PSICOSIS Y PATOLOGÍA
EL DELIRIO EN LA ESQUIZOFRENIA COMO DISFUNCIÓN DAÑINA
DOI:
https://doi.org/10.4067/s0718-50652024000100218Palabras clave:
Delirio, esquizofrenia, patología, disfunción, psicosisResumen
El delirio es considerado como uno de los síntomas más complejos de la psicosis. Con una mayor prevalencia en la esquizofrenia, la idea de que el delirio es un fenómeno “patológico” parece intuitiva. Sin embargo, la pregunta acerca de qué es exactamente lo que hace a un delirio patológico sigue abierta, especialmente considerando propuestas que sugieren que el fenómeno sería producido por la mente humana por los beneficios que su adopción implicaría. La propuesta de la disfunción dañina propone que una condición es patológica cuando resulta de cierto tipo de disfunción que se torna perjudicial para el sujeto. Lo que hace a una condición patológica es, por lo tanto, su impacto negativo significativo en el bienestar (elemento perjudicial) del sujeto y el hecho de que algunos mecanismos directa o indirectamente relacionados con su producción no cumplen las funciones originales para los que fueron seleccionados evolutivamente (elemento disfuncional). Antes de clarificar ciertos asuntos preliminares sobre el debate general, este artículo explora críticamente la aplicación del enfoque de la disfunción dañina al caso específico del delirio en la esquizofrenia. Luego de analizar una serie de críticas a la propuesta dominante, en la sección final nos referimos a ciertos asuntos fundamentales que aparentemente permanecen abiertos en el debate.
Citas
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Bortolotti, L. (2015). The epistemic innocence of motivated delusions. Consciousness and Cognition, 33, 490–499. https://doi.org/10.1016/j.concog.2014.10.005
Bortolotti, L. (2022). Are delusions pathological beliefs. Asian Journal of Philosophy, 1(31), 1-10. https://doi.org/10.1007/s44204-022-00033-3
Bortolotti, L. (2020). The epistemic innoncence of irrational beliefs. Oxford: OUP. https://doi.org/10.1093/oso/9780198863984.001.0001
Bortolotti, L. (2016). The epistemic benefits of elaborated and systematised delusions in schizophrenia. British Journal for the Philosophy of Science, 67(3), 879–900 https://doi.org/10.1093/bjps/axv024
Bruno, N., Sachs, N., Demily, C., Franck, N., & Pacherie, E. (2012). Delusions and metacognition in patients with schizophrenia. Cognitive neuropsychiatry, 17(1), 1-18. https://doi.org/10.1080/13546805.2011.562071
Butler, P. (2000). Reverse Othello syndrome subsequent to traumatic brain injury. Psychiatry: Interpersonal and Biological Processes, 63(1), 85–92 https://doi.org/10.1080/00332747.2000.11024897
Connors, MH. & Halligan PW. (2020). Delusions and theories of belief. Conscious Cogn. 81 [Online First] https://doi.org/10.1016/j.concog.2020.102935
Coltheart, M., Langdon, R. & McKay, R. (2011). Delusional Belief. Annual Review of Psychology, 62, 271- 298. https://doi.org/10.1146/annurev.psych.121208.131622
Freeman, D., Startup, H., Dunn, G., Wingham, G., Černis, E., Evans, N., Lister, R., Pugh, K., Cordwell, J., & Kingdom, D. (2014). Persecutory delusions and psychological well-being. Soc Psychiatry Psychiatr Epidemiol 49, 1045–1050 https://doi.org/10.1007/s00127-013-0803-y
Frith, C. D. (1993). The cognitive neuropsychology of schizophrenia. Choice Reviews Online, 31(01), 31–0601. https://doi.org/10.5860/choice.31-0601
Jaspers, K. (1963). General Psychopathology (7th ed.). Manchester: Manchester University Press
Humpston, C. S. (2022). Isolated by oneself: Ontologically impossible experiences in schizophrenia. Philosophy, Psychiatry, & Psychology, 29(1), 5–15. https://doi.org/10.1353/ppp.2022.0001
Huq, S., Garety, P., & Hemsley, D. (1988). Probabilistic judgements in deluded and non-deluded subjects. The Quarterly Journal of Experimental Psychology, 40(4), 801–812. https://doi.org/10.1080/14640748808402300
Kendell, R. E., Freedman, A. M., Brotman, R., Silverman, I., & Hutson, E. D. (1986). Issues in psychiatric classification: Science, practice, and social policy.
