The attachment theory of psychosis

[Carl-Richard]

Many years ago, I had an intuition about a way to explain psychosis, which essentially goes like "more attachment = higher predisposition to psychosis". However, back then, I didn't have much of a theoretical or analytical rationale for the theory. It was really just an intuition. But now, I think the pieces are starting to fall together.

I started thinking about the distinction between "rumination" and "reflection", which was essentially coined to resolve the apparent paradox that thinking obsessively (deeply and repetitively) about oneself is both associated with increased quality of life (through things like increased self-insight, intellectual depth, problem-solving, etc.; "reflection") and a decreased quality of life (through things like depressive brooding, mulling over past mistakes, or worrying about future events; "rumination").

While I haven't specifically looked at the literature yet, an "intuition" I had about this is that rumination concerns primarily unresolved goal-discrepancies (things not going the way you want or believe is right) with accompanying strong negative emotional reactions, and while reflection may also involve unresolved goal-discrepancies, it will not have the same strong negative emotional reactions (it will generally have a more positive, lighter or detached tone).

Now, rumination predisposes one to a reduction of quality of life and mental illnesses, where psychosis is one possibilty (and arguably a logical conclusion or extreme end-point of mental illness; a disintegration of the normal functioning of the psyche). Also, in a paper on spontaneous thought (which rumination is a sub-category of), they speculated that the "funneling effect" associated with rumination where you focus obsessively on the self, could also be present in mania in bipolar disorder (where intense excitement and obsessive focus on quite particular topics produce thoughts at a rapid pace), which of course at its extremes lead to psychosis.

Now, what could this "funneling effect" (obsessive focus or self-focus) and strong emotional reactions to things not going the way you want or believe is right, also be described as? Attachment.

Now, during this insight about reflection vs. rumination, I also saw the connection to self-determination theory, in that self-determination is when your behavior is determined by what you want, or think is right or enjoyable, which is of course associated with positive and lighter emotions and motivation. So when reflecting about something deep about yourself, about something you want to do, or when reflecting is itself something you want to do, that will of course be associated with more positive and lighter emotions. Conversely, rumination focuses much more on things that you "don't" want (resistance), and even the process itself might be something you don't want (because it involves strong negative emotions).

So self-focus + resistance creates stronger emotional reactions and stronger attachments. Conversely, when your emotions are lighter, you are more "detached", less emotionally reactive, more meta-cognitively aware; generally higher cognitive functioning. Two related concepts, "cognitive flexibility" and "psychological flexibility", more generally describe the ability to problem-solve in ways that are more cognitively functional in these ways, and for the latter, "acceptance" (the opposite of resistance) is listed as a sub-category.

So reflection could be a generally more self-determined form of introspection while rumination could be generally less self-determined. Rumination is also specifically associated with decreased meta-cognitive awareness (awareness of thinking or that you are thinking), so the thinking is more outside one's sense of control and you might not even notice that it's happening before a long time. This is another way it becomes less self-determined.

 

So in short: obsessive thoughts about things that don't happen the way you want or believe is right + strong negative emotional reaction = attachment -> reduction of quality of life -> mental illness -> psychosis.

Edited February 8 by Carl-Richard