“Show me a sane man and I will cure him for you.”
Within the mental health profession, clinicians and researchers who value a system of categorical illnesses and individual defects too often proclaim that the major feature delineating “real psychosis” from other “disorders” is the presence of delusions. Two recent articles in the New York Times exemplified for me how skewed this assertion is. It also led to a greater awareness, more specifically, of how problematic it is to view so-called delusions as meaningless indicators of disease . . . for we all experience delusion. How one experiences the self, the world, and relationships (usually based on our relationships with our caregivers) determines the level with which one must cling to seemingly irrational ideas in order to maintain a sense of order and meaning in the world. Let me explain . . .
The first article, entitled “Hating Good Government“, is an op-ed piece that can be summed up by this quote: “At this point it’s hard to think of a major policy dispute where facts actually do matter; it’s unshakable dogma, across the board.”
It goes on to describe various political situations wherein people strongly adhere to their political views even in the face of overwhelming evidence to the contrary. Lest anybody mistake this present piece for a political one, I am not defending the legitimacy of any of the accusations made by the NYT author; rather, the important point is that the article highlights how strongly people can believe in something that may be completely false (whatever side you might be on), and how these beliefs become even more rigid in the face of contrary evidence. None of us can deny that this happens in politics all the time . . . on all sides.
The other article, titled: “How Expensive it is to be Poor“, can be summarized by its first paragraph: “Earlier this month, the Pew Research Center released a study that found that most wealthy Americans believed ‘poor people today have it easy because they can get government benefits without doing anything in return.'” The author goes on to say that “This can be the view only of those who have not known — or have long forgotten — what poverty truly means.”
Interestingly, in the first article, the beliefs are described as “dogma” and in the second as an “obtuse view.” To me, these were overt examples of the universality of delusion as part of human nature. Isn’t it remarkable how language can change everything when describing something?
What Are Delusions?
A delusion is described as “a fixed-false belief.” Using this definition, both of the NYT articles are describing delusional beliefs that just happen to be held by groups rather than lone individuals. Look, though, at how horrible this word is, and how quickly it dismisses the belief itself or, more importantly, the foundation upon which it is based. Many who are reading this blog now may believe some of the beliefs described in these articles. I imagine such persons would be enraged by my insinuation that their beliefs are delusional . . . and rightly so. So why do we think it is ok to do just that to people deemed “insane” or “psychotic”? I suggest that the view that “delusions” are the meaningless drivel of madmen can be the view only of those who have not known — or have long forgotten — what being mad truly means.
Delusions are the brain’s way of doing its job. Even in the actually diseased brain, in those suffering the debilitating effects of dementia, the brain is trying to make sense of its surroundings based on the limited knowledge it has left or the concurrent associations that arise through the degenerative process. The beliefs themselves are not disease, but may be indicative of some internal problem (with true “disease” being only one possibility). The beliefs appear irrational due to the lack of current context with which to appropriately explain circumstances.
Where is the line between an “irrational belief” and a delusion? Some might say that “real” delusions, as in psychosis, are bizarre and completely implausible. Hmmm . . . so who gets to define what is bizarre? Is Scientology a delusion? Telepathy? The idea that there is a humanoid-like figure who died and came back to life after first being born to a virgin? The existence of good and evil? Who decides where to draw this ambiguous line of “bizarre” and “implausible” and a respected “belief”?
They may not always be overt or spoken aloud, but we all have delusions that underscore a great deal of suffering. This assertion is not unique to me; much of Buddhist philosophy is built on this basic tenet. Delusions are not symptoms or diseases unto themselves; they are a “side-effect,” if you will, of being thinking, imperfect, humans. Trouble ensues, however, when one’s beliefs fall too far astray from the majority belief and/or when it leads one to behave in seemingly bizarre, socially unacceptable, or aggressive ways. Perhaps these behaviors result in being labeled a criminal, a sociopath, a narcissist, a terrorist, an evangelical, a genius, an artist, a gangster, or, maybe it just gets one labeled as psychotic.
Trauma and Childhood Development
Any kind of ideology can provide people a sense of control, particularly when experiencing chaos or confusing random events.1, 2 The more confusing, terrifying, overwhelming, chaotic or unjust the world in which one exists, the more elaborate, concrete, or fantastical the beliefs needed to feel in control, ease anxiety, and have a sense of purpose and importance. In general, belief systems serve to protect us and help us survive.
Like all other living beings, survival is the greatest instinct motivating human behavior. The term “trauma” is often used to describe events that are perceived as life-threatening and that create a sense of terror and dread; however, this term too often results in judgmental assertions of what is “bad” enough to be considered traumatic despite its subjective nature. Trauma theorists have long said that “trauma disorders” are behaviors and experiences that were once adaptive but now are causing problems. Why does this not translate beyond those recognized conditions or behaviors that are so-called “trauma-based”? I tend to talk about “trauma” because this is the field that appears to have the greatest amount of research on how problematic childhoods and overwhelming life experiences lead to what society calls “mental illness.” But, really, the term refers to an internal experience of panic, dread, terror, and brushes with death.
