Polythematic Delusions and Logico-Theoretical vs. Experimentalist Turn of Mind

This article aims to contribute to cognitive therapy of polythematic delusions by proposing a preliminary step to the implementation of traditional cognitive therapy, based on the construction of alternative hypotheses to delusions and testing of the latter. This additional step resides in the construction in the patient of the necessary skills to use the general experimentalist method of knowledge acquisition. Such an approach is based on the contrast between the logico-theoretical and the experimentalist turn of mind. Some elements such as to allow any such construction in the patient are then described and analyzed.

hypotheses. At this point, w e can observe th at this approach is associated w ith a general method ology of the same nature, w hich is not based on the very polythem atic d elusions inherent to the p atient. Such an approach proves then grou nd ed on the acquisition of the general ability to build up alternative hypotheses and to carry ou t tests on d ifferent hypotheses. Unlike trad itional therapy that bears specifically on the content of the polythem atic d elusions, su ch an approach presents a general nature and proves likely to refer to any type of hyp otheses. We can d escribe the general nature of such an approach as experimentalist.
We can observe here that the fact that classical cognitive therapy is based on strengthening in the p atient the ability to d evelop alternative hypotheses to d elusions and to p erfo rm tests on them, implicitly relies on the fact that such an ability is low or d eficient in the patient, at least w ith respect to the d elusions d eveloped by the latter. We su ggest then to m ake the w id er assu mption that the overall ability to d evelop altern ative hypotheses and tests in ord er to valid ate or invalid ate id eas, could be low or d eficient in the p atient, and that the problem encou ntered w ith d elusions represents the visible p art of a more general problem that is inherent to the p atient. We also pr op ose that the tw o above-mentioned elements (test implementation and construction of alternative hyp otheses) are also part of an overall ability that also includ es ad d itional elements, and can be d efined as the ability to im plement the experimentalist method of knowled ge acquisition.
For the purp ose of the present stud y, it is necessary to further clarify the very notion of general method ology of experimentalist nature. To this end , it is w orth contrasting first the experimentalist turn of mind with the logico-theoretical one. Such opposition allows for a better und erstand ing of the experimentalist approach itself. This op position correspond s essentially to a classical op position in science, w hich contrasts tw o p articu lar styles that each lead to acquisition of know led ge. Whereas the m ethod of experimentalist inspiration proceed s by elaborating hypotheses and testing them, the logico -theoretical method proceed s by logical d ed u ction or ind u ction from a set of know led ge of w hich the one w ho exerts it strives to m aintain consistency. Both m ethod s, on the scientific level, each have their supporters and d etractors. However, ad vances in knowled ge are to be cred ited to both method s, w hich ultim ately appear as complementary and m ay eventu ally be regard ed as tw o w ays of accessing scientific know led ge.
The opposition betw een experimentalist vs. logico -theoretical turn of mind is not limited , how ever, to the scientific field . Ind eed , such opposition has a more general scope and also applies to any bod y of know led ge, includ ing that resulting from the process of acqu iring information and know led ge concerning everyd ay life. In this context, the logico -theoretical turn of mind notably proceed s by d ed uction, by trying to acquire know led ge in a logical w ay; it is aimed at explaining and interpreting facts and phenomena. Such an approach is und erpinned by a concern for consistency of the whole correspond ing set of knowled ge, by also trying to id entify and rem ed y any internal contrad iction. The logico -theoretical ap p roach may also proceed by ind u ctive reasoning, thus m aking use of ind uctive generalization. In ad d ition, w hen an internal contrad iction is found , thus rend ering the w hole set of knowled ge inconsistent, the one w ho proceed s in a logico-theoretical w ay strives to quickly restore this consistency, by possibly m od ifying some elements that are part of the overall know led ge at his/ her d isposal. Conversely, the one w ho proceed s w ith the help of the experimentalist approach is basically concerned w ith valid ating theories and hyp otheses, through experimentation, testing, and search for evid ence. H e/ she is then concerned w ith only retaining ultim ately that know led ge that has been valid ated by experience and w hose strength lies in the evid ence w hich has been thus collected .
