Background Delusions in schizophrenia are commonly approached as empirical false beliefs about everyday reality. Phenomenological accounts, by contrast, have suggested that delusions are more adequately understood as pertaining to a different kind of reality experience. How this alteration of reality experience should be characterised, which dimensions of experiential life are involved, and whether delusional reality might differ from standard reality in various ways is unclear and little is known about how patients with delusions value and relate to these experiential alterations. This study aimed to investigate the nature of delusional reality experience, and its subjective apprehension, in individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis.Methods In this qualitative phenomenological study, we recruited individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis from two psychiatric-hospital services in Belgium using homogenous sampling. Criteria for participation were having undergone at least one psychotic episode with occurring delusional symptoms, present at least 1 year before participation, on the basis of clinical notes assessed by the attending psychiatrist; a schizophrenia-spectrum diagnosis, ascertained through clinical interview by the attending psychiatrist upon admission; being aged between 18 years and 65 years; and having the capacity to give informed consent. Exclusion criteria included worries concerning capacity to consent and risk of distress caused by participation. We did phenomenologically driven semi-structured interviews with the participants to explore the nature of delusional reality experience and their subjective valuation of these experiences. We used interpretative phenomenological analysis, a qualitative method tailored to the in-depth exploration of participants' first-person perspective, to analyse their accounts.
The philosophy of psychosis and the psychosis of philosophy: a philosopher draws on his experience of madness. In this book, philosopher and linguist Wouter Kusters examines the philosophy of psychosis—and the psychosis of philosophy. By analyzing the experience of psychosis in philosophical terms, Kusters not only emancipates the experience of the psychotic from medical classification, he also emancipates the philosopher from the narrowness of textbooks and academia, allowing philosophers to engage in real-life praxis, philosophy in vivo. Philosophy and madness—Kusters's preferred, non-medicalized term—coexist, one mirroring the other. Kusters draws on his own experience of madness—two episodes of psychosis, twenty years apart—as well as other first-person narratives of psychosis. Speculating about the maddening effect of certain words and thought, he argues, and demonstrates, that the steady flow of philosophical deliberation may sweep one into a full-blown acute psychotic episode. Indeed, a certain kind of philosophizing may result in confusion, paradoxes, unworldly insights, and circular frozenness reminiscent of madness. Psychosis presents itself to the psychotic as an inescapable truth and reality. Kusters evokes the mad person's philosophical or existential amazement at reality, thinking, time, and space, drawing on classic autobiographical accounts of psychoses by Antonin Artaud, Daniel Schreber, and others, as well as the work of phenomenological psychiatrists and psychologists and such phenomenologists as Edmund Husserl and Maurice Merleau-Ponty. He considers the philosophical mystic and the mystical philosopher, tracing the mad undercurrent in the Husserlian philosophy of time; visits the cloud castles of mystical madness, encountering LSD devotees, philosophers, theologians, and nihilists; and, falling to earth, finds anxiety, emptiness, delusions, and hallucinations. Madness and philosophy proceed and converge toward a single vanishing point.
Background Delusions in schizophrenia are commonly approached as empirical false beliefs about everyday reality. Phenomenological accounts, by contrast, have suggested that delusions are more adequately understood as pertaining to a different kind of reality-experience. To date, however, the specific nature of delusional reality-experience has not been subject to systematic empirical study. It is also unclear howthis alteration of reality-experience should be characterized, which dimensions of experiential life are involved and whether delusional reality may differ from standard reality in various ways. Furthermore, little is known about how delusional patients value and relate to these experiential alterations. This study aimed to investigate the natureof delusional reality-experience, and its subjective apprehension, in individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis.Methods In this study, individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis formed a purposeful sample. Phenomenologically driven semi-structured interviews were conducted to explore the nature of delusional reality-experience and participants’ subjective valuation of these experiences. Interpretative Phenomenological Analysis (IPA), a qualitative method tailored to the in-depth exploration of participants’ first-person perspective, was used to analyse participants’ accounts.Findings Between Mar 2, 2020 and Sep 30, 2020, 18 adults with a clinical schizophrenia-spectrum diagnosis and lived experience of delusions participated in the interview-study. The findings suggest that delusions are often embedded in wide-ranging alterations of basic reality-experience, involving quasi-ineffable atmospheric and ontological qualities that undermine participants’ sense of the world as unambiguously real, fully present, and shared with others. We also found thatdelusional reality-experience can differ from standard reality in various way (i.e., in a hypo –and hyper-real form), across multiple dimensions (e.g., meaningfulness, necessity/contingency, detachment/engagement), and that participants are often implicitly or explicitly aware of the distinction between delusional and standard reality. Finally, delusional experience can have an enduring value and meaning that is not fully captured by a strictly medical perspective.Interpretation Increased awareness and recognition of the distinctive nature of delusional reality-experience, in both clinical and research settings, can improve diagnostic accuracy, explanatory models, and therapeutic support for delusional individuals whose lived realities are not always evident from an everyday perspective.
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