A sense of terror and fear of death has been shown to increase when confronted with questions regarding the meaning of life3 often brought about during times of life crises. Furthermore, an increased fear of death develops when a person’s strong beliefs are directly refuted or challenged,4 leading one to cling even harder to said beliefs in an effort to ease the overwhelming terror and anxiety. Protection against this cycle of psychological entrapment is brought about, in part, by close relationships5 and secure attachment to caregivers.6 On the other hand, when attachment with caregivers is damaged through engulfment, stress, neglect, inconsistency, or outright abuse, a child often learns to manage anxiety partly through symbolic representations of others .7 Additionally, an insecure attachment has been shown to be directly associated with odd behaviors in the face of existential fears and terror,8 and being diagnosed with a mental disorder.9
So, when a person grows up with a fractured or undeveloped sense of self due to difficulties within the family dynamics, he or she is much more prone towards extreme emotions and socially abnormal behaviors, particularly when experiencing fear and anxiety. Usually such children have also become either hyper-vigilant (where they over-react to sensory experiences and are constantly on alert), hypo-vigilant (where they shut down and become disconnected from the self and the world), or on a roller-coaster cycle of both. When the terror-inducing experiences are overt, a belief system that makes sense to others may develop around these events. Conversely, when the experiences are covert or implicit, greater effort needs to be put forth to explain the internal extreme emotional distress, and often this is done through symbolization.
For instance, when a person is beaten or sexually abused (and it is actually acknowledged by others) and this results in overwhelming anxiety, fear, feeling unreal, feeling the world around the person is a dream, heightened sensitivity to sensory experiences, rage, and violent images haunting their very existence, it is likely that this person will have the context of the physical threat to the body to make sense of these anomalous experiences. When they hear voices, they are often more clearly related to these events and are conceived as flashbacks, and “paranoia” is contextualized as hypervigilance. Because they can make some sense of these experiences, so can all those around this person. The person may feel like they are “going crazy,” but are never quite deemed so because the context for meaning-making exists, even if it is only on a superficial level.
On the other hand, when the source of one’s fears and anxiety is less identifiable (for instance, experiencing severe alienation, parental engulfment, confusing communication within the family, parents who are chronically stressed, double binds, implicit discrimination, etc.) or when overt trauma is denied by others, the more confusing things become. A child experiencing these phenomena is just as threatened as he who is being beaten, but does not have the recognition of others or the context in which to make sense of his emotional state. The fact that some of these experiences are just as traumatic to a child is backed up by research: Children who experience psychological “trauma,” such as emotional abuse, insults, verbal bullying, isolation, and overwhelming psychological demands within the family, are MORE likely to develop severe psychological disorders as adults than those who have been physically or sexually abused.10 This includes so-called “symptoms” of PTSD. Of course, too often, children experience a combination of all 3.
When terror and anxiety develop through psychological trauma, or when physical trauma is denied within the family, a belief system is likely to develop that serves to make sense of this illogical world. Robust research shows the undeniable link between childhood trauma and symptoms of psychosis, including delusions.11 Additionally, some researchers have argued quite convincingly that in many cases, delusions directly represent extreme emotional distress that can be understood through developmental processes.12
Importantly, the person who is stuck in a state of terror is one whose brain has directed all of its resources on survival. This does not leave room for taking the time for “rational” thought, decision-making, patience, conforming to social norms, etc. Research shows that those who are prone to what is clinically determined to be “delusional” thinking are also more likely to impulsively jump to conclusions, generally resulting in inaccurate decision-making.13 Perhaps most striking, is that many of these studies are conducted with “healthy” undergraduate university students who display a wide range of “delusional” thinking, thus further underscoring the idea that delusion is universal and is not necessarily indicative of disease.
So, people develop belief systems to help them make sense of the world, ease anxiety, create identity and meaning, and to provide a sense of protection. When a person has been traumatized (psychologically or physically), has a fractured sense of self, has had their reality chronically invalidated, experiences extreme and confusing internal states, and is alienated and alone, their belief system will develop accordingly. When such a person comes to the conclusion, for instance, that they are God, perhaps this is serving to explain the power such a child had growing up to greatly affect a parental figure, the fear this child had that if he was not “good” enough his parent might die (a normal reaction of a child to a distraught parent), a sense of identity that counter-balances the internal feeling of overwhelming worthlessness, and a sense of purpose or meaning as to why he suffers so. Once such a belief sets in, everything else must be explained in terms of this to protect the belief system . . . anything that refutes it is either ignored or distorted to maintain the illusion of identity and purpose. The more one challenges said beliefs, the more it triggers self-hatred, increased fear, anxiety, etc . . . leading one to need that belief even more.
Isn’t it ironic that we live in a world where “treatment” is focused on precisely that? And then we wonder why so many “patients” never heal? And this remains the case despite the fact that when a strong belief system is directly challenged, almost every human being in existence will react in the same defensive and rigid fashion.
How “Delusion” Becomes Viewed as “Illness”
Unfortunately, most of what the mental health field bases its assumptions regarding “delusion” and “psychosis” on is individuals who have been referred for mental health services. Once there, they have often been acutely traumatized by the process of involuntary commitment, their immediate presentation is often exacerbated by acute reactions to drugs/alcohol, and they are seen through a prism of biases that, in turn, create iatrogenic behaviors that may not have existed before entering the system in the first place (not to mention the effect of “medications”). Once a belief has been determined “sick” or “delusional”, the actions and attitudes against said person correspond. In turn, the person reacts to this invalidation and injustice in understandably extreme ways. It has been shown with so-called “normal” populations that when there is uncertainty, fear, and a sense of being treated unfair, people will exhibit extreme emotional reactions.14, 15 So imagine, then, the person who is already terrified and experiencing extreme emotions and then is invalidated and unjustly imprisoned. The person will behave in a manner that confirms the biased beliefs that set off such behaviors in the first place. As R. D. Laing said in “The Divided Self”: “The initial way we see a thing determines all our subsequent dealings with it.”
