Perception of self and other in psychosis: A method for analyzing the structure of the phenomenology

Abstract

Introduction Although the phenomenology accompanying psychoses is fascinating, hitherto empirical examinations have been qualitative and thus limited in their clinical conclusions regarding the actual underlying cognitive mechanisms responsible for the formation and maintenance of the delusion, which is often distressing to the patient. Methods We investigated the internal cognitive structure (i.e., connections) of some delusions pertaining to self and others in a patient with psychosis who was very fluent and thus able to provide a lucid account of his phenomenological experiences. To this end we employed a clustering method (HICLAS disjunctive model) in conjunction with standard neuropsychological tests. Results A well-fitting, but parsimonious solution revealed the absence of unique feature sets associated with certain persons, findings that provide a compelling case underlying the confusion in certain instances between real and delusional people. Conclusions We illustrate the methodology in one patient and suggest that it is sensitive enough to explore the structure of delusions, which in conjunction with standard neuropsychological and clinical assessments promises to be useful in uncovering the mechanisms underlying delusions in psychosis.

Concepts of ‘self’ in delusion resolution

“…The maps highlight the patient's changing concept of ‘self’. A change in the patient's perspectives of ‘self’ and ‘others’ was concordant with her understanding of her delusions, and highlights the link between the ‘self’, symptoms and changes in the content of (false) beliefs ( Dean et al, 2009 ). However, although the patient no longer explicitly endorsed any of her delusions at the final evaluation, she still struggled in the workplace.…”

Variations of self-experience in manic episodes: A review

“…This subject was disregarded for a long time because of the supposed metaphysical connotation of concepts such as Ego and Self and the supposed difficulty in carrying out connected investigations into observable behaviour (Berrios & Marková, 2003;Gusnard, 2017;Marsh & Hattie, 1996). Part of this revival movement is attributed to the clinical evidence regarding the centrality of variations of self-experience in psychosis (Longenecker et al, 2015;Dean et al, 2009;Watts et al, 2022) and their prominent predictive and prognostic value.…”