Do you want to understand the delusions? Listen to the people who have them

For the first In Sohee Park’s decades-long career in schizophrenia research, she rarely stopped to reflect on what life was like for her research subjects. Now a professor of psychology at Vanderbilt University, Park has made a name for himself studying working memory, the fast, notepad-like memory that helps us keep track of what we’re doing. Using simple tasks to deconstruct how the schizophrenic brain works, Park hoped to unravel the underlying causes of the condition’s reality-distorting symptoms, such as delusions, false beliefs that resist conflicting evidence, and hallucinations, which take often the form of imaginary voices.

“We do symptom interviews all the time, where we ask set questions about symptoms — and those are very standardized, and that’s what we’re supposed to do,” she says. “We never really discuss life, or their philosophy of life, or what they think of their condition in general.”

Psychological research on schizophrenia generally looks like this: A person who has been diagnosed with schizophrenia, or another illness that causes similar psychosis, goes through test after test. Usually one of them is the PANSS, or “Positive and Negative Syndrome Scale”. The administration of this test is usually the only time the researcher will ask their subject about their actual experience of psychosis – and everything the subject says will be distilled into numerical scores from 1 to 7. For the PANSS, a grand delusion ( “I am the second coming of Jesus”) is tantamount to a delusion of persecution (“Someone is trying to kill me”) is tantamount to a referential delusion (“Everyone is talking about me”).

In recent years, Park has taken a different approach: she asks her research subjects open-ended questions. She has heard of things far beyond the confines of the PANSS, such as out-of-body experiences; imagined presences; and deep flow states, throughout the day, induced by painting. Today, his research focuses primarily on how people with schizophrenia experience their own bodies.

In psychiatry, Park’s emphasis on personal experience is unusual. Academic psychologists have long favored quantitative, neuroscientific methods, like symptom checklists and brain scans, over hard-to-quantify personal accounts. But although they present analytical challenges, these accounts can still be studied. Last month, articles that appeared in mass-circulation journals — one in The Lancet Psychiatry and the other in Global Psychiatry– analyzed first-person accounts of delirium and psychosis. To some, this type of research, which deals with words and ideas rather than numbers and mathematical models, may seem unscientific. But Park, who was not involved in any of these studies, is among a small group of philosophers, psychologists and neuroscientists who believe that first-person accounts provide insight into what psychosis looks like and how it happens. works. “In the rush to want to be accepted by biological and physical scientists,” she says, “what we’ve left behind is who is going through this stuff? Who are the people who are actually going through these experiences?”

This neglect begins at the time of diagnosis. In the Diagnostic and Statistical Manual (DSM), the so-called bible of psychiatric diagnosis, conditions are defined as scorecards: You must have X of these Y symptoms for Z months to have a particular mental illness. The original purpose of this system was to facilitate research by providing an objective basis for deciding who had a mental illness and who did not. But these checklists leave little room for real-life complexities. “In my daily encounter with patients, there was very little resonance between what I was listening to in terms of lived experience – the complexity and the nuance and the detail and the context, the life context that this person was describing – and those very reductive boxes that you tick when making a diagnosis or thinking about treatment,” says Rosa Ritunnano, a psychiatrist and PhD student in interdisciplinary mental health research at the University of Birmingham, and lead author of the paper. in The Lancet Psychiatry.

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