Better yet is when professionals assert their descriptions of what “real psychosis” is, based on people who are in their 50s and have been shocked, locked up, and drugged several times a year off and on for decades. The continuum of experience goes unrecognized and the context in which the extreme states have developed go ignored. The iatrogenic effects of the system and the so-called “treatment” is hidden and never spoken of. Even in cases where some attempt is made at meaning-making, the process may be so convoluted due to decades of interwoven associations and beliefs setting in, that the professional might still be “proven right” that no meaning can be made from “delusions.”
I would venture to state that for many, “delusion” can save from a far worse fate: death of the soul; suicide; annihilation. I know for myself, one of the worst phenomena I’ve experienced is overwhelming internal panic and a chronic need to escape. When I have believed that I must escape a friendship because the person wishes to harm me, or quit a job because all the employees are plotting against me, or I am being haunted within my own home by beings from the netherworld, or I’m being watched by unseen boogiemen, I have found relief; there was something to escape from. When I started to realize that everything I desperately wanted to escape was within me, there was nowhere to go. How does one run away from their self? An alternate reality sometimes is the only escape that results in continued survival.
In fact, psychosis may not be a “bad” thing at all, but rather the body’s way of healing. Let’s look at it from an evolutionary, human survival perspective. Inflammation, now erroneously considered a disease unto itself, is actually the body’s process of trying to heal itself. We drug it, haphazardly take supplements to decrease it, but when we pay attention, we might find the true disease. It is often stress, poor diet, a virus, an acute injury, and/or a lack of balance within the body that leads to its attempt to heal: inflammation.
If we just suppress the inflammation without looking at the source, we may get even sicker or even die because we have not found what the body is trying to heal from. Likewise, if we just insist on suppression of the anomalous experiences, dismiss them through terms like “delusion”, and ignore their purpose, the person may get even sicker because we have not found what the body is trying to heal from (which most often is trauma, oppression, a fractured identity, and learned behavior). Sometimes the extreme experiences must be temporarily abated in order to prevent great harm, but in most cases they must be tolerated and understood in order to foster the process of healing.
Imagine if mental health professionals did not insist upon gaining “insight” (really a euphemism for “believe what I tell you”), “fixing” a “broken brain”, or managing “symptoms.” Imagine if instead we all recognized that there is a reason someone has developed the beliefs they have and that understanding the suffering underneath is the key to healing and growth. What if we simply acknowledged a person for having a particular belief system instead of using judgmental qualifying terms like “delusion”? Mental health professionals have stopped asking “why” and instead focus so much on “what is wrong.” I believe this has set back any possible advance in the field of human studies because the “what is wrong” is ever-changing so long as the “why” is never addressed. If mental health professionals were to take a moment to view strange beliefs from this perspective, it might lead them to then ask “What happened, or what is happening that makes such beliefs logical?”
What do the delusions represent, what is the need? This is where intervention may come in. Directly invalidating and negating one’s beliefs is unhelpful and even harmful when they have developed to either protect from an even worse reality or to make sense of chaotic internal experiences. Understanding how they are used and what they represent opens a window into finding the source of pain or confusion. The one thing that is for certain, is that behind almost every so-called mental illness is a person who has little to no compassion for his or her self and likely loathes his or her very being. That is why “treatments” that focus on building true relationships, meaning-making, empowerment, a sense of purpose, calmness, autonomy, and validation are so incredibly powerful.
We all must strive to foster compassion on all levels. Building compassion comes from moving beyond our ego-centric viewpoints and understanding those with whom we disagree or do not understand the most. The truth is that we all live with some delusion. The recent NYT articles are just 2 examples of how delusions exist on a large societal level. Perhaps this whole blog is in some way a delusion. Maybe I don’t have a clue what I’m talking about. But . . . what if I do? At the end of the day, really, all any of us can do is our best to hold our beliefs lightly and be wary of what we think we know, while respecting and trying to understand that which we don’t.
1. Kay, A. C., & Eibach, R. P. (2013). Compensatory control and its implications for ideological extremism. Journal of Social Issues, 69(3), 564-585.
2. Pirutinsky, S. (2009). The terror management function of Orthodox Jewish religiosity: A religious culture approach. Mental Health, Religion & Culture, 12(3), 247-256.
3. Hayes, J., Schimel, J., Arndt, J., & Faucher, E. H. (2010). A theoretical and empirical review of the death-thought accessibility concept in terror management research. Psychological Bulletin, 136(5), 699-739.
4. Schimel, J., Hayes, J., Williams, T., & Jahrig, J. (2007). Is death really the worm at the core? Converging evidence that worldview threat increases death-thought accessibility. Journal of Personality and Social Psychology, 92, 789-803.
