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

Nevertheless, we have an impregnable bastion in the eyes of others: intimate thought. At least to this day, what we think about remains in the realm of the private, unless we deliberately reveal it.

Metacognitive delusions, however, act (for those who suffer them) like 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 as they wish.

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

Metacognitive delusions

Metacognitive delusions constitute an alteration in the processes from which an individual assumes consciousness of the confluences that constitute his mental activity (emotion, thought, etc.), integrating them into a congruent unit that is recognized as his own (and different in turn from that which others possess). 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 respect, 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 suppose the dissolution of the “I” as an agent that monitors and coordinates mental life, which then becomes conditioned by the influence of “people” or “organizations” that are located somewhere outside and over which there is a lack of control or even knowledge. That is why they have often been categorized as delusions of passivity, since the individual would be perceived (with distress) 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 there is a logic that can form part of the delusions of persecution that occur in the context of paranoid schizophrenia.

1. Thought control

We people understand our mental activity as a private exercise, in which we tend to deploy a discourse oriented by will. However, a high percentage of people with schizophrenia (approximately 20%) state that it is not guided by their own designs, but is manipulated from some external source (spirit, machine, organization, etc.) through a specific and invasive mechanism (such as telepathy or experimental technologies).

It is for this reason that they develop a belligerent attitude towards some of his mental contents , through which one perceives a deliberate attempt to take away his ability to proceed from his free will. In this sense, delirium assumes an intimate dimension that denotes a deep anguish from which it is difficult to escape. Attempts to escape from it only increase the emotion, which is often accompanied by an iron suspicion.

Control delusions can be the result of a misinterpretation of automatic and negative mental contents, which are a common phenomenon in the general population, but whose intrusiveness in this case would be valued as subject to the dominance of a third party. The avoidance of 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 assuming an attitude of suspicion before any interaction with people in whom one does not deposit full confidence, to the modification of the space in which one lives with the inclusion of elements directed to “attenuate” the influence on the mind (isolation in the walls, for example). In any case, it implies a problem that deeply deteriorates the development of daily life and social relations.

2. Theft of thought

The theft of thought 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 irrational interpretation of the difficulty in accessing declarative memories (episodic, for example), which are considered relevant or which may contain sensitive information.

The subjects who present this delirium usually refer that they cannot speak as they would like to because the thoughts necessary for their expression have been taken away by an alien force (more or less known), which has left their mind “blank” or without “useful” ideas. Thus, this phenomenon too can arise as a disjointed 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, because it involves the decomposition of one’s life history and the overwhelming feeling that someone is collecting personal experiences. The privacy of one’s own mind is involuntarily exposed, precipitating a fear of psychological inquiry (interviews, questionnaires, self-registration, etc.), which can be perceived as an additional attempt at theft.

3. Diffusion of thought

The reading of thought is a phenomenon similar to the previous one, which is included (together 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, may manifest the sensation that when he thinks the rest of the people may immediately know what he is saying to himself (as it would sound “loud”).

The main difference from the theft of thought is that in the latter case there is no deliberate subtraction, but rather the thought would have lost its essence of privacy and would have been displayed to others against one’s will. Sometimes the phenomenon occurs in a two-way way, which would mean that the patient adds that he also finds it easy to access the minds of others.

As we can see, there is a laxity in the virtual barriers that isolate the private worlds of each one. The explanations that are made of the delirium are usually of 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 the thought (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 delirious 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 their property, but has been imposed by someone from the outside.

When combined with the subtraction of thought, the subject comes to feel passive about what is going on inside. Thus, he would become an external observer of the flow of his cognitive and emotional life, completely losing control over what might 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 break out in the context of acute episodes of a psychotic disorder, and thus tend to fluctuate in the same individual, within a spectrum of severity. Classical therapeutic interventions involve 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 reduced the severe side effects associated with the use of this drug, 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 inespecificity of their action, they are useful to reduce positive symptoms (such as hallucinations and delirium), since they act on the mesolimbic pathway on which they depend. However, they are less effective for negative symptoms (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 cognitive behavioral therapy. In this case, delirium is seen as an idea that has similarities with non-delirious thinking, and whose discrepancies lie in an issue associated with information processing. The benefits and scope of this strategy will require, for the future, a greater volume of 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, J.M. (2003). Consciousness Disorders in Schizophrenia: a Forgotten Land for Psychopathology. International Journal of Psychology and Psychological Therapy, 3(2), 209-234.