Phenomenology, delusions, and belief

Abstract

Jasper Feyaerts and colleagues1Feyaerts J Henriksen MG Vanheule S Myin-Germeys I Sass LA Delusions beyond beliefs: a critical overview of diagnostic, aetiological, and therapeutic schizophrenia research from a clinical-phenomenological perspective.Lancet Psychiatry. 2021; (published online Jan 21.)https://doi.org/10.1016/S2215-0366(20)30460-0Summary Full Text Full Text PDF PubMed Scopus (29) Google Scholar make an important point about recognising the experiential dimensions of delusions. Following Jaspers and Schneider, they note that some delusions, particularly in schizophrenia, appear to arise spontaneously and reflect more pervasive shifts in phenomenological experience. As such, they argue that delusions have an inherently experiential component that is distinct from ordinary beliefs and overlooked in contemporary research. We agree with Feyaerts and colleagues on the importance of phenomenology, although we note three caveats. First, their distinction between delusion and ordinary belief presupposes a conception of what ordinary belief entails. Beliefs, however, are highly heterogeneous and current concepts are poorly defined, but evolving.2Connors MH Halligan PW A cognitive account of belief: a tentative roadmap.Front Psychol. 2015; 51588Crossref PubMed Scopus (18) Google Scholar Beliefs can vary along many properties—including their origins and relationship to experience—and they can encompass several distinct subtypes.2Connors MH Halligan PW A cognitive account of belief: a tentative roadmap.Front Psychol. 2015; 51588Crossref PubMed Scopus (18) Google Scholar A phenomenological approach might therefore need to be applied to ordinary belief to help better frame nosological boundaries. Such research could help characterise delusions themselves: experiencing delusions as anomalous, which some patients report, implies a level of insight and preservation of other beliefs. Second, many delusions have been productively understood as beliefs.2Connors MH Halligan PW A cognitive account of belief: a tentative roadmap.Front Psychol. 2015; 51588Crossref PubMed Scopus (18) Google Scholar Detailed studies of individual patients have revealed evidence of circumscribed deficits that plausibly generate the patients' delusions.3Connors MH Halligan PW Delusions and theories of belief.Conscious Cogn. 2020; 81102935Crossref PubMed Scopus (16) Google Scholar Other research has used hypnosis to model clinical delusions and found that suggestions for specific deficits can produce highly compelling experiences that appear strikingly similar to the clinical condition.4Connors MH Hypnosis and belief: a review of hypnotic delusions.Conscious Cogn. 2015; 36: 27-43Crossref PubMed Scopus (13) Google Scholar, 5Oakley DA Halligan PW Hypnotic suggestion: opportunities for cognitive neuroscience.Nat Rev Neurosci. 2013; 14: 565-576Crossref PubMed Scopus (114) Google Scholar Taken together, these findings suggest that delusions, however experienced, appear predicated on a false premise that is strongly and consistently entertained. Third, previous models have attempted to account for the phenomenological experience of delusions in addition to their cognitive content. Our own integrative framework2Connors MH Halligan PW A cognitive account of belief: a tentative roadmap.Front Psychol. 2015; 51588Crossref PubMed Scopus (18) Google Scholar, 3Connors MH Halligan PW Delusions and theories of belief.Conscious Cogn. 2020; 81102935Crossref PubMed Scopus (16) Google Scholar highlights the potential role of subjective experience as a precursor to delusions—including source monitoring deficits that could lead to delusions seeming to arise spontaneously. Our account also notes the effect of delusions on subjective experience, such that they might reconfigure other cognitive processes, shape perception of one's self and world, and lead to elaboration of other beliefs. We believe that phenomenology, as Feyaerts and colleagues observe, remains key to any complete understanding of delusions. However, cognitive neuropsychiatric and phenomenological approaches are not mutually exclusive, and it is not clear how phenomenology alone could provide a viable testable alternative. Contrary to Jaspers, who maintained that many delusions were un-understandable, we remain hopeful that ongoing empirical study—with careful consideration of phenomenology as Feyaerts and colleagues rightfully advocate—will continue to reveal delusions' cognitive and neurobiological underpinnings. We declare no competing interests. Phenomenology, delusions, and belief – Authors' replyWe previously argued that certain types of delusions, typically present in schizophrenia, are not adequately captured as ordinary false beliefs, and that this conception has impeded diagnostic, aetiological, and therapeutic schizophrenia research.1 We proposed that reconsideration of the phenomenological dimension of delusions, including structural alterations in self or world experience sustaining these delusions, could help address current research challenges. We thank Michael Connors and Peter Halligan for their thoughtful commentary and agree with several issues raised. Full-Text PDF Delusions beyond beliefs: a critical overview of diagnostic, aetiological, and therapeutic schizophrenia research from a clinical-phenomenological perspectiveDelusions are commonly conceived as false beliefs that are held with certainty and which cannot be corrected. This conception of delusion has been influential throughout the history of psychiatry and continues to inform how delusions are approached in clinical practice and in contemporary schizophrenia research. It is reflected in the full psychosis continuum model, guides psychological and neurocognitive accounts of the formation and maintenance of delusions, and it substantially determines how delusions are approached in cognitive-behavioural treatment. Full-Text PDF