5. Hart, J., Shaver, P. R., & Goldenberg, J. L. (2005). Attachment, self-esteem, worldviews, and terror management: Evidence for a tripartite security system. Journal of Personality and Social Psychology, 88, 999-1013.
6. Bowlby, J. (1969/1982). Attachment and loss: Attachment (Vol. 1). New York, NY: Basic Books.
7. Maxfield, M., John, S., & Pyszczynski, T. (2014). A terror management perspective on the role of death-related anxiety in psychological dysfunction. The Humanistic Psychologist, 42, 35-53.
8. Goldenberg, J. L., & Arndt, J. (2008). The implications of death for health: A terror management health model for behavioral health promotion. Psychological Review, 115(4), 1032.
9. Lima, A. R., Mello, M. F., & de Jesus Mari, J. (2010). The role of early parental bonding in the development of psychiatric symptoms in adulthood. Current Opinion in Psychiatry, 23(4), 383-387.
10. Spinazzola, J., Hodgdon, H., Liang, L-J., Ford, J. D., Layne, C. M., Pynoos, R., Briggs, E. C., Stolbach, B., & Kisiel, C. (In Press). Psychological Trauma: Theory, Research, Practice, and Policy. Retrieved from: http://www.apa.org/news/press/releases/2014/10/psychological-abuse.aspx
11. Read, J., van Os, J., Morrison, A. P., & Ross, C. A. (2005). Childhood trauma, psychosis, and schizophrenia: A literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112, 330-350.
12. Freeman, D., & Garety, P. A. (2003). Connecting neurosis and psychosis: The direct influence of emotion on delusions and hallucinations. Behaviour Research and Therapy, 41, 923-947.
13. Cafferkey, K., Murphy, J., & Shevlin, M. (2014). Jumping to conclusions: The association between delusional ideation and reasoning biases in a healthy student population. Psychosis, 6(3), 206-214.
14. De Cremer, D., & Van Hiel, A. (2008). Procedural justice effects on self-esteem under certainty versus uncertainty emotions. Motivation and Emotion, 32(4), 278-287.
15. Van den Bos, K. (2001). Uncertainty management: The influence of human uncertainty on reactions to perceived fairness. Journal of Personality and Social Psychology, 80, 931-941.
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.
Yes it’s highly subjective, it’s like saying your depression is serious because it’s “clinical”.
Thank you very much for the enlightening article.
Wisdom comes from Detachment: I was told when I went into hospital that I had a physical brain disease and the talking treatments wouldn’t work for me. This was a DELUSION.
When I stopped taking psychotropics and learned to how to Detach I could see resolutions to my problems (in the same way as someone with Anxiety could).
I really liked this very thoughtful article. When I was a child, since I grew up in a state hospital and I had almost no adult support, I had to figure out for myself what I thought about things. I knew it would be dangerous for me if I accepted all the beliefs I was supposed to agree with. And I still see a lot of the ideas that I am supposed to agree with without question as irrational and, yes, delusional.
It is very hard sometimes not to go along with the program, but it still seems dangerous to me to agree with beliefs that are called “normal” that seems to have no grounding in reality. It gets me in trouble sometimes, since most people, as the author points our here, react almost violently when their beliefs are challenged.
It is hard and dangerous to think for oneself.
Thank you for your comment, Ted. It is dangerous and painful to think for oneself. I think it is the people who are able to stand strong and do so anyway that bring about the justice we do have in this world.
“It is no measure of health to be well adjusted to a profoundly sick society.” – Jiddu Krishnamurti
Sometimes the widely accepted idea is a lie.
This was a great blog; it has deepened my understanding of the relationship of trauma and psychosis.
In my first blog written at MIA (Addiction, Biological Psychiatry, and the Disease Model) I made the following statement:
“…extreme states of psychological distress can lead to altered states of consciousness that are mislabeled as a “mental illness” and a “disease,” but could instead be better looked at as a creative and necessary coping mechanism dealing with an experienced and/or perceived hostile and threatening environment. This coping mechanism, as with addiction, may also prevent more extreme reactive behaviors or provide an escape or temporary relief from intense physical or emotional pain.”
Your blog has given deeper meaning to the actual content of these types of coping mechanisms.
“I would venture to state that for many, “delusion” can save from a far worse fate: death of the soul; suicide; annihilation. I know for myself, one of the worst phenomena I’ve experienced is overwhelming internal panic and a chronic need to escape. When I have believed that I must escape a friendship because the person wishes to harm me, or quit a job because all the employees are plotting against me, or I am being haunted within my own home by beings from the netherworld, or I’m being watched by unseen boogiemen, I have found relief; there was something to escape from.”
This is a brilliant description of one’s possible thought process and related coping mechanism when faced with unexplained (at the time) feelings of internal fear and terror.
As to your references to when people believe they are God (or Jesus) you alluded to another powerful point; you said:
“When such a person comes to the conclusion, for instance, that they are God, perhaps this is serving to explain … a sense of purpose or meaning as to why he suffers so.”
A similar explanation came to me when I was recently counseling someone who had endured horrific childhood sexual abuse. Her memories came back to her in dream like sequences with heavy religious overtones. Her identification with Jesus was one of the only ways she could explain how a human being such as her could possibly be forced to endured so much human suffering – similar to Jesus on the cross.
Great stuff – a thorough going refutation of the theory and practice of Biological Psychiatry!
