Yesterday I had the chance to meet & talk with the members of a Rutgers grad seminar co-taught by Louis Sass & Brian McLaughlin on the philosophy & phenomenology of delusions. Philosophy and clinical psych folks together in one place (in the US)—a rare (and invigorating) opportunity!
A few highlights of the evening:
(1) A provocative discussion re the pros and cons of interviewing primarily “highly articulate” research subjects: To what extent, we asked, might a more fine-grained vocabulary, better developed critical thinking skills and introspective agility provide unique access to the nuances of psychotic experience (or subjective phenomena more generally)? What might the implications of these differences be for qualitative research & ethnography? Conversely, is the goal of “better” (more ‘accurate’?) narrative accounts fundamentally problematic—i.e. in a “pre-linguistic” reality? Or does the combination of linguistic nuance and critical introspection more centrally re-shape phenomenal experiences (as suggested, e.g., by Gendron et al., 2012) ?
(2) Delusional double bookkeeping: again & again we circled around the nature of the relationship between—for lack of a better word—delusional ‘alter-realities’ and consensual reality. Are alter-realities the product of a kind of literal skepticism, leading to the suspension of tacit assumptions re the consensual ‘real’ and the subsequent proliferation of possible alternative ‘worlds’, or instead a less (philosophically, affectively?) “motivated” response to the whole or partial disruption of various grounding conditions of possibility of meaning? Are there both wholly or partially “conscious” and unconscious (but still tacitly “aware”) variants of double bookkeeping? I.e. might double bookkeeping sometimes play out as a doubling of conscious ontological worlds, and sometimes as the decoupling of cognitive or intellectual commitments from ‘worldly’ actions (as described, early on, by Bleuler)?
(3) Delusions vs hallucinations: Can we effectively distinguish delusions from “hallucinations,” particularly in the context of psychosis (as opposed to dissociation, organic disorders, and so forth)? To what extent is “thought” (and/or language) reflexively implicated in psychotic alterations of perception (and affect)? Are there truly cognitively sui generis delusions? Similarly what are some of the potential limitations of decoupling voice hearing (for example) from psychotic experience more broadly? (Is the whole fundamentally different from the sum of its parts?) Finally, what of the differences between transmitted “messages” (in which meaning is ‘received’ without articulated words vs ‘verbal’ inserted thoughts vs various shades of ‘voices’?
(4) Emotion/affect & psychosis: If we look beyond the classic “basic” emotions, in what ways are intellectual or existential affects implicated in & affected by psychotic processes? How, for instance, are we to reconcile the co-occurrence of heightened environmental salience and anhedonic response? (We didn’t go here, but it might be helpful to also consider the import of recent cognitive neuroscience research questioning the distinction between emotion and cognition in general (e.g. Duncan & Barrett, 2007)? What role might does affect play in derealization (cause, consequence or both?), and what potentially (a)motivational role in double bookkeeping?
I’m sure there was more, but it’s already slipping my mind…