Rethinking “Delusions”: Envisioning a Humanistic Approach to Troublesome Beliefs


When people are told they have “psychosis,” it’s usually because they are experiencing one or both of the following:

  • “hallucinations,” defined as sensations that don’t seem to have any physical cause, and
  • “delusions,” defined as beliefs that don’t agree with others in one’s culture and/or with physical reality.

Thanks to the revolutionary impact of the Hearing Voices Movement, many people around the world are now able to think of the experience of the first phenomenon, “hallucinations,” as something much broader than just a part of  “psychosis.” In fact, even the term “hallucination” has been questioned, with less medicalized terms like “hearing voices” and “seeing visions” proposed instead. And it has been asserted that hearing voices itself should never be defined as an illness. Instead, hearing voices is conceptualized as a human variation, like being left-handed or gay. It is understood that people may have problems with the voices and may need help figuring out how to relate to them, but once the relationship has been improved, the experience may change to something that is overall benign or even beneficial to the person.

Unfortunately, less attention has been brought to that other key component of psychosis, the “delusions.” And yet, the need for a revolution in how they are approached may be just as intense.

Sometimes, revolutions start with changes in understanding. One area, to begin with, might be the notion of a firm distinction between hallucinations and delusions. Hallucinations are understood as disorders of perception, while delusions are understood as disorders of conception. But in practice, conception plays a big role in perception and vice versa. For example, consider the difference between thinking that an external force is controlling one’s thoughts (classified as a delusion) and “hearing” thoughts that seem to be coming from outside one’s mind (classified as a hallucination). Are these two really that different? Or are they better thought of as on a continuum, with some experiences in the middle and not easily classified as one or the other?

The history of the distinction between hallucinations and delusions is explored in the article “Voices, Visions and ‘Persons Under the Floor’: ‘Delusions’ and ‘Hallucinations’ in Nineteenth-Century Psychiatry.” It notes that the belief in a clear distinction between the two was not always present and that our imagining that there is a clear distinction can make us insensitive to the reality of people’s lived experiences.

In hearing-voices groups, the lack of a clear distinction between perceiving a different reality and conceptualizing or believing in a different reality is often understood, and so alternative ways of relating to “unshared beliefs” have been developed alongside alternative ways of relating to voices. But these alternative approaches to working with troublesome beliefs have not received as much publicity as have approaches to hearing voices.

One example of a person working to change that is Rufus May. At age 18, Rufus became convinced that he was a spy and that a device had been planted in his chest. His beliefs were treated in the conventional way by the mental health system: He was diagnosed with “schizophrenia,” hospitalized, and drugged. But Rufus decided he did not believe in the diagnosis and the drugs, and he eventually found his own way to regain control of his life. Then, using undercover skills which he had previously just fantasized, he infiltrated the mental health system, keeping his psychiatric history secret as he completed his training as a psychologist.

With his training complete, Rufus shifted to being open about his history and became an effective advocate and educator for alternative approaches. And while some of his efforts have been around alternative approaches to hearing voices, he has also written very coherently about alternative approaches to working with difficult beliefs, for example in his article “Accepting Alternative Realities.” He will also explore that topic in an upcoming webinar, Believe It or Not! Ways of Working with “Delusions” or “Unusual Beliefs” (more on that at the end of this post).

One reason I believe Rufus is a great teacher on this topic is due to the degree of flexibility, creativity, and respect for people that he brings to the work.

A key issue with “delusions” is that people are often holding beliefs in a rigid manner; this tends to prompt those around the person to become unhelpfully rigid in return. In conventional mental health treatment, this rigidity involves insisting that the person “get insight” into the “fact” that their belief is a delusion and is a sign of the presence of a “mental illness” like “schizophrenia.” This rigidity is maintained despite evidence that many ideas about “schizophrenia” may be as untrue as any “delusion,” and despite extensive evidence that confronting any strongly held belief in a rigid way tends to make the person holding the belief dig in and defend it more.

I’ve been practicing CBT for psychosis for many years, and CBT does have some ways to approach “unshared beliefs” in a less rigid way. But there is still a tendency in much CBT literature to emphasize attempting to change the belief seen as troublesome. That is sometimes possible, and work around reconsidering beliefs can be important, but it is also sometimes not possible or not the most helpful approach.