Thank you, Richard. I really do appreciate all your thoughts (and your blog too!)
Truly beautiful synthesis of the various factors that create our subjective reality. So who’s to say who’s delusional? We all awaken constantly to new realities as we go through life. Life is more fun when it’s surreal, and our thinking is creative and multi-dimensional, rather than simply linear.
What I have found to be most toxic is when I state a positive belief about myself and it is challenged. Sometimes it seems that the mental health industry is based on this practice, to challenge our happiness, joy, and positive self-image as we move along in our growth. I know that during critical parts of my healing, I was told I wasn’t ‘as good as I thought I was.’ I’ve also been told ‘you are not as happy as you think you are. You are in denial.’
How sinister! If I feel good and good about myself, why on earth should that be challenged in any way? That’s ridiculous, and reeks of bitter jealousy to me.
It’s also criminal, to my mind, when it is said to a person who is healing and recovering from disability, when hope, validation, and encouragement are the order of the day. That should be illegal in the mental health world, to project such a negative attitude on a recovering person, because it does great, great harm. In that stage of healing, that is nothing short of traumatic! It’s crazy-making.
Healing from trauma is about a person creating positive self-beliefs, and during this process, the worst thing one can do is to call them ‘narcissistic’ or tell them they have ‘delusions of grandeur’ when they are feeling their personal power, and it happens so often. We want to encourage those positive self-beliefs, as it is the core of healing so called ‘mental illness.’ The edges will smooth as people go along evolving, personal growth doesn’t stop at any point, and no one is perfect. But at least give a person their day in the sun when they are succeeding.
All I got was challenged and knocked down and continually sabotaged by the system and even by advocacy, as I was growing into my own voice and personal independence, as though they resented it or were threatened by it. I was not trying to compete, I was trying to find my path as I healed; but competition was all they knew. I never found trustworthy advocacy, always betraying and petty.
I’m still standing, stronger than ever and firmly on my path, creating my life based on my beliefs, and it’s working for me so I must be in synch with my beliefs–delusional to others or not, what do I care? That’s not even an issue to me, how others judge me or assess my reality. I’m the one living it and enjoying it.
But this was really my biggest gripe going along, going through the mental health industry. To me it’s ‘support 101,’ but apparently, being demeaning is an inherent part of this culture, and what beliefs that behavior is based on is something about which I can only speculate.
“The one thing that is for certain, is that behind almost every so-called mental illness is a person who has little to no compassion for his or her self and likely loathes his or her very being.”
YES, exactly my point!
Thank you for this wonderfully clear and enlightening article. In fact, I think it’s groundbreaking.
“All I got was challenged and knocked down and continually sabotaged by the system and even by advocacy, as I was growing into my own voice and personal independence”
When you are in this system everything you say or do is a symptom. It’s Catch 22. If you’re positive and recovering you’re seen as just as “sick” as when you’re down (or even more so – precisely because it is threatening to their own delusion).
I had a psychiatrist tell me I was narcissistic and thought that I was smarter than everyone else because I happened to (truthfully) inform him I was enrolled in a PhD program. Another one couldn’t believe me that I didn’t have an abusive family and tried hard to convince me there “must be something” to the point that I had to defend my parents in front of this ***. He also tried to convince me that my friends don’t really like me. And all that because he wanted to fit a BPD diagnosis and it somehow didn’t want to stick. They can’t even react neutrally to simple facts – they have to over-interpret everything to suit their preconceptions. I have literally never seen such amount of delusional thinking in any other profession.
Thank you for presenting this clear link between trauma and what gets labelled ‘illness’ or psychosis. I also completely agree with you that we are all ‘delusional’ to varying degrees at various times in our lives…for many reasons. My wish is that we could always assume that when a person is distressed or acting in a way we do not understand, that he/she is making sense of his/her experience the best he/she can, as you suggest…and to work to connect with each person going through whatever he/she is going through…This is why I have hope for Open Dialogue and hope that it becomes an available alternative in the US.
Thanks Noel, for another good and thoughtful article!
I do think though it might help to point out that psychiatrists see delusions as something more specific than the definition you used, of “a fixed-false belief.”
Here’s a definition from http://www.medicinenet.com/script/main/art.asp?articlekey=26290
“Delusion: A false personal belief that is not subject to reason or contradictory evidence and is not explained by a person’s usual cultural and religious concepts (so that, for example, it is not an article of faith). A delusion may be firmly maintained in the face of incontrovertible evidence that it is false. Delusions are a frequent feature of schizophrenia.”
In other words, they only call it a “delusion” if you came up with the idea yourself, or at least if it’s pretty rare. This allows them to overlook all the “fixed false beliefs” that people maintain in the face of the evidence, that are consistent with one’s culture or subculture (at least if that subculture is established enough to be recognized as such by one’s psychiatrist.)
There is a bit of logic to that approach: a belief that is established in a culture is in some ways less likely to be risky, as lots of people have already tried living with it and have gotten on OK. It also allows the psychiatrists to get along with all the powers that be, no matter how irrational, and to focus their attention on those who are creative enough, and deviant enough, to have come up with unique beliefs.
