Psychotic-like experiences in esoterism: A twilight zone?
Introduction
The last decades of research point towards a temporal and phenomenological continuum of psychotic experiences and suggest that psychotic symptoms occur not only in patients with schizophrenia-spectrum disorders (Morgan et al., 2009, Nuevo et al., 2012), but also in patients with affective and anxiety disorders (Hanssen et al., 2003) and individuals of the general, non-help-seeking population (Verdoux and van Os, 2002). Under the assumption of a psychosis continuum, the concept of the “at-risk mental state” (ARMS) has been described resulting in the development of operationalized criteria for the detection of individuals at ultra high risk (UHR) for developing full-blown psychosis (Yung et al., 2003). The UHR criteria include attenuated psychotic symptoms (APS), brief limited intermittent psychotic symptoms (BLIPS) or the genetic risk and deterioration (GRD) syndrome. In contrast to the ARMS concept, which is accompanied by distress and help-seeking behavior of the affected person, psychotic symptoms in the presumed absence of illness and distress are referred to as psychotic-like experiences (PLEs), also described as a non-clinical psychotic phenotype (Kelleher and Cannon, 2011). A meta-analysis by van Os et al. (Van Os et al., 2009) reported a median prevalence of 5–8% for PLEs in the general population and even higher rates have been shown in children and adolescents (Laurens et al., 2007, Pontillo et al., 2016). Albeit subclinical, PLEs in children as well as in adults were shown to increase the risk of developing schizophrenia-spectrum disorders (Kelleher and Cannon, 2011, Poulton et al., 2000). This led to the idea of psychotic symptoms being distributed within different states of transition along a continuum, in different intensities and different stages of persistence, rather than perceiving them as a dichotomous feature, i.e. present or absent. The clinical meaning of PLEs within this transitory state is still indistinct today (Lee et al., 2016). Broadening the scope of research on this “twilight zone” of PLEs in different subgroups may provide new insights into the development of psychotic disorders, potential predictors and their aetiology.
PLEs are phenotypically similar to paranormal beliefs and experiences (Cella et al., 2012), which are common in the general population (Pechey and Halligan, 2011) and refer to “physically impossible” processes (Thalbourne, 1994) only explainable through the revision of scientific fundamentals (Tobacyk and Milford, 1983). Esoterism may be defined as practices involving the inner experiences of some form of faith, the mystical aspects, accessible only to the initiated; and on a broader, more colloquial level, the activities and faith involved around paranormal beliefs and experiences. Several studies have suggested a positive relationship between paranormal beliefs or experiences and PLEs (Lawrence and Peters, 2004, Thalbourne, 1994), schizophrenia-spectrum disorders (Peters et al., 2004) and schizotypy (Hergovich et al., 2008, Tobacyk and Wilkinson, 1990), including similar cognitive biases between paranormal and delusional beliefs (Blackmore and Trościanko, 1985, Lawrence and Peters, 2004, Wierzbicki, 1985). Similar to the definition of the “non-clinical psychotic phenotype”, MyCreery and Claridge described the concept of the “healthy schizotype” as referring to an individual's perceptual anomalies and out-of-body-experiences without impairment of cognition or social functioning (McCreery and Claridge, 2002).
Recent research has shown interest in PLEs in individuals of special subpopulations. Powers et al. examined non-help-seeking clairaudient psychics receiving daily auditory messages in comparison with psychotic patients with acoustic hallucinations. Interestingly, the psychics with acoustic hallucinations without any help-seeking-behavior were able to control the onset and offset of their voices, and were less distressed and received a more positive reaction when admitting to voice-hearing for the first time (Powers et al., 2016).
Since the clinical role of PLEs is still a matter of research, the aim of this study was to investigate the prevalence of PLEs in a non-clinical general population sample of individuals with interest in esoterism compared to a sample of individuals without any interest in esoterism. To the authors' knowledge, this is the first study assessing the presence of PLEs in a subpopulation in which PLEs might be more common, those interested in esoterism, by means of a clinically used screening instrument originally developed to identify at-risk mental state individuals. Since PLEs have been reported as occurring significantly more often at younger age (Laurens et al., 2007, Pontillo et al., 2016), we also assessed the relationship between the extent of PLEs in each group and age. In this study, esoterism and paranormal beliefs/experiences are used with the broader definition above, i.e. as an umbrella term referring to the manifold field of subjects including clairvoyance, mediumship and channeling etc.
Section snippets
Sample
The study sample is a non-help-seeking general population sample of 224 individuals with (IE) and 178 individuals without interest (NE) in esoterism. Women and men aged 18 to 90 years were eligible to participate.
Procedure
The anonymized 16-item version of the Prodromal Questionnaire (PQ–16) (Ising et al., 2012) was administered to a non-clinical general population sample of individuals with interest in esoterism as well as a control group of individuals without interest in esoterism during a large
Results
The final sample included 402 individuals. Participants were between 19 and 83 years old. Of the final sample, 224 subjects (55.7%) reported interest in esoterism and 178 subjects (44.3%) showed no interest in esoterism. There were more female subjects in the total sample (71.4%). In the IE group there were more women (58.2% female subjects) compared to the NI group (41.8% female subjects). The mean PQ-16 score of IE individuals (6.24 ± 3.47) was 4.04 points higher compared to NI individuals (2.20 ±
Discussion
In this study, a non-clinical sample of individuals interested in esoterism showed significantly higher scores on an anonymized self-report screening instrument for psychotic-like experiences compared to individuals without interest in esoterism. Higher scores in the mean PQ-16 score were shown especially in the younger individuals interested in esoterism. While the mean PQ-16 score decreased with increasing age in the group of individuals interested in esoterism, the score remained almost
Role of funding source
No funding.
Contributors
Author BH contributed to: design of the study, literature searches, data acquisition, interpretation of the results and drafted the manuscript.
Author NM contributed to: design and implementation of the study, supervision, analysis, interpretation of results and writing of the manuscript.
Authors ZL, SS, DK, MG contributed to: data acquisition and writing of the manuscript.
Authors FF and AK contributed to: design of the study, interpretation of results and writing of the manuscript.
Conflict of interest
AK receives funding from the U.K. Medical Research Council. The other authors declare that they have no conflicts of interest.
Acknowledgement
We would like to thank Benjamin Missbach for his support at data acquisition and Ingrid Salazar for editing of the manuscript.
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