Kraemer, H. C., Kupfer, D. J., Clarke, D. E., Narrow, W. E., & Regier, D. A. (2012). DSM-5: How Reliable Is Reliable Enough? American Journal of Psychiatry, 169(1), 13–15. https://doi.org/10.1176/appi.ajp.2011.1101005
Lancellotta, E. & Bortolotti, L. (2019). Are clinical delusions adaptive? Wiley Reviews on Cognitives Sciences, 10, 1-19. https://doi.org/10.1002/wcs.1502
López-Silva, P. (2024). Thinking in Schizophrenia and the Social Phenomenology of Thought Insertion. Philosophical Psychology, DOI: 10.1080/09515089.2024.2334720
López-Silva, P. (2023). El problema etiológico de los delirios psicóticos en la neuropsiquiatría actual. Revista Ciencias de la Salud, 21(2), 1-16. https://doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.10378
López-Silva, P. (2016). The typology problem and the doxastic approach to delusions. Filosofía Unísinos 17(2), 202-211.
López-Silva, P. & McClelland, T. (2023). Intruders in the Mind: Interdisciplinary Perspectives on Thought Insertion. Oxford: Oxford University Press.
López-Silva, P. & Cavieres, A. (2022). El delirio psicótico como objeto de estudio multidisciplinar para la filosofía de la mente. Sophia, 33, 71-90 https://doi.org/10.17163/soph.n33.2022.02
López-Silva, P. & Cavieres, A. (2021). La Realidad Transformada: Hacia una Recalibración de la Psicopatología Contemporánea. Santiago: SONEPSYN.
López-Silva, P., Harrow, M., Jobe, T. H., Tufano, M., Harrow, H., Rosen, C. (2022). 'Are these my thoughts?’: A 20-year prospective study of thought insertion, thought withdrawal and thought broadcasting and their relationship to auditory verbal hallucinations. Schizophrenia Research https://doi.org/10.1016/j.schres.2022.07.005
López-Silva, P. Núñez de Prado, M. & Fernández, V. (2022). Sobre Doxasticismos y Anti-Doxasticismos: Hacia un Mapeo del Problema Tipológico de los Delirios. Resistances: Journal of Philosophy of History. Online First. https://doi.org/10.46652/resistances.v3i6.95
López-Silva, P. & Cavieres, A. (2021). Salto a Conclusiones y Formación de Delirios en Psicosis: Un Análisis Crítico. Psiquiatría Biológica, 28(1), 9-13. https://doi.org/10.1016/j.psiq.2020.12.002
Martin, J.-R., Dezecache, G., Pressnitzer, D., Nuss, P., Dokic, J., Bruno, N., … Franck, N. (2014). Perceptual hysteresis as a marker of perceptual inflexibility in schizophrenia. Consciousness and Cognition, 30, 62–72. https://doi.org/10.1016/j.concog.2014.07.014
Mishara, A. López-Silva, P., Rosen C. & Heinz, A. (2023). Self-Disturbances, Perceptual Anomalies, and Physicality: Towards a Multimodal Model of Thought Insertion. In López-Silva, P. & McClelland, T. (Eds.). Intruders in the Mind: Interdisciplinary Perspectives on Thought Insertion. Oxford: Oxford University Press. https://doi.org/10.1093/med/9780192896162.003.0003
Morgades-Bamba, C. I., Fuster-Ruizdeapodaca, M. J., & Molero, F. (2019). The impact of internalized stigma on the well-being of people with Schizophrenia. Psychiatry Research, 271, 621–627. https://doi.org/10.1016/j.psychres.2018.12
Miyazono , K. (2018). Delusions and Beliefs: A Philosophical Enquiry. London: Routledge
Miyazono, K. (2015). Delusions as harmful malfunctioning beliefs. Consciousness and cognition, 33, 561-573. https://doi.org/10.1016/j.concog.2014.10.008
Miyazono, K., & McKay, R. (2019). Explaining delusional beliefs: A hybrid model. Cognitive Neuropsychiatry, 2(5), 335–346. https://doi.org/10.1080/13546805.2019.1664443
Miyazono, K. (2022). Replies to critics. Asian Journal of Philosophy, 1(2). https://doi.org/10.1007/s44204-022-00048-w
Ohlhorst, J. (2022). Delusions and beliefs: A knowledge-first approach. Asian Journal of Philosophy, 1(1), 1–7. https://doi.org/10.1007/s44204-022-00035-1
Orellana, G., & Slachevsky, A. (2013). Executive functioning in schizophrenia. Frontiers in Psychiatry, 4. https://doi.org/10.3389/fpsyt.2013.00035
Organización Mundial de la Salud [OMS] (2019) CIE-11. Undécima revisión de la Clasificación Internacional de las Enfermedades. Ginebra.
