La perte de contingence : un concept phénoménologique renseignant les modèles cognitifs du délire de type paranoïaque

Abstract

ObjectivesWhen researching delusions, cognitive sciences have developed certain models involving philosophy, psychology and neuroscience but these mainly focus on a monothematic delusion (such as the Capgras syndrome) and schizophrenia. Paranoia is a princeps clinical entity in the psychopathological tradition of psychoses. Persecutory delusion has recently been the subject of specific studies focusing on attention and cognitive models, whether general or specific (Bentall, Freeman), and isolating a number of factors. We propose to analyze the pertinence of these models in order to test their fruitfulness. We have attempted to put data from cognitive sciences and clinical knowledge in order. MethodA review underscores the cognitive approach to persecutory delusion. On the one hand, general or specific models are available, on the other, several cognitive mechanisms are thought to be impaired. Moreover, in accordance with an interdisciplinary view, we propose to bring the philosophical concept of contingency into the cognitive psychology of paranoia. According to Minkowski, loss of contingency is hypothesized to be the fundamental disorder concerning “being in the world” of paranoia. ResultsThree main models attempt to explain delusion: firstly, top-down account that considers delusion as a high order defect; secondly, bottom-up account where the first problem comes from experience; thirdly, a mixed model which associates low and high order levels. This splitting between percept and intellect is not very interesting for paranoia. Elsewhere, specific models place paranoia as a way of defense against depression (Bentall) and paranoia as directly reflecting anxiety (Freeman). According to these points of view, paranoia is not a specific disorder. On the contrary, loss of contingency as the primary disturbance enables us to specify paranoia. With this in mind, attribution's style is strained, the theory of mind is hypertrophied and social and emotional perception disorders are understood and, likewise, reasoning biases (jumping-to-conclusion, need to closure) highlight a kind of irrationality. DiscussionTraditionally, research in cognitive sciences is interdisciplinary. By integrating a concept derived from phenomenology and clinical tradition, we gain in fruitfulness. In fact, specific models that are actually available rely on ideas stemming from affective psychopathology: depression and anxiety. If you grasp paranoia as a specific phenomenon according to the history of psychiatry, you can propose a model more fitting to clinical reality. Nevertheless, loss of contingency does not fit all experimental data. We notice that some data are partially conflicting and patch worked. A challenge remains to define paranoia well: the actual definition, according to the DSM IV-TR, is too restricted. Indeed, paranoia is not only persecutory delusion. Moreover, interpretation and systematization are critical concepts when targeting paranoia outside of the field of schizophrenia. ConclusionLoss of contingency is therefore a heuristic hypothesis which best explains most data and provides a new perspective to orient future cognitive experimental research, especially in the field of virtual reality. The clinical features of paranoia are highly suitable for cognitive studies in order to improve accounts.