While there is value to mental diversity in general and while psychiatry should be criticized for usually failing to recognize that, I do think there can also be a problem with just accepting all the diversity of beliefs, since some can be really destructive. “I think so and so is an enemy alien and must be killed” can be a destructive belief, etc. And group beliefs such as “we can all continue doing X behavior and ignore the science that says this behavior is making the planet unlivable” can be a big problem if the science is in fact correct.
But often, what is most needed is to just take the time to listen, explore the sorts of factors you write about, in a gentle and respectful way, etc.
Why would we care what a psychiatrist would have to say about ‘delusion?’ Of all people…
We, each, own our lives. No one is–or should be–under obligation to prove anything to anyone. Lack of moral compass and doing harm to others is an entirely different matter.
Thanks for your thoughts Ron. I went back and forth on a lot of things, and ultimately decided to not directly touch upon the cultural mentions in the DSM because, quite frankly, an entire other essay could be written about that. The rest of the definition you quote, however, is in line with everything I outlined in the beginning. A personal belief that is not subject to reason, continues to be maintained in the face of incontrovertible evidence (as if there is such a thing) that it is false, etc.
I must disagree with you, on your comment that there is a problem with accepting diversity of beliefs. There is a difference between what I’ve said here (accepting that people have beliefs that serve a purpose, and trying to understand that purpose and help to ease their pain and suffering in order to help bring about change) versus what you are implicating (accepting that people have beliefs that are destructive and just leave them be and do nothing about it). There is no choice…no matter who you are, you will never convince a person their belief system is false without first accepting and understanding how that belief serves the person. They might humor you, but they will not just change their belief.
I also quite adamantly disagree with the idea that a belief is somehow less destructive because culture, or a large group, agrees with it. The Nazi’s had a pretty big cultural support system throughout the world. So did slavery. So does the DSM. So does the idea that poor people should just learn to work harder. So is the idea that bombing the heck out of the Middle East is somehow going to make the world safer. I’d say these are pretty destructive beliefs that our society here in America has supported and have led to probably at this point billions of deaths. So, no, there is no logic to the idea that if a group believes it, it is somehow “less likely to be risky”.
In any case, I always appreciate your thoughts, even in the rare case where we seem to disagree!
Also I just wanted to add to Alex’s comment…who cares what anybody says? The main point of the whole article is that beliefs themselves are not the problem- it is what they represent. No matter who you are. And if you have violent or rage full tendencies, those will find an expression in other ways if a belief is just suppressed or forced to be agreed to as wrong. If I believe that somebody is an alien and needs to be killed nobody is going to convince me otherwise. But why do I believe this? That is the point. Who is this person? What would killing an alien mean for me? Just telling somebody that aliens don’t exist might turn you into the alien. And then a shot of haldol is sure to follow…
Yes, that is my point, too. A belief represents the story being told–which is neutral, in that I would not feel compelled to evaluate it, but instead, to learn it and understand it. Our beliefs contain stories, the cumulative result of our very personal life experience.
In my line of work, this is considered to be a person’s ‘spiritual trajectory.’ If there are violent thoughts inherent in the belief, exploring that belief with interest and curiosity–not to question it or ask for some kind of proof or evidence, but simply to understand it–these will be dissipated in the exploration. Beliefs are malleable, we can shift them when we feel compelled. Violent thoughts will release and shift when we let go of resentment and blame, which relaxes our minds and bodies and shifts us into new beliefs, but those can be sticky sometimes.
Interestingly, along the lines of your alien example, I was responding to an issue with a client in the public system once, years ago, and he started talking about aliens, and not belonging, and the belief that he was going to be kidnapped from his home any day. We talked for about 45 minutes as I asked him some questions I felt were relevant, and it turned out he had a housing issue and feared being evicted from public housing. From that information, I was able to get the information I needed to allay his fears and get him the right info. There was no reason for me to doubt his story of aliens, I knew there was something he was trying to communicate to me. I knew that asking him questions about it and exploring it would lead to some kind of truth about his needs. Ironic that you brought up that exact same example.
In short, if I had a client that felt that someone was an alien and that they were dangerous so they needed to kill them, my first order of business would be to understand why they’d want to kill anyone at all. Way more than likely, that desire is based on one or more false beliefs, although hearing that person’s story, one would probably be able to understand why they felt like killing someone.
The story is one thing, but the emotions attached to it are what’s important for compassion, empathy, and healing. When we get distracted by the belief because it seems outrageous to us, we miss the point of what is really trying to be communicated–paranoia, rage, etc.
From my perspective, I can’t accept what you said in the comment above is the “main point” of your whole post, which is that “beliefs themselves are not the problem- it is what they represent.” Sometimes it seems to me beliefs themselves are a real big problem, they lead to people taking actions that have really big consequences, so it seems misleading to suggest that beliefs are never “the” problem, even though it would also make sense to be curious about what is behind them.
And sometimes people’s recovery stories have a progression that involves learning to question “delusional” beliefs BEFORE the person learns to reflect on what they might mean. For a public example, think of Eleanor Longden, who first learned to question the belief that her voices were real beings outside of her that had the power to do things like damage her family: after that she learned to reflect on what was going on psychologically behind the voices. I’ve also seen plenty of people who made progress by learning to question their beliefs (but that of course is different than having someone try to force that concept into their head.)
