Uncovering the realities of delusional experience in schizophrenia: a qualitative phenomenological study in Belgium

Abstract

Background Delusions in schizophrenia are commonly approached as empirical false beliefs about everyday reality. Phenomenological accounts, by contrast, have suggested that delusions are more adequately understood as pertaining to a different kind of reality experience. How this alteration of reality experience should be characterised, which dimensions of experiential life are involved, and whether delusional reality might differ from standard reality in various ways is unclear and little is known about how patients with delusions value and relate to these experiential alterations. This study aimed to investigate the nature of delusional reality experience, and its subjective apprehension, in individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis.Methods In this qualitative phenomenological study, we recruited individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis from two psychiatric-hospital services in Belgium using homogenous sampling. Criteria for participation were having undergone at least one psychotic episode with occurring delusional symptoms, present at least 1 year before participation, on the basis of clinical notes assessed by the attending psychiatrist; a schizophrenia-spectrum diagnosis, ascertained through clinical interview by the attending psychiatrist upon admission; being aged between 18 years and 65 years; and having the capacity to give informed consent. Exclusion criteria included worries concerning capacity to consent and risk of distress caused by participation. We did phenomenologically driven semi-structured interviews with the participants to explore the nature of delusional reality experience and their subjective valuation of these experiences. We used interpretative phenomenological analysis, a qualitative method tailored to the in-depth exploration of participants' first-person perspective, to analyse their accounts.

Empathy, Emotion Recognition, and Paranoia in the General Population

“…Delusions, including paranoia, are a self-conscious experience that are thought to be born from an unstable boundary between the self, the world, and others ( Sass and Parnas, 2003 ). While speculative, relationships between Fantasy and paranoia may be an unexpected glimpse into this boundary disturbance that can occur in individuals on the delusion spectrum ( Feyaerts et al, 2021 ). Its relationship with paranoia could also be a byproduct of the safety that fictional characters can provide.…”

‘An experience of meaning’: A 20-year prospective analysis of delusional realities in schizophrenia and affective psychoses

“…The king could have entered my room, so to speak, and I would have found that normal. I wouldn't have been surprised at all (1). "…”

“…It has been argued that the "individualistic source of evidence (e.g., perception, reasoning, memory)" and understanding of "deviations that give rise to delusions" are incomplete without the contextual "social source of evidence (e.g., testimonial isolation and testimonial discount)" and that delusions are "overwhelmingly socially and relationally themed" which is central and relevant to both the formation and maintenance of delusions within the social structure (46,47). Overall, delusions are best understood as part of a complex multimodal sensory, perceptual, cognitive, emotional, social, and somatic embodiment that extends beyond the framework of a belief and into an "experience of meanings" that fundamentally redefines the experience of reality (1,15,(48)(49)(50).…”

“…"It was as if I suddenly gained a new form of consciousness, that I discovered a different sort of world which others couldn't understand (1). "…”

Subjectivity, psychosis and the science of psychiatry

“…Hallucinated voices may not exactly be “heard”. What we call “delusions” may or may not be taken literally and, rather than being “erroneous beliefs”, may sometimes involve withdrawal into a private or subjective world that the pa­tient himself actually recognizes as such 8 . So‐called “poverty of con­­tent of speech” – a type of “formal thought disorder” – may somet­imes contain profundities.…”