Who’s Delusional? And How Do We Support Them?


In mainstream society, when attempting to assess whether or not someone is “mad” or “mentally ill,” a lot of effort is put into trying to determine whether or not someone is “delusional” (i.e, is harboring beliefs that do not conform to those generally held within mainstream society), and if deemed so, trying to coerce that person to conform. I believe this approach, however, is not only seriously misguided but potentially extremely harmful—not just to the individual but also to our society, our species and our planet.

I readily agree that when trying to support someone’s movement towards health and wellbeing, it is very important to consider their belief systems; however, I don’t believe it is the degree of anomaly (the degree of so called “delusion”) that is particularly important, but rather the degree to which these beliefs support or interfere with the meeting of one’s needs. I believe that this shift in emphasis (from pushing for conformity to the meeting of one’s needs) offers us a relatively simple framework for offering genuine support to someone who is challenged by distressing anomalous beliefs.

  1. First of all, as supporters, it’s important that we assess whether an individual’s anomalous beliefs really are distressing (i.e., significantly impeding on the needs of self or others), and honestly evaluate our own reasons for wanting to challenge them.
  2. Foster healthy skepticism of one’s beliefs, not only in the person we are trying to support, but in ourselves as well.
  3. Finally, try to determine the basic needs that are not getting met, distinguish these needs from a particular strategy or behavior that someone may be fixated upon, and support the person in exploring the most sustainable and least harmful strategies for meeting these needs. (Here is a good list of what I mean by “needs”).

I’ll expand on each of these:

1.  Distressing vs. Nondistressing Anomalous Beliefs:

As I mentioned above, there tends to be a strong emphasis in mainstream mental health and mainstream thinking in general to place our primary focus on determining whether or not a particular belief conforms to the consensus, to see deviation in this regard as representing “illness,” and then to put our efforts into coercing the person to conform. But is this really so beneficial, and if so, to whom?

I believe that Ernest Becker (in his book, “Denial of Death”), made an excellent case that the mere presence of other individuals holding belief systems radically different than our own may illicit within us a profound sense of anxiety, threatening our own sense of existential security and acting not unlike someone pointing a gun at our head. Furthermore, this profound insecurity is likely to compel us to do whatever we can to eliminate this threat, either by converting the individual(s) to our own belief systems or eliminating them from our sphere of existence altogether—such as by killing them, incarcerating them or invalidating them (e.g., they’re “crazy,” “mentally ill,” “evil,” etc.)

But if we have the courage and honesty to recognize our own insecurity in this regard, to practice “easygoing in the not knowing,” and reevaluate someone’s belief system from this stance, we’re likely to be in a much better position to determine whether this person’s belief in and of itself is actually harmful. Just because it’s anomalous doesn’t mean it’s harmful; and in fact, it may be beneficial.

To give a personal example, my own mother believes that she is a Venusian walk-in who came to inhabit her Earthean body when it was just 7 years old, benevolently taking over after the original occupant experienced serious abuse and needed a way out (she shares this openly, so I don’t mind sharing it here). She has held this belief solidly for as long as I can remember, and it doesn’t appear to cause any significant harm to herself or others—to the contrary, I think that in many ways it has really served her. I find it hard to see the benefit of trying to convince her to conform to the consensus and relinquish this belief system.

Looking more broadly, when we as a society put so much emphasis on the importance of determining whether or not people’s beliefs and perceptions line up with consensus reality, insisting that those who stray too far are in need of “treatment,” what leg do we really have to stand on? Let’s look around at the world that is rapidly taking shape as its human inhabitants become ever more indoctrinated into an increasingly globalized form of consensus reality—rampant environmental and biospheric destruction; perpetual war and empire building; an exponential increase in the unequal distribution of wealth, resources and power; a steadily eroding regard for human rights and genuine democracy; one of the largest species extinctions our planet has ever seen, with our own species likely not far behind; and the list goes on and on…   I have a really hard time seeing our consensus belief systems and corresponding behaviors as “sane.”  If this is what we call “sanity,” then I suspect our species could use a lot more “madness,” and a lot more respect, curiosity and openness towards the messages conveyed by those we deem “mad” or “delusional.”

