Metacognitive delusions: what they are, the main causes and symptoms

We live in an age where the concept of privacy is starting to lose its meaning: people use social media to tell almost everything that happens in our daily life, turning everyday life into a public event.

However, we harbor an impregnable bastion in the eyes of others: intimate thought. At least to this day, what we think about remains in the private sphere, unless we deliberately reveal it.

Metacognitive delusions, however, act (for those who suffer from it) like a ram that brings down such an impenetrable wall, leaving mental content uncovered or making it easier for others to access and altering it to their liking.

These are disturbances in the content of thought, which often combine in the context of psychotic disorders such as schizophrenia. His presence also coexists with a deep sense of anguish.

    Metacognitive delusions

    Metacognitive delusions constitute an alteration of the processes from which an individual becomes aware of the confluences that constitute his mental activity (Emotion, thought, etc.), by integrating them into a congruent unit that is recognized as one’s own (and in turn different from that which others have). Therefore, it is essential to identify as subjects with cognitive autonomy, and to be able to reflect on what we think and feel about what we feel.

    In this regard, there are a number of delusional phenomena which can be understood as disturbances of metacognition, as they impair the ability to reason correctly about the nature of the mental product or the attribution of its origin. For example, an individual may perceive (and express verbally) that what he is thinking is not an elaboration of himself, or that some content has been stolen from him by the participation of an external entity.

    All of these phenomena involve the dissolution of the ego as an agent which oversees and coordinates mental life, which becomes conditioned by the influence of “people” or “organizations” located somewhere outside and on whom there is a lack of control, even knowledge. . This is why they have often been categorized as illusions of passivity, because the individual would be perceived (with anguish) as the receptacle of a foreign will.

    In the future, we will delve into the most relevant metacognitive delusions: control, theft, reading and thought insertion.. It is important to keep in mind that in many cases two or more of them can occur at the same time, because in their synthesis there is a logic that can be part of the delusions of persecution that occur in the context. paranoid schizophrenia.

    1. Thought control

    People understand our mental activity as a private exercise, in which we tend to deploy will-oriented speech. However, a high percentage of people with schizophrenia (around 20%) report that it is not guided by their own conceptions, but is manipulated from an external source (mind, machine, organization, etc.) through a concrete and invasive mechanism (such as telepathy or experimental technologies).

    It is for this reason that they develop a belligerent attitude towards some of their mental contents., Whereby a deliberate attempt is seen to deprive him of the ability to proceed of his free will. In this sense, delirium takes on an intimate dimension which denotes a deep anxiety and from which it is difficult to get out. Attempts to run away from it only increase the excitement, which is often accompanied by a hint of iron.

    Control delusions can be the result of misinterpreting automatic and negative mental content, which is a common occurrence in the general population, but intrusion in this case would be assessed as subject to third party control. Avoiding these ideas tends to increase their persistence and availability, which would heighten the sense of threat.

    The strategies to avoid this manipulation can be very varied: from the hypothesis of an attitude of suspicion in the face of any interaction with people in whom total confidence is not placed, to the modification of the space in which we live with the inclusion of targeted elements. to “attenuate” the influence on the mind (insulation on the walls, for example). In any case, it is a problem that deeply affects the development of daily life and social relationships.

    2. Thought flight

    The flight of thought it consists of the belief that a particular element of mental activity has been extracted by an external agent, For a perverse or harmful purpose. This delirium generally results from an irrational interpretation of the difficulty of accessing declarative memories (episodic for example), deemed relevant or which may contain sensitive information.

    Subjects exhibiting this delirium often report that they cannot speak as they would like because the thoughts necessary for their expression have been stolen by a foreign force (more or less known), which left their minds “empty” or without. ideas. utilitarian. ”Thus, this phenomenon can also present itself as a distorted interpretation of the poverty of thought and / or emotion (allergy), a negative symptom characteristic of schizophrenia.

    Thought theft is an agonizing experience, as it involves the decomposition of one’s own life history and the alluring sensation that someone is piling up personal experiences. The intimacy of the mind itself would be exposed involuntarily, precipitating a cervical fear of the psychological type investigation (interviews, questionnaires, self-recordings, etc.), which may come to be perceived as an attempt additional subtraction.

    3. Diffusion of thought

    Thought reading is a phenomenon similar to the above, which is collected (along with others) under the general rubric of alienated cognition. In this case, the subject perceives that the mental content is projected outward in a manner similar to that of the spoken voice, rather than remaining in the silence inherent in all thoughts. Therefore, can express the feeling that when he thinks that the rest of the people can know right away what he is saying (Well, that would sound “loud”).

    The main difference with regard to thought theft is that in the latter case no deliberate subtraction is observed, but the thought would have lost its essence of intimacy and unfold in front of others against its own will. Sometimes the phenomenon is presented in a bidirectional way which would mean that the patient adds that he also finds it easy to access the minds of others.

    As we can see, there is a lax virtual barrier that isolates private worlds from each other. The explanations given for delirium are generally incredible in nature (encounter with extraterrestrial beings, existence of a specific machine tested on the person, etc.), so it should never be confused with the cognitive bias of reading the mind. (non-pathological belief that the will of the other is known without it being necessary to examine it).

    4. Insertion of thought

    Thought insertion is a delusional idea closely related to thought theft. In this case, the person feels that some ideas are not his own, that they were not developed by his will or that they describe facts that he has never experienced in his own skin. Thus, it is appreciated that a percentage of what one believes or remembers is not their property, but has been imposed by someone from the outside.

    When combined with the thought subtraction, the subject becomes passive about what is going on inside. Thus, she would present herself as an external observer of the flow of her cognitive and emotional life, completely losing control of what might happen inside her. The insertion of thought is often accompanied by ideas about its control, which were described in the first of the titles.

    treatment

    Delusions such as those described usually arise in the context of acute episodes of a psychotic disorder, and therefore tend to fluctuate in the same individual, in a spectrum of gravity. Classic therapeutic interventions include the use of antipsychotic drugs, which chemically exert an antagonistic effect on dopamine receptors in the four brain pathways available for the neurotransmitter (mesocortical, mesolimbic, nigrostriatal and tuberoinfundibular).

    Atypical antipsychotics may have reduced the serious side effects associated with the use of this medication, although they have not been completely eliminated. These compounds require the direct supervision of the doctor, if they are dosed and in its possible modification. Despite the non-specificity of their action, they are useful in reducing positive symptoms (such as hallucinations and delusions), as they act on the mesolimbic pathway on which they depend. However, they are less effective for the negatives (apathy, abulia, allergy and anhedonia), which are associated with the mesocortical route.

    There are also psychological approaches that, in recent years, are increasing their presence for this type of problem, in particular by highlighting cognitive behavioral therapy. In this case, delirium is considered to be an idea that has similarities to non-delusional thinking, and the divergences lie in a problem with information processing. The benefits and scope of this strategy will require more research volume in the future.

    Bibliographical references:

    • Tenorio, F. (2016). Psychosis and schizophrenia: effects of changes in psychiatric classifications on clinical and theoretical approaches to mental illness. History, Science and Health-Manguinhos, 23 (4), 941-963.
    • Villagrán, JM (2003). Disorders of Consciousness in Schizophrenia: A Forgotten Land for Psychopathology. International Journal of Psychology and Psychological Therapy, 3 (2), 209-234.

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