Concepts of ‘self’ in delusion resolution

Abstract

The concept of ‘self’ has a pivotal role in psychotic symptoms (Conrad, 1958), but its utility in the treatment process has been limited. Since perceptions of ‘self’ – and of ‘others’ – change as symptoms evolve and resolve (Parnas andHandest, 2003), if appropriately assayed this concept provides a unique entry-point through which the congruity between delusions and illness can be examined. The potential clinical value of this cannot be overstated as delusions are frequently associated with poor clinical outcomes and enormous emotional distress (Leifker et al., 2009), which is often not remedied by treatment (Haddock et al., 1998). Employing a visual ‘mapping’ technique we examined how delusions of the ‘self’ affected one patient's social world, and how delusional content and sense of ‘selves’ augmented in parallel during recovery. The resulting maps rendered visible the connections between delusions and concepts of the ‘self’ that are usually concealed intentionally or due to lack of insight. Such maps can provide information concerning the origins of emotional distress, and require less time to obtain than dialogue based approaches (Hermans, 2001).