Research articles
Delusion and Meaning
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https://muse.jhu.edu/article/937765
Hermeneutical injustice as a concept has evolved since its original formulation by Miranda Fricker (2007). The concept has been taken up in psychiatry, with its moral, epistemic and clinical premium on the interpretation of extremely complex and difficult experiences (Kidd et al., 2022). There are many varieties of hermeneutical injustice with different forms, sources, degrees, effects, and interpersonal and socio-structural aspects (Medina, 2017). José Eduardo Porcher has proposed the addition of a new form of ‘radical’ hermeneutical injustice, with a case study of psychotic symptoms involving religious content.He offers different characterizations of this injustice:
a particularly radical form of injustice, namely, having their own interpretation of their experiences unjustifiably undermined.
a form of hermeneutical injustice that occurs when a patient diagnosed with psychosis is denied the opportunity of interpreting their own experiences within their own religious framework.
These are different things. Denying someone the opportunity to interpret their experiences in their own, preferred framework is one way of undermining their interpretations. Another is forcing someone to use your own preferred framework and then belittling their own, which seems doubly wrong. Misusing some preferred interpretive framework can be as unjust as not using it. The two definitions could be combined, but then much will depend on what it means to undermine someone’s interpretation of an experience. We think there is a form of radical hermeneutical injustice—different to the one described by Porcher. Some interpretations of kinds of experience with religious content can be undermined if one is committed to a metaphysical naturalism. In these cases, one person cannot regard someone’s interpretive framework as coherent or intelligible (one that involves supernatural entities, for instance).
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https://www.taylorfrancis.com/chapters/edit/10.4324/9781003296386-4/delusion-meaning-rosa-ritunnano-jeannette-littlemore?context=ubx
The territory of meaning in delusions can be carved up in many ways, depending on the different senses of the word ‘meaning’. In this chapter, we address three main philosophical questions arising from three distinct regions of meaning: psychological meaningfulness, felt meaning, and metaphorical meaning. There are many ways in which delusions are harmful or can lead to harm, but there is also increasing evidence that they can be lived through at certain times, and in certain contexts, as meaningful. To solve this apparent tension, we adopt a dynamical perspective on delusions as complex, performative, and situated phenomena arising through multiple layers of meaning-making across embodied, psychological, linguistic, and social levels of analysis. Within this framework, we consider the felt dimension of experiencing as a generative locus of meaning, particularly for those delusions referred to as ‘primary’ and described by Jaspers as analogous to the seeing of meaning. However, meaning is not only felt but also articulated in delusions through linguistic and cognitive acts of meaning-making which operate at the boundaries between the literal and metaphorical. Here, we encounter both a blurring of these boundaries and the boundaries between ‘novel’ or unconventional uses of metaphors. Guided by these insights, we suggest that our ability to genuinely engage with delusional discourse may improve once we understand delusions as expressive attempts at articulating felt meaning and understanding, rather than unshakeable assertions of truth. -
https://doi.org/10.1016/S2215-0366(22)00104-3
BackgroundDelusions are a common transdiagnostic feature of psychotic disorders, and their treatment remains suboptimal. Despite the pressing need to better understand the nature, meaning, and course of these symptoms, research into the lived experience of delusional phenomena in psychosis is scarce. Thus, we aimed to explore the lived experience and subjective apprehension of delusions in help-seeking individuals with psychosis, regardless of diagnosis and thematic content of the delusion.
Methods
In our systematic review and qualitative evidence synthesis, we searched MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science for qualitative studies published in English from database inception, with the last search on Sept 9, 2021. Grey literature search and hand-searching of relevant journals were also done. Studies were eligible if they provided an analysis of lived experience of delusions or predelusional phenomena presented from the perspective of individuals (age 14–65 years) who had developed a clinical high-risk stage of psychosis, or a diagnosable affective or non-affective psychotic disorder (as clinically defined, self-reported, or assessed within the primary study). Studies with only a subset of relevant participants were eligible only if data for the population of interest were reported separately. Studies that did not discriminate between the experience of delusion and other positive symptoms (eg, hallucinations) were included only if data for delusions were reported separately or could be extracted. First-person accounts (and author interpretations) discussing changes in the sense of self, lived world, and meaning in relation to delusions were extracted and synthesised using a novel thematic synthesis approach informed by a critical realist stance and a phenomenological theoretical framework. Analytic themes were developed into a new overarching framework for understanding the emergence of delusional phenomena. The study was registered with PROSPERO, CRD42020222104.
