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• W3137999831 abstract "We previously argued that certain types of delusions, typically present in schizophrenia, are not adequately captured as ordinary false beliefs, and that this conception has impeded diagnostic, aetiological, and therapeutic schizophrenia research.1Feyaerts J Henriksen MG Vanheule S Myin-Germeys I Sass LA Delusions beyond beliefs: a critical overview of diagnostic, aetiological, and therapeutic schizophrenia research from a clinical-phenomenological perspective.Lancet Psychiatry. 2021; (published online Jan 21.)https://doi.org/10.1016/S2215-0366(20)30460-0Summary Full Text Full Text PDF PubMed Scopus (29) Google Scholar We proposed that reconsideration of the phenomenological dimension of delusions, including structural alterations in self or world experience sustaining these delusions, could help address current research challenges. We thank Michael Connors and Peter Halligan for their thoughtful commentary and agree with several issues raised. First, we agree that cognitive neuropsychiatric and phenomenological research are not mutually exclusive—we made no claim to the contrary. In fact, one of us has previously discussed the compatibility of recent neuropsychiatric research with the phenomenological approach to delusion.2Sass L Byrom G Phenomenological and neurocognitive perspectives on delusions: a critical overview.World Psychiatry. 2015; 14: 164-173Crossref PubMed Scopus (55) Google Scholar Second, we agree that so-called belief is polysemic, and that teasing out its various meanings could help psychiatric research. Following Wittgenstein,3Wittgenstein L On certainty. Blackwell, Oxford1975Google Scholar not everything that sounds like an empirical belief is one. Statements like the earth exists or there are physical objects are presuppositions of our empirical beliefs and constitute certainties that ground our existence. In schizophrenia, such certainties are often unhinged. Primary delusions too (including first-rank symptoms) are not straightforward empirical beliefs. Yet, current delusion research assumes that delusions are empirical beliefs. Third, we applaud Connors and Halligan's attempt to integrate anomalous experiences as precursors of delusions. We maintain, however, that primary delusions in schizophrenia are not simply incorrect inferences about everyday reality but presuppose pervasive alterations in the overall sense of self and world. This is also why primary delusions are not beliefs about everyday reality, but expressions of a profound change in existential orientation. An example might illustrate this point: Madeleine, a patient with schizophrenia, had a habit of walking on her tiptoes as a part of her experience of divine ascension. Dr Janet once commented, provokingly, that if her divine ascension was true, then her feet should be at least 10 cm above the floor. Madeleine responded: ‘What a strange idea, to apply metric measures to divine matters!”4Škodlar B Henriksen MG Sass LA Nelson B Parnas J Cognitive-behavioral therapy for schizophrenia: a critical evaluation of its theoretical framework from a clinical-phenomenological perspective.Psychopathology. 2013; 46: 249-265Crossref PubMed Scopus (53) Google Scholar Primary delusions are neither anchored in everyday reality nor amendable by conflicting evidence pertaining to this reality. Finally, not all delusions are primary in nature. Some delusions, often with a non-bizarre content (eg, delusions of jealousy), do pertain to the shared social world. Such delusions can, in our view, be studied as beliefs, arising from disruptions of cognitive processes that underlie belief formation. Connors and Halligan's five-stage account of belief formation might be helpful for understanding such delusions.5Connors MH Halligan PW Delusions and theories of belief.Conscious Cogn. 2020; 81102935Crossref PubMed Scopus (16) Google Scholar We declare no competing interests. Phenomenology, delusions, and beliefJasper Feyaerts and colleagues1 make an important point about recognising the experiential dimensions of delusions. Following Jaspers and Schneider, they note that some delusions, particularly in schizophrenia, appear to arise spontaneously and reflect more pervasive shifts in phenomenological experience. As such, they argue that delusions have an inherently experiential component that is distinct from ordinary beliefs and overlooked in contemporary research. We agree with Feyaerts and colleagues on the importance of phenomenology, although we note three caveats. Full-Text PDF Delusions beyond beliefs: a critical overview of diagnostic, aetiological, and therapeutic schizophrenia research from a clinical-phenomenological perspectiveDelusions are commonly conceived as false beliefs that are held with certainty and which cannot be corrected. This conception of delusion has been influential throughout the history of psychiatry and continues to inform how delusions are approached in clinical practice and in contemporary schizophrenia research. It is reflected in the full psychosis continuum model, guides psychological and neurocognitive accounts of the formation and maintenance of delusions, and it substantially determines how delusions are approached in cognitive-behavioural treatment. Full-Text PDF" @default.
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• W3137999831 title "Phenomenology, delusions, and belief – Authors' reply" @default.
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