Disturbances in dialogue and metacognition: A renewed way to understand and respond to alterations in self-experience in psychosis

Abstract

A dialogical model of psychosis proposed that the collapse of dialogue may explain the alterations in sense of self and agency observed in psychosis. This view was hampered by lack of clarity regarding the processes that support or hinder dialogue. Since then, research on metacognition has offered an alternative but also partially complementary approach. To explore this issue a brief history of the original dialogical conceptualization of psychosis and the difficulties that it confronts is offered along with the essential contributions of research on metacognition in psychosis. Next, we explore how this more recent research has deepened the exploration of some core ideas of dialogical self theory, including the multiplicity of the self, while calling into question other aspects of that theory. Lastly, we discuss issues awaiting future research including models linking disturbances in basic brain function, social injustice, community connection, and self-experience in psychosis from the frame of a network.