Drawing on interviews conducted with people experiencing clinically significant delusions and analysing the data using Interpretative Phenomenological Analysis (IPA), we show how this alteration in lived experience manifests as emotional, affective and/or perceptual anomalies.
Writing about IPA Smith and colleagues use Heidegger’s notion of appearing and liken interpretation to a kind of detective work where the researcher is mining the material for possible meanings, thus allowing the phenomenon of interest to shine forth (Smith et al., 2009, p. 35). The double hermeneutic means that the researcher is always trying to make sense of the participant, who is in turn trying to make sense of what is happening in the context of her lifeworld as an embodied, situated person.
For example, one research participant (who I have called Andrew) was severely bullied at work and described it thus:
It’s that awful. You’ve seen the original ‘Planet of the Apes’… film, 1964 I think it is with Charlton Heston… and you know how he’s treated during it? Management treat you the… similar to that. That’s how it felt.(In the film ‘Planet of the Apes’ human beings are treated like animals, used for slave labour, kept in cages and experiments are done on them.)
This constituted a radical alteration in his experience and his world-view. He had never experienced anything like this before and could not really understand what was happening or why it was happening to him. He went on to develop voice-hearing experiences which he described as God talking to him – these experiences assured him that justice would be done and perhaps prevented him from feeling utterly powerless in an impossibly difficult and distressing work situation.The framework of the Enactive Approach posits that a person interacts with her environment in terms of sense-making and a vast array of factors (biological, psychological and environmental) are intermeshed to create a ‘person-environment system’. A person is not a discrete object; persons are comprised of bodies, stories, concepts, origins, commitments, connections, affordances - and so on - and are constantly reacting with their environment.
From a clinical perspective, this demands an attempt to understand the phenomenology of the experience.
In this context the focus of treatment might then be directed towards affective, perceptual and emotional aspects of a person’s lived experience as well as environmental and relational factors. To think of delusion simply in terms of ‘false beliefs’ which are ‘firmly sustained despite… obvious proof or evidence to the contrary…’ (DSM-V, American Psychiatric Association, 2013, p. 819) is to limit them to cognitive anomalies, over-simplify the experience and deny the meaning an experience might hold for a given individual.
There is a wide literature on the nature of stigma in mental illness (see for example Canadian Health Services Research Foundation, 2013; Mehta & Farina, 1997) and framing delusion formation in this way helps us to reduce stigma: how can a person who is doing her best to make sense of her world be ‘at fault’ or ‘bad’?
We suggest that if the alteration in lived experience is sufficiently radical, then delusion formation is inevitable. A person strives for sense-making in whatever environment she finds herself. We are all susceptible to this possibility.