The shared ideation of the paranoic delusion. Implications of empathy, theory of mind and language

L’ideazione condivisa nel delirio paranoico. Implicazioni dell’empatia, della teoria della mente e del linguaggio

A. Bucca

Department of Cognitive science, University of Messina

In many ways, schizophrenia and paranoia are the extremes of the experience of madness. The first develops (often abruptly) at a relatively young age: the subject suffers delirious confusion, bizarre dissociative and cognitive impairment as a result of the disease. However, thanks to new neuroleptic drugs, the illness is less debilitating than in the past. Typical of schizophrenic psychosis is the autistic closure with which the subject attempts to cope with the feeling of losing his personal characteristics, the feeling of the splitting of his ego or the hallucinatory experiences that reinforce his distress experienced in relation to the ‘outside world’, of others and to what is different. Schizophrenics, thus, tend to live their delusional reality, entrenching themselves in defense of what remains of the central conceptual core of themselves. Paranoia, on the other hand, begins to manifest itself (after a long period of ‘incubation’) in middle age. It is expressed with morbid yet lucid ideation that borders on the plausible, and resisting all forms of treatment, almost always ending up with the patient in the darkness of a cell. In contrast to schizophrenic psychosis, in paranoiac psychosis, the patient experiences the ominous presence of a persecutor and sees no other way to protect himself other than by attacking with all means available (verbally, physically, etc.). In short, in schizophrenia there seems to be a necessary opposition to otherness, in paranoia, instead, there is the need or search for the presence of the other. We can therefore say, that behind the usual psychiatric definition of psychosis, there are very different ontological and psychopathological developments. In addition to the delusional continuum that characterizes psychopathological states, forms of madness assume different and specific emotional, cognitive and social aspects.
Herein, we will outline the ontological distance between psychopathology and the existential modalities of madness, and that of schizophrenia and paranoia, while portraying two aspects of one single delusion that seem distant enough such that the Kraepelinian distinction between dementia praecox and madness is still relevant. This gap can be investigated on the grounds of personal drive to live emotional experiences, on the recognition of the object (internal) or subject (external) of morbid ideation, or by analyzing the communicative and relational needs of the delusional patient. In other words, can the tendency to experience feelings of empathy, the need to consider others and their beliefs in the sense of obtaining a theory of mind (ToM) or get to the point of understanding and sharing the content of a morbid idea with another delirious subject constitute a phenomenological complex that can be used to establish the difference between the various forms of psychosis? Above all, is the role that language plays in these processes a key question?

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