We live in times where the concept of privacy begins to lose its meaning: we people use social networks to report almost everything that happens in our day to day, turning everyday life into a public act .
However, we harbor an impregnable bastion to the gaze of others: intimate thought. Until today, at least, what we think about remains in the private sphere, unless we reveal it deliberately.
Metacognitive delusions, however, act (for those who suffer them) like a battering ram that demolishes such an impenetrable wall, exposing the mental contents or facilitating others to access and modify them to their liking.
These are disturbances in the content of thought, which often occur in the context of psychotic disorders such as schizophrenia . His presence also coexists with a deep sense of anguish.
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Metacognitive delusions
Metacognitive delusions constitute an alteration in the processes from which an individual becomes aware of the confluences that constitute his mental activity (emotion, thought, etc.), integrating them into a congruent unit that is recognized as their own (and distinct from their time that others have). Therefore, it is essential to identify ourselves as subjects with cognitive autonomy, and to be able to think about what we think and feel about what we feel.
In this regard, there are a series of delusional phenomena that can be understood as disturbances of metacognition, since they alter the ability to reason correctly about the nature of the mental product or about the attribution of its origin. For example, an individual may perceive (and verbally express) that what he is thinking is not his own elaboration, or that certain contents have been removed from his head through the participation of an external entity.
All these phenomena suppose the dissolution of the self as an agent that monitors and coordinates mental life, which comes to be conditioned by the influx of “people” or “organizations” that are located somewhere outside and over which there is no control. or even knowledge. That is why they have often been categorized as delusions of passivity, since the individual would perceive himself (with anguish) as the receptacle of another’s will.
From now on we will delve into the most relevant metacognitive delusions: control, theft, reading and insertion of thought . It is important to bear in mind that on many occasions two or more of them can be presented 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 of paranoid schizophrenia.
1. Thought control
People understand our mental activity as a private exercise, in which we tend to display a will-oriented discourse. However, a high percentage of people with schizophrenia (approximately 20%) state that this is not guided by their own designs, but is manipulated from some external source (spirit, machine, organization, etc.) through a mechanism concrete and invasive (such as telepathy or experimental technologies).
It is for this reason that they develop a belligerent attitude towards some of their mental contents , through which a deliberate attempt to take away the ability to proceed from their free will is perceived. In this sense, delusion assumes an intimate dimension that denotes a deep anguish and from which it is difficult to escape. Attempts to run away from him only increase the emotion, which is often accompanied by iron suspicion.
Control delusions may be the result of an erroneous interpretation of automatic and negative mental contents, which suppose a common phenomenon in the general population, but whose intrusiveness in this case would be valued as subject to the domain of a third party. Avoiding these ideas tends to increase their persistence and availability, which would intensify the feeling of threat.
The strategies to avoid this manipulation can be very varied: from the assumption of an attitude of suspicion before any interaction with people in whom full confidence is not deposited, to the modification of the space in which one lives with the inclusion of elements aimed at “attenuate” the influence on the mind (insulation on the walls, for example). In any case, it implies a problem that profoundly deteriorates the development of daily life and social relationships.
2. Theft of thought
Theft of thought consists in the belief that a specific element of mental activity has been extracted by some external agent , with a perverse or harmful purpose. This delusion is usually the result of irrationally interpreting the difficulty of accessing declarative memories (episodic, for example), which are considered relevant or may contain sensitive information.
The subjects who present this delirium usually refer that they cannot speak as they would like because the thoughts necessary for their expression have been taken away by a foreign force (more or less known), which has left their minds “blank” or without “useful” ideas. ” Thus, this phenomenon can also emerge as a distorted interpretation of the poverty of thought and / or emotion (alogia), a negative symptom characteristic of schizophrenia.
The theft of thought is experienced in a distressing way, since it supposes the decomposition of the history of one’s own life and the gripping feeling that someone is collecting personal experiences. The privacy of one’s own mind would be exposed in an involuntary way, precipitating a fear of psychological inquiry (interviews, questionnaires, self-records, etc.), which may be perceived as an additional attempt at subtraction.
3. Diffusion of thought
The reading of thought is a phenomenon similar to the previous one, which is included (along with the others) in the general heading of alienated cognition. In this case, the subject perceives that the mental content is projected outwards in a similar way to that of the spoken voice, instead of remaining in the silence proper to all thoughts. Thus, it can manifest the sensation that when he thinks the rest of the people they can know immediately what he is saying to himself (because it would sound “on high”).
The main difference with respect to the theft of thought is that in the latter case there is no deliberate subtraction, but rather that the thought would have lost its essence of privacy and would unfold before the others against one’s own will. Sometimes the phenomenon occurs bidirectionally, which would mean that the patient adds that it is also easy for him to access the minds of others.
As can be seen, there is a laxity of the virtual barriers that isolate the private worlds of each one. The explanations that are made of the delusion are usually of an incredible nature (encounter with extraterrestrial beings, existence of a specific machine that is being tested on the person, etc.), so it should never be confused with the cognitive bias of reading thought ( non-pathological belief that the will of the other is known without having to inquire into it).
4. Insertion of thought
The insertion of thought is a delusional idea closely linked to the theft of thought . In this case, the person values that certain ideas are not his, that they have not been elaborated by his will or that they describe events that he never lived in his own skin. Thus, it is valued that a percentage of what is believed or remembered is not their property, but has been imposed by someone from outside.
When combined with the subtraction of thought, the subject becomes passive with respect to what is happening within him. Thus, he would establish himself as an external observer of the flow of his cognitive and emotional life, completely losing control over what could happen in it. The insertion of thought is usually accompanied by ideas regarding its control, which were described in the first of the epigraphs.
Treatment
Delusions such as those described usually erupt in the context of acute episodes of a psychotic disorder , and therefore tend to fluctuate within the same individual, within a spectrum of severity. Classic therapeutic interventions contemplate the use of antipsychotic drugs, which chemically exert an antagonistic effect on dopamine receptors in the four brain pathways available to the neurotransmitter (mesocortical, mesolimbic, nigrostriatal, and tuberoinfundibular).
Atypical antipsychotics have been able to reduce the severe side effects associated with the consumption of this medicine, although they have not been completely eliminated. These compounds require the direct supervision of the physician, in their dosage and in their eventual modification. Despite the non-specificity of their action, they are useful to reduce positive symptoms (such as hallucinations and delusions), since they act on the mesolimbic pathway on which they depend. However, they are less effective for negatives (apathy, abulia , alogia, and anhedonia ), which are associated with the mesocortical pathway.
There are also psychological approaches that in recent years are increasing their presence for this type of problem, especially highlighting cognitive behavioral therapy . In this case, delusion is seen as an idea that has similarities to non-delusional thinking, and whose discrepancies lie in an issue associated with the processing of information. The benefits and scope of this strategy will require more research in the future.