I also wanted to point out that you seriously misread me when you thought I was saying that “a belief is somehow less destructive because culture, or a large group, agrees with it.” What I did say was that a “belief that is established in a culture is in some ways less likely to be risky, as lots of people have already tried living with it and have gotten on OK.” That of course doesn’t mean that it isn’t also possible that sometimes beliefs will form within a culture or subculture that are quite terrible – you mentioned the Nazis, I made reference to people with beliefs that could lead to planetary destruction (David Oaks refers to Normalgeddon) – there the problem is, assuming climate science is accurate, that we can all collectively get away with being wrong in a very bad way for a long time until the consequences catch up to us.
I liked a lot of your perspectives on beliefs, you had some good angles, but I think sometimes coming at it from some other angles also makes sense. When I cover this in the seminars I do on CBT for psychosis, I emphasize finding the angle that works for the person, which may shift over time. And I emphasize it as a collaborative investigation, not one person forcing a belief on another.
I think maybe I understand a little better what you are saying, Ron, but perhaps may still be misreading you a bit. It’s always tough sometimes to engage in a complicated dialogue in relatively brief typed out comments. I will say that from what I am hearing, I can’t help but feel that you are way oversimplifying both my blog and my response to you. That is unfortunate, and I’m not entirely sure how to respond to that. But, I will try to respond to what I do think I understand you to be saying…
I would venture to guess that nobody’s progression through healing and growing is quite so linear as to say, well first X happened and then Y and then Z. Usually it’s an interwoven process of all 3 and the rest of the alphabet too. As for your examples with Longden and others who learn to question their beliefs…Yes, of course. But, one must first have a reason to question their beliefs. Everyone’s individual process is different, and not really something I touched upon anywhere in this piece. On the other hand, if I come to a person with whom I do not understand and/or agree with, I cannot just step in and tell them to question their beliefs. Collaboration on learning ways to challenge one’s beliefs usually comes through many, many, many steps combined…again it is not so black and white and linear. And I’m guessing that it rarely happens until either some basic level of understanding and trust has been reached between people, or the person has become so beaten down by the process up to that point that “compliance” becomes a top priority. Even a cursory enough belief to say “this represents something, but I don’t know what yet” is giving some understanding to the why, rather than just saying one has a “delusion” that must be gotten rid of because it is a “symptom” of a “disease” and has no meaning. I’m pretty sure you are not approaching your clients in such a manner, so that point is kind of moot.
My last sentence, “At the end of the day, really, all any of us can do is our best to hold our beliefs lightly and be wary of what we think we know, while respecting and trying to understand that which we don’t” I think makes it pretty clear that I think we should all challenge ourselves to be wary of our beliefs and engage in reality-testing. I think where we may just agree to disagree is that it appears you are saying there really is a difference between a “psychotic delusion” and what the rest of humans experience. This is where I say, it is the internal world, the rage, the fear, the worthlessness is the “problem” and what is difference. The process of forming a belief system around that is a normal human experience. We all have delusions. We all need to challenge our rigid beliefs. We all need to question our actions, particularly if they might cause someone harm, before blindly engaging in them. At no point anywhere have I said that “never” should beliefs be considered problematic.
Ron, with all due respect, what you say is exactly how systemic stigma and discrimination are perpetuated. Noel is trying to level the playing field and heal this split within humanity.
I certainly agree with you that it is hard to be clear about complex matters in brief comments on a blog! And in a case like this where I had a disagreement with a couple of things, it’s hard to also convey that I agreed with the vast majority of the things you were saying, even though I did try to communicate that.
You wrote in your latest comment about how before a person can learn to question his or her beliefs, he or she must have a reason to question them. I would agree with that – but sometimes it’s the consequences of holding the belief that are so severe, which makes a person think of questioning them. So it may actually be focusing on how the belief causes problems that gives the person incentive to question it.
You also wrote in your latest comment that “At no point anywhere have I said that “never” should beliefs be considered problematic.” OK, but you did write that “The main point of the whole article is that beliefs themselves are not the problem- it is what they represent.” It was the “beliefs themselves are not the problem” part that I was responding to, which seemed to me to imply that you were saying was that we shouldn’t think of the beliefs themselves as ever being what was problematic, even though I get it that you really didn’t intend that.
So I doubt that things are perfectly clear yet, but this is my attempt to clarify……
“There is no choice…no matter who you are, you will never convince a person their belief system is false without first accepting and understanding how that belief serves the person. ”
Excellent point. Empathy is a key to understanding an effective dialogue. Anything else is only leading to the two camps digging themselves deeper in their positions, putting the fingers in their ears and going “lalala”. Even if one camp happens to be 100% right dismissive and paternalistic attitude is not going to help to convince the otehr side. You have to go to the otehr side, look at things their way (which is sometimes very difficult) and then try to figure out what would convince you. It won’t always work but if anything works – that’s it.
So is “all Muslims are terrorists” and “corporations are people my friend”. Dangerous delusions are even more serious when there are more people believing in them but we concentrate on targetting individuals because they are defenseless.
Once again, you write an incredibly forceful and moving blog about such an important topic! Much of what you say gets to the roots of why the DSM-based paradigm is so destructive. It’s easy to get caught up in arguments about medication side effects and scientific bases for treatment and forget that the entire enterprise is based on one big delusion.
