Do Delusions Have and Give Meaning?

Today's post is by Rosa Ritunnano (University of Birmingham and Melbourne), consultant psychiatrist and PhD candidate at the Institute for Mental Health, Birmingham, UK. Here she talks about a recent paper she co-authored with Lisa Bortolotti, “Do delusions have and give meaning?”, recently published in Phenomenology and the Cognitive Sciences (open access). 

Rosa Ritunnano

For many people living with psychosis, delusional experiences are hugely distressing. They are not only harmful because of the negative emotions they often carry along, but they are also dysfunctional (Miyazono, 2015). Someone who believes, for example, that everyone in their workplace is reading their thoughts and controlling their movements through a mysterious influencing machine, may feel extremely nervous, gradually withdraw from their friends and family, and give up their job. This can lead to a disruption in good functioning and may be accompanied by a constellation of symptoms attracting a diagnosis of psychosis or schizophrenia.

 

This view of delusions as irrational beliefs, which are also harmful and disruptive, currently dominates the way many psychiatrists and cognitive psychologists think about, investigate, and treat delusions. The same view is also widespread in popular culture and has been reinforced by stigmatising media coverage and work of works of fiction in literature and cinema, where people with delusions are routinely represented as irrational, unpredictable, and dangerous. Often ensuing from reflections on this set of negative features, is the argument that delusions are both devoid of meaning and strip meaning away from people’s lives.

In this new paper, we are of a different opinion. We argue that this emphasis on delusions as ‘empty speech acts’ or ‘meaningless symptoms’—more common since the operational turn in psychiatric nosology in the 1970s—has led us astray. That, notwithstanding the harmful consequences, delusions are often meaningful for the person experiencing them and, in some circumstances, they can enhance the sense that one’s life is meaningful. We share this view with phenomenological as well as psychodynamic approaches, which have often highlighted the potentially adaptive role of delusional phenomena.

 

Specifically, we argue that a more balanced understanding of delusions should acknowledge that they are not mere “glitches in the brain”, but rather outputs of a belief formation system whose primary aim is to make sense of the surrounding world. If the world stops making sense, we inexhaustibly try to find some meaning. In the case of delusions, this meaning may seem prima-facie implausible or incomprehensible to others. However, as we discuss in our paper through many examples from the empirical and philosophical literature, this apparent incomprehensibility often fades once the interlocutor obtains specific information about the experiences preceding the onset of the delusion, about the person’s life narrative or their experiential world. 

But delusions not only seem to acquire meaning once our interlocutor has been suitably informed. We argue that, in some cases, they can also confer meaningfulness to one’s life, and that adopting a delusion can even be beneficial—albeit just in one respect and in the short term. A phenomenological approach to psychopathology can help examine this counterintuitive claim.

In the context of schizophrenia, for example, people often report uncanny changes in their basic sense of reality and in their felt sense of existing as a unified living agent (as conceptualised in the ipseity-disturbance model of schizophrenia, Sass et al., 2018). An unbearable sense of all-encompassing threat may take over, subverting previously established and familiar relations of meaning and throwing the agent into a state of radical and overwhelming uncertainty. Delusions emerging in this context can help the person make sense of unusual experiences that would otherwise seem inexplicable and cause anxiety. As a patient with schizophrenia puts it: “Delusions are an attempt to explain a very deep restlessness. It is an attempt to seek rescue in a story in which you eventually get lost” (Henriksen et al., 2010, p. 366).

Additionally, we argue that—even from an objective point of view—some people can attain superlative intellectual and creative achievements thanks to the transformative power of certain delusional experiences. In his pathographical analysis of Friedrich Hölderlin and Vincent van Gogh (1977), for instance, Karl Jaspers had already recognised the meaningful interplay between the extraordinarily talented personalities and their psychotic suffering. But he was also acutely aware, as we are, of the inescapable destructive effects of the illness over time: “Just as a diseased oyster can cause the growth of pearls, by the same token schizophrenic processes can be the cause of mental creations of singular quality” (Jaspers, 1977, p. 134).

We think that maybe there is more to delusions than the idea that the person is making an incorrect judgement about external reality, or simply ‘jumping’ to the wrong conclusion because of a cognitive dysfunction. This narrow account of delusion fails to acknowledge both the person’s life story and some basic experiential changes that affect the person’s way of seeing the world. Acknowledging that delusions have meaning and can also give meaning to people’s lives has implications for our understanding of psychotic symptoms and for addressing the stigma associated with psychiatric conditions.