In many cases, it can be more helpful to work on things like understanding the life experience that led to the belief, exploring the possibility of living successfully even while continuing to have the belief, and/or looking at the belief as a possibly metaphorical message about something that needs attention, and then shifting the focus to that area.

A couple of years ago I had a chance to hear Aaron Beck, a key founder of CBT, speak about his understanding of how to approach apparent “delusions.” It may be common for older people to be rigid in their views, but I was pleased to find that Beck, then age 97, was advocating for a more creative direction. He was asked, for example, how he might respond to a man who was claiming to have been roasted in an oven. Beck said first he would acknowledge the man’s story, and be curious about what that experience was like, how it felt, etc. Then he would ask about other times in the man’s life when he may have felt that way and then inquire about whether anything currently was making him feel something similar. In other words, he was saying it might make more sense to follow the vein of emotional content to where it might connect with the man’s past or current issues and distress, which then could be addressed directly. That could be way more effective than simply trying to change beliefs.

Too often in conventional mental health treatment, once people express a belief that seems “insane,” there is just an effort to suppress the belief, rather than to really understand where the person might be coming from and what their most important concerns might be.

Another example Beck gave involved a man who told hospital staff that his psychiatrist was a threat and revealed that he wanted to shoot the psychiatrist. In a conventional setting, this would be seen as a sign of the worsening of a dangerous psychosis, and an increase in antipsychotic drugs, by force if necessary, would have been seen as the solution. But in this case, the psychiatrist had been trained to proceed with more sensitivity and flexibility, so instead of treating it as a symptom, he asked the patient, “Why do you want to shoot me?” The patient responded, “Because you are planning to shoot me!” “But,” the doctor explained, “I don’t even own a gun!” “Well,” said the patient, “you use your drugs like a gun.” The doctor thought about it and said, “I wonder if you are feeling you have very little control? That must be frustrating. But I know you must have lots you want to do outside of here and I want to help you get out so you can do that!” This made sense to the person and they started to work together.

In the Hearing Voices Movement, it is often pointed out that the voices may be “poor communicators” and that working things out with them may require considering alternative interpretations of what they are saying until a more constructive meaning emerges. For example, a voice that tells someone “You need to die” may be better understood as a part of the person saying that “Something is wrong, you need to change something” or “You need to let something about you die.” Once the message is properly understood, it becomes something helpful rather than destructive. The voice-hearer can learn to be like the parent who hears the child say “I hate you” but is able to infer that the child needs some love and a nap rather than taking the statement literally.

One interesting thing about “delusions” is that people can be disturbed by their own beliefs; that is, they can find themselves falling into a belief, but sense that there is something wrong with it at the same time. At that point, they are like the voice-hearer who hears a message that seems disturbing but which they are also starting to believe.

A key skill people need to learn is discernment: sorting out what might be a valid message in the belief or in what the voice is saying while dismissing what might be an exaggeration or a too-literal interpretation. This allows them to resolve the situation by believing the helpful part of the message while disregarding the rest.

At other times people are not at all disturbed by their belief, but their having the belief does become disturbing to others. At that point, the person with the belief is, in relation to us, like the voice is in relation to the voice-hearer. The person is saying something, and we must decide how to respond to it. Do we see them as the enemy, and someone whose views simply need to be suppressed? Or do we consider the possibility that while the person may be a poor communicator, there may be some valid message in what they are trying to communicate, even if we can’t agree with all of it?

To develop an adequate approach to difficult beliefs, it is also important to think more broadly about the nature and function of beliefs in general and to understand how all humans tend to “behave irrationally” around their beliefs when those beliefs become important to their world view and their identity.

Beliefs are often a tribal kind of thing: People may believe something to fit in with others, not because of logic. Having a tendency to do so may benefit individuals in an evolutionary sense because it makes the individual more likely to get along with others in their social group. (This works, of course, only when the belief is not so destructive as to lead to the extinction of the entire group; it remains to be seen, for example, how the “tribal belief” in the non-existence of the climate crisis, popular in many quarters, will affect the evolutionary viability of humanity.)