Findings
Of the 3265 records screened, 2115 were identified after duplicate removal. Of these, 1982 were excluded after title and abstract screening and 106 after full-text eligibility assessment. Of the 27 studies entering quality assessment, 24 eligible studies were included in the qualitative evidence synthesis, representing the perspectives of 373 help-seeking individuals with lived experience of delusions in the context of psychosis. Gender was reported as male (n=210), female (n=110), transgender (n=1), or not reported (n=52). Only 13 studies reported ethnicity, with White being predominant. The age of most participants ranged from 15 to 65 years. We found no eligible studies investigating subclinical or predelusional experiences in at-risk mental state populations through qualitative methods. Most studies were undertaken in western, educated, industrialised, rich, and democratic (WEIRD) societies, and most included participants had received or self-reported a diagnosis within the schizophrenia spectrum. Studies differed in relation to whether they focused on one kind or theme of delusion or delusional phenomena more generally as a unified category. Three superordinate themes relating to experiential changes and meanings in delusion were identified: (1) a radical rearrangement of the lived world dominated by intense emotions; (2) doubting, losing, and finding oneself again within delusional realities; and (3) searching for meaning, belonging, and coherence beyond mere dysfunction. Based on the review findings and thematic synthesis, we propose the Emergence Model of Delusion to advance understanding of delusional phenomena in psychosis.
Interpretation
Delusions are best understood as strongly individualised and inherently complex phenomena emerging from a dynamic interplay between interdependent subpersonal, personal, interpersonal, and sociocultural processes. Integrative approaches to research on delusion, which consider their potential adaptiveness and favour explanatory pluralism, might be advantageous. Effective clinical care for individuals with psychosis might need adapting to match more closely, and take account of, the subjective experience and meaning of delusions as they are lived through, which might also help redress power imbalances and enduring epistemic injustices in mental health.
Funding
Priestley Scholars, Wellcome Trust.
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https://doi.org/10.1192/bjb.2020.151
AbstractCan delusions, in the context of psychosis, enhance a person’s sense of meaningfulness? The case described here suggests that, in some circumstances, they can. This prompts further questions into the complexities of delusion as a lived phenomenon, with important implications for the clinical encounter. While assumptions of meaninglessness are often associated with concepts of ‘disorder’, ‘harm’ and ‘dysfunction’, we suggest that meaning can nonetheless be found within what is commonly taken to be incomprehensible or even meaningless. A phenomenological and value-based approach appears indispensable for clinicians facing the seemingly paradoxical coexistence of harmfulness and meaningfulness.
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https://doi.org/10.1007/s11097-021-09764-9
Delusions are often portrayed as paradigmatic instances of incomprehensibility and meaninglessness. Here we investigate the relationship between delusions and meaning from a philosophical perspective, integrating arguments and evidence from cognitive psychology and phenomenological psychopathology. We review some of the empirical and philosophical literature relevant to two claims about delusions and meaning: (1) delusions are meaningful, despite being described as irrational and implausible beliefs; (2) some delusions can also enhance the sense that one's life is meaningful, supporting agency and creativity in some circumstances. Delusions are not incomprehensible representations of reality. Rather, they can help make sense of one's unusual experiences and in some circumstances even support one's endeavours, albeit temporarily and imperfectly. Acknowledging that delusions have meaning and can also give meaning to people's lives has implications for our understanding of psychotic symptoms and for addressing the stigma associated with psychiatric conditions.Keywords: Cognitive psychology; Creativity; Delusions; Meaning; Meaningfulness; Phenomenology; Sense of coherence.
