[Psychological and psychopathological issues of conspiracy theories: From the COVID-19 health crisis to the existential crisis]. / Enjeux psychiques et psychopathologiques des croyances conspirationnistes : de la crise sanitaire du COVID-19 à la crise existentielle.

OBJECTIVES: Research on conspiracy theories (CT) has increased significantly in recent years. Studies come from various disciplines in the field of the humanities and social sciences. They show in particular that adherence to CT rebounds at every moment of "crisis". The health crisis we are experiencing is no exception: COVID-19 pandemic entails an "infodemic", according to Tedros Ghebreyesus, General Director of the World Health Organization. Indeed, we are witnessing the production, and international dissemination, of false informations, including conspiracy explanations of the coronavirus and its consequences. This outbreak of CT is an opportunity to examine the psychological and psychopathological issues of this phenomenon in the face of the "crisis", whether collective or individual, health or existential. METHODOLOGY: We present a review of the important international scientific literature regarding CT related to the health crisis of the COVID-19. RESULTS: Work that addresses CT related to the COVID-19 crisis has resulted in more than fifty publications in recent months. This research is mainly in the fields of social psychology, medical psychology, differential psychology, political science and public health. The rates of adherence to CT related to COVID-19 are of great concern. The literature mentions predisposing factors to the adherence or diffusion of CT on COVID-19: inclination for CT in general, low level of education, low knowledge of the disease, high level of anxiety, acceptance of xenophobic policies, unfavourable attitude towards marginal groups, nationalist stance. Unsurprisingly, there is widespread agreement in the literature that the conspiracy-prone fringe of the population is less likely to comply with government recommendations related to contamination risks, such as handwashing, social distancing, wearing masks, and using diagnostic tests. This crisis thus demonstrates once again that the circulation of false news and adherence to CT is not just a marginal and inconsequential thinking: it concerns a very large part of the population, with a potentially tragic impact in terms of public health. While there is usually no significant difference in adherence to CT according to gender, it would seem that women are less affected by CT related to the COVID than men, regardless of their political affiliation. Finally, studies on the links between adherence to COVID-related CT and stress levels do not seem to reach a consensus. The same uncertainty can be found in work on other types of CT. CONCLUSION: These results suggest that in order to understand the psychological causes of CT, it may be useful to address the psychodynamic issues underlying adherence to these beliefs. In particular, a psychopathological approach to this phenomenon enables to understand these beliefs as a defensive solution to cope with psychic vulnerability. CT involves overproducing meaning, as delusion does: CT can be considered as the collective, cultural equivalent of a delusional production. Moreover, it is impervious to arguments and evidences, in the same manner as delusion. However, it differs from it by at least two major characteristics: it is shareable and socializing; it gives rise to a consistent attitude.

Acting on delusion and delusional inconsequentiality: A review.

OBJECTIVES: Two of Europe's most influential psychopathologists at the start of the twentieth century (Eugen Bleuler and Karl Jaspers) pointed out the fact that patients rarely act according to their delusions. This study proposes an investigation of how this issue is addressed in psychopathological literature. METHODS: This article offers a critical review of psychopathological literature which focuses on the influence of delusional ideation on behaviour. RESULTS: Phenomenological psychiatry has relied on the paradox pointed out by Bleuler and Jaspers to emphasize disorders of self-experience in psychosis whereas analytical philosophy of delusion has focused on the psychological status of delusion, regarded as belief, certainty, or imagination. The empirical studies conducted during the past three decades - which were devoted to acting on delusion - focused on violent and safety-seeking behaviours. These studies have shown that these behavioural disorders are motivated by an emotional outburst (anger and/or fear) rather than by delusional content. CONCLUSION: Delusional inconsequentiality can be clarified by conceptual research in phenomenological psychiatry and analytical philosophy, even though its role in the psychopathological processes has not yet been clearly identified or conceptualised. Empirical psychopathology on acting on delusion confirms the delusional inconsequentiality, but only implicitly, by highlighting the role of affectivity (rather than beliefs) in delusional actions. Given the major implications of better understanding this phenomenon, in terms of psychopathology and clinical practices, we suggest considering delusional inconsequentiality as a promising concept which could guide further research in contemporary psychopathology.

Does the Beck Cognitive Insight Scale predict change in delusional beliefs?

OBJECTIVES: The Beck Cognitive Insight Scale (BCIS) is composed of two subscales, self-reflectiveness and self-certainty, assessing reflectiveness and openness to feedback, and mental flexibility. Delusions have previously been associated with low cognitive insight. The aim of this study was to determine whether changes in BCIS scores predict changes in delusional beliefs. METHODS: The study is a secondary analysis of a previously published randomized controlled trial. All participants had a psychotic disorder diagnosis and received treatment as usual, with half of them also receiving the cognitive restructuring intervention 'Michael's game'. Participants were assessed at three different times: at baseline (T1), at 3 months (T2), and at 9 months (T3). Cognitive insight was measured with the BCIS, belief flexibility with the Maudsley assessment of delusions schedule (MADS), and psychotic symptoms with the Brief Psychiatric Rating Scale (BPRS). RESULTS: A total of 172 participants took part in the trial. After using generalized estimating equation (GEE) modelling, we observed (1) significant main effects of BCIS self-certainty and Time and (2) significant Time × BCIS self-certainty and Time × treatment group interaction effects on belief flexibility. Improvements in self-certainty (i.e., decrease in scores) were associated with more changes in conviction over time, more accommodation, improved ability in ignoring or rejecting a hypothetical contradiction and increased use of verification of facts. Medication and BPRS total scores were controlled for in the GEE analyses at their baseline values. CONCLUSIONS: Overall improvement in BCIS self-certainty scores over time predicted better treatment outcomes as assessed with MADS items. PRACTITIONER POINTS: Treatments for patients with psychosis should focus on improving cognitive insight as this seems to improve overall treatment outcomes and recovery. The Beck Cognitive Insight Scale can be used to measure changes during treatment and can predict treatment outcomes.

