Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium; Centre for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Ghent, Belgium.
Independent researcher, Reeuwijk, The Netherlands.
Lancet Psychiatry. 2021 Sep;8(9):784-796. doi: 10.1016/S2215-0366(21)00196-6. Epub 2021 Aug 3.
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.
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.
Between March 2, 2020, and Sept 30, 2020, 18 adults (13 men and five women, aged 19-62 years) participated in the interview study. The findings suggest that delusions are often embedded in wide-ranging alterations of basic reality experience, involving quasi-ineffable atmospheric and ontological qualities that undermine participants' sense of the world as unambiguously real, fully present, and shared with others. We also found that delusional reality experience can differ from standard reality in various ways (ie, in a hypo-real and hyper-real form), across multiple dimensions (eg, meaningfulness, necessity and contingency, and detachment and engagement), and that participants are often implicitly or explicitly aware of the distinction between delusional and standard reality. Delusional experience can have an enduring value and meaning that is not fully captured by a strictly medical perspective.
Increased awareness and recognition of the distinctive nature of delusional reality experience, in both clinical and research settings, can improve diagnostic accuracy, explanatory models, and therapeutic support for individuals with delusions whose lived realities are not always evident from an everyday perspective.
FWO Flanders.
For the Dutch translation of the abstract see Supplementary Materials section.
精神分裂症中的妄想通常被视为对日常现实的经验性错误信念。相比之下，现象学描述表明，妄想更适当地被理解为与不同类型的现实体验有关。这种现实体验的改变应该如何被描述，体验生活的哪些方面涉及其中，以及妄想的现实是否可能以各种方式与标准现实不同，这些都不清楚，也很少有人了解妄想患者如何看待和应对这些体验的改变。本研究旨在调查个体经历妄想和精神分裂症谱系诊断时的妄想现实体验的本质及其主观感知。
在这项定性的现象学研究中，我们通过同质抽样，从比利时的两家精神病医院服务机构招募了有妄想经历和精神分裂症谱系诊断的个体。参与标准包括：至少经历过一次伴有妄想症状的精神病发作，在参加者精神科医生评估的临床记录中至少在参与前 1 年出现；精神分裂症谱系诊断，通过参加者入院时精神科医生的临床访谈确定；年龄在 18 至 65 岁之间；以及有能力做出知情同意。排除标准包括对同意能力的担忧和参与造成的困扰风险。我们对参与者进行了现象学驱动的半结构化访谈，以探索妄想现实体验的本质及其对这些体验的主观评估。我们使用解释现象学分析，这是一种针对参与者第一人称视角的深入探索的定性方法，来分析他们的叙述。
在 2020 年 3 月 2 日至 9 月 30 日期间，有 18 名成年人（13 名男性，5 名女性，年龄 19-62 岁）参加了访谈研究。研究结果表明，妄想通常嵌入广泛的基本现实体验改变中，涉及近乎难以言喻的大气和本体论性质，这些性质破坏了参与者对世界作为明确真实、完全存在和与他人共享的感觉。我们还发现，妄想的现实体验可以在各种方面（即，在一种低现实和高现实形式）、在多个维度（例如，意义、必要性和偶然性、分离和参与）上与标准现实不同，并且参与者通常对妄想和标准现实之间的区别有隐含或明确的认识。妄想体验可以具有持久的价值和意义，这不能完全从严格的医学角度来理解。
在临床和研究环境中，提高对妄想现实体验的独特性质的认识和认可，可以提高对妄想患者的诊断准确性、解释模型和治疗支持，因为他们的现实生活并不总是从日常角度显而易见。
FWO 佛兰德斯。
