Dr. Rosa Ritunnano, MD, PhD

From Anomalous Experience to Affective (Dis)Orientation: Psychosis, Emotional Upheaval, and the Psychiatric Encounter

In this talk, I propose a shift from the language of ‘anomalous experience’ toward that of ‘affective (dis)orientation’: embodied ways of finding oneself already situated within a meaningful, but often unstable, life structure. From this perspective, common ‘symptoms’ observed in the context of psychosis, such as delusions and hallucinations, may be understood not simply (and statically) as anomalous perceptions or epistemic failures, but rather as embodied enactments of affective and metaphorical meanings: attempts to articulate a deeply affective and embodied kind of relatedness to oneself, others, and the world in the midst of emotional upheaval. Such an approach does not deny the reality of suffering and distress in psychosis but seeks to reopen possibilities for understanding where clinical frameworks risk overlooking, overdetermining, or rendering subjective life unintelligible. I suggest that attending to the embodied, affective and meaning-laden dimensions of psychosis may help mitigate forms of epistemic and hermeneutical injustice, while fostering more dialogical and ethically responsive psychiatric practice.

To develop this account, I draw on recent in-depth qualitative studies that offer rich and nuanced descriptions of emotional experience in schizophrenia and psychosis. I focus particularly on experiences of “emotional upheavals” frequently reported in the period preceding psychosis, and interpret these as disruptions or radical reorganisations of affective orientation. Such upheavals often reflect interpersonal situations in which one’s life project—understood as a structured system of hopes, desires, expectations, commitments, and possibilities—is profoundly destabilised.

I discuss shame as a paradigmatic example of this process. Acute or enduring experiences of interpersonal victimisation, humiliation, rejection, exclusion, or disconnection may disrupt a deeper layer of relationality that is constitutive of human existence and fundamental to experiences of safety, belonging, and self-acceptance. Where consciousness becomes structured through the embodiment of shame, bodily self-experience, the perception of others, and self-identity may be disclosed together as a unified affective gestalt. In such situations, the social world may be experienced as exposing, invasive, (verbally) judging, belittling, or threatening, while the bodily self is experienced as fundamentally vulnerable, exposed, diminished, tainted, deserving of punishment, and driven to withdraw or hide. I argue that this phenomenological profile closely resembles some of the experiential transformations observed in psychosis, including what are commonly described as “persecutory delusions,” “ideas of reference,” “thought broadcasting,” “active social withdrawal,” and “derogatory voices.”

I conclude by suggesting the idea of affective (dis)orientations as a useful framework for understanding how experiences often understood as bizarre, ineffable, or delusional can emerge from transformations in embodied relatedness and emotional consciousness. More broadly, I argue that embodied and affective approaches may help illuminate dimensions of subjectivity that remain obscured when symptoms of psychosis are prematurely separated into and approached as positive/negative symptoms, cognitive/perceptual deficits, or anomalous experiences.