In short, if someone’s anomalous beliefs are not causing significant harm to self or others, can we find the courage to let them be, and maybe even open up to the possibility that their beliefs may have some merit and be willing to reevaluate our own beliefs?

2.  Fostering Healthy Skepticism:

I believe that we all perceive and experience the world through the distorting lenses of our own belief systems. If we want to offer real support to someone who is distressed by anomalous beliefs, it’s important that we be willing to suspend our own belief system so that we can support the person in a genuinely open-minded exploration of  their own beliefs, helping them to look honestly at the evidence for and against their beliefs. In this approach, it’s particularly helpful to emphasize making the distinction between observation and interpretation, and to encourage a willingness to hold interpretations lightly.

For example, one young man I was working with came to me with a diagnosis of “paranoid schizophrenia,” was on a heavy cocktail of psych drugs, and was struggling with the highly distressing belief that most of the people whom he encountered (strangers on the bus, students and teachers in class, etc.) were intensely fixated on him, harboring highly critical and hateful thoughts about him. I acknowledged that I was in no position to directly refute his beliefs (how could I—I hadn’t been with him in those locations and even if I had been, how could I ever know with certainty what was going on in the others’ minds?) However, by encouraging him to first notice how preoccupied he was with himself and his own needs, and by sharing my own personal experience and my experience with others in this regard, I encouraged him to consider that maybe other people are also far too preoccupied with themselves and their own needs to devote the kind of attention to him that he was imagining. We also explored what reasons he imagined people had for harboring such intense hatred for him, and he wasn’t able to come up with anything concrete. So together we developed a new hypothesis—that others may actually be far more preoccupied with themselves than what he had been imagining, and that perhaps most of them actually didn’t harbor such intense animosity towards him. I then encouraged him to test this new hypothesis out in the world, comparing it to the behaviors he was actually observing in others. He soon realized that these new beliefs seemed to be much more congruent with his observations than his former beliefs. His distress diminished, he successfully tapered off of his drug cocktail, and the door opened for us to begin exploring the deeper core material that was feeding these kinds of distressing beliefs in the first place.

As a second example, returning to my own mother and her anomalous beliefs, in my younger years, there were times when I tried to challenge her beliefs (for various reasons, including my own existential insecurities); yet, she was always able to respond with very coherent, difficult-to-refute answers, even considering that I am someone who has studied physics and cosmology fairly extensively. She is so convincing, in fact, that she has developed a following of believers. As a result, I have come to hold my own beliefs in this regard very lightly—on one hand, maybe she has unconsciously constructed an elaborate belief system to protect herself from the terrible injuries of her youth; on the other hand, maybe she really is a Venusian—who am I to say otherwise?

3. Finally, Exploring the Unmet Needs Underlying the Distressing Belief System, and Supporting the Person in Developing Effective Strategies for Meeting Them:  

I believe this is really what genuine support is all about. As living organisms, when our basic needs are met “well enough,” we generally enjoy our lives and are unlikely to have to resort to potentially harmful or distressing strategies or belief systems in attempts to meet our needs.

Returning to the case of the young man I discussed above, when we first began our work together, his most pressing need was to feel safe. Since his belief system itself was clearly distressing and relatively simple to challenge, by focusing initially on the strategy of fostering healthy skepticism towards this belief system, and developing his capacity to distinguish observations from interpretations, he was able to meet his need for safety, at least “well enough.” This then opened the door to recognizing deeper needs that had generally been unmet in his life and which had been fuelling his distressing beliefs—chief among these being self-acceptance and belonging and acceptance from others—which we were in turn able to explore and to then work on developing effective strategies for meeting these.

