Delusion

This chapter offers an overview of the phenomenological approach to delusions, emphasizing what Karl Jaspers called the "true delusions" of schizophrenia. Phenomenological psychopathology focuses on theexperienceof delusions and the delusional world. Several features of this approach are surveyed, including emphasis on formal qualities of subjective life (e.g., mutations of time, space, causality, self-experience, or sense of reality) and questioning of standard assumptions about delusions as erroneous belief (the traditional doxastic view, or "poor reality-testing" formula). The altered modalities of world-oriented and self-oriented experience that precede and ground delusions in schizophrenia, especially the experiences of revelation that Klaus Conrad termed the outer and innerapophany, are then discussed. The chapter first considers the famous "delusional mood" (feelings of strangeness and tension, and a sense of tantalizing yet ineffable meaning ), then the role of ipseity-disturbance (altered minimal or core self, of the basic, pre-reflective sense of existing as a unified and vitalsubjectof experience). In both cases it is explained how delusions can develop out of these distinctive alterations of perception and feeling. The classic question of the understandability or comprehensibility of schizophrenic delusion, together with the related issues of wish-fulfillment and rationalizing motives are then considered. The chapter addresses the crucial but neglected issue of the felt reality-status of delusions or the delusional world, discussing derealization, "double bookkeeping" (in which the patient experiences delusional reality as existing in a different ontological domain from everyday reality), and "double exposure" (merging of two perspectives on reality, with the potential for confusion this implies). The chapter concludes by discussing delusions typically found in paranoid and affective psychoses, and monothematic delusions found in certain organic conditions.