Thus characterized through their opp osition, it is no less app arent that each of the experimentalist or logico-theoretical method of know led ge acquisition has its d raw backs w hen pushed to the extreme. When applied in excess, the logico -theoretical method thus lead s to risky specu lation and lack of evid ence, to u nrealistic and d isconnected from the reality view p oints. Conversely, experimentation pushed to the extreme lead s to know led ge that lacks p ow er of abstraction, explanatory and p red ictive pow er, and d oes not a llow und erstand ing of the d ata and the p henomena. In ord er to better emphasize the related notions and also better highlight the relationship w ith the d ifferent neighboring concep ts, it is w orth provid ing some ad d itional insight over the opposition betw een experim entalist and logico-theoretical method ology. We shall propose then to make use of the matrices of concepts, w hich allow to emphasize the relationship s betw een some given concepts. A m atrix of concepts thu s consists of six concepts, d istributed alon g tw o d u al poles: A and Ā. Each of these p oles ad mits of respectively a concept of neutral A 0 , Ā 0 , p ositive (A + , Ā + ) and negative (A -, Ā -) nature. In total, the matrix consists of the six follow ing concep ts:  At this step, w e are in a p osition to construct the matrix of concep ts that applies to the opposition betw een theoretical-logical and experim entalist turn of mind . Each of these concepts presents an intrinsic neutral nature, but is likely to give ris e to a p ositive and a negative form. The corresp ond ing m atrix of concep ts is thus the follow ing: We can see here that the theoretical-logical turn of mind presents a positive form w hich lead s to fruitfu l theorization, and a negative form that engend ers u nrealistic id eas and hazard ous speculations. Conversely, the experimentalist turn of mind has a p ositive form w hich entails the solid ity of know led ge and the search for evid ence, and a negative form w hich lead s to extreme empiricism, associated w ith lack of u nd erstand ing and absence of explanation.

GEN ERAL APPLICATION OF THE EXPERIMEN TALIST METHOD OLOGY
The foregoing analysis lead s to the hyp othesis that it m ight be ad visable to rebu ild preliminarily in the patient the general ability to imp lement the experimentalist method of know led ge acquisition, before applying it later in a specific w ay to p olythematic d elusions. Cognitive therap y targeted at polythem atic d elusions w ou ld accord ingly involve tw o p hases: the first aimed at restoring in the p atient the functional ability to the experimentalist general approach; and the second intend ed to imp lement the latter, in a specific w ay, by app lying it to p olythem atic d elu sions. Several argu ments seem to lean in favor of such an option. Firstly, it seems preferable that the patient be first convinced of the merits of the exp erimentalist method of acquiring know led ge, even before app lying it to p olythematic d elusions. In other w ord s, it seems better than the p atient has him self/ herself acquired first the belief that the theoretical-experimental m ethod is effective and u seful before applying it to the specific topics corresp ond ing to d elusions. Second , it also seems preferable that the p atient w ou ld acquire a prior good practice and be exercised first to the experimentalist method on external, neutral and impersonal facts, before applying it to his/ her ow n d elusions w hich present for him / her an em inently em otional, personal and sensitive nature. Presum ably also the choice of topics external to the p atient should be such as to enable him/ her to m obilize his/ her cognitive abilities optim ally. Third ly, it is reasonable to think that the fact of applying the experimentalist method ology exclusively to the content of polythem atic d elusions, w ithou t possessing at the same tim e such a general ability might have some d isad vantages. One of these d raw backs m ay lie in the fact that the patient could quickly rebui ld some other d elu sions from other them es than those u su al to him / her. Finally, it is w orth m entioning that the acquisition and the general practice of the experim entalist method ology on topics that are fecund theorization + reliability + , pragmatism + , search for evidence + logico-theoretical turn of mind 0 experimentalist turn of mind 0 hazardous speculationunrealistic views -extreme empiricismlack of explanation -+ + 0 -0 -completely ind epend ent of the content itself of the p olythem atic d elu sions should be nonconfrontational, and likely to preserve the therapeutic alliance.
At this point, it is possible to sketch an outline of w hat could consist such a preliminary part of cognitive therapy for polythem atic d elusions. This las t p art w ould includ e a comp onent targeted at learning the construction of alternative hyp otheses, and a comp onent designed to the learning of testing different hypotheses. However, in order to form a coherent w hole, it is reasonable to think that this p art of the therapy should also includ e an explanation of a nu mber of related concepts, among w hich w e can mention: the d istinction betw een fact and hyp othesis; the notion of proof; the d istinction betw een evid ence and conviction; the notion of valid ation and invalid ation of a hyp othesis; the d istinction betw een fact and interp retation of fact; the d istinction betw een fact and p ercep tion of fact; the d istinction betw een fact and fact narration; the construction of alternative hyp otheses; the d evelopment of tests w ith regard to a hyp othesis; the cau sal relationship betw een facts; the proof of the causal relationship; the d istinction betw een facts w hose cau se is intentional or non-intentional; the notion of explanation of a given p henomenon. Several of these elem ents, especially those related to the construction of alternative hyp otheses, are integral part of the training program for metacognition d eveloped by Moritz et al. (2010Moritz et al. ( , 2011. It is also u seful to p oint out here several areas w here the above -mentioned p rinciples could be put into practice. These areas are p otentially very d iverse, but it is how ever possible to d escribe more accurately some of them, w hich relate to electronics and comp uter science. In the field of electronics first, consid eration could be given to take an interest in electronic circuits (or comp uter sim u lations thereof) and their operation. Thus, the p atient's attention cou ld focu s on the op erational p roblem s of su ch and su ch circu it and esp ecially on the search for causes of observed failu res (e.g. the fact that a led ind icator d oes not light up). It w ill then be necessary to formulate d ifferent hyp otheses regard ing the cause of the malfunction, w hich may relate to d ifferent circuit comp onents (transistors, power supply, the led ind icator itself, etc..) which can then be tested in order to be valid ated or invalidated, and later give rise, d epend ing on the test resu lts to other hypotheses, etc..
