“This, is the world that you know.”

My registrars and I have been reading about and discussing phenomenology, in preparation for a presentation (which we did today, but I was most disappointed that the video clips I had embedded – and that worked fine on other computers – didn’t play on the laptop we had for the presentation, so I had to recite Morpheus’ lines from the clips below). We focused on delusions to illustrate many of the aspects of phenomenology – as opposed to (relatively) simple descriptive psychopathology. The standard definition of a delusion is along the lines of “a fixed false belief, not understandable within the patient’s culture/social group, that is not amenable to reason” – or some variation. The essential points being that it is false, it isn’t shared with others, and it’s fixed/can’t be reasoned away.

Karl Jaspers, a psychiatrist and philosopher, wrote about phenomenology, and found that standard definition wanting. Rather than the content of the belief (that is, that it is false, and not shared with others), he wrote that the form was what defines the phenomenon: in particular the characteristic way the belief arises.

Jaspers described a primary delusional process – kind of the archetype of a delusion; not all will be like this, but it’s like an underlying template. First there is often what is termed a “delusional mood” or delusional atmosphere. Anyone who’s seen The Matrix should recognise this: it is a state of heightened sensitivity, where everything around has increased meaning and seems to refer to the self. There is a sense of perplexity, that something is wrong but they do not know what.

Here’s one of the best descriptions of that state I have heard:

Out of that state crystallises the primary delusion, in a fashion quite different from ordinary belief: it is instantly known, fully-formed (sometimes in response to a perception that becomes imbued with delusional significance – and is termed a delusional perception). The delusion “explains” the preceding unpleasant dysphoric perplexed and anxious state, and thereby allows the person to feel again that everything makes sense.

This delusion is then held to with extraordinary conviction. The person is unable to even subject it to logic, as it becomes bound so closely with their sense of self that for the delusion to go would mean complete collapse of how they now see themselves and the world. Rather than misapplying logic, it appears the deluded person parcels off the delusion and logic is simply not applied to it at all.

In contrast to secondary delusions (for example: forming a delusional belief about one’s hallucinatory voices), the primary delusion process is seen as irreducible: we cannot break it down into anything more basic. It is also said to be ultimately un-understandable, as it is so qualitatively different from normal human experience. As I was thinking about this however, I began to relate it to the notion of epiphany. The more I thought about it, the more I thought that phenomenologically it is in fact analogous to the primary delusional process. I’ll illustrate with my own experience of an epiphany.

One evening in my late teens I was walking home from my crappy supermarket job. I recall feeling somewhat odd or different, and that everything was a bit more “real” and meaningful than usual. It was dark, and as I walked I looked up and saw the stars. Suddenly – and instantly – I was struck by a realisation of the vastness of the universe, my own cosmic insignificance, and yet my connectedness to that unfathomably vast universe.

The parallels are, I hope, clear. Another thing about my experience which appears to be shared with the delusional process is that it was not simply the idea that sprang into my mind; it was accompanied by its own quite intense affect. That seems to be the case with delusions: it’s not “just” a belief; there is a feeling (an affective state) associated with that belief.

Both the idea/belief and its associated affect have remained with me, unchanged, for 2 decades now. It has become a very important part of how I see myself and the world – and if I really think about it, it’s not something I do, or want to, apply logic to. The fact that the universe is in actuality unfathomably vast, and I am indeed cosmically insignificant (though made from elements forged in supernovae) is irrelevant. Just because it is true doesn’t mean there’s any logic in it, and it does feel somehow odd if I try to aim logic toward it: to even begin trying to formulate a course of logical enquiry is uncomfortable.

It’s also interesting that this happened for me in my late teens – around when schizophrenia often has its onset in males. I wonder if there’s any pattern to the ages at which prophets have their revelations….

So. The point of that?

Simply that I think the apparently un-understandable primary delusional process might not be as qualitatively different and alien as we generally think, and perhaps there is some scope for empathic understanding of the deluded person’s experience.

I’ll finish with another clip from the Matrix with relevance to psychiatry, philosophy and phenomenology. Why? Because I got it all set for our presentation and it failed, and so I might as well use it here. The connection is that a delusionary belief does not exist in isolation: it occurs within the person’s experience of reality … so what is real?