“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.
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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.