The Phenomenology of Psychosis. A qualitative study investigating the lived experience of psychosis.

In this doctoral thesis, we studied the phenomenology of psychosis. Our starting point was that in research there is a lack in first-person descriptions of psychosis. Thereby, we questioned whether concepts and hypotheses actually correspond to the experience or phenomenology of psychosis and argued that we need to study experiences of psychosis as they are described and lived through by individuals that can give firsthand descriptions from their personal experience. To achieve this goal, we developed a qualitative research project from the ground up, from writing the preliminary plan, to gaining ethical approval, recruiting participants, interviewing them, and conducting focus group, transcribing and coding the material and writing research papers based hereon. We took the unusual route of conceptualizing psychosis based on the lived experience of the doctoral researcher and investigated this conceptualization based on the interviews and focus groups conducted by the researcher, with the help of research assistants and the CCP team. Hereby we found that in the accounts of participants insight experiences indeed play a crucial role in their experiences of psychosis and we described examples of aha- and anti-aha-experiences as described by our participants. We showed different aspects thereof, supported by examples our participants applied us with through the interviews and focus groups. Through our philosophical approaches, we shed light on the experience of psychosis offering alternatives for 2-step models of delusion formations, that consider hallucinations as “aberrant saliences” or “aberrant perceptions” that lead to faulty and misguided inferences. We argued that a clear distinction between cognition and perception is problematic and hence so is a clear distinction between delusions and hallucinations. By focusing on the insight experience, we demonstrated that perceptual shifts, insight experiences and differences in what is salient for whom might offer us a new way of looking at psychotic experiences. With the introduction of the anti-aha-experience, we intended to create a potential bridging principle between the existential dimension, the dimension of belief systems and delusions, ungrounding experiences and perceptual alterations (e.g., the game of chess). From a Wittgensteinian perspective we argued that experiences of perplexity and of a loss of common sense can be interpreted fruitfully with the concept of “blind spots” and “hinge propositions”, which offers a starting point for a potential alternative for “aberrant saliences”, whereby it is argued that “irrelevant” stimuli come to the center of attention. We argue that the pre-reflective background, necessary for a natural interaction and healthy subjectivity, comes to the foreground and destabilizes a self – other – world relation.
Lastly, we used first-person descriptions to investigate from a philosophical phenomenological perspective the intersubjective dimension of psychosis. There, we gave preliminary evidence for the idea that psychosis as a disordered self can potentially have its roots in some cases in intersubjective alienation, isolation, and estrangement. We furthermore exemplified how intersubjective reconnection, taking up roles and tasks that help regain a sense of self and identity in relation to others, might be a crucial aspect in recovering from psychotic experiences.