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Schizophrenia and the Place of Egodystonic States in the Aetiology of Thought Insertion

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Abstract

Despite the diagnostic relevance of thought insertion for disorders such as schizophrenia, the debates about its aetiology are far from resolved. This paper claims that in paying exclusive attention to the perceptual and cognitive impairments leading to delusional experiences in general, current deficit approaches overlook the role that affective disturbances might play in giving rise to cases of thought insertion. In the context of psychosis, affective impairments are often characterized as a consequence of the stress and anxiety caused by delusional episodes. However, here I explore some of the conceptual and empirical reasons to think that affective problems might in fact play a crucial doxastic role in the aetiology of thought insertion. Finally, I conclude by proposing a way of integrating the main insights of my analysis with the current ‘two-factor’ deficit approach to thought insertion and I explore the potential adaptive role that some delusions might have within this framework.

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Notes

  1. In this context, by ‘adaptive’ I simply mean ‘beneficial’ in any way for the patient’s life. For a further discussion of this issue, see: McKay and Dennett (2009); Bortolotti (2014)).

  2. As we will see in the last section, I do not consider these approaches as completely incompatible.

  3. One of the weaknesses of Butler’s position is that its primary interest is with a very specific and rare delusion. Therefore, it is not entirely clear if his conclusions can be extrapolated to the analysis of other delusions.

  4. It is widely granted among psychotherapists that a good quality psychotherapeutic intervention should use the patient’s own psychological resources and biographically relevant elements for the intervention to be meaningful (see Guidano 1991; Arciero and Bondolfi 2010).

  5. This hypothesis is attributed to Snyder (1974).

  6. I thank one of the anonymous referees for pointing out this issue

  7. It is important to note that most approaches to delusions have overlooked the examination of the role that the context of the occurrence might have in the aetiology of delusional episodes

  8. Interestingly, this idea resembles the way in which the TAH explains the first stage of the occurrence of inserted thoughts (Section 3).

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Acknowledgments

I would like to thank to Dr Joel Smith, Prof Tim Bayne, Prof Dr Thomas Fuchs, and the two anonymous referees provided by the journal for helpful comments on sections of this paper. Preliminary versions were presented in Symposium: From mental illness to disorder and diversity of the Meeting of The Society for the Study of Artificial Intelligence and Simulation of Behaviour (AISB), University of Kent (United Kingdom), and at the Heidelberg University Clinic for General Psychiatry ‘Kolloquium der Sektion Phänomenologie’ (Germany).

Financial support

The writing of this paper has been supported by the BECAS-CHILE programme of the National Commission for Science and Technology, CONICYT (Government of Chile), and partially supported by the Deutscher Akademischer Austausch Dienst (DAAD) Scholarship for Young Researchers.

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  1. Manchester Mind Group, Department of Philosophy, The University of Manchester, U.K, Arthur Lewis Building (4th Floor), Oxford, Road, Manchester, M13 9PL, UK

    Pablo López-Silva

  2. Centre of Psychosocial Medicine, Department of General Psychiatry, Section Phenomenology, The University of Heidelberg, Voss-Str. 2, D 69115, Heidelberg, Germany

    Pablo López-Silva

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López-Silva, P. Schizophrenia and the Place of Egodystonic States in the Aetiology of Thought Insertion. Rev.Phil.Psych. 7, 577–594 (2016). https://doi.org/10.1007/s13164-015-0272-1

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