Pienkos, E., Silverstein, S., & Sass, L. (2017). The phenomenology of anomalous world expe- rience in schizophrenia: a qualitative study. Journal of Phenomenological Psychology, 48(2), 188–213. https://doi.org/10.1163/15691624-12341328
Sakakibara, E. (2016). Irrationality and Pathology of Beliefs. Neuroethics, 9, 147–157. https://doi.org/10.1007/s12152-016-9256-9.
Sakakibara, E. (2022). On the nature, pathology, and etiology of delusions: Comments on Miyazono’s delusions and beliefs. Asian Journal of Philosophy, 1(1), 1–8.
Sass, L., & Byrom, G. (2015). Phenomenological and neurocognitive perspectives on delusions: a critical overview. World Psychiatry, 14(2), 164-173. https://doi.org/10.1002/wps.20205
Sass, L. A., & Pienkos, E. (2013). Delusion: the phenomenological approach. In K. W. M. Fulford, M. Davies, R. G. T. Gipps, G. Graham, J. Z. Sadler, G. Stanghellini, & T. ornton (Eds.), e Oxford Handbook of Philosophy and Psychiatry (pp. 632–657). Oxford: Oxford University Press. https://doi.org/10.1093/oxfordhb/9780199579563.001.0001
https://doi.org/10.1007/s44204-022-00034-2
Sullivan-Bissett, E. (2022). Against a second factor. Asian Journal of Philosophy, 1(1), 1–10. https://doi.org/10.1007/s44204-022-00036-0
Wakefield, J. C. (1992a). The concept of mental disorder: On the boundary between biological facts and social values. American Psychologist, 47(3), 373–388. https://doi.org/10.1037//0003-066x.47.3.373
Wakefield, J. C. (2007). The concept of mental disorder: diagnostic implications of the harmful dysfunction analysis. World Psychiatry, 6(3), 149-156. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2174594/
Wakefield, J. C. (2011). Darwin, functional explanation, and the philosophy of psychiatry. In P. R. Adriaens & A. De Block (Eds.), Maladapting minds: Philosophy, Psychiatry, and Evolutionary Theory (pp. 43–172). Oxford University Press. https://philpapers.org/rec/WAKDFE
Wakefield, J. C. (1992b). Disorder as harmful dysfunction: A conceptual critique of DSM-III-R’s definition of mental disorder. Psychological Review, 99(2), 232–247. https://doi.org/10.1037/0033-295X.99.2.232
Atkinson, C. J. (2022). Beliefs, delusions, and dry-functionalism. Asian Journal of Philosophy, 1(2), 1–7. https://doi.org/10.1007/s44204-022-00038-y
Bolton, D. and Gillett, G. (2019). The biopsychosocial model of health and disease: New philosophical and scientific developments. Palgrave https://doi.org/10.1007/978-3-030-11899-0
Bell, D. (2003). Paranoia. Cambridge, UK: Icon
Bortolotti, L. (2023). Why delusions matter. London: Bloomsbury https://doi.org/10.5040/9781350163331
Bortolotti, L. (2015). The epistemic innocence of motivated delusions. Consciousness and Cognition, 33, 490–499. https://doi.org/10.1016/j.concog.2014.10.005
Bortolotti, L. (2022). Are delusions pathological beliefs. Asian Journal of Philosophy, 1(31), 1-10. https://doi.org/10.1007/s44204-022-00033-3
Bortolotti, L. (2020). The epistemic innoncence of irrational beliefs. Oxford: OUP. https://doi.org/10.1093/oso/9780198863984.001.0001
Bortolotti, L. (2016). The epistemic benefits of elaborated and systematised delusions in schizophrenia. British Journal for the Philosophy of Science, 67(3), 879–900 https://doi.org/10.1093/bjps/axv024
Bruno, N., Sachs, N., Demily, C., Franck, N., & Pacherie, E. (2012). Delusions and metacognition in patients with schizophrenia. Cognitive neuropsychiatry, 17(1), 1-18. https://doi.org/10.1080/13546805.2011.562071
Butler, P. (2000). Reverse Othello syndrome subsequent to traumatic brain injury. Psychiatry: Interpersonal and Biological Processes, 63(1), 85–92 https://doi.org/10.1080/00332747.2000.11024897
Connors, MH. & Halligan PW. (2020). Delusions and theories of belief. Conscious Cogn. 81 [Online First] https://doi.org/10.1016/j.concog.2020.102935
Coltheart, M., Langdon, R. & McKay, R. (2011). Delusional Belief. Annual Review of Psychology, 62, 271- 298. https://doi.org/10.1146/annurev.psych.121208.131622
Freeman, D., Startup, H., Dunn, G., Wingham, G., Černis, E., Evans, N., Lister, R., Pugh, K., Cordwell, J., & Kingdom, D. (2014). Persecutory delusions and psychological well-being. Soc Psychiatry Psychiatr Epidemiol 49, 1045–1050 https://doi.org/10.1007/s00127-013-0803-y
Frith, C. D. (1993). The cognitive neuropsychology of schizophrenia. Choice Reviews Online, 31(01), 31–0601. https://doi.org/10.5860/choice.31-0601
Jaspers, K. (1963). General Psychopathology (7th ed.). Manchester: Manchester University Press
Humpston, C. S. (2022). Isolated by oneself: Ontologically impossible experiences in schizophrenia. Philosophy, Psychiatry, & Psychology, 29(1), 5–15. https://doi.org/10.1353/ppp.2022.0001
Huq, S., Garety, P., & Hemsley, D. (1988). Probabilistic judgements in deluded and non-deluded subjects. The Quarterly Journal of Experimental Psychology, 40(4), 801–812. https://doi.org/10.1080/14640748808402300
Kendell, R. E., Freedman, A. M., Brotman, R., Silverman, I., & Hutson, E. D. (1986). Issues in psychiatric classification: Science, practice, and social policy.