So, in this case, the beliefs were relatively simple to challenge, but how do we support someone who is having distressing anomalous beliefs that are not so easy to challenge? One example I find illuminating in this regard (I believe given by Tamasin Knight or Rufus May) was of a woman who believed aliens were beaming messages into her mind. This is clearly a very difficult belief to directly challenge. How could we ever really disprove this? Who knows? Hypothetically, it may actually be true? So the support person chose to focus on the most pressing unmet need—safety—but not by directly challenging the belief. Working collaboratively, they agreed that the person should experiment with wearing a tinfoil hat on her head. This did indeed result in her feeling more safe, but now she found herself feeing embarrassed when she noticed others staring at her in her tinfoil hat. So this strategy, while meeting her need for safety, didn’t meet her needs for acceptance and belonging. So the strategy was modified, and the tinfoil remained but an ordinary hat was used to cover and hide the tinfoil. Now, with her basic needs for safety and acceptance being met well enough that her distress was reduced to a more workable level, the “malevolent aliens” belief faded away, and she was able to go on to make significant resolution with more core material that lay beneath these experiences.

And what about cases where an individual is experiencing belief systems that are highly unstable, a condition we often think of as “florid psychosis”? I believe that this particular experience suggests a kind of extreme state in which a person is undergoing a growth-oriented transformation at a core level of their being. Even in such extreme cases, the recovery research is quite robust in suggesting that when the emphasis is on meeting their basic needs (e.g., safety, empathy, dignity, respect, choice, etc.), they are much more likely to experience a successful resolution of this chaotic condition and move towards genuine wellness (I discuss this in more detail in Rethinking Madness).

Finally, while on the issue of needs and developing strategies to meet them, it’s important to recognize that we are very social beings living in a profoundly interconnected and interdependent world. This is why it’s important to consider not only our own needs but also those of others when developing effective strategies. For example, killing someone who poses some kind of threat to us may seem to be an effective strategy for meeting our own need for safety or perhaps dignity. However, what about the needs of the person who we intend to harm? And even if we are so furious or callous that we are unable to consider the needs of this other person, we still must recognize our own needs likely to be undermined by such an act—security and ease, as we are likely to be sought by the law or friends and relatives of the individual; authenticity and honesty, as we now have to try to hide this ugly truth; peace of mind, as such an act can rarely be accomplished without reinforcing a particularly unhealthy state of mind within ourselves, such as rage, fear or guilt; etc.

So, Having Addressed Anomalous Beliefs, What Do We Do About Consensus (Mainstream) Beliefs That Are Harmful?  

I suggest we take the same approach in working with harmful consensus beliefs as we do with harmful anomalous beliefs.

One example of a belief that is consensus within many large groups while also being potentially extremely harmful is the belief that human activity is not leading to climate change. So, to support those harboring this particular belief, we would first assess whether the belief is actually harmful. In this case, the fact that this belief has the potential to wipe out much of the life on this planet, including our own species, strikes me as being clearly very harmful, so I think we can say that this preliminary criterion is safely met.

Second, we foster healthy skepticism:  The evidence supporting the theory of human-induced climate change is very abundant and growing all the time, whereas the evidence against it is rapidly diminishing and approaching nil, if not already there. However, since the belief that humans are not causing climate change may not appear to be directly distressing to the individual holding it and may be even beneficial to them, it’s likely that they will have little motivation to challenge this belief in an open-minded way. Therefore, we may need to begin with the third step and go straight to identifying the unmet needs underlying this belief.

I suspect that for many people who deny human-induced climate change, such denial is a strategy to try to meet their need for security and also perhaps ease (with “denial” implying a refusal to look honestly at actual observations made by oneself and others). However, it’s not difficult to point out that denial tends to be an effective short term strategy and a very poor long term strategy, in that it inhibits open observation and the flexible responsiveness necessary to continue meeting one’s needs—clearly these people could use some support in developing more effective strategies for meeting their long-term security needs. Another strategy we can say is often employed by those denying climate change (particularly those invested in the fossil fuel industry) is the hoarding of wealth and resources for oneself, which also are most likely means to meet one’s need for security as well as personal power. But again, we see a strategy that may be very effective for these individuals in the short term but very ineffective in the long term. Again, these individuals really could use some support in developing more sustainable strategies for meeting their needs. (And considering just how devastating this particular belief system has the potential to be, this may be one of those instances where the protective use of force is justified, but that’s another story.)

