Le regard paranoïaque à l’épreuve du visage neutre

Abstract

ObjectivesFor paranoid patients, the confrontation with a neutral face is a perceptual and interpretative challenge. Since birth, faces seem to be the favorite visual stimulus of humans, and unexpressive faces tend to provoke discomfort (according to the still face paradigm). Considering their symptoms, this discomfort might be particularly strong for paranoid adult patients. Images of neutral faces are often used in eye-tracking studies to mesure scanpath impairments, but almost only draw a comparison with expressive faces. A short review of eye-tracking studies, in which neutral faces are presented to paranoid patients, could allow a first interpretation of visual exploration impairments and their relational consequences, through the prism of the paranoid symptoms revealed by the unexpressivity of the face. Materials and methodsStudies focusing on the relationship between delusional symptomatology (in schizophrenia or in the general population) and visual exploration of neutral faces, seem to offer an interesting area of research. According to those studies, and to others showing the existence of varying degrees of delusional paranoid thoughts in healthy subjects, we have selected eye-tracking studies including clinical (schizophrenic) and non clinical subjects with paranoid delusions, looking at images of neutral faces. Those eye-tracking data were then confronted with clinical elements of paranoia, such as threat anticipation, or jumping to conclusion biais. ResultsThe confrontation with a neutral face begins with hypervigilance toward ambiguity (extensive visual scanning style to the neutral face features). Then the pattern becomes similar to a visual exploration of a threatening face, to end up with a gaze avoidance. The need to avoid ambiguity, which is unbearable for paranoid patients, is influenced by a hasty and conclusive information processing, focused on proattitudinal, threat-related informations. Contradictory results concerning the extent of the exploration, the duration or the number of fixations could be related to a fluctuating dimension of the paranoid clinic. The gaze on a neutral face seems to represent, at a basic level, the frequent failure of relational interactions of those patients. The visual exploration of healthy patient's first degree relatives is similarly impaired, which might show pathological shared cognitions on which the attention of patients and their relatives risk to rely. ConclusionSocial isolation due to those interactional failures is a major problem for paranoid patients. Building a therapeutic relationship represents the possibility of a gaze change, that might help those patients to stay in a relational world.