisensory neurons in the frontoparietal brain facilitate appropriate reactions. I used VR-based multisensory integration tasks to identify the inflection point where multisensory reaction time is facilitated, which estimates the size and slope of personal space. I found that individuals with schizophrenia generate small but unclearly-defined personal space boundaries relative to controls in the social context. The size or shape of personal space was associated with the severity of negative symptoms and hallucinations. In an ongoing review study, I further demonstrated how personal space is altered in various mental disorders (e.g., anxiety, post-traumatic stress disorder, autism spectrum disorders, etc.). The personal space size is enlarged in various disorders; however, the self-space is more solidly formed in individuals with anxiety and autism spectrum disorders, while the boundary is unclearly generated in those with schizophrenia. My dissertation research further examines the altered representation of personal space, investigating the effect of threat, social distress, and socioemotional factors.
Another line of research is investigating cross-cultural differences in the manifestation of psychosocial dysfunction. Previously, I examined the impact of the COVID-19 pandemic on the mental health of the general population from various cultures. Given the pandemic and social distancing were increasing feelings of social disconnection and loneliness, I expected that social disconnection and loneliness play a major role in poor physical and mental health. Delving into how cultural differences in public health strategies and compliance of the general population yield variances in reported stress, mood, anxiety, and psychotic experiences provided me with either a microscopic or a macroscopic view of psychosocial dysfunction. Moreover, I investigated culture-general and specific aspects of mental health symptoms and abnormal self-related experiences in schizophrenia. Previous cross-cultural works highlighted that though symptoms and self-disturbances are salient and prevalent in both Western and non-western cultures, there were culture-specific aspects such as relatively high tolerance for anomalous self-experiences and less attenuated embodied emotion in Koreans. I would like to continue to investigate cultural effects on psychosocial functions.
Psychiatric research is still mostly driven by researchers from Europe and North America. As a Korean scientist, I believe we have valuable contributions to make to this field and I hope to increase the representation of Korean and other Asian scientists in the field of schizophrenia research. Increased diversity of ideas and approaches will surely positively impact the future of the Schizophrenia International Research Society (SIRS).
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