There are plenty of other examples of harmful consensus beliefs that we could approach along these same lines (e.g., the belief in the medical model of “mental illness”—see my article here; the belief in the sustainability of expansion economics and unbridled capitalism; the belief that violence is an effective way to obtain peace; etc.). But my main point is that when it comes to supporting the movement towards wellbeing—whether for individuals, societies or our planet as a whole—I don’t believe that it is particularly helpful to focus on how anomalous a particular belief is. Rather, what’s most helpful is to recognize that, ultimately, wellbeing is most directly related to how well we are able to meet our needs, and that by holding all belief systems with healthy skepticism and by developing effective strategies for meeting those needs in a sustainable way, we are far more likely to succeed in moving towards genuine health and wellness.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


  1. Paris thanks for an informative, revealing and thought-provoking post. I like that you share your mother’s story and that she is OK about it. I like hearing the case of the young man who you worked with, a practical demonstration of getting alongside and connecting. I like your mention of skepticism, being a skeptic myself, about nearly everything. As in, take it with a pinch of salt.

    However, rather than advocating suspending belief, I would say it’s useful to suspend judgement. To not allow our belief system to impinge on another person’s way of seeing things. My belief is a faith that is central to my life. It’s about me and not about others. It’s not a religion or a way of life although it is the way I live my life. By faith. It’s a paradox. I won’t be suspending it but I won’t be expecting others to believe what I do. Equally I don’t want them to be forcing their beliefs or religion on to me.

    I don’t mind if others judge me. It’s part of human nature I think to form opinions that become judgements. Skepticism as you say keeps the rigidity of judgementalism at bay and our feet on the ground. Laughing at ourself is another leveller I find, along with laughing at others. We’re all in it together. Life. It’s a funny old world. I do want to enjoy the time I have left in it.

  2. How do we NOT support the Delusional , you mean?
    A prison that is not a prison because “we” call it a hospital.
    A poison/drug that is not a poison/drug because “we” call it medicine.
    A lobotomy that is not a lobotomy because “we” call it treatment.
    A religion that is not a religion because “we” call it science.

    It is all about following orders.

  3. Paris, thank for reinforcing the need to suspend belief/judgement by giving some examples. As a mother who has made the acquaintance of other mothers in the “mad” community, it is difficult to accept that the belief system that our relatives has constructed is not harmful to them or us, because it inevitably makes us sad for our relative and despairing that things will ever be better for them. And that’s exactly WHY we must change our own beliefs – to take the stress off our relatives or friends and help them gain confidence.

    This past year I have befriended a woman who has been involuntarily confined to a psychiatric hospital and lost custody of her child to her ex-husband because her behavior was increasingly seen as unhealthy for her child. Her beliefs, or at least the one that was the most noticeable, was that her husband is an imposter. Others who know this lady believe she is seriously mentally ill, but after thinking about it a bit, I figured she’s probably right about her husband. He’s not the man she married, e.g. this unrecognizable person who she presumably once loved, now has locked her up and denied her access to their child. Not at all the behavior of the man she married. She’s was traumatized before she entered hospital, but is slowly getting better, and the last thing I would ever want to do is to label her “mentally ill.” She would lose all trust in me and feel panicked.

  4. Rossa–that is so kindhearted and intelligent of you. Most people congratulate themselves on refusing to create a space for mutual acceptance with someone who is hard put to focus on an argument ahead of how to keep minimal trust in yourself and things.

