Journal of evaluation in clinical practice · 2026
The Insight Trap: Recursive Affective-Symbolic Loops and the Architecture of Chronicity.
СтатьяНазвание и аннотация: Перевод в очереди
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Vezzoli Rafael Tonella
Аннотация
RATIONALE: Chronic psychological suffering may persist despite adequate diagnosis, evidence-based treatment and preserved cognitive insight. In clinical practice, this persistence is often interpreted as treatment resistance, symptom severity or insufficient adherence. However, such explanations may fail to capture the structural organization through which suffering becomes stabilized over time.
AIMS AND OBJECTIVES: This theoretical article proposes an alternative conceptualization of psychopathological chronicity as a structural mode of organization sustained by recursive affective-symbolic loops, rather than by the mere persistence of symptoms. It aims to explain the paradox of insight without recovery and to clarify how chronic suffering may acquire a homeostatic function.
METHOD: The article integrates concepts from clinical psychopathology, phenomenology, affective neuroscience and predictive processing. It also draws on converging evidence from clinical domains in which psychological status, perceived health and self-regulatory appraisals modify relationships among symptom reports, objective findings, functional impairment and somatic outcomes. Clinical vignettes are used to illustrate the proposed model.
RESULTS: The proposed framework suggests that cognition may become functionally recruited in the stabilization of chronic suffering. Within this organization, chronicity can operate as a form of "pathological health", protecting the subject from greater psychic fragmentation while simultaneously maintaining distress. The model also highlights how therapeutic interactions may inadvertently reinforce recursive loops when interventions remain confined to cognitive insight, reassurance or premature disruption.
CONCLUSION: Psychopathological chronicity may be better understood as an affective-symbolic architecture that organizes symptoms, self-appraisal, embodiment and relational patterns. Structural change may therefore require embodied and transferential interventions capable of disrupting the recursive core, together with operational markers for distinguishing timely therapeutic destabilization from premature disruption. This model is primarily applicable to adult and older adolescent populations and may contribute to a more nuanced evaluation of chronicity in clinical practice.
AIMS AND OBJECTIVES: This theoretical article proposes an alternative conceptualization of psychopathological chronicity as a structural mode of organization sustained by recursive affective-symbolic loops, rather than by the mere persistence of symptoms. It aims to explain the paradox of insight without recovery and to clarify how chronic suffering may acquire a homeostatic function.
METHOD: The article integrates concepts from clinical psychopathology, phenomenology, affective neuroscience and predictive processing. It also draws on converging evidence from clinical domains in which psychological status, perceived health and self-regulatory appraisals modify relationships among symptom reports, objective findings, functional impairment and somatic outcomes. Clinical vignettes are used to illustrate the proposed model.
RESULTS: The proposed framework suggests that cognition may become functionally recruited in the stabilization of chronic suffering. Within this organization, chronicity can operate as a form of "pathological health", protecting the subject from greater psychic fragmentation while simultaneously maintaining distress. The model also highlights how therapeutic interactions may inadvertently reinforce recursive loops when interventions remain confined to cognitive insight, reassurance or premature disruption.
CONCLUSION: Psychopathological chronicity may be better understood as an affective-symbolic architecture that organizes symptoms, self-appraisal, embodiment and relational patterns. Structural change may therefore require embodied and transferential interventions capable of disrupting the recursive core, together with operational markers for distinguishing timely therapeutic destabilization from premature disruption. This model is primarily applicable to adult and older adolescent populations and may contribute to a more nuanced evaluation of chronicity in clinical practice.