Curiously, psychiatry identifies only untrue beliefs held by one or at most a few people who are at odds with their culture as having mental health problems and doesn’t consider the possibility that beliefs held by larger groups or even entire cultures may be even more of a problem—even though the dangerousness of a belief tends to increase the more people endorse it!

(If psychiatry were more able to recognize the “pathology” of widely held beliefs, it might, for example, be more able to reflect on the damage done by beliefs it has itself promoted, such as the one about how “mental disorders” are caused by “biochemical imbalances.”)

But, one might ask, if people often hold beliefs just to fit in with their group or tribe, why do some individuals seem to go their own way and choose beliefs that put them at odds with their community?

One answer may be that when a person’s life does not seem to them to be working out, they may be motivated to try on different beliefs, sometimes desperately grabbing onto whatever seems to offer some chance at inner coherence amid chaos and disruption. Once a belief that seems to help restore internal order is found, the person may be reluctant to let go of it, even when that puts them at odds with their culture and gets them labeled “psychotic.”

It is also true that evolution would never work if there were not genetic variations, and cultural beliefs can never evolve unless we have people trying on different perspectives.  Much variation in belief may be just a part of human diversity and not a problem that needs to be solved. A skilled approach to working with beliefs involves both toleration of differences in perspective and an awareness of a variety of possible things that can be tried when a belief is causing problems that do not seem to be tolerable, either to the person or to others with whom they must interact.

There’s a lot more that could be said about this topic; this post just scratches the surface. I encourage those of you who would like to explore this subject further to consider attending the “Believe It or Not” webinar.

Topics covered will include:

  • understanding the protective function of beliefs,
  • understanding how they may be linked to past life events,
  • ways to be with someone with different beliefs, and
  • if someone is motivated to hold their beliefs more lightly how we might help them with this.

This webinar will be presented on Monday, March 9, 2020, from 11:30 AM to 1:00 PM (EDT). If interested, you can register at this link. You will be asked to make a small donation to help support Rufus and the sponsoring organization (ISPS-US) but no one will be turned away for lack of funds.


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.


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  1. Hi Ron, This is a great topic. You explain the subject very clearly.

    It seems to me that there are mostly two types of ‘delusions’: fear based, or ambition based.

    I can understand a person thinking people are watching them or have planted microchips in their brains, if they have been on the receiving end of extreme intrusion. But I notice people can be ‘pathologically’ intrusive anyway, even as groups.

    A friend of mine (who works in Mental Health) told me that that sometimes neighbours harass people to such an extent, that they only leave their houses at night.

    I see ‘delusions’ as ’emotional reasoning’ – when my head is away from an idea, and I look at it again, I see it ‘rationally’. I have to do this all the time.

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    • Hi Fiachra, I think you make some good points.

      Regarding the “two types of delusions” thing: I’ve noticed something along the same lines, that some express fears, while others are more an attempt to counter fears and make things seem OK or even great. Though it is also true that the emotional meaning often gets mixed. For example I asked one guy who was constantly bothered by and scared of people who seemed to be constantly monitoring him, how he would feel if that stopped or if he found out it wasn’t happening, and when he really thought about it he noticed he would feel unimportant and alone. So the belief in being monitored was both organized around fear and his hope of being important enough for someone to pay attention to.

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    • I met a man my dad was trying to help when I was fourteen. He had ambition based delusions.

      “Willie” would go through periods of believing he was the Chosen One called to save the world be becoming President in 1988. Alternating with periods of intense despair and suicidal depression.

      We thought the drugs helped him because he became subdued and less annoying after every hospitalization for a month or two. But he still got depressed since he was lonely and his life stunk.

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  2. Great blog Ron, thank you.

    Also great comment Fiachra.

    I think we can judge belief systems by their ability to harm much of society.
    IF belief systems in people, whether mass beliefs, or adherence to beliefs by institutions cause harm, discrimination and injustices to many of it’s citizens, then we know it needs treatment.

