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Learn more. Sass and Byrom 1 convincingly argue for the need to systematically investigate the lived or subjective experience of schizophrenic delusions. Moreover, they connect phenomenological accounts of delusion formation with current neurocognitive models of salience dysregulation and prediction error. I fully subscribe to this approach, yet I want to draw the reader's attention to an additional dimension of delusions which may be elucidated by a phenomenological and enactive approach.
What threatens to be overlooked in both cases is that schizophrenic delusions are essentially intersubjective phenomena , both in form and content. Bizarre delusions aside, in most cases the psychiatrist will hardly be able to empirically falsify the patient's delusional claims — but this won't even be necessary.
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Delusions typically manifest themselves in an intersubjective situation, namely as a peculiar inability or refusal of the patient to adequately take the other's perspective into account, to understand his doubts, to try to make himself adequately understood, etc.. In other words, delusions appear primarily as a specific disturbance or breakdown of communication : the mutual comparison and alignment of perspectives fails.
Nevertheless, regarding content, schizophrenic delusions notoriously show a pervasive reference to others by whom the patient feels observed, spied at, persecuted or manipulated. Even though the others often remain hidden, act covertly or in a roundabout way, the patient nevertheless has the impression of being in the centre of their gazes, intentions and actions. Weir's Truman Show is a movie which patients often mention in order to describe their experience.
Thus it seems that an adequate analysis of the phenomenon of delusion has to take its intersubjective dimension into account 2. This implies circular processes of mutual understanding, negotiation of intentions, alignment of perspectives and reciprocal correction of perceptions — processes that take place in every interaction and communication with others. This decisive step of human cognitive development may also be summarized as reaching the excentric position , a term coined by German philosopher H.
Such is the case, for example, when one of the partners is deaf, or does not understand the other's language or cultural background. In these cases, adequate understanding of verbal utterances is compromised, leading to a disturbance of the circles of social interaction and perception. With some modifications, this description applies to schizophrenic delusions as well. In the prodromal stages of the psychosis, the alienation of perception and the resulting loss of familiar significances particularly extend to the social sphere.
The faces, the gazes and the behaviour of others become highly ambiguous, and the interactive circles with others are fundamentally disturbed. In the delusional mood arising from this ambiguity, the basic trust in others breaks down 9 , But this does not at all mean that the others are no longer important.
Delusions may thus be described as a loss of the excentric position. Deluded patients are able to take the supposed perspective of others; what they lack, however, is the independent position from which they could compare and integrate their own and another's point of view, and from which they could also relativize or question their feeling of centrality and reference being observed, spied at, persecuted, etc.
Another result is the exclusion of chance For the schizophrenic patient, however, the situation is reversed: it is precisely the normally irrelevant and accidental background elements that adopt a meaningful, sinister and threatening character. The deluded person does no longer acknowledge the possibility of chance, and thus refuses to treat the shared situation as an open one. Everything revolves around him. In sum, delusions may not be sufficiently described as individual false beliefs. Email Newsletter.
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The writer has failed in her attempt to cure the patient, who now intended to sue her for harassment. If the extra-conscious element is a known physical process, the psychic phenomena are then signs or symptoms of this process … pp— If 1 and 2 are read as generics and they certainly should not be read as universal generalizations , then the triad is not, strictly-speaking, inconsistent. He postulated that delusions in schizophrenia arise from faulty logical reasoning. Current Psychiatry Reports, 8 3 , My view says:. Please try again.