Introduction: This paper proposes the hypothesis that aesthetics plays an important role in the construction and maintenance of delusional ideas in schizophrenia. Method: A selective review of the literature on the cognitive science of aesthetics, beginning with the work of William James on the stream of thought, was undertaken together with a review of some of the cognitive neuroscience literature on delusion formation in schizophrenia.Results: It is suggested that delusion formation has some similarities to to the creative process, but commences with a proto-psychotic anomalous experience in which an aberrant Jamesian fringe experience is generated. The consequence of such deviation from standard or expected conscious experience is to direct processing resources in a search for meaning, but under conditions of reduced prefrontal cortex monitoring and control mechanisms. Lowering of the usual constraints exercised by prefrontal cortex regulatory mechanisms causes the search for explanation or interpretation to be characterised by low self-reflection, temporal distortion and low volitional control, permitting relatively unfiltered ideas that do not conform to convention to emerge in consciousness. The combination of aberrant Jamesian fringe experience and reduced prefrontal regulatory mechanisms evoke idiosyncratic contextual associations and drive a hypersensitive salience assignment system in the search for meaning, out of which process nascent delusional beliefs emerge. These are accompanied by a ‘sense of rightness’ in the Jamesian fringe which signals the presence of a ‘good fit’ between the proto-psychotic anomalous experience in the centre of consciousness and the contextual associations evoked. Conclusion: The ‘sense of rightness’ or ‘good fit’ is responsible for the aesthetic qualities of the delusion and, it is proposed, accounts for the incorrigibility of the delusions.
Cognitive Neuropsychiatry Vol. 15, Issue 1-3, p. 181-201