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Phenomenological Psychiatry
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https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2024.1390885/full
Mental disorders are increasingly understood as involving complex alterations of self that emerge from dynamical interactions of constituent elements, including cognitive, bodily, affective, social, narrative, cultural and normative aspects and processes. An account of self that supports this view is the pattern theory of self (PTS). The PTS is a non-reductive account of the self, consistent with both embodied-enactive cognition and phenomenological psychopathology; it foregrounds the multi-dimensionality of subjects, stressing situated embodiment and intersubjective processes in the formation of the self-pattern. Indications in the literature already demonstrate the viability of the PTS for formulating an alternative methodology to better understand the lived experience of those suffering mental disorders and to guide mental health research more generally. This article develops a flexible methodological framework that front-loads the self-pattern into a minimally structured phenomenological interview. We call this framework ‘Examination of Self Patterns’ (ESP). The ESP is unconstrained by internalist or externalist assumptions about mind and is flexibly guided by person-specific interpretations rather than pre-determined diagnostic categories. We suggest this approach is advantageous for tackling the inherent complexity of mental health, the clinical protocols and the requirements of research. -
https://doi.org/10.1017/S2045796022000762
This editorial reflects on current methodological trends in translational research in mental health. It aims to build a bridge between two fields that are frequently siloed off from each other: interventional research and phenomenologically informed research. Recent years have witnessed a revival of phenomenological approaches in mental health, often – but not only – as a means of connecting the subjective character of experience with neurobiological explanatory accounts of illness. Rich phenomenological knowledge accrued in schizophrenia, and wider psychosis research, has opened up new opportunities for improving prediction, early detection, diagnosis, prognostic stratification, treatment and ethics of care. Novel qualitative studies of delusions and hallucinations have challenged longstanding assumptions about their nature and meaning, uncovering highly complex subjective dimensions that are not adequately captured by quantitative methodologies. Interdisciplinary and participatory research efforts, informed by phenomenological insights, have prompted revisions of pre-established narratives of mental disorder dominated by a dysfunction framework and by researcher-centric outcome measures. Despite these recent advances, there has been relatively little effort to integrate and translate phenomenological insights across applied clinical research, with the goal of producing more meaningful, patient-valued results. It is our contention that phenomenological psychopathology – as the basic science of psychiatry – represents an important methodology for advancing evidence-based practices in mental health, and ultimately improving real-world outcomes. Setting this project into motion requires a greater emphasis on subjectivity and the structures of experience, more attention to the quality and patient-centredness of outcome measures, and the identification of treatment targets that matter most to patients. -
https://doi.org/10.1177/14777509231208361
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https://doi.org/10.1080/09515089.2022.2144192
Traditional psychopathological approaches to modelling the evolution of mental disorders, such as schizophrenia, often rest on the assumption that symptoms are the passive expression of an underlying disease process. In contrast, phenomenological approaches have highlighted the role that the person, as a meaning-making agent undergoing basic anomalous experiences, plays in the construction of their worlds – thus partly shaping the manifestation and course of illness. However, it remains to be explored how specific patterns of interaction between the person and his/her basic anomalous experiences unfold and play out. We appeal to the Husserlian notion of “position-taking” (Stellungnahme) to provide a framework for the investigation of the person’s attempts at healing as a fundamental component of the dialectics of symptom formation in the psychoses. Within this framework, psychotic symptoms are understood as the expression of the person’s efforts at making sense of, and adapting to, the existential challenges associated with the onset of anomalous self- and world-experiences. We draw on selected case studies and the testimony of one of the authors, to illustrate the potential clinical applications of this model. Finally, we outline some advantages of this approach, including its potential to address oft-neglected troubling experiences without threatening the person’s epistemic agency. -
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Item https://doi.org/10.1002/wps.20878 description
Hermeneutical Injustice in Mental Health
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https://doi.org/10.1080/00071773.2022.2031234
Winner of the Wolfe Mays Essay Prize 2021 awarded by the British Society for Phenomenology (BSP) and the Journal of the British Society for Phenomenology (JBSP).
The significance of critical phenomenology for psychiatric praxis has yet to be expounded. In this paper, I argue that the adoption of a critical phenomenological stance can remedy localised instances of hermeneutical injustice, which may arise in the encounter between clinicians and patients with psychosis. In this context, what is communicated is often deemed to lack meaning or to be difficult to understand. While a degree of un-shareability is inherent to subjective life, I argue that issues of unintelligibility can be addressed by shifting from individualistic conceptions of understanding to an interactionist view. This takes into account the contextual, historical and relational background within which meaning is co-constituted. I conclude by providing a corrective for hermeneutical injustice, which entails a specific attentiveness towards the person’s subjectivity, a careful sensitivity to contingent meaning-generating structures, and a degree of hermeneutical flexibility as an attitude of openness towards alternative horizons of possibility.
Cognitive Remediation (RCT)
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https://doi.org/10.1093/schbul/sbae021
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https://www.nature.com/articles/s41537-023-00390-9
Special Issues
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Topic Editors: E. Pienkos, J. Feyaerts, R. Ritunnano, J. Englebert, & L. Sass.
https://www.frontiersin.org/research-topics/30313/situating-phenomenological-psychopathology-subjective-experience-within-the-world