Understanding the Blind Spots of Psychosis: A Wittgensteinian and First-Person Approach

Background: Experiences of psychosis are often assumed to be strange, bizarre, or incomprehensible. The aim of this article is to offer a new step towards a better understanding of how the psychotic process affects a prereflective background.

Methods: We use concepts from the philosophy of Ludwig Wittgenstein to clarify the first-person perspective on psychosis of one of the authors.

Results: We describe the early psychotic process as breaking down the "nest of propositions," shaking the scaffolds of our language games. Hereby, the prereflective background that forms our existential orientation in the world is fundamentally altered. We identify different aspects of this process: a dialectic of aha and anti-aha experiences, the experience of groundlessness, and blind spots. Acknowledging and exploring the depth and impact of this process on a person's world may be a first step towards resolving their isolation and suffering. Philosophy can facilitate such an exploration, while interpersonal activation may offer structure and trust in the world, helping the patient to find solid ground in action and interaction.

Conclusion: This article combines a philosophical approach with a first-person perspective on psychosis to illuminate aspects of psychosis that have not been described or elaborated on before. We argue that psychosis entails an experience of existential groundlessness. Our view has implications for treatment of and recovery from psychosis.