Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium; Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium.
Center for Subjectivity Research, Faculty of Humanities, University of Copenhagen, Copenhagen, Denmark; Mental Health Center Amager, Copenhagen, Denmark; Mental Health Center Glostrup, Brøndbyvester, Denmark.
Lancet Psychiatry. 2021 Mar;8(3):237-249. doi: 10.1016/S2215-0366(20)30460-0. Epub 2021 Jan 21.
Delusions 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. In this Review, we draw on a clinical-phenomenological framework to offer an alternative account of delusion that incorporates the experiential dimension of delusion, emphasising how specific alterations to self-consciousness and reality experience underlie delusions that are considered characteristic of schizophrenia. Against that backdrop, we critically reconsider the current research areas, highlighting empirical and conceptual issues in contemporary delusion research, which appear to largely derive from an insufficient consideration of the experiential dimension of delusions. Finally, we suggest how the alternative phenomenological approach towards delusion could offer new ways to advance current research and clinical practice.
妄想通常被认为是一种坚信不疑且无法纠正的错误信念。这种对妄想的理解在精神病学的历史中一直具有影响力，并继续影响着临床实践和当代精神分裂症研究中对妄想的处理方式。它反映在完整的精神病连续性模型中，指导了对妄想形成和维持的心理和神经认知解释，并且在很大程度上决定了在认知行为治疗中如何处理妄想。在这篇综述中，我们借鉴临床现象学框架，提供了一种替代妄想的解释，其中包含了妄想的体验维度，强调了自我意识和现实体验的特定改变如何构成了被认为是精神分裂症特征的妄想。在此背景下，我们批判性地重新考虑当前的研究领域，突出了当代妄想研究中的实证和概念问题，这些问题似乎主要源于对妄想的体验维度考虑不足。最后，我们提出了对妄想的替代现象学方法如何为推进当前研究和临床实践提供新途径。