Does Change over Time in Delusional Beliefs as Measured with PDI Predict Change over Time in Belief Flexibility Measured with MADS?

Delusional beliefs and their behavioral consequences are predominant symptoms in patients with psychosis and play an important role in the treatment. Delusional beliefs are a multidimensional concept which can be divided into three components: distress, preoccupation and conviction of delusions. These can be measured using Peters delusions inventory (PDI-21). We question, whether changes in delusional beliefs over time during treatment measured with the PDI-21 can predict changes in belief flexibility measured with the Maudsley assessment of delusions schedule (MADS). We used a group of patients from a randomized controlled trial for a cognitive intervention for psychosis or psychotic symptoms. Aside standard treatment for psychosis, half of the patients took part in a group treatment "Michael's game". Patients were assessed at baseline (T1), at 3 months (T2), and at 9 months (T3). We measured delusional beliefs using PDI-21 and belief flexibility with the MADS. One hundred seventy-two patients were included in the analysis. We measured a main effect of PDI-21scores on belief flexibility measured with MADS. PDI-21 Conviction scores predicted outcomes for all measured MADS items. Increasing PDI Distress and Preoccupation scores were predictors for being more likely to dismiss beliefs and change conviction. Time itself was a predictor for changing conviction and being able to plan a behavioral experiment. Overall the changes in PDI scores predicted outcomes for belief flexibility measured with MADS items. The PDI-21 could be a simple and effective way to measure progress in treatment on delusional beliefs.

Roots and vicissitudes of psychic bisexuality.

Sigmund Freud considered the difficulty in defining masculinity and femininity from a psychic point of view as a hiatus in psychoanalytic theory. I contend that masculinity pertains to the centrifugal (to that which goes out, and ultimately to that which one loses), and femininity to the centripetal (to the appetency for taking the object into one's own internal space), whether one is considering their archaic roots or their genitalized culmination. The masculine/feminine pair draws support from the body (and, through anaclisis, from the subjective space), identified with a container that is liable already in the first psychic stages of life to empty itself of its own content and to be filled by a foreign content: the content is subjective in the masculine and object-related in the feminine. The conflicts of ambivalence related to these two movements (desire/anxieties linked to active and passive penetration) lead to the setting up of the rigid and labile poles of the personality, and they are liable to give rise to obsessional and hysterical solutions respectively. My hypotheses will be examined in the light of the two key cases of hysteria and obsessional neurosis in Freud's work: Dora (1905e) and the Rat Man (1909d).

Reducing Delusional Conviction through a Cognitive-Based Group Training Game: A Multicentre Randomized Controlled Trial.

OBJECTIVE: "Michael's game" (MG) is a card game targeting the ability to generate alternative hypotheses to explain a given experience. The main objective was to evaluate the effect of MG on delusional conviction as measured by the primary study outcome: the change in scores on the conviction subscale of the Peters delusions inventory (PDI-21). Other variables of interest were the change in scores on the distress and preoccupation subscales of the PDI-21, the brief psychiatric rating scale, the Beck cognitive insight scale, and belief flexibility assessed with the Maudsley assessment of delusions schedule (MADS). METHODS: We performed a parallel, assessor-blinded, randomized controlled superiority trial comparing treatment as usual plus participation in MG with treatment as usual plus being on a waiting list (TAU) in a sample of adult outpatients with psychotic disorders and persistent positive psychotic symptoms at inclusion. RESULTS: The 172 participants were randomized, with 86 included in each study arm. Assessments were performed at inclusion (T1: baseline), at 3 months (T2: post-treatment), and at 6 months after the second assessment (T3: follow-up). At T2, a positive treatment effect was observed on the primary outcome, the PDI-21 conviction subscale (p = 0.005). At T3, a sustained effect was observed for the conviction subscale (p = 0.002). Further effects were also observed at T3 on the PDI-21 distress (p = 0.002) and preoccupation subscales (p = 0.001), as well as on one of the MADS measures of belief flexibility ("anything against the belief") (p = 0.001). CONCLUSION: The study demonstrated some significant beneficial effect of MG.

The hysterical organization.

The term hysteria has been used in the history of the psychoanalytical movement to describe a large variety of psychic modalities. What is the common denominator of the hysterias? The author suggests that ambivalence in relation to penetration in its passive form (vaginal desire), in its pregenital and genital valences, constitutes the essence of hysteria. It seems that the issue of hysteria thus configured finds its best resolution in the fantasy of an incorporeal penetration, which leads to orgasm, and spares one from the anxiety of destruction to the internal space as well as from the anxiety of guilt following the hoped for climax. The author is attempting to discern, by means of two case studies, how disembodied penetration, depending on whether it is fantasized or delusional, constitutes a solution, neurotic or psychotic respectively, to the issue of hysteria: the private theatre in neurosis, as well as the inhabited and influenced mind in psychosis (delusion of control), act as psychic figurations of vagina.