    Paris–I wanted to chime in about how helpful and encouraging it is that you talk over your educational adventures of all sorts, collecting the points in terms of how it leads you to orient yourself in the help you extend to folks working through deep problems. Obviously, learning to put learning experiences to work is a major element in the recovery toolkit, and seeing someone up close who does that makes for timely inspiration.

      • Hi Rossa–Several little things and other things in general that justified the effort got me to the name. My sister took her own life, under the influence of Paxil, withdrawing from Paxil, having a rough time with her second postpartum depression, and not a lot of the type of support she needed. Also, I believe that she got little or nothing more than than a cursory version of concern expressed by professionals in whose “care” she was. And that includes what they might have said to her husband, and so on. Anyway, she lived in Paris for a year and attended university there…

        So, besides the appeal of the language and tradition, there was visiting her there myself to keep as a memory beyond her death. In addition, then, once, to connect to some website or other, I had to create a gmail account, and all the words I was trying were in prior use. So I took the travelling dictionary out and constructed this handle out of concepts related to this historical worker’s liberation speech that went coldly regarded at the time, that Sartre once gave to striker’s, I believe, in support of their cause and to enlighten their rhetoric and point up faults in the establishment. Beauvoir wrties poignantly of it.

        As far as what I saw in your comment, it helped me to assume the right attitude toward the potential for putting into action the ideas that Paris (the man) had written about here. I have been reading philosophy and just finished up some articles and chapters on religious belief, and one of these talked about the benefit of a particular shift in attitude that allowed you to construe new categories of actual truths from within a framework that you cannot empirically justify, relative to the fact that you can’t demonstrate the existence of anything supernatural.

        All of that sort of thing is about how feelings may take us beyond words, and yet leave us with worthwhile things to think about, maybe the most worthwhile things. I’m not a believer, but I wanted to get it right. So seeing your way of putting Paris’s point, and thinking of how I’d like to know how to give anyone their space, offered somewhat of a chance to try this withholding of judgment and maintaining a certain openness.

        I look forward to more of your posts, and Paris’s, too. My own experiences don’t extend to offering clinical care, and as a consumer I’ve gotten very little worth much of anything at all.

  5. Thanks Paris for this coherent view of how to approach people with really different beliefs! I think the bit about the importance of noticing when beliefs impact needs was well written and addresses a really important issue.
    I have heard of research showing that the majority of the population holds at least one belief that psychiatry believes is delusional, and that 10% of the population holds more “delusional” beliefs than does the average “psychotic inpatient.” Obviously, these people are not all in need of being “helped” to make their beliefs more normal! So it makes sense we need to be careful to only offer help when it is truly needed, and to then do our best to insure it is really helpful and not destructive.

  6. Paris,

    I very much agree, the psychiatric industry must rethink their right to call everything they are unaware of, or don’t personally believe in, a “delusion.” After all, the DSM isn’t really a valid “bible.”

    My NW suburban Chicago psychologist and psychiatrists believed this former New Yorker’s disgust at 9.11.2001, was an “odd belief.” They are, however, the only people I’ve ever met who believe this, other than the guys who raped my four year old child and tried to cover that up by denying my daughter a baptism at the exact moment the second plane hit the second World Trade Center building, then spewed a bunch of lies and gossip to the psychologist.

    But, according to medical records, this ELCA “Christian therapist,” the Jewish psychiatrists, and Christian psychiatrist all also thought a dream query regarding the Holy Spirit was a “Holy Spirit voice” proving psychosis. I guess they all allowed their belief in the “lacking in validity” DSM “bible” to trump their hypocritically proclaimed belief in the Holy Bible?

    Personally I’m quite certain a lot more open mindedness is needed within the psychiatric industry (in part because it is actually still illegal in the US to defame and poison people for belief in the Holy Spirit). And because “antipsychotics don’t cure concerns of child abuse” (especially once the medical evidence has been handed over), disgust at 9.11.2001, or belief in the Holy Spirit and God.

