Making Sense of Spiritual, Metaphysical, and Eschatological Elements in Delusions: A Qualitative Study Using Interpretative Phenomenological Analysis.

Delusions with spiritual, metaphysical, or eschatological elements (SMEDs) resemble mystical experiences in how they alter perceptions of space, time, and unity, and are accompanied by a sense of enlightenment that remains ineffable. Seven participants described SMEDs as sources of ontological insight, mental health issues, inspiration for a new life orientation, or examples of the limits of knowledge. Making sense of these experiences involved an internal dialogue reflecting contradictory positions, and participants often struggled to reconcile the experiences' apparent significance with the dominant illness explanation. Integrating SMEDs into one's life is challenging. A philosophical, non-pathological interpretation of SMED, derived from a novel perspective on mystical experience, may have therapeutic utility.

Study at a glance

Abstract

Spiritual, metaphysical, or eschatological elements in delusions (SMEDs) are frequent and often subjectively regarded as profound transformational experiences, similar to mystical experiences. This study aimed (1) to explore how SMEDs are experienced and in which aspects they are similar to mystical experiences and (2) to investigate how individuals make sense of SMED. Seven participants were interviewed, and their expressions were analyzed using interpretative phenomenological analysis. We found that SMEDs were similar to mystical experiences with regard to alterations in perception of space, time, and unity. Furthermore, SMEDs were accompanied by a sense of enlightenment that however remained ineffable. SMEDs were interpreted from different viewpoints, i.e., as a source of ontological insight, as a mental health issue, as an inspiration for a new orientation in the world, and, for some participants, as an example of the limits of knowledge. Making sense of SMED appeared to follow a lively internal dialogue in which various, sometimes contradictory positions were reflected upon. Participants usually struggled to align the ostensible ontological significance of SMED to the dominating illness explanation. SMEDs have similarities to mystical experiences, but integrating SMED into one's own life is challenging. We propose a philosophical, non-pathological interpretation of SMED derived from a novel perspective on mystical experience which may also have some therapeutic utility.