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  3. A “psychotic break” is a natural “protective” response of the brain to a build-up (over time) of stress. It could be biological (gradual poisoning), or it could be the environment. What antipsychotics (and as an extension, psychiatrists) do, is to maintain and increase the level of stress over time. Fear and submission keep the “patient” in line most of the time. A bit like slavery.

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    • slavery indeed.
      Sad when people have to form an underground and flee their own houses, leaving their families behind.
      Psychiatry further writes this fleeing, as a “disorder”, I believe it is drapetomania.
      Wikipedia tells me that: “It has since been debunked as pseudoscience and part of the edifice of scientific racism.”

      Interesting that it is still referred to as “scientific racism”

      All other “disorders” still stand, you know, scientifically correct. To observe psychosis is scientific.

      When a shrink casts his eyes down, or glares at you without cracking a smile, what do we call that? Do my observations of a shrink count as science?
      Ohh the great science of neurology and psychiatry, and even medicine.

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    • I agree with you that a psychotic break is a natural reaction, though it may have very unhelpful aspects. In that way it is like other natural reactions: for example, I might see a spider, jerk my head back to get pull away from it, and in doing so bash my head into something behind me. Quite natural, but also painful! Regarding antipsychotics and psychiatry: my sense is that not all use of antipsychotics, and not all psychiatrists, are the same. For example in the article I talked about one person’s interaction with a psychiatrist, where at first the person felt just like a target for the psychiatrist’s drugs, but when the psychiatrist talked respectfully they were able to form a collaborative relationship. I suspect there may be times when antipsychotics may be helpful to a person, at least for a bit, to help the person avoid over-reacting when they don’t have a better way to do that. Though I believe in always looking for a way to do it without the drugs wherever we can.

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      • Yes, I agree, a psychotic break is by it’s nature unpredictable. Antipsychotics, however, increase the biological vulnerability for psychosis, especially evident if one stops abruptly. It’s not been studied, as far as I know, how quickly the brain adapts to antipsychotics.

        If your on an antipsychotic for more than a year or two, you will find increasingly less psychiatrists willing to help you come off them.

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        • Yes, psychiatrists and other mental health workers too often get stuck in what they are offering and don’t want to take the risk of supporting a change: that’s partly because they only look at the risk of stopping and they don’t consider there are also huge, perhaps bigger, risks from continuing without trying a change.

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  4. “Delusions” are what William Glasser referred to as “creative symptoming.”

    They’re acts of creativity. Which is why art therapy can sometimes be helpful.

    Find other ways to express creativity and you won’t need “hallucinations” and “delusions” anymore.

    Or help someone figure out how the “delusion” is helping him or her. Szasz referred to erroneous, odd beliefs–Bertrand Russell’s man who thinks he’s a poached egg and wants toast to sit on–as lies people believe.

    The truth is far more complicated than psychiatry would have us believe. And far more interesting. 🙂

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  5. Disagreeing with psychiatry, and their chemical imbalance theories, is “delusional” thinking/anosognosia to the psychiatrists. And in this age of “fake news,” well, someone said it better than I could, “In a time of universal deceit — telling the truth is a revolutionary act.” Being a truth teller is dangerous today, so is being a painter of the truth.

    And it’s always wise to remember, “It is no measure of health to be well adjusted to a profoundly sick society.”

    So we need to ask, is a society that wages never ending wars, and has other systemic societal problems, such as …“We now live in a nation where doctors destroy health, lawyers destroy justice, universities destroy knowledge, governments destroy freedom, the press destroys information, religion destroys morals, and our banks destroy the economy.” Do we live in a sick society?

    Thankfully, many other economists are now seeing the problems that I saw coming, right after 9/11/2001. But those who profit from these societal problems, certainly still do NOT want to change the status quo. Despite the fact that maintaining the status quo is destroying Western civilization.

    It was me alone, just after being drugged by psychiatrists in late 2001, that was on a “Runaway train never going back, Wrong way on a one-way track.” Now it’s seemingly all of Western civilization. I agree, “beliefs held by larger groups or even entire cultures may be even more of a problem,” than this banker’s daughter’s beliefs, who innately knew the wrong bankers were in charge in 2001.

