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

Firstly decades of Sohee Park’s career in schizophrenia research, she rarely stopped to consider what life was like for her research subjects. Park, now a professor of psychology at Vanderbilt University, has made a name for himself by studying working memory – the fast-paced, scratch-block-like memory that helps us keep track of what we do. By using simple tasks to deconstruct the functioning of the schizophrenic brain, Park hoped to find out the underlying causes of the condition’s reality-bending symptoms – such as delusions, false beliefs that are resistant to conflicting evidence, and hallucinations that often take the form of imagined votes.

“We do symptom interviews all the time, where we ask regular questions about symptoms – and these are very standardized, and that’s what we have to do,” she says. “We never really talk just about life or their life philosophy, or how they feel about their condition in general.”

Psychological research into schizophrenia typically looks like this: A person who has been diagnosed with schizophrenia, or another condition that causes a similar psychosis, takes test after test. Usually one of these is PANSS, or “Positive and Negative Syndrome Scale”. Administering this test is generally the only time the researcher will ask their subject about their actual experience of psychosis – and everything the subject says will be distilled to numerical scores from 1 to 7. For PANSS is a magnificent delusion (“I am the coming of the other Jesus “) is the same as a persecuting delusion (” Someone is trying to kill me “) is the same as a referential delusion (” Everyone is talking about me “).

For the past many years, Park has chosen a different approach: She asks her researchers open-ended questions. She has heard of things far beyond the limits of PANSS, such as out-of-body experiences; imagined presentations; and deep, day-long flow states evoked by painting. Now her research focuses primarily on how people with schizophrenia experience their own body.

In psychiatry, Park’s focus on personal experience is unusual. Academic psychologists have long preferred quantitative and neuroscientific methods, such as symptom checklists and brain scans, over personal narratives that are difficult to quantify. But even though they present analytical challenges, these narratives can still be studied. Last month, articles in widely read magazines – one in Lancet Psychiatry and the other in World Psychiatry-has analyzed first-person accounts of delusions and psychosis. To some, this kind of research, which is about 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 narratives provide a better understanding of what psychosis is and how it works. “In the rush to be accepted by biological and physical scientists,” she says, “is what we have left behind who is experiencing this? Who are the people who actually have these experiences?”

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

Leave a comment