ABSTRACT
It is through an integration of sensory information and stored knowledge in memory that we perceive and interpret the objects, events and emotions that make up our world. Thus, we may perceive a state of happiness in the self, or another, when inner cues such as a feeling of elation, or external signs like a smiling face, are detected and associated with previously held conceptions about what a state of happiness is. In patients with psychosis, however, this transaction between external and internal environmental cues and knowledge of the self and the world can be disrupted at any point. Indeed, psychosis is a mental state where there is, proverbially, some loss of contact with reality and where there are disturbances to the normal processes of thought and perception. When the normal mechanisms of mental appraisal are impaired, it is not only the perception and appraisal of external behaviours and events that is at risk of misinterpretation. The realization and understanding of the psychotic state in the self is likely to be distorted. In respect of auditory hallucinations, for example, patient explanations of the phenomena may range from claims of possessing a special power to hear such voices, to a belief that the voices are normal and that others can hear them too. If anomalous mental events such as hallucinations are adjudged in this way, the consequences can extend from disagreement with those who contest that interpretation, to a failure to recognize that help may be needed to manage such disordered and often distressing thought processes. In this chapter we focus on the link between the self-appraisal of psychotic states, the impact that has on perceived treatment needs and how that is re¯ected in treatment-related behaviour.
