Metacognitive delusions: what they are, causes and main 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 the daily into a public act.

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

Metacognitive delusions, however, act (for those who suffer them) like a battering ram that knocks down so impenetrable wall, exposing the mental contents or making it easier for others to access and modify them at their own discretion. taste.

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.

• Recommended article: "The 12 most curious and shocking types of delusions"

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 its own (and different in turn from 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 to feel about what we feel.

In this regard, there are a series of delusional phenomena that can be understood as disturbances of metacognition, because they alter the ability to reason correctly about the nature of the mental product or about the attribution of its source. For example, an individual may perceive (and verbally express) that what he is thinking is not a own elaboration, or that certain contents have been taken from his head through the participation of a external entity.

All these phenomena suppose the dissolution of the ego as an agent that monitors and coordinates mental life, which becomes conditioned by the influx of "people" or "organizations" that are located somewhere abroad and over which there is no control or even control 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 consideration that on many occasions two or more of them can be presented at the same time, since in their synthesis they are he finds a logic that may 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 speech oriented by the will. However, a high percentage of people with schizophrenia (approximately 20%) state that it is not guided by its own designs, but is manipulated from some external source (spirit, machine, organization, etc.) through a concrete and invasive mechanism (such as telepathy or technologies experimental).

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 his free will is perceived. 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 excitement, which is often accompanied by fierce suspicion.

Control delusions can be the result of a misinterpretation of automatic and negative mental contents, which represent a common phenomenon in the general population, but whose intrusiveness in this case would be valued as subject to the domain of a third. Avoiding these ideas tends to increase their persistence and availability, which would intensify the sense 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 it is not deposited full confidence, to the modification of the space in which one lives with the inclusion of elements aimed at "attenuating" the influence on the mind (insulation in the walls, for example). In any case, it implies a problem that profoundly deteriorates the development of daily life and social relationships.

2. Thought theft

Thought theft consists of 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 in accessing memories declarative (episodic, for example), which are considered relevant or which may contain information delicate.

Subjects with this delusion often report that they cannot speak as they would like because the thoughts necessary for their expression have been stolen by an alien force (more or less known), which has left his mind "blank" or without ideas "of utility". Thus, this phenomenon can also arise 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 an anguished way, since it supposes the decomposition of history life itself and the overwhelming feeling that someone is gathering up the experiences personal. The privacy of the mind itself would be exposed in an involuntary way, precipitating a cerval fear of the type inquiry. psychological (interviews, questionnaires, self-records, etc.), which can come to be perceived as an additional attempt to subtraction.

3. Dissemination of thought

Thought reading is a phenomenon similar to the previous one, which is included (along with the others) under the general heading of alienated cognition. In this case, the subject perceives that the mental content is projected out in a similar way to that of the spoken voice, instead of remaining in the silence typical of all thoughts. So that, may express the feeling that when others think they can immediately know what they are saying to themselves (as it would sound "high").

The main difference with respect to the theft of thought is that in the latter case a deliberate subtraction is not appreciated, but thought would have lost its essence of privacy and would unfold before others against its 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, 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 thinking reading (non-pathological belief that the will of the other is known without the need to inquire into her).

4. Thought insertion

Thought insertion is a delusional idea closely linked to thought theft. 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 his property, but has been imposed by someone from outside.

When combined with thought subtraction, the subject becomes passive about what is happening inside. Thus, he would set himself up as an external observer of the flow of his cognitive and emotional life, completely losing control over what may happen in it. The insertion of thought is usually accompanied by ideas regarding its control, which were described in the first of the sections.

Treatment

Delusions such as those described often emerge in the context of acute episodes of psychotic disorder, and therefore they tend to fluctuate in the same individual, within a spectrum of gravity. The classical 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, nigrostriatal and tuberoinfundibular).

Atypical antipsychotics have been able to reduce the severe side effects associated with the use of this drug, although they have not been totally 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 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, praises 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 problems, especially highlighting the cognitive behavioral court therapy. In this case, delusion is seen 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 a greater volume of research in the future.

Bibliographic references:

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