Sunday, 28 September 2008

Deriving Paranoid Delusional Content from Paranoid Delusional Form

Cognitive psychologists have rather too little to say about the relationship between delusional content (what the delusional person delusionally believes) and the condition from which the delusional person is suffering (e.g. schizophrenia.) In fact, I can put the question I wish to ask even without invoking putative conditions which might be found ontically or ontologically unacceptable by the cognitivist. So: Why is it that we find the same kinds of delusions again and again (grandiose; sexual; deadness; conspiracies; etc.); why is there not an even distribution of delusional content? Why for example are so many people with delusions paranoid? Why do they start to believe that there are plots against them?

No appeal to a bias or failure in a general cognitive or attributional mechanism would seem to have this covered. In fact, I'm not even sure of a psychodynamic explanation which has this possibility covered. So, sure, if we project our own hate into others, we may experience them as hateful. But: plots, conspiracies? Against us in particular? Perhaps with the help of an alleged regression we may attain the egocentricity; perhaps.

But the phenomenologists have the beginning of an account. Maggini and Raballo, for example, describe a phenomenological progression of obsidional delusional experience into delusional belief. We are to move, that is, from a disturbance in proprioception, to an alteration in the field of experience characterised by self-centrality, to full-blown paranoid beliefs. This is something we see in the non-delusional experience of our paranoid patients: It is as if, they tell us, the world around them appears to have been magicked up for them, just then; people have been put in place in the street just for when they walk past.

The progression is not available to the cognitivist who tends to assume that beliefs only follow perception through the content, rather than the form, of the perceptual experience. But this isn't what the experience of reference suggests to us. (Such prototypical delusional phenomena show straight away the inadequacy of the 'delusions either due to correct interpretation of faulty perception, or to reasoning problems' forced choice of empiricist psychopathology.) What it suggests is that something in the way that experience is itself meaningfully organised (people are experienced, not just interpreted, as doing things for one's own benefit (or disbenefit)) has gone awry.

So let us agree with Maggini and Raballo:

(3) SC is a cognitive BS reflecting a disturbance in the familiarity and controllability of the peripersonal space, which presents itself on a background of corporeal experience [8, 20]. Therefore BS involving bodily misperceptions are expected to be predictive of SC, and

(4) according to the BSM transitional sequences, SC is a ‘microproductive’ BS [13, 14] that precedes the delusional attribution (i.e. psychotic externalization phase) rather than a post-psychotic delusional byproduct.


Nevertheless, our original question now just moves backwards: Why has experience become referential? How does this self-centrality grow out of a disturbance of the familiarity and controllability of the peripersonal space, a disturbance which is ultimately corporeal? Maggini and Raballo do not tell us.

Bovet and Parnas have a crack at this issue too. Like Maggini and Raballo, these authors are concerned to elucidate the 'basic phenomena' which mediate between altered neurobiology and alterations in discrete symptoms (delusions, hallucinations, etc.). (Incidentally, this is a fine example of a phenomenological approach to tackling one version of the mind-body problem: identify an intermediate layer which is neither purely physiologically bodily nor having to do with particular intentional contents - but which grows out of the former and constrains the latter.) But what they say is also, in this respect, less than satisfactory.
We propose that the normal subject, always immersed in intersubjectivity, searches in himself for the main clues to his future, whereas the preschizophrenia subject, unframed by intersubjective ties, is forced to look for such guiding clues in the "outer world," rendering the latter potentially selfreferential. If such a vulnerable individual finds himself committed to a situation that threatens his autonomy beyond his capacities, the way to escape the threat is to reshape the context of his being-in-the-world, either by an "autoplastic," delusional reshaping of the experience or by a temporary, senseless "alloplastic" behavior. Such episodes may relieve the tension, and the individual may return to the status quo ante or progress
by an autocatalytic process into a long-lasting schizophrenic episode...
So, I look to the world around me for an understanding of what is going to happen to me. But, well, we all do this - and why should doing more of it render it 'self-referential' in the way that speaks not simply to the uses to which I can put what I find in the world, but to an altered structure of experience - which has now become referential, or more generally, manifesting an Ich-Storungen - itself? Bovet and Parnas nicely draw on Blankenbury to explain, by the way, how delusions of control and of omnipotence are cases where the boundary between self and world has been re-drawn in a too-close or too-far from self manner. No similar elaboration of the origins of paranoia / self-centrality is however forthcoming.

It is tempting to appeal instead to a dysfunctioning neurocognitive mechanism. We do after all seem to experience normal self-referential experiences (e.g. when we overhear people talking about us, or for that matter when we find our lives temporarily the topic of conversation at the dinner party). Or perhaps we could appeal instead to a regressed mode of psychological functioning, in which self-centrality represents an energetically easier systemic equilibrium. But these options would need serious work before they could be said to achieve any explanatory adequation.

A metaphorical explanation I have sometimes toyed with has to do with the 'reversal of the direction of intentionality'. If we imagine the intentional relation as typically moving from subject to world/other - whereby my projects and interests are 'projected out' into the world (I find in the world what conforms to my plans), then we can imagine the reverse of this being an experience of the world as bearing significance for the self. The significance function keeps going, but the direction of intentionality, due to a disturbance of an Ich-Storungen type, is reversed. However I honestly have no idea as to how to explicate further such an involution of intentionality so that it retains an explanatory rather than merely suggestive force.