The field of computer science, second , cou ld offer variou s field s of ap p lications, esp ecially in programm ing. We m ay notably consid er a computer program that is supposed to prod uce a given result but has a d efect in its execution, d ue to a "bug". It w ill be then a matter of accu rately d eterm ining the cau se of this bu g i.e., of find ing the sp ecific ins tru ction w ithin the program, w hich is resp onsible. The p atient w ould thus be required to make assumptions regard ing the sp ecific instru ction in the p rogram am ong instr 1 , instr 2 , instr 3 , ..., instr n , w hich is at the origin of the bug and to test successively the latter. This w ill lead for examp le to eliminate the instruction instr 1 of w hich it w ill be assu m ed that it is the origin of the bu g and to test the program w ithout it, etc.. If the latter test invalid ates the hypothesis, such an approach w ill then lead to test another instruction instr 2 , and so on.

SPECIFIC APPLICATION OF THE EXPERIMEN TALIST METHOD OLOGY TO POLYTHEMATIC D ELUSION S
Classical cognitive therap y of schizophrenia (Kingd on & Turkington, 1994;Beck & Rector, 2000;Kingd on & Turkington, 2002) aim s to grad u ally red uce the d egree of belief in the patient's d elu sions. For this purpose, the therap ist suggests to the patient, in a spirit of d ialogue of Socratic inspiration to bu ild alternative hypotheses. H e/ she also teaches to the patient the process of testing the various competing hypotheses by seeking evid ence, thus allow ing to confirm or refu te them.
It seems useful, at this p oint, to d escribe the d ifferent stages that occur d ifferently d epend ing on the level-prim ary, second ary or tertiary-of the correspond ing d elusions. We shall consid er in turn each of these levels. We propose to analyze here the d elusions of reference, given that the analysis can be transposed to the d elusions of influence, of telepathy, of thou ght projection or of control.
A primary delusional argument of reference, first, has the following structure (the symbol ? denotes the conclusion): (R1) in T 1 I was drinking an aperitif premiss 1 (R2) in T 2 the presenter of the show said: "Don't drink!" premiss 2 (R3) ? in T 2 the presenter of the show said: "Don't drink!" because in T 1 I was drinking an aperitif conclusion The corresp ond ing d elusional id ea is that accord ing to w hich the presenter said in T 2 : "Don't d rink!" because the patient has been d rinking an aperitif in T 1 . The structure of such a d elusional id ea is as follow s: the event E 1 (in T 1 I w as d rinking an aperitif) is the cause of the event E 2 (in T 2 the presenter of the show said : "Don't d rink!"). In this case, the logical structure of the alternative hypothesis to the d elu sional conclusion (R3) is that the event E 1 w hich is internal to the patient is not the cause of the external event E 2 . The d ifferent alternative hypotheses id entify then themselves w ith alternative causes to the event E 2 . Thu s, the d elusional conclusion (R3) m ay be confronted w ith an alternative hyp othesis such as: the presenter said in T 2 : "Don't d rink!" because the script of this television program contained it. Another alternative hyp othesis is that it is the assistant presenter w ho su ggested to say it, etc..
