Philosophy 2044F/G Lecture Notes - Lecture 9: Delusional Disorder, Spirit Possession, Psychosis
13 Jun 2018
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Discussion Questions:
(1) What are some examples of accepted delusional-like religious beliefs?
(2) What are some examples of cultural differences in what may count as delusional beliefs?
(3) What are some modern Western psychiatric delusions?
(4) Is there anything ojetive to the onept of delusion?
Ethan waters reading:
- Ethnographic studies of 2 different families in Zanzibar
- How might cultural ideas of mental illness itself influence the treatment outcomes of people
living with schizophrenia?
- What is expressed emotion and what are its cultural roots?
- Differences of schizophrenia in time and place
o Delusional content is itiatel tied to oes eioet e.g. Kimwana hearing voices
of bicycle repair person
o The prevalence of schizophrenia is higher in urban areas than rural areas
o Those living in industrialized nations faced shorter periods of remission and lower levels
of social functioning in comparison to those living in developing countries
- Colletiel efeed to as High Epessed Eotio: they are criticism, hostility, and emotional
overinvolvement
- Cultural sources of emotional tenor (low EE):
o First, certain religious beliefs advocate for the view that one ought to see illness and life
tails as a oppotuit to eeie Gods gae
o Secondly, the belief that spirit possession is the cause of the symptoms. spirit
possession was relatable and it had its own set of interventions (the goal being to
placate the spirit rather than cast it out).
- Copae Kiaa ad “hazis failies
- Expressed emotion in Anglo-American families:
o An interval based locus of control reflects an approach to the world that is active,
resourceful, and emphasizes personal accountability
o Biomedical models of mental illness can increase stigma against the mentally ill; it
pushes ill people outside the group (compare to spirit possession model this is less
permanent)
o Biomedical models of mental illness are unappealing and dehumanizing
-
Spiritual experience and psychopathology by Mike Jackson and K.W.M. Fulford:
- A recent study of relationship b/w spiritual experience and psychopathology suggested that
psychotic phenomena could occur in context of spiritual experiences rather than mental illness
- It is argued that pathological and spiritual psychotic phenomena cannot be distinguished by:
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o Form and content alone
o By their relationship either with other symptoms or with pathological causes
o B efeee to the desiptie iteia of etal illess iplied the edial odel
- Distinction is shown to depend rather on the way in which psychotic phenomena themselves are
embedded in values and beliefs of the person concerned → this impacts diagnosis +
psychopathological research
Background:
- It has long been recognized that there are similarities b/w spiritual and psychotic experiences
e.g. time distortion, synesthesias, loss of self-object boundaries and the transition from a state
of oflit ad aiet to oe of sudde udestadig
- However, there is important distinction b/w the two, spiritual experiences have nothing
(directly) to do with medicine (Fulford, 1996), it would be wrong to treat them with neuroleptic
drugs
- Pathological psychotic experiences or psychotic symptoms are a proper object of medical
treatment and must be treated, would be wrong to leave someone genuinely ill untreated
- Different opinions exist on this, some extreme others more complex, but one problem is the
critical difficulty of the definition
o Both spiritual experience and psychopathology come in many varieties, terms are used
in different ways
o More restricted use of the term psychosis also has no agreed meaning
- Study conducted to explore difficulties arising at the interface b/w religion and psychiatry
Results of study conducted:
- 2 groups → diagnosed and undiagnosed
- Diagnosed group had recovered from major psychoses but still interpreted their experiences in
strongly spiritual terms
- Only a minority of experiences reported by either group were sub-culturally influenced and this
factor was more widely observed in the diagnosed group
- Undiagnosed interviewees had markedly grandiose beliefs about their own status and spiritual
role, some reported experiences of both malignant and idiosyncratic spiritual entities, they
lacked volitional control over their experiences, they described both emotionally +ve and -ve
experiences, true and pseudo hallucinations, mood congruent and incongruent hallucinations,
isual ad audito halluiatios, the held delusioal eliefs ith full oitio, laked
insight into possibility that experiences could be explained by psychology not spirituality,
