Le délire est-il un récit ? Une approche narrative de la psychose

Objectives

Delusion is one of the emblematic symptoms of psychiatry. However, it remains one of the great enigmas of psychopathology. Contemporary psychiatry has not resolved the paradox of delusion: it is incorrigible as a belief, but inconsequential as an imaginary fiction. In this study, the authors consider the extent to which the paradigm of narrativity can inform the understanding of delusion and psychotic experience.

Methods

The authors introduce the concept of narrativity, according to the work of French philosopher Paul Ricœur in the 1980s and 1990s. Based on these notions, they propose to identify the psychic functions of storytelling. They discuss the rationale for approaching delusional discourse as a narrative, drawing on the phenomenological and psychoanalytical literature on psychosis and delusion.

Results

Phenomenologists emphasize that delusion is a translation: it is the expression, in everyday language, of ideas and emotions, of a deformation of the structure of lived space and lived time. But delusion is not a metaphor, since it is associated with conviction. Psychoanalytical literature describes a “work of delusion”: The delusional process seeks to contain and reduce the experience of loss of meaning which is specific to emerging psychosis. Delusional narrative renders the psychotic experience bearable and shareable. It has certain points in common with narrative: it produces sense and organizes the experience of the passing of time. But delusional narrative attests to the failures of narrativity, since it lacks the distance between narrator and narrative. Delusion is a paradoxical form of discourse, both metaphorical (as an attempt to represent the lived experience, it doesn’t claim to describe objective reality) and non-metaphorical (as a part of experience itself, it does claim to describe it). Delusional narrative is not the result of the symbolization process, but it replaces it, which explains its paradoxical nature. Finally, the authors propose to consider delusional narrative as an individual myth: Delusion has the same function as myths in collective psychology. It provides answers to questions about the origins and meaning of life and organizes chaos. Delusional narrative is a matrix of symbolization, in the same way that primal phantasies, complexes, family romance, and childhood sexual theories are.

Conclusions

The issue of considering delusion as a narrative must be addressed carefully: Narrativity provides a better understanding of the psychotic experience, but delusion cannot be reduced to a narrative. This approach suggests scientific and clinical perspectives, which involve the development of a framework for collecting delusional narratives from people with delusional disorders and analyzing them based on the issues of narrativity. This should lead to a better understanding of the psychological status of delusion, its function, and the nature of delusional conviction.