Kasper Møller Nielsen

The concept of pseudohallucination (PH) occupies an awkward position in psychiatry. The concept was deemed overly polysemous and hence unusable a few decades ago by various authors. However, the concept has recently reemerged from the ashes by its inclusion in the International Classification of Diseases, 11th edition, in different places. This warrants another look at this awkward concept. In this paper, I argue that a more specific account of PH can be obtained by returning to especially Kandinsky’s but also Jaspers’ work. Despite this achieved specificity, because of the polysemy of the concept, I believe that it should be renounced. I start by developing Kandinsky’s and Jaspers’ accounts of PH as involuntary, intrusive, and vivid imagery, as seen in schizophrenia spectrum disorder. The third section relates this to contemporary research on disturbances of imagination and pseudo-obsessions. In the fourth section, I turn to auditory PHs, which reveals that what ties these prima facie disparate phenomena together is disturbances of the self–world relationship. Based on this achieved specificity, the next section reconsiders the concepts of true hallucination and PH. In the sixth section, I turn to contemporary research on PH and discloses additional issues related to this polysemous concept. In the seventh section, I conclude by asking: what is the added value of the concept of PH and why we insist on retaining it? Given that we have better concepts at our disposal, I argue for its renunciation.

The conceptual pair of own-world (ídios kósmos) and common world (koinós kósmos) constitutes an archaic pair, originally introduced by Heraclitus. More than two millennia after its introduction, Binswanger picked up this conceptual pair in the attempt to understand existence and mental disorder. Ever since, this conceptual pair has been part of the conceptualization of schizophrenia in phenomenological psychopathology. However, the concepts of ídios kósmos and koinós kósmos have seldomly been elaborated and expanded upon, and certain unclarities rest within the literature. This paper resolves some of these unclarities and contributes to a theory of anthropological proportions, which furthers our understanding of ídios kósmos and koinós kósmos. The paper begins with an exploration of the theoretical underpinnings of this conceptual pair, i.e., it discusses the concept of world, what is understood by common world, and what it means to live in an own-world. This theoretical exploration segues into an in-depth analysis of the alterations of experiential life in schizophrenia, which can be illuminated via this conceptual pair. It is further argued that this conceptual pair contributes to an understanding of the puzzling phenomenon of double bookkeeping. Finally, the paper concludes in a discussion of clinical implications of this conceptual pair, stressing the importance of a mindfulness of the alterations to the ídios kósmos and koinós kósmos in schizophrenia.

Delusional perception designates a sudden, idiosyncratic, and often self-referential delusion triggered by a neutral perceptual content. In classical psychopathology, delusional perception was considered almost pathognomonic for schizophrenia. Since delusional perception has been erased from ICD-11 and always been absent in DSM, it risks slipping out of clinical awareness. In this article, we explore the clinical roots of delusional perception, elucidate the psychopathological phenomenon, and discuss its two predominant conceptualizations, i.e., Schneider’s well-known two-link model and Matussek’s lesser known one-link model. The two-link model posits that delusional perception amounts to an abnormal interpretation of an intact perception, whereas the one-link model posits that the delusional meaning is contained within a changed perception. Despite their differences, both models stress that delusional perception is a primary delusion that takes place within an altered experiential framework that is characteristic of the psychopathological Gestalt of schizophrenia. We discuss the role of delusional perception in future psychopathological and diagnostic assessment and argue that such assessments must be conducted in comprehensive manner, eliciting the psychopathological context within which symptoms and signs are embedded. Finally, we discuss the compatibility of the two models of delusional perception with contemporary cognitive models on delusion and cognitive psychotherapeutic approaches.

The research field of epistemic justice in healthcare has gained traction in the last decade. However, the importation of Miranda Fricker’s original philosophical framework to medicine raises several interrelated issues that have largely escaped attention. Instead of pushing forward, crafting new concepts or exploring other medical conditions, we suggest that it is time to take stock, reconsider, and articulate some fundamental issues that confront the field of epistemic injustice in healthcare. This paper articulates such fundamental issues, which we divide into scientific, conceptual, and theoretical issues. Scientifically, the research field is confronted by a lack of empirical evidence. It relies on cases, making generalizations impossible and the field vulnerable to bias. Conceptually, many of the claims advanced in the literature are presented as facts but are merely hypotheses to be tested. Moreover, a criterion for applying the concept of testimonial injustice in medicine is lacking, impeding the development of a construct to empirically measure said injustices. Theoretically, many of the cases discussed in the literature do not prima facie qualify as cases of testimonial injustice, since they lack necessary components of testimonial injustice in Fricker’s framework, i.e., being unintentional and caused by identity prejudices in the hearers. If epistemic injustice is as pervasive as it is claimed in this literature, it should be of concern to us all. Addressing the issues raised here may strengthen the conceptualization of epistemic injustice in healthcare and lead to development of constructs that finally can explore its empirical basis.

Comorbidity between schizophrenia and social anxiety disorder (SAD) is found to be considerable. However, contra current conventional psychiatric belief, one might also view social anxiety as appertaining to the schizophrenia spectrum, and not merely as a co-occurring disorder. In this paper, I argue that by comprehensively investigating an unspecific phenomenon, such as social anxiety, we can acquire a grasp of the specific ways-of-being-in-the-world for the person with schizophrenia. In this respect, social anxiety proves revelatory of the Gestalt of schizophrenia, yet, simultaneously, the Gestalt reciprocally illuminates the quality of the social anxiety. I begin by outlining the structure of social anxiety in schizophrenia, which has a qualitatively different structure from social anxiety in itself or in other conditions, since the anxiety primarily is directed toward the social domain as such, i.e., sociality may constitute an ontological threat. Next, I discuss three modalities of social anxiety in schizophrenia: anxiousness about losing uniqueness, fusion anxiety, and engulfment. I end by stressing the importance of the Gestalt-oriented approach in the elucidation of social anxiety in schizophrenia. Additionally, I also introduce some reflections on the relationship between social anxiety and psychosis, and some considerations on psychotherapy for social anxiety in schizophrenia.