    We have bad systems, set up and financed by, those globalist bankers, who create our money out of nothing. And their knowledge of, “For the love of money is the root of all evil,” is how they are destroying the United States and the rest of Western civilization from within.

    Interesting subject, Ron. And as one who shares a birthday with MLK Jr., I will say I agree with him. “Human salvation lies in the hands of the creatively maladjusted.” But this, of course, would require society to stop just worshipping a defunct monetary system, and actually listen to, and appropriately address the societal concerns, of the “too truthful” artists.

    And I know my childhood religion, and their systemic child abuse and rape covering up, by DSM design deluded, psychologists, psychiatrists, therapists, mainstream doctors, and social workers, have no interest in changing their evil ways.

    Why? It’s “too profitable” to stop DSM defaming, and neurotoxic poisoning the children, according to a Lutheran pediatrician. I hope some day we may get them to actually listen to us “creatively maladjusted” “canaries in the coal mine,” who actually utilize both the creative and analytical sides of our brains, instead.

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    • Psychiatry would/might be half believable if the DSM did not in effect make it a crime or reduce the victims of labels to targets of arrows.
      To give someone a “diagnosis” is literally exposing them to abuse in the most legal sense.

      In that way, we know it is absolutely not to help people, but rather hopes to destroy them. Psychiatry is the mass murderer allowed to, by law, to lie about, and abuse it’s victims. No one within the legal and political arena questions their crimes.

      It is the most insane society. I honestly regret having had kids.

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  6. Dear Someone Else,
    “We now live in a nation where doctors destroy health, lawyers destroy justice, universities destroy knowledge, governments destroy freedom, the press destroys information, religion destroys morals, and our banks destroy the economy.” Do we live in a sick society? ” Yes, yes we do. Many have no plans to change because if they did they would not be able to maintain their lifestyles of oversized houses, sleek cars, lavish vacations and all consuming self interest. This does not apply just to those that dole out pills. Many try to fix the holes in their heart with worldly goods, then run to doctors to fix their “stressful lives’ and then unknowingly become the byproducts of the neurotoxins they ingest. The Merry-Go-Round continues……..

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  7. To strongly believe anything industriously is powerful but dangerous. We know why. Yet, the mind constantly wanders and wonders. There’s room for change. Psychosis must pull from resources hidden from knowledge long forgotten and that which is dispersed with current thought yearned for or unspoken. People generally do not fully explain themselves to boot! It’s not so surprising that psychosis is possible given the right circumstances.

    Talking ordinarily and comprehensively might be the best thing someone could do. Just talk. It’s the way anyone makes sense of the world and gets grounded. To be seen, we talk!

    The world can be harsh. Diversified minds come from hard work and considering endless possibilities.

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  8. Thank you Ron . Rufus May is one of the most helpful and caring people I have ever met in my life he gave me hope when I had none and I will never forget that in my horrible ,sad and lonely journey as a carer. Just a tiny rare ray of light tho.They call it a journey to fool u into thinking its like a trip or a holiday.. aS my friend ann always says” you wouldn’t fecking pay to go on this journey ” But there are not enough people like Ron and Rufus to go around and it is virtually impossible to cope and make any progress on your own when you live in a place where there are NO alternative treatments or supports. As much as everyone might want to deny it you get to a situation where you can see no way out other than back to the demonic and horrific system because you are worn down and all exhausted and have run out of options.

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    • Yes, I think that’s why it’s so important that we start training professionals differently! People should be able to turn to “the system” and find that it is helpful. I’m reminded of someone Daniel Mackler interviewed who lived in the area where Open Dialogue is practiced – this person compared the mental health system with the system which delivers water to each house: reliable, of good quality, and available when needed!

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    • Hi Fiachra, thanks for posting the link to the video! And thanks for joining us for the webinar itself. I hope lots of people do check out the video and then try practicing what Rufus talks about. You are right in a sense that there is nothing too mysterious about how to help people with troublesome beliefs – but we do have to unlearn a lot of what is conventionally taught about them, as well as to overcome what are pretty natural impulses to just get more rigid in response to encountering beliefs that seem to us seriously wrong.

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