Kraemer, H. C., Kupfer, D. J., Clarke, D. E., Narrow, W. E., & Regier, D. A. (2012). DSM-5: How Reliable Is Reliable Enough? American Journal of Psychiatry, 169(1), 13–15. https://doi.org/10.1176/appi.ajp.2011.1101005
Lancellotta, E. & Bortolotti, L. (2019). Are clinical delusions adaptive? Wiley Reviews on Cognitives Sciences, 10, 1-19. https://doi.org/10.1002/wcs.1502
López-Silva, P. (2024). Thinking in Schizophrenia and the Social Phenomenology of Thought Insertion. Philosophical Psychology, DOI: 10.1080/09515089.2024.2334720
López-Silva, P. (2023). El problema etiológico de los delirios psicóticos en la neuropsiquiatría actual. Revista Ciencias de la Salud, 21(2), 1-16. https://doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.10378
López-Silva, P. (2016). The typology problem and the doxastic approach to delusions. Filosofía Unísinos 17(2), 202-211.
López-Silva, P. & McClelland, T. (2023). Intruders in the Mind: Interdisciplinary Perspectives on Thought Insertion. Oxford: Oxford University Press.
López-Silva, P. & Cavieres, A. (2022). El delirio psicótico como objeto de estudio multidisciplinar para la filosofía de la mente. Sophia, 33, 71-90 https://doi.org/10.17163/soph.n33.2022.02
López-Silva, P. & Cavieres, A. (2021). La Realidad Transformada: Hacia una Recalibración de la Psicopatología Contemporánea. Santiago: SONEPSYN.
López-Silva, P., Harrow, M., Jobe, T. H., Tufano, M., Harrow, H., Rosen, C. (2022). 'Are these my thoughts?’: A 20-year prospective study of thought insertion, thought withdrawal and thought broadcasting and their relationship to auditory verbal hallucinations. Schizophrenia Research https://doi.org/10.1016/j.schres.2022.07.005
López-Silva, P. Núñez de Prado, M. & Fernández, V. (2022). Sobre Doxasticismos y Anti-Doxasticismos: Hacia un Mapeo del Problema Tipológico de los Delirios. Resistances: Journal of Philosophy of History. Online First. https://doi.org/10.46652/resistances.v3i6.95
López-Silva, P. & Cavieres, A. (2021). Salto a Conclusiones y Formación de Delirios en Psicosis: Un Análisis Crítico. Psiquiatría Biológica, 28(1), 9-13. https://doi.org/10.1016/j.psiq.2020.12.002
Martin, J.-R., Dezecache, G., Pressnitzer, D., Nuss, P., Dokic, J., Bruno, N., … Franck, N. (2014). Perceptual hysteresis as a marker of perceptual inflexibility in schizophrenia. Consciousness and Cognition, 30, 62–72. https://doi.org/10.1016/j.concog.2014.07.014
Mishara, A. López-Silva, P., Rosen C. & Heinz, A. (2023). Self-Disturbances, Perceptual Anomalies, and Physicality: Towards a Multimodal Model of Thought Insertion. In López-Silva, P. & McClelland, T. (Eds.). Intruders in the Mind: Interdisciplinary Perspectives on Thought Insertion. Oxford: Oxford University Press. https://doi.org/10.1093/med/9780192896162.003.0003
Morgades-Bamba, C. I., Fuster-Ruizdeapodaca, M. J., & Molero, F. (2019). The impact of internalized stigma on the well-being of people with Schizophrenia. Psychiatry Research, 271, 621–627. https://doi.org/10.1016/j.psychres.2018.12
Miyazono , K. (2018). Delusions and Beliefs: A Philosophical Enquiry. London: Routledge
Miyazono, K. (2015). Delusions as harmful malfunctioning beliefs. Consciousness and cognition, 33, 561-573. https://doi.org/10.1016/j.concog.2014.10.008
Miyazono, K., & McKay, R. (2019). Explaining delusional beliefs: A hybrid model. Cognitive Neuropsychiatry, 2(5), 335–346. https://doi.org/10.1080/13546805.2019.1664443