described experiences which continued for longer time periods
- Visual hallucinations specifically more common in diagnosed group
- Individuals in both groups acquired more volitional control with passage of time
- Phenomenological similarities existed in both groups along with marked differences
- Diagnosed subjects had been totally overwhelmed by their psychoses and had lost contact with
consensual reality for extended time periods during which they acted out their delusions in
bizarre behaviour but this was found to be less severe in undiagnosed group
- Diagnosed group also differed in reporting intensely negative experiences unanimously but this
was considerably less extensive in undiagnosed group
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- Overall experiences were broadly similar as described by both groups but these tended to be
more negative and overwhelming in diagnosed group
Simon:
- Reported sporadic, relatively unremarkable, psychic experiences, this lead him into seeking
guidance fro a pofessioal see
- thought he had direct communication with God, this meant he had a special purpose or mission,
then received revelations → this belief meets the PSE definition of a primary delusion as it was
ased o seso epeiees ad ioled hi suddel eoig oied that a
patiula set of eets had a speial eaig
- his interpretation of revelations through certain images was consistent with Delusions of
Grandiose Ability (PSE symptom 78)
- revelations were very beneficial in his life
- experience may suggest schizophrenia (on basis of thought insertion and a primary delusion),
alternatively it can be a DSM IIIR diagnosis of delusional disorder (on basis of well systematized
set of delusions in absence of prominent hallucinations)
Sara:
- faced untreated depression in her early 30s
- heard a voice which she thought was from outside and was of Jesus, in PSE this would be
classified as psychotic or Ture Hallucination as the voice is experienced as coming from outside
the mind
- she elieed that though Gods help she had auied aious paaoal ailities, itepeted
her experiences as a divine calling, according to PSE her beliefs involved Delusions of Grandiose
Ability (PSE symptom 76) as she thought she was chosen by higher power for special purpose
because of her unusual talents and also Religious Delusions (symptom 78) as described for
Simon since they were expressed with convention
- got a alidatig espose fo he piest too, fo he ad he piests pespetie, “aas
experiences were firmly embedded in mainstream Christian doctrine
- her experiences, if delusional and hallucinatory, were overwhelmingly positive in their content
and fruits
Sean:
- as a ilitat atheist fo ost of his life util the oset of his spiitual epeiees
- several different voices spoke to him, the voice came from within him, was an internal voice, but
he as etai it ast his o oie, he elieed the to e fo highe leel of osi
hierarchy
- “eas epeiees, udestood as pshopatholog, fall somewhere b/w Thought Insertion (PSE
symptom 55) and Auditory Pseudo hallucinations (PSE symptom 65)
- Experiences completely separate from his cultural background, had +ve impact on his life,
Overview of cases:
- Cases involve a number of psychotic phenomena, including a primary delusion (Simon), religious
delusions (Simon and Sara), delusions of grandiose ability (Simon and Sara), thought insertion
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Document Summary
Ethnographic studies of 2 different families in zanzibar. Colle(cid:272)ti(cid:448)el(cid:455) (cid:396)efe(cid:396)(cid:396)ed to as (cid:862)high e(cid:454)p(cid:396)essed e(cid:373)otio(cid:374)(cid:863): they are criticism, hostility, and emotional overinvolvement. Spiritual experience and psychopathology by mike jackson and k. w. m. A recent study of relationship b/w spiritual experience and psychopathology suggested that psychotic phenomena could occur in context of spiritual experiences rather than mental illness. Distinction is shown to depend rather on the way in which psychotic phenomena themselves are embedded in values and beliefs of the person concerned this impacts diagnosis + psychopathological research. It has long been recognized that there are similarities b/w spiritual and psychotic experiences e. g. time distortion, synesthesias, loss of self-object boundaries and the transition from a state of (cid:272)o(cid:374)fli(cid:272)t a(cid:374)d a(cid:374)(cid:454)iet(cid:455) to o(cid:374)e of sudde(cid:374) (cid:862)u(cid:374)de(cid:396)sta(cid:374)di(cid:374)g(cid:863) However, there is important distinction b/w the two, spiritual experiences have nothing (directly) to do with medicine (fulford, 1996), it would be wrong to treat them with neuroleptic drugs.