    I agree with others who’ve commented that the psychiatric industry has turned itself into nothing more than an unscientific, secular religion. But since that’s what they want to be, they should remember we do still technically have a First Amendment guaranteeing freedom of religion in the US. Their DSM “bible” doesn’t actually trump the Holy Bible, nor even come close to the wisdom provided within the Holy Bible, IMHO. And I DO have a legal right to that opinion. And what if the Holy Bible is correct and denial of the Holy Spirit is the one and only unforgivable sin? Those who harm children and cover it up are the “unforgivable”? What if there is a just God?

  7. The definition of delusional seems to be more defined by the outsider than the person experiencing the delusion. (And while I do not mean to spark a religious debate in saying this) If I talk to a person who no one can see, and I can’t prove to exist, I’m hallucinating. However, if I talk to God, it’s suddenly okay. It is not delusional to think that your morals are so superior to others that you should be able to dictate them into law, but it is delusional for me to think that I can live with this disorder without psychiatry and medications. In fact, I think the presence of a label of mental illness actually leads people to assume I’m delusional rather than making a thorough inquiry. Don’t get me wrong. I’m quirky, but I think that’s part of my charm.

  8. Re “I suspect that for many people who deny human-induced climate change, such denial is a strategy to try to meet their need for security and also perhaps ease (with “denial” implying a refusal to look honestly at actual observations made by oneself and others). ”

    1. Read about the global warming theory, they use all the same disclaimer words as people pushing the serotonin theory “suggests” , “linked to” , “presumed to be”.

    2. Earth’s current atmospheric CO2 concentration is almost 390 parts per million (ppm). Adding another 300 ppm of CO2 to the air has been shown by thousands of experiments to greatly increase the growth or biomass production of nearly all plants. People who grow cannabis indoors know all about this !

    More CO2 and plants grow faster to deal with it. The tundra melts and a million + square miles turns to forest .

    Call me delusional as you want but I believe there would be no life on earth at all if this planet did not have a “checks and balance” system that works very very well, well enough to cope with our petty little influence over a few decades.

    Life on earth survives meteor strikes , massive volcanoes all links of stuff for millions of years but then man kind comes along and digs up some coal and oil and burns it and now it all comes to a cataclysmic end !

    This is the way the world ends
    This is the way the world ends
    This is the way the world ends
    Not with a bang but a whimper.

    T. S. Eliot


    • Lets keep burning 1.2 gallons of petroleum to make one gallon of ethanol !
      “An acre of U.S. corn yields about 7,110 pounds of corn for processing into 328 gallons of ethanol. But planting, growing and harvesting that much corn requires about 140 gallons of fossil fuels and costs $347 per acre, according to Pimentel’s analysis. Thus, even before corn is converted to ethanol, the feedstock costs $1.05 per gallon of ethanol.

      * The energy economics get worse at the processing plants, where the grain is crushed and fermented. As many as three distillation steps are needed to separate the 8 percent ethanol from the 92 percent water. Additional treatment and energy are required to produce the 99.8 percent pure ethanol for mixing with gasoline.

      * Adding up the energy costs of corn production and its conversion to ethanol, 131,000 Btu are needed to make 1 gallon of ethanol. One gallon of ethanol has an energy value of only 77,000 Btu. “Put another way,” Pimentel said, “about 70 percent more energy is required to produce ethanol than the energy that actually is in ethanol. Every time you make 1 gallon of ethanol, there is a net energy loss of 54,000 Btu.”


  9. Hi Paris, Thank you for this very interesting post. I am most intrigued by your comment that a person who is experiencing extreme anxiety may want to kill someone who threatens their existential security. I personally have never experienced wanting to kill someone, so it has been extremely difficult for me to understand why my son threatens to kill me when he has episodes. It is so hard for me to understand why he hates me so much when I have always tried to be so supportive. I think perhaps I haven’t really understood his needs. Maybe he needs more independence and wants people to respect him rather than try to take care of him. I appreciate your addressing this issue since it is rarely mentioned.