My interest in exploring the nature and meaning of delusions has grown out of my own experience as a clinician and as a phenomenological researcher. Delusions are an elusive and slippery concept. Working definitions describe them as unusual and fixed beliefs held in the face of counterevidence, though your mileage may vary depending on who is reviewing the evidence and who is deciding what is 'unusual'. In discussing delusional beliefs with patients experiencing psychosis, it may at times feel like you are talking at cross purposes, never quite reaching one another in your respective realities. This is not something limited to delusions or psychosis: in a way, we all inhabit our own, private, experiential worlds and sometimes get into unwinnable fights as we try and reconcile the ensuing disagreements. For a low-stakes example, consider The Dress ‘that broke the Internet’ in 2015. Millions of people —divided into two opposing camps — could not agree on whether the dress depicted in a photograph was coloured black and blue, or white and gold. Though some disagreements may have got heated, the divides this laid bareprobably did not marginalise people in any meaningful way. For the most-part, unbuilt bridges between different perspectives don't cause insurmountable problems and we all stroll through life, mostly holding onto a casual, pragmatic certainty about the reality of things around us. But psychosis is different in this regard: once you have seen what lies behind the curtains, be it a world full of demonic conspiracies or the key for true love, you can’t unsee it. Jeppsson, a Swedish philosopher, describes this in her first-person account
“The world I inhabit is not very firm. It is flimsy, and occasionally flutters and falls apart, as if someone tore down the painted backdrop at the scene to expose what lies behind: a dangerous place where everything is slightly off, skewed, two-dimensional and washed-out, and full of murderous demons. The mainstream world can grow back up over the demon world again, covering it, until the next time it falls apart. Sometimes it does not fall apart, but remains thin enough to be translucent.” (p.1)
In another account from Jensen, it’s when another ‘private’ (but no less valid) reality forces itself upon one’s subjectivity that delusions happen, and the bridge doesn’t quite meet in the middle:
“While it is somewhat rare that I experience full-blown psychotic symptoms, the experience of a presence of something ‘otherly’ and bizarre as well as the experience of two parallel and sometimes conflicting realities are more common. In my experience, the sense of another reality is often a factor that is coupled with the emergence of delusions.” (p. 1)
Applied phenomenology pays particular attention to these subjective alterations of the person’s ‘lived world’, often glossed over by other approaches within mainstream psychiatry.
Applied phenomenology, encompassing a range of philosophical, clinical and research approaches to the study of psychopathological experiences, pays particular attention to these subjective alterations of the person’s ‘lived world’, often glossed over by other approaches within mainstream psychiatry. To this end, it provides a powerful method for the investigation of the basic structures of experiencing, such as selfhood, time, space, embodiment and affectivity. These structures, which shape and give meaning to our conscious life, may become disrupted or altered in the context of psychosis. Thus, by elucidating these alterations, phenomenological engagement with personal narratives can offer a glimpse of what it may be like to experience, for instance, a delusional reality. But it often claims to do more than that. By going beyond the description of an individual experience, some phenomenological approaches seek to elucidate the ‘essential’ or ‘invariant’ features of a phenomenon—that is, the universal aspects that come into view once contingent features fade away. It’s here that, I think, applied phenomenology risks running into a problem that I have called ‘Phenomena Lost’.
Some phenomenological approaches seek to elucidate the ‘essential’ or ‘invariant’ features of a phenomenon—that is, the universal aspects that come into view once contingent features fade away. It’s here that, I think, applied phenomenology risks running into a problem that I have called ‘Phenomena Lost’.
‘Phenomena Lost’ refers to a variety of quantitative and qualitative methodological practices that eschew engagement with and critical reflection on the situated, discursive, and relational processes that shape, and ultimately constitute the person’s experience of a given condition. To put it in other words, I worry about the narrow focus on ‘particulars’ of experience, or a narrow search for its ‘invariant’ or ‘essential’ features, extracted from key social or personal context. Like a 19th century anthropologist, trying to understand a remote culture from its artefacts rather than learning to speak its people's language, this may ultimately lead to the alienation of psychopathological research from its phenomena as they are lived through, spoken and re-told out there, in the world, with others. This may, in addition, curtail opportunities for genuine engagement with new and alternative conceptualisations of psychopathological experiences, while increasing the divide between those whose meanings conform to preconceived frameworks, and those who do not fit in the box.
In the case of delusions, understanding particular alterations of the lived world may help me to draw near, if only indirectly, to another person's experience of a delusional reality (that, previously, I may not even have conceived of). But for this knowledge to be put to use to understand and alleviate someone’s distress, I cannot assume that I know how they make sense of their experience, whether it is or isn’t distressing, whether the delusion itself may be serving a valuable or meaningful purpose in that moment, or how communicative exchanges and personal relationships may be shaping the meaning of the experience itself. This work isn’t possible without a consideration of the person’s unique life story, social, relational, and cultural context.
As phenomenological psychopathology proceeds in its own process of renewal and innovation, it’s crucial that its methods are attentive to the inherently complex, dynamical, and situated nature of any given condition under study. Only in this way phenomena can be found again, and phenomenology can engage in an ethically responsive and clinically useful dialogue with those communities it purports to serve.
Rosa Ritunnano is Consultant Psychiatrist in a specialist Early Intervention in Psychosis Service in the UK, and joint doctoral researcher at the Universities of Birmingham and Melbourne. Her research explores the experience and meaning of delusions in psychosis from multiple disciplinary perspectives, combining methods from phenomenology, narrative theory and applied linguistics.