Miyazono, K. (2022). Replies to critics. Asian Journal of Philosophy, 1(2). https://doi.org/10.1007/s44204-022-00048-w
Ohlhorst, J. (2022). Delusions and beliefs: A knowledge-first approach. Asian Journal of Philosophy, 1(1), 1–7. https://doi.org/10.1007/s44204-022-00035-1
Orellana, G., & Slachevsky, A. (2013). Executive functioning in schizophrenia. Frontiers in Psychiatry, 4. https://doi.org/10.3389/fpsyt.2013.00035
Organización Mundial de la Salud [OMS] (2019) CIE-11. Undécima revisión de la Clasificación Internacional de las Enfermedades. Ginebra.
Pienkos, E., Silverstein, S., & Sass, L. (2017). The phenomenology of anomalous world expe- rience in schizophrenia: a qualitative study. Journal of Phenomenological Psychology, 48(2), 188–213. https://doi.org/10.1163/15691624-12341328
Sakakibara, E. (2016). Irrationality and Pathology of Beliefs. Neuroethics, 9, 147–157. https://doi.org/10.1007/s12152-016-9256-9.
Sakakibara, E. (2022). On the nature, pathology, and etiology of delusions: Comments on Miyazono’s delusions and beliefs. Asian Journal of Philosophy, 1(1), 1–8.
Sass, L., & Byrom, G. (2015). Phenomenological and neurocognitive perspectives on delusions: a critical overview. World Psychiatry, 14(2), 164-173. https://doi.org/10.1002/wps.20205
Sass, L. A., & Pienkos, E. (2013). Delusion: the phenomenological approach. In K. W. M. Fulford, M. Davies, R. G. T. Gipps, G. Graham, J. Z. Sadler, G. Stanghellini, & T. ornton (Eds.), e Oxford Handbook of Philosophy and Psychiatry (pp. 632–657). Oxford: Oxford University Press. https://doi.org/10.1093/oxfordhb/9780199579563.001.0001
https://doi.org/10.1007/s44204-022-00034-2
Sullivan-Bissett, E. (2022). Against a second factor. Asian Journal of Philosophy, 1(1), 1–10. https://doi.org/10.1007/s44204-022-00036-0
Wakefield, J. C. (1992a). The concept of mental disorder: On the boundary between biological facts and social values. American Psychologist, 47(3), 373–388. https://doi.org/10.1037//0003-066x.47.3.373
Wakefield, J. C. (2007). The concept of mental disorder: diagnostic implications of the harmful dysfunction analysis. World Psychiatry, 6(3), 149-156. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2174594/
Wakefield, J. C. (2011). Darwin, functional explanation, and the philosophy of psychiatry. In P. R. Adriaens & A. De Block (Eds.), Maladapting minds: Philosophy, Psychiatry, and Evolutionary Theory (pp. 43–172). Oxford University Press. https://philpapers.org/rec/WAKDFE
Wakefield, J. C. (1992b). Disorder as harmful dysfunction: A conceptual critique of DSM-III-R’s definition of mental disorder. Psychological Review, 99(2), 232–247. https://doi.org/10.1037/0033-295X.99.2.232
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25-10-2024
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López-Silva, P., Cuadros, P., Cavieres, Álvaro, Navarro, F., & Salinas, E. (2024). PSICOSIS Y PATOLOGÍA: EL DELIRIO EN LA ESQUIZOFRENIA COMO DISFUNCIÓN DAÑINA. LÍMITE Revista Interdisciplinaria De Filosofía Y Psicología, 19. https://doi.org/10.4067/s0718-50652024000100218
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Derechos de autor 2024 Pablo López-Silva, Pamela Cuadros, Álvaro Cavieres, Fernanda Navarro, Esteban Salinas
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
