Delusions beyond beliefs: a critical overview of diagnostic, aetiological, and therapeutic schizophrenia research from a clinical-phenomenological perspective

Feyaerts, Jasper; Henriksen, Mads Gram; Vanheule, Stijn; Myin-Germeys, Inez; Sass, Louis A.

doi:10.1016/s2215-0366(20)30460-0

Cited by 68 publications

(35 citation statements)

References 135 publications

(189 reference statements)

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“…1 This view has been dominant throughout the history of psychiatry, 2 and continues to inform contemporary research and practice. 3 In explanatory research, the viewpoint underlies cognitive and neuro cognitive attempts to explain delusions in terms of impairments or biases in cognitive reasoning. 4 In clinical practice, it motivates cognitive-behavioural strategies focusing on the rational evaluation and reframing of delusional appraisals.…”

Section: Introductionmentioning

confidence: 99%

“…Clarifying how delusional realities might differ from standard reality would offer an important corrective to the standard approach to delusion as an empirical false belief, with implications for diagnostic assessment, explanatory research, and clinical practice. 3 Moreover, knowledge of how shifts in reality experience are recognised, valued, and dealt with by patients could offer a deeper understanding of the actual lived context of delusions, something that is often overlooked in contemporary research. 10 Yet, although alterations in delusional reality experience have previously been noted in the literature, 11,13 a systematic empirical investigation has yet to be done.…”

Section: Introductionmentioning

confidence: 99%

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Uncovering the realities of delusional experience in schizophrenia: a qualitative phenomenological study in Belgium

Feyaerts

Küsters

Duppen

et al. 2021

The Lancet Psychiatry

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Uncovering the realities of delusional experience in schizophrenia: a qualitative phenomenological study in Belgium

Feyaerts

Küsters

Duppen

et al. 2021

The Lancet Psychiatry

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“…Indeed, whereas the meta-narratives of our participants might seem to indicate an incorrect interpretation, they are actually a way to make sense of strange experiences. As such, it is not participants' interpretation of reality that is distorted, but their experiences themselves (see also Feyaerts et al, 2021) To conclude: based on our findings we argue for more attention for narrative processes underlying overt negative symptomatology. Instead of seeing negative symptoms as a deficit, our findings suggest that these symptoms are a possible reaction to experiential shifts that take place in psychosis.…”

Section: Notementioning

confidence: 59%

Negative symptoms in psychosis: failure and construction of narratives

et al. 2021

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Background: Despite considerable scientific interest in the negative symptoms of psychosis, the subjective dimension of these experiences has barely been studied. Methods: This paper aims at addressing this shortcoming by means of an Interpretative Phenomenological Analysis of semi-structured interviews with 12 participants with a psychotic disorder. Results: The analysis yielded three major themes: 1) negative symptoms can be conceptualized as a failure of narratives to account for perplexing experiences participants are confronted with in psychosis; 2) negative symptoms challenge participants to make sense of them with metanarratives; 3) participants highlight a withdrawn attitude towards life after psychosis. Conclusions: The standard characterization of negative symptoms as a loss of normal functioning should be revised, as this does not match participants' subjective experiences. Negative symptoms rather represent hard to verbalize experiences. This difficulty of linguistic expression is not 20 a shortcoming of the person experiencing them, but characteristic of the experiences themselves.

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“…Instead of being attentive to the possibility of dissimulation, clinicians, in our experience, seem to be more inclined to believe that patients are simulating their symptoms, for example, if their psychotic symptoms are not clearly behaviorally manifest. Yet, failing to act upon delusional or hallucinatory experiences is more likely a sign of double bookkeeping -a cardinal symptom of schizophrenia [23][24][25] -than evidence of simulation. 2.…”

Section: Discussionmentioning

confidence: 99%

“Transition” to Schizophrenia or Fluctuations within the Same Disorder?

et al. 2021

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Background: To prevent or delay the onset of psychotic disorders or ameliorate their course, prodromal research has strived to identify and treat individuals at risk of developing psychosis. While this approach is laudable, it is, however, not entirely unproblematic from clinical and conceptual perspectives. For example, it remains unclear how we are to understand the development from a nonpsychotic, distressing condition such as schizotypal disorder to a psychotic disorder such as schizophrenia? The current terminology on the subject implies either a nonlinear jump (“conversion”) or a more linear progression (“transition”) from one disorder to another. To enrich our understanding of such diagnostic shifts, we examined the psychopathological pictures of patients who “transitioned” from schizotypal disorder to schizophrenia. Methods: From a larger study on psychopathology, we examined 40 patients who were diagnosed with schizotypal disorder at baseline. At 5-year follow-up, 30 patients maintained the diagnosis of schizotypal disorder, while 10 were re-diagnosed with schizophrenia. We examined detailed descriptions of the 10 patients who progressed to schizophrenia, comparing psychopathology and level of functioning. Results: The level of functioning decreased slightly from baseline to follow-up in 9 out of 10 patients. Eight patients had previously had micro-psychotic or psychotic experiences. All patients had self-disorders at baseline, and several patients had perceptual disorders. Nine patients had formal thought disorders at baseline. The progression is illustrated by 2 cases. Conclusion: In this small study, we did not find any striking changes in any of the patients, neither in terms of psychopathological manifestations nor in terms of their level of functioning. Thus, rather than witnessing a genuine “conversion” or “transition” from schizotypal disorder to schizophrenia, we observed dimensional fluctuations within the same condition.

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Delusions beyond beliefs: a critical overview of diagnostic, aetiological, and therapeutic schizophrenia research from a clinical-phenomenological perspective

Cited by 68 publications

References 135 publications

Uncovering the realities of delusional experience in schizophrenia: a qualitative phenomenological study in Belgium

Uncovering the realities of delusional experience in schizophrenia: a qualitative phenomenological study in Belgium

Negative symptoms in psychosis: failure and construction of narratives

“Transition” to Schizophrenia or Fluctuations within the Same Disorder?

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