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…
This was really fantastic to read this morning. Sounds like a very lively and fascinating discussion on all the nuanced and juxtaposed variables that affect one’s subjective experiences of what is termed “psychosis.”
It’s fairly clear to me that narrative articulation skills and critical orientation to one’s experience have everything to do with how delusions manifest and are processed. A person with developed (and supported) critical inquiry skills may have a much easier time finding balance in double (triple, quadruple…) bookkeeping than a person who hasn’t had the opportunity to develop a sense of subjective/objective context. Anecdotally, it seems to me that a lot of the people who “recover” (meaning that they are able to navigate their non-neuronormative experiences in way that makes sense and is manageable to them in the context of their self-determined lives) from unbridled extreme states of consciousness and conflict of context often have a privileged intelligence and/or circumstantial access to resources, ethos, and culture that are of assistance to them in their process of meaning making. It’s been my observation that those who have been circumstantially and/or culturally denied the opportunity to develop (or practice) critical thought/mindful orientation skills and those constained in rigid, intolerant psychosocial realities may have a far more treacherous time in navigating (and coping with the process of navigating) what is real and what is not, in our worlds as they relate to the presumed consensus reality.
It’s exciting to me that there are discussions on how people actually figure these experiences out, learn to live with them. “Bookkeeping” is, to me, such a wonderful way to think about balancing belief, as books hold stories and to keep is to hold onto.
Those are some vast landscapes that you all considered, encompassing much of what I understand to be the roots phenomenology and philosophy. Madness is such a wonderful topic through which to explore the world as we know it.
Thanks for being out in the world sharing ideas.
Thanks much. You always leave such great comments! Wish you’d been there to weigh in last night. Sass is one of the few people who has really persisted in exploring the nuances of double bookkeeping and I sorely wish there were more discussions re these sorts of themes going on in public fora (by both academics and mad-identified folks). I just returned from the 2012 Alternatives conference and although it was incredible and inspiring in many ways, there seemed little (public/formal) space for critical explorations of the experience, theory and phenomenology of madness….
Great post!
Great work…and I do agree with ‘cloudcalling’ too- in fact that is the exact conclusion i am coming to in the course of some research i am into : that those who are able to navigate thru their experiences and are able to integrate them better and take the position of witnesses in their stories are the ones who actually really recover and i dare say- go on to the next better level for their own selves.
I completely agree with the issue of articulation and qualitative research- as that is what I myself am into from the position of a participant-observer…and in some parts i do see myself that when people have a linguistic edge it somewhere points also to a certain other acuteness, which if they can use well, helps them restore their own balance. Of all the subjects i have studied till now, i see this for sure.
Thanks for leaving a comment! Are you doing ethnographic work specifically with individuals with mental health issues/psychiatric disabilities? I would love to hear more about it.
In the quantitative literature high “premorbid accomplishments” are often analyzed as a positive prognostic indicator, but I think what we’re discussing gets at something much more interesting.
(And just saw that you emailed me, so I’ll email you.
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