Of course, the real difference between a “delusion” and a dogmatically held irrational belief system is how many people you can get to agree with you. The psychiatric/DSM delusion only works because so many people believe in it. I prefer the “delusion” you are spinning here, as it’s far more likely to actually lead to people becoming more aware and more competent and in control of their own lives, which in the end is what any good therapy needs to do.
Thanks again for sharing your beautiful and scientifically grounded essay!
Thank you for your kind words Steve!
Thanks for the great, thoughtful article. I printed it out so I could read it carefully. I’m glad to see such a compassionate healthcare writer. Feel better about my needed “delusions” now! It seems the old health care system could only judge, label and medicate, all of which was harmful.
Thank you, Danielle, for you comment. I’m so happy to hear that maybe you might find a bit of validation in anything I’ve thrown out there. At the end of the day, that’s really what’s most important. Thanks for reading.
“the only people who have proof of their sanity are those who have been discharged from mental institutions”
― Marshall McLuhan,
Hello, and good day to you, I would like to address some of your thinking and send out the positions you take and maybe share with you, if that works, maybe you are a——–Valkyrie?
I ask …Sentience is seldomly a value in systems is not? What is that we value, in this state of human existence? I would ask why reflection is not apart of education.
Sentience in another view:
Eastern philosophy, sentience is a metaphysical quality of all things that requires respect and care.
What do we value but things and logos? Has not human engineering created madness and delusions that lives value is to be a Consumer? That the pinnacle of assigned liberty is to be Neurotic: see book ( The Adjusted American) We respect the megalomaniac for wearing good shoes and having the house and status, and negate the untold deaths in his wake. Religious Bagman come in and are nothing but the lyrics of the old song: Lying, Cheating and stealing in the name of the lord! Yet these savages are honored.
Delusions indeed my fair young lady! At the great schools of thought we call the university it can be said that these qualities are sought first and foremost:
4) Worship of authority
Yet, in this bastions of higher learning come or Masters in the Republic and in our Psychological DR’s. Only the wise few escape the process by playing possum…for anyone else who thinks otherwise is obliterated – cast to the outbounds.
Poverty: like the old spiritual phrase ( The Razors Edge) is path that few ever come out of unscathed, if they come out at all. Yet is the testing ground for the spirit: become a saint or a monster, learn to love the moment, fight as you wish or go inward to booze and drugs and die in hell.
We are disconnected in this world, no stories, no sharing, no value to the experience of others lives we learn from. Eternal hoop is broken here and elsewhere, as sure as women have been kicked out the circle: corporation sing to us their story and the TV is now the fire we sit beside to be fed the messages….and again the cult of domination is here in force: war is the great creative moment of life… this is their position, and in the woods and in the streets the soldiers weep, drink and blow their fucking brains out as the arms dealer buys another woman and drink and car. We are nuts in this society and any sanity is to be killed or done in with.
In the land of the blind, the one-eyed man is a hallucinating idiot…for he sees what no one else does: things that, to everyone else, are not there.”
― Marshall McLuhan
The System is no compassionate, it is run by halfwits 90% of the time, who call themselves full wits and thereby make everyone nitwits for listening to them…in my years with the County Psychological Apparatus – I saw 90% of folly, malice, illegality, immorality and outright thuggery….yet the victims own insight is a crime, a sign of delusions, and even the courts well back that up — so you can fight them and they will section and quarter you metaphorically speaking, or you can just die in their hands or run like hell for the woods and new day, a new way!
Essentially you must find new forms of feedback and reflection –art, association where you are not ruled the idiot….let us see what life has taught you and what the meaning of your being is my Lady!
Noel, thank you very much for this incredibly thoughtful and well articulated article. It means a lot to me to find that there are others who are able to examine mental health outside of the dominant paradigm! In regards to delusions, I feel that humans are essentially a cult-ish species and for the most part our understanding of the world around us comes from the dominant narratives of our culture. I think if we want to deal with mental health issues in an honest way then we will need voices like yours that are able to step outside the current narrative!
“Courage consists, however, in agreeing to flee rather than live tranquilly and hypocritically in false refuges. Values, morals, homelands, religions, and these private certitudes that our vanity and our complacency bestow generously on us, have many deceptive sojourns as the world arranges for those who think they are standing straight and at ease, among stable things”
― Gilles Deleuze, Anti-Oedipus: Capitalism and Schizophrenia
“The fact that some of these experiences are just as traumatic to a child is backed up by research: Children who experience psychological “trauma,” such as emotional abuse, insults, verbal bullying, isolation, and overwhelming psychological demands within the family, are MORE likely to develop severe psychological disorders as adults than those who have been physically or sexually abused.”
There are also more subtle types of psychological abuse (also known as “crazy making” or “gaslighting”). They are a form of relationship abuse or parental abuse and leave the person feel confused so that they don’t know what is real and what is deception. There’s also Stockholm syndrome when the abused person will do everything it takes to protect and justify the abuser. All those things are well known psychological phenomena yet they are completely ignored by psychiatry at large.
By far the most delusional people are psychiatrists and they project those delusions on all of us.
Thank you for adding this important piece to the equation. Yes, the subtle dynamics that leave a person confused are extraordinarily powerful and rarely recognized. I think in large part they go unrecognized due to the fact that most mental health professionals engage in that very same “crazy making” communication that leaves one in a never-ending cycle of chaos and confusion.