Finding order within the disorder: a case study exploring the meaningfulness of delusions

Ritunnano, Rosa; Humpston, Clara; Broome, Matthew R.

doi:10.1192/bjb.2020.151

Cited by 22 publications

(12 citation statements)

References 32 publications

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“…The self-referential experiences are frequently associated with grandiose delusions 49,57,60,79,89,91,104,124 ("To feel like I have everyone following me around, whether it's negative or positive, that alone is a force of power… knowing that you can influence people's mind in the right way" 144 ), or with Truman-like 49,72 delusions 85,145 ("I deduced that I had been on a secret TV show all of my life, similar to the Truman Show" 49 ) (see Figure 3).…”

Section: Feeling That Everything Relates To Oneselfmentioning

confidence: 99%

The lived experience of psychosis: a bottom‐up review co‐written by experts by experience and academics

et al. 2022

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Psychosis is the most ineffable experience of mental disorder. We provide here the first co‐written bottom‐up review of the lived experience of psychosis, whereby experts by experience primarily selected the subjective themes, that were subsequently enriched by phenomenologically‐informed perspectives. First‐person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of psychosis as well as family members and carers, representing a global network of organizations. The material was complemented by semantic analyses and shared across all collaborators in a cloud‐based system. The early phases of psychosis (i.e., premorbid and prodromal stages) were found to be characterized by core existential themes including loss of common sense, perplexity and lack of immersion in the world with compromised vital contact with reality, heightened salience and a feeling that something important is about to happen, perturbation of the sense of self, and need to hide the tumultuous inner experiences. The first episode stage was found to be denoted by some transitory relief associated with the onset of delusions, intense self‐referentiality and permeated self‐world boundaries, tumultuous internal noise, and dissolution of the sense of self with social withdrawal. Core lived experiences of the later stages (i.e., relapsing and chronic) involved grieving personal losses, feeling split, and struggling to accept the constant inner chaos, the new self, the diagnosis and an uncertain future. The experience of receiving psychiatric treatments, such as inpatient and outpatient care, social interventions, psychological treatments and medications, included both positive and negative aspects, and was determined by the hope of achieving recovery, understood as an enduring journey of reconstructing the sense of personhood and re‐establishing the lost bonds with others towards meaningful goals. These findings can inform clinical practice, research and education. Psychosis is one of the most painful and upsetting existential experiences, so dizzyingly alien to our usual patterns of life and so unspeakably enigmatic and human.

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Section: Feeling That Everything Relates To Oneselfmentioning

confidence: 99%

The lived experience of psychosis: a bottom‐up review co‐written by experts by experience and academics

et al. 2022

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Section: Are Delusions Comprehensible?mentioning

confidence: 99%

“…To feel like I have everyone following me around, whether it's negative or positive, that alone is a force of power...knowing that you can influence people's minds in the right way, I feel like Jesus (of course I'm not) but why not believe?' (Ritunnano et al, 2021, epub ahead of print p. 2 abridged) For Simon and Harry, the delusional experience is not lived as a burden or perceived as generating anxiety, but is seen as empowering and enlightening, at least for the most part. For Harry, the delusions seem to confer a sense of belonging and connection to others.…”

Section: Are Delusions Comprehensible?mentioning

confidence: 99%

“…It is worth reflecting on the fact that beliefs sharing the same epistemic features as those detailed in the DSM definition of delusion can be described as empowering in some circumstances. Let us consider the stories of Simon (Fulford & Jackson, 1997 ; Stanghellini et al, 2013 ) and Harry (Ritunnano et al, 2021 ): Simon was a black, middle-class professional in his forties. He reported a series of “revelation” experiences conveyed by delusional perceptions and thought insertion.…”

Section: A Psychological Perspective On Delusions and Meaningmentioning

confidence: 99%

“…So people are like a family for me, it’s like a safety blanket, they make me feel so comfortable now...If I found out that they are not watching me and reading my mind, I would feel alone and crazy like everyone else. To feel like I have everyone following me around, whether it’s negative or positive, that alone is a force of power...knowing that you can influence people’s minds in the right way, I feel like Jesus (of course I’m not) but why not believe?’ (Ritunnano et al, 2021 , epub ahead of print p. 2 abridged)…”

Section: A Psychological Perspective On Delusions and Meaningmentioning

confidence: 99%

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Do delusions have and give meaning?

Ritunnano

Bortolotti

2021

Phenom Cogn Sci

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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.

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Consistency of Delusion Themes Across First and Subsequent Episodes of Psychosis

Grunfeld,

Lemonde,

Gold

et al. 2024

JAMA Psychiatry

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ImportanceDespite growing interest in the phenomenology of delusions in psychosis, at present little is known about their content and evolution over time, including whether delusion themes are consistent across episodes.ObjectiveTo examine the course of delusions and thematic delusion content across relapse episodes in patients presenting to an early intervention service for psychosis.Design, Setting, and ParticipantsThis longitudinal, observational study used clinical data systematically collected from January 2003 to March 2018 from a cohort of consenting patients with affective or nonaffective first-episode psychosis, followed up naturalistically for up to 2 years in an early intervention service for psychosis in Montréal, Quebec, Canada. Data included the thematic content and severity of delusions (scores ≥3 using the Scale for the Assessment of Positive Symptoms) and associated psychotic and nonpsychotic symptoms, both across an initial episode and, in the event of remission, a potential relapse. Data were analyzed from September 2021 to February 2023.ExposureAn early intervention service for psychosis, organized around intensive case management and a multidisciplinary team approach, which observed each patient for up to 2 years of care.Main Outcomes and MeasuresThe primary outcome was positive symptom relapse and remission, including the presence and content of delusions, which was coded per the Scale for the Assessment of Positive Symptoms and accepted definitions. The main statistical measures included repeated paired-sample t tests and binary logistic regression analyses.ResultsOf 636 consenting patients, mean (SD) age was 23.8 (4.75) years; 191 patients were female, 444 were male, and 1 patient was nonbinary. Remission rates were high, and relapse rates were relatively low: 591 individuals had baseline delusions, of which 558 (94.4%) achieved remission. Of these 558 patients, only 182 (32.6%) had a subsequent relapse to a second or later episode of psychosis. Of the 182 patients who did relapse, however, a large proportion (115 [63.2%]) reported threshold-level delusions. Of these 115, 104 patients (90.4%) had thematic delusion content consistent with that reported during the index (first) episode. Those who relapsed with delusions had fewer delusion themes present during subsequent episodes of psychosis compared with the index episode and lower levels of other psychotic and nonpsychotic symptoms.Conclusions and RelevanceSpecialized early intervention services for psychosis can achieve high rates of sustained remission. However, in this study, the minority of individuals with delusions who later relapsed experienced similar delusion themes during subsequent episodes. These findings raise important considerations for the conceptualization of delusions and have clinical implications for trajectories of illness and care.

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Finding order within the disorder: a case study exploring the meaningfulness of delusions

Cited by 22 publications

References 32 publications

The lived experience of psychosis: a bottom‐up review co‐written by experts by experience and academics

The lived experience of psychosis: a bottom‐up review co‐written by experts by experience and academics

Do delusions have and give meaning?

Consistency of Delusion Themes Across First and Subsequent Episodes of Psychosis

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