What is Metacognitive Delusion: main causes and symptoms

We live in times where the concept of privacy begins to lose its meaning: people make use of social networks to relate almost everything that happens in our day to day, turning everyday life into a public event.

However, we harbor an impregnable bastion to the gaze of others: intimate thinking. At least until today, what we think remains in the private sphere, unless we reveal it deliberately.

Metacognitive delusions, however, act (for those who suffer them) as a battering ram that knocks down such an impenetrable wall, exposing the mental contents or making it easier for others to access them and modify them to their liking.

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

Metacognitive delusions

Metacognitive delusions constitute an alteration in the processes from which an individual assumes awareness of the confluences that constitute his mental activity (emotion, thought, etc.), integrating them into a congruent unit that is recognized as his own (and distinct from his instead of what 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 number 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 an elaboration of his own, or that certain contents have been removed from his head through the participation of an external entity.

All these phenomena involve the dissolution of the self as an agent that monitors and coordinates mental life, which becomes conditioned by the influence of “people” or “organizations” that are located somewhere outside and over which control is lacking. or even knowledge. That is why they have often been categorized as delusions of passivity, since the individual would be perceived (with anguish) as the receptacle of an alien will.

From now on we will delve into the most relevant metacognitive delusions: control, theft, reading, and insertion of thought . It is important to take into account that in many occasions two or more of them can be presented at the same time, since in their synthesis there is a logic that can be part of the delusions of persecution that occur in the context of a paranoid schizophrenia.

1. Thought control

People understand our mental activity as a private exercise, in which we tend to display a discourse oriented by will. 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 is perceived to take away their ability to proceed from their free will. In this sense, delirium assumes an intimate dimension that denotes a deep anguish and from which it is difficult to escape. Attempts to flee from him only increase the emotion, which is usually accompanied by a strong suspicion.

Control delusions may be the result of an erroneous interpretation of automatic and negative mental contents, which are a common phenomenon in the general population, but whose intrusiveness in this case would be assessed 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 to 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 everyday life and social relations.

2. Theft of thought

The 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 delirium is usually the result of irrationally interpreting the difficulty of accessing declarative memories (episodic, for example), which are considered relevant or that may contain sensitive information.

The subjects who present this delirium usually refer that they cannot speak as they would wish because the thoughts necessary for their expression have been stolen by a foreign force (more or less known), which has left their mind “blank” or without ideas “useful “. Thus, this phenomenon can also arise as a differentiated interpretation of the poverty of thought and/or emotion (alogia), a negative symptom characteristic of schizophrenia.

The theft of thought is lived in an anguishing way, because it involves the decomposition of the history of one’s life and the overwhelming feeling that someone collects personal experiences. The privacy of one’s mind would be exposed in an involuntary way, precipitating a cerval fear of psychological inquiry (interviews, questionnaires, self-records, etc.), which can be perceived as an additional attempt to subtract.

3. Diffusion of thought

Thought reading is a phenomenon similar to the previous one, which is collected (together with others) in the general heading 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 being kept in the silence of all thoughts. So, you can express the feeling that when you think the rest of the people can know immediately what you are saying to yourself (it would sound “loud”).

The main difference regarding the theft of thought is that in the latter case there is no deliberate subtraction, but that the thought would have lost its essence of privacy and would unfold before others against one’s own will. Sometimes the phenomenon occurs in a bidirectional way, which would mean that the patient adds that it is also easy for him to access the minds of others.

As can be seen, a laxity of the virtual barriers that isolate each one’s private worlds is manifested. The explanations that are made of delirium 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 thought reading ( non-pathological belief that the will of the other is known without the need to investigate 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 own, that they have not been elaborated by his will or that they describe facts that he never lived in his own skin. Thus, it is valued that a percentage of what is believed or remembered is not owned, but has been imposed by someone from abroad.

When combined with the subtraction of thought, the subject becomes passive about what happens inside. 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 section.

Treatment

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

With the atypical antipsychotics it has been possible to reduce the severe side effects that are 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 dose and in their eventual modification. Despite the non-specificity of their action, they are useful for 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 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 these types of problems, especially cognitive behavioral therapy. In this case, delirium is contemplated as an idea that harbors similarities with non-delusional thinking, and whose discrepancies lie in an issue associated with information processing. The benefits and scope of this strategy will require, for the future, more research.

Bibliographic references:

  • Tenorio, F. (2016). Psychosis and Schizophrenia: Effects of Changes in Psychiatric Classifications on Clinical and Theoretical Approaches to Mental Illness. História, Ciências e Saúde-Manguinhos, 23 (4), 941-963.
  • Villagrán, JM (2003). Consciousness Disorders in Schizophrenia: a Forgotten Land for Psychopathology. International Journal of Psychology and Psychological Therapy, 3 (2), 209-234.

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