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Delusion Delusion-like phenomena Dysphoria Prognosis Understanding psychopathology
Abstract
The `nonunderstandability` that traditional psychopathology attributes to 'true' delusion does not have a clear demarcation line, but, rather, it is a continuum of various delusional experiences. The attention paid to emotional situations and, specifically, to dysphoria, often contributes to making the delusional phenomenon, and, above all, its persistence, more understandable. A positive correlation between productive psychotic symptoms and the dysphoric mood often prevails in delusions with unfavorable prognoses.
Copyright (c) 2000 S. Karger AG, Basel
Introduction
In this paper, we wish to discuss the importance of the dysphoric emotion in the context of delusions from two angles, without any pretext of referring to diagnostic categories, but, instead, in the sense of a transnosographical psychopathology. The two points that we will be discussing are:
(1) The role that anger, similar to or more than other emotive states, can have in triggering predelusional situations and in sustaining persecutory delusions. Generally, these delusions are, instead, considered `mood incongruous'. Compared to these `incongruous' delusions, the most widely used nosography considers this emotional disorder a diagnostic criteria only if a full depressive or manic syndrome is present. It does not consider the specific meaning of the angry-dysphoric characteristic of the mood.
(2) How the dysphoric structure modifies, in a powerfully negative way, the delusion's evolution and the possibilities of recovery from it, at whatever point it appears in the course of the delusion.
Our paper is based on our experiences in decades of clinical work in the Psychiatry Service of Florence, which have been compared to the considerations that have been developed by the Vienna Research Group.
Understandable and Nonunderstandable Delusions
An often quoted passage of Jaspers' [ 1 ] General Psychopathology notes, `We apply the name "true delusional ideas" only to thoses delusional ideas that originate from a primary pathological experience.... In contrast, we call "delusion-like ideas" those that are, in some way, understandable by other psychic processes, and that, therefore, may be psychologically traced back to emotions, drives, desires and fears.' In this case, `primary pathological experience', as we all know, means `the latest one'. We have to refer to the `latest' one since, tracing back to the start of a delusional idea during the exploration...