One m ay think, how ever, that the fact of proposing to the patient alternative hy potheses to the d elusional conclusion (R3) just mentioned , could prove insufficient. In effect, the patient's d elusional id ea that the event E 1 internal to the patient is the cause of the external event E 2 , not only has the nature of a hyp othesis, bu t also has explanatory power, in the sense that it constitutes an exp lanation of the fact that app ears bew ild ering to the patient that the presenter has said : "Do not d rink!" immediately after the patient has been d rinking an aperitif. In comparison, the fact th at the event E 2 internal to the patient is not the cause of the external event E 2 , constitutes an alternative hyp othesis, but proves d evoid of such explanatory pow er. For this reason, w e believe that the mere statement, u nd er this form, of the latter alter native hypothesis shou ld not suffice to gain the sup port of the patient. For it is necessary to submit to the latter an alternative hyp othesis to the conclu sion (R3), w hich is also able to p rovid e an explanation for the rapid succession of events E 1 and E 2 . In this context, an alternative hypothesis that also allow s to provid e an explanation for the rapid succession of tw o phenomena, is the one accord ing to w hich the external event E 2 succeed ed im m ed iately after internal event E 1 , by the effect of a coincidence. Und er these cond itions, the p atient faces tw o competing hypotheses that may explain the rapid and d isturbing sequence of events E 1 and E 2 : the first hypothesis being that E 1 is the cau se of E 2 ; and the second being that the rap id succession of E 1 and E 2 is bu t a coincid ence.
Secondly, the structure of secondary delusional arguments of reference is as follows: The corresp ond ing d elusional id ea of reference is then the conclu sion (R10) that the presenters of the show s sp eak accord ing to w hat the patient makes or feels. The conclusion (R10) is of an ind uctive nature and constitutes a generalization from the several instances (R1), (R2), (R3), ... H ere, the logical stru ctu re of the alternative hyp othesis to the conclu sion (R10) is that the presenters of the show s do not speak accord ing to w hat the p atient makes. But in the same w ay as above, such a hypothesis proves d evoid of explanatory pow er. In contrast, the alternative hypothesis, w hich has an ad d itional explanatory p ow er, is the fact that by the effect of coincid ences, the rap id succession of tw o events that m ay give the impression of the existence of a relationship causality, occurs frequently.
Finally, the ternary delusional arguments of reference exhibit the following structure: (R10) ? the presenters of the shows speak according to what I do or what I feel premiss (R11) ? television speaks about me conclusion The ternary d elusional id ea of reference is the one accord ing to w hich television speaks of the patient. The logical structu re of the alternative hyp othesis is the one und er w hich television does not speak of the patient. H ow ever, in the same w ay as above, such a hypothesis d oes not possess in itself an explanatory p ow er. For the conclusion (R11) has, in the patient's m ind , an explanatory fu nction to the succession of events that he/ she experienced . It p roves thus necessary, at this stage, to propose an alternative exp lanation, w hich resid es in the fact that throu gh the effect of coincid ences, it frequently happens that the p atient's internal events are immed iately follow ed by external events, w hich can give the impression that there is a causal relationship betw een the tw o successive events. H ow ever, it may be p ointed out to the patient, there is a much larger number of pairs of su ccessive events that are not consiste nt w ith a causal relationship . It is ind eed a com mon attitud e to p ay attention only to the succession of tw o events that cou ld be meaningful, even though it occurs every d ay m any more successions of tw o u nmeaningfu l events and to w hich one d oes not p ay any attention. This appears as a special case of misinterpretation of random data (Bressan, 2002).

CON CLUSION
At this p oint, it is w orth translating the previou s elem ents in terms of testable hypotheses by the clinician. This lead s thus to test the hyp othesis that cognitive therapy applied to p olythem atic d elu sions m ay be m ore effective if it inclu d ed tw o su ccessive step s: the first ad vocated by the p resent stu d y that aim s to reconstru ct the p atient's general ability to acquisition of know led ge throu gh the practice of the experimentalist method ; and the second , classically d efined by cognitive therapy of schizophrenia that lead s to ap ply specifically the skills thus acqu ired to the content of polythem atic d elu sions. Finally, it is possible to synthesize the id eas regard ing the co-morbid ity of schizophrenia w ith the elements resu lting from the present stud y. We are thu s able to d efine the d ifferent stages of the resulting process for cognitive therapy of d elusions inherent to schizop hrenia. This w ou ld mean thus, in a first step, d etermining the co-morbid d isord ers (specific phobias, generalized anxiety d isord er, social p hobia, intermittent explosive d isord er, etc.). associated in the p atient w ith the d elusional id eas and to app ly first a specific cognitive t herapy. In a second step, it w ould mean app lying the learning p hase of the above -mentioned method experimentalist of a general nature. Finally, in a final phase, it should be p roceed ed as ind icated by classical cognitive therapy, by app lying specifically t he exp erimentalist method ology to the content of d elusions. This can be translated as follow s in term s of testable hypotheses: a cognitive therapy of schizop hrenia that w ou ld proceed accord ing to these three successive stages could be more effective than classical cognitive therap y.