What are delusions? Examining the typology problem

Delusions are a heterogenous transdiagnostic phenomenon with a higher prevalence in schizophrenia. One of the most fundamental debates surrounding the philosophical understanding of delusions concerns the question about the type of mental state in which reports that we label as delusional are grounded, namely, the typology problem. The formulation of potential answers for this problem seems to have important repercussions for experimental research in clinical psychiatry and the development of psychotherapeutic tools for the treatment of delusions in clinical psychology. Problematically, such alternatives are scattered in the literature, making it difficult to follow the current development and state of the target discussion. This paper offers an updated critical examination of the alternatives to the typology problem currently available in the literature. After clarifying the two main philosophical views underlying the dominant formulation of the debate (interpretivism and functionalism), we follow the usual distinction between doxastic (the idea that delusions are a type of belief) and anti-doxastic views. We then introduce two new sub-distinctions; on the doxastic camp, we distinguish between revisionist and non-revisionist proposals; on the anti-doxastic camp, we distinguish between commonsensical and non-commonsensical anti-doxasticisms. After analyzing the main claims of each view, we conclude with some of the most fundamental challenges that remain open within the discussion. This article is categorized under: Philosophy > Foundations of Cognitive Science Philosophy > Consciousness Philosophy > Psychological Capacities Neuroscience > Cognition.

Spanish version of Multidimensional Mentalizing Questionnaire (MMQ): Translation, adaptation and psychometric properties in a Chilean population

This paper presents the first translation and adaptation of the Multidimensional Mentalizing Questionnaire (MMQ) into Spanish for a native Spanish-speaking sample in Chile. The study examines the psychometric properties and internal consistency of the translated MMQ. The instrument undergoes modifications based on a confirmatory factor analysis of the original structure, resulting in the elimination of items with cross-loadings and improvement in model fit. The modified scale is then analyzed, demonstrating strong psychometric properties. Convergent evidence is assessed by correlating MMQ subscales with the Interpersonal Reactivity Index (IRI) and Empathy Quotient (EQ), while divergent evidence is assessed by correlating aggressive traits using the Buss-Perry Aggression Questionnaire (BPAQ). The study also explores gender differences and age. Results reveal positive correlations between good mentalizing and empathy, particularly cognitive empathy, supporting the significance of positive mentalization in empathy. Negative mentalization is associated with difficulties in perspective-taking and social skills, as well as aggressive traits. Gender differences in mentalizing capacities are observed, and negative aspects of mentalization decrease with age. The availability of the Spanish translation of the MMQ, the first self-reporting scale measuring mentalization adapted to Chilean population, contributes to research aiming to understand its relationship with other psychological phenomena in different cultural context and facilitating clinical interventions with different population groups. We therefore encourage further investigation into cultural, gender and age differences in mentalization.

'Are these my thoughts?': A 20-year prospective study of thought insertion, thought withdrawal, thought broadcasting, and their relationship to auditory verbal hallucinations

The co-occurrence of delusions and other symptoms at the onset of psychosis is a challenge for theories about the aetiology of psychosis. This paper explores the relatedness of delusions about the experience of thinking (thought insertion, thought withdrawal, and thought broadcasting) and auditory verbal hallucinations by describing their trajectories over a 20-year period in individuals diagnosed with schizophrenia, affective and other psychosis, and unipolar depression nonpsychosis. The sample consisted of 407 participants who were recruited at index hospitalization and evaluated over six follow-ups over 20 years. The symptom structure associated with thought insertion included auditory verbal hallucinations, somatic hallucinations, other hallucinations, delusions of thought-dissemination, delusions of control, delusion of self-depreciation, depersonalization and anxiety. The symptom constellation of thought withdrawal included somatic hallucinations, other hallucinations, delusions of thought dissemination, delusions of control, sexual delusions, depersonalization, negative symptoms, depression, and anxiety. The symptom constellation of thought broadcasting included auditory verbal hallucinations, somatic hallucinations, delusions of thought-dissemination, delusion of self-depreciation, fantastic delusions, sexual delusions, and depersonalization. Auditory verbal hallucinations and delusions of self-depreciation were significantly associated with both thought insertion and thought broadcasting. Thought insertion and thought withdrawal were significantly associated with other hallucinations, delusions of control, and anxiety; thought withdrawal and thought broadcasting were significantly related to sexual delusions. We hypothesize that specific symptom constellations over time might be explained as the product of pseudo-coherent realities created to give meaning to the experience of the world and the self of individuals in psychosis based on both prior top-down and ongoing bottom-up elements.

[Being Depressed or Having Depression. The biomedical model and the difference between mood and illness]

Along with the increase in reported figures of depression in the world's population, organizations such as the WHO have begun to promote screening and pharmacological treatment of mild symptomatic cases. The problem in this context is that the manifestations of 'normal' and 'pathological' depressive mood do not differ much from each other, which creates difficulties at a diagnostic and scientific level. This article explores an approach that could facilitate the clinical and scientific task of differentiating between non-specific affective disturbances (depressive mood) and depression as an illness as such. It is proposed that various causal stressors interact with individual predispositions to trigger a transient change in mood as an adaptive response. In turn, the greater the intensity of the stressors (psychological, social, etc.), the greater the neuroinflammation, which would diminish neuronal plasticity and the possibilities of mood compensation and behavioral change of the subject. The existence of this neurobiological alteration (decreased neuronal plasticity), rather than depressive mood, would help us to categorize depression as a disease.

