Implausibility and Evidentiality in Schizophrenic Delusions: A Case of High Risk of Suicide

Abstract

This article presents the case of a patient who, tormented by auditory hallucinations, made an almost fatal suicide attempt by shooting himself. He expressed the firm conviction that traumatic events in his life, including his suicide attempt, were going to occur again in the same form. The case was conceptualized in terms of phenomenological, psychodynamic, and linguistic concepts that informed his psychotherapeutic treatment. He was also treated with standard pharmacological intervention. This case uses previously neglected insights from linguistics to illustrate how implausibility of delusions can best be understood in terms of competing rules of evidentiality rather than abnormal reasoning and faulty interpretations of experience. The favorable outcome is explained by the replacement of delusional with nondelusional ways of making sense of the world, the decrease of hyperreflexivity, and the restoration of the patient’s sense of power over his life.