Social Perception Deficit as a Factor of Vulnerability to Psychosis: A Brief Proposal for a Definition

Disturbances in social cognition are a core feature of schizophrenia. While most research in the field has focused on emotion perception, social knowledge, theory of mind, and attribution styles, the domain of social perception has received little specific attention. In this paper, we suggest that this issue can be explained by the lack of a precise and unitary definition of the concept, this leads to the existence of different competing uses of the concept and their conflation with other domains of social cognition. Relying on resources coming from the ecological approach to psychology and the phenomenological tradition in psychiatry, we propose that the concept of Social Perception should be used to refer to low-level pre-reflective processes underlying the awareness of interpersonal interactions with and between others. Clinical data suggests that people with schizophrenia have problems perceiving social situations as opportunities for social engagement, so, in order to fulfil this explanatory need, we propose that the term should be used to capture this important-yet neglected-domain of social cognition. We conclude with the discussion of some future directions for research derived from our proposal.

The phenomenology of auditory verbal hallucinations in schizophrenia and the challenge from pseudohallucinations

In trying to make sense of the extensive phenomenological variation of first-personal reports on auditory verbal hallucinations, the concept of pseudohallucination is originally introduced to designate any hallucinatory-like phenomena not exhibiting some of the paradigmatic features of "genuine" hallucinations. After its introduction, Karl Jaspers locates the notion of pseudohallucinations into the auditory domain, appealing to a distinction between hallucinatory voices heard within the subjective inner space (pseudohallucination) and voices heard in the outer external space (real hallucinations) with differences in their sensory richness. Jaspers' characterization of the term has been the target of a number of phenomenological, conceptual and empirically-based criticisms. From this latter point of view, it has been claimed that the concept cannot capture distinct phenomena at the neurobiological level. Over the last years, the notion of pseudohallucination seems to be falling into disuse as no major diagnostic system seems to refer to it. In this paper, we propose that even if the concept of pseudohallucination is not helpful to differentiate distinct phenomena at the neurobiological level, the inner/outer distinction highlighted by Jaspers' characterization of the term still remains an open explanatory challenge for dominant theories about the neurocognitive origin of auditory verbal hallucinations. We call this, "the challenge from pseudohallucinations". After exploring this issue in detail, we propose some phenomenological, conceptual, and empirical paths for future research that might help to build up a more contextualized and dynamic view of auditory verbal hallucinatory phenomena.

[In defense of the biomedical model in psychiatry. the case of depression]

Defining what is meant by "mental illness" has three dimensions: (i) the ontological dimension, which attempts to answer the question of what is a mental illness in itself, (ii) the scientific dimension, which attempts to identify its causes, and (iii) the practical dimension, which will seek a treatment. This article uses depression to examine how various conceptual alternatives in contemporary literature attempted to tackle the problem of what is a mental illness. After evaluating the scope of their proposals in the three dimensions mentioned above, it is concluded that the biomedical model could become a good candidate for developing a useful framework for understanding, having a scientific explanation and treating depression.

Mapping the Psychotic Mind: a Review on the Subjective Structure of Thought Insertion

Delusions of thought insertion involve subjects claiming that external agents of different nature had placed thoughts into their minds/heads. However, despite being regarded as one of the most severe and complex symptoms of psychotic disorders, a number of disagreements surround the description of its most fundamental phenomenology. This work has reviewed classic and current research on thought insertion in order to examine and clarify its main experiential features as reported by patients from a first-person perspective. The review shows that such features can be grouped into two categories: (i) experiential changes characterizing the period preceding the adoption of the delusion and, (ii) subjective features of full-blown delusional cases. While the discussion of the latter set of experiential features has received some attention within literature, the examination of the former set has been largely neglected. After this, the review offers a discussion of the most important conceptual disagreements surrounding the phenomenological descriptions of the symptom. Overcoming disagreements regarding the experiential structure of thought insertion is fundamental to elaborate phenomenologically and empirically coherent explanatory theories of the symptom and advance its clinical treatment.

Consideraciones críticas sobre la propuesta de Thomas Szasz. Entre filosofía de la mente, fenomenología y psiquiatría

El siguiente artículo discute algunos aspectos básicos de la crítica al concepto de 'enfermedad mental' elaborada por Thomas Szasz. El análisis incluye elementos provenientes desde la psiquiatría, fenomenología y filosofía de la mente. Junto con ofrecer conclusiones respecto del aporte de la propuesta de Szasz para los actuales desarrollos críticos de las comprensiones de la psicopatología, también concluimos con algunas notas clasificatorias respecto de la naturaleza interdisciplinaria de la relación entre psiquiatría, fenomenología y filosofía de la mente.