By Dr David Laing Dawson
Well, let’s talk about delusions. The word, as a verb, is used in common parlance as “You’re deluded.” or “He is deluded.” referring to a mistaken belief, often one that will soon be proved wrong.
Much time is spent in undergraduate psychology, philosophy and medicine discussing, arguing about the concept. Could one man’s delusion be another man’s truth?
One could probably find more evidence to support the notion that the earth was populated by visiting spacemen a million years ago than the notion God created everything in seven days 4,000 years ago.
I suspect one would be hard pressed to find any man or woman out of our seven billion who does not hold to at least one irrational belief. Ghosts, lunar influences, karma, fortune tellers, telepathy, vengeful Gods, and ….. this list could go on and on.
So when is an irrational belief a delusion? More importantly, when does this phenomenon indicate illness, mental or neurological? When is it a symptom of illness?
And how does one decide this?
I suspect that the anti-psychiatry movement is partially fuelled by this fear. The fear that this group of professionals, working within a medical model, goes about arbitrarily deciding what belief is delusional and what belief is not. And each psychiatrist, being a member of one culture or another, will hold some irrational beliefs of his or her own, acceptable in that culture.
Karl Jaspers, psychiatrist and philosopher, defined delusions in 1903 as beliefs that fulfill these three criteria:
- certainty (held with absolute conviction)
- incorrigibility (not changeable by compelling counterargument or proof to the contrary)
- impossibility or falsity of content (implausible, bizarre or patently untrue)
All well and good until we come to the third criteria. Who decides, and upon what basis, the belief is implausible, bizarre, or patently untrue?
On the other hand, it is a very rare event for a psychiatrist to find out later that what he diagnosed delusional was actually true. And the reason for this is that Jaspers has ignored one other criteria for a belief to be considered part of an illness, an aberration of the mind/brain. And that is the manner the delusional conviction overrides all social realities and drives behaviour to destructive and self-destructive pathways and actions.
When talking with a psychiatrist a sane person, whether patient, friend or colleague, might preface a conviction with, “You will probably think I’m crazy but…”. Whatever the belief (astrology, karma, ghosts), this person is aware, at the same time, of the present social reality, the possible or probable response of the other. He or she is sane.
But there is no preface for the delusional person. He or she will launch right into the conviction, either oblivious to the current social reality or unable to read it, or (delusionally) convinced that this idea he or she has will over ride, or somehow dominate this other reality.
Hence the young man, with both parents in the room with me, announces that he is “the illegitimate son of Adolf Hitler”. (I wondered at the time why this delusion included the unnecessary word, ‘illegitimate’, but as with most delusions, the phrase, the words, often carry more reality than the inferred physical reality. Which is why, I think, that I have often over the years, been able to admit such a patient to hospital voluntarily. As long as I don’t challenge the assertion with countering words, he will come with me to the ward and stay awhile.)
It is one thing to harbour a belief that perhaps you could survive on oxygen, water and the word of God alone, without food, but not mention this to your family doctor, your dietician, or test out this theory. It is quite another to wander into the woods, or travel to Alaska, to put this theory into practice.
It is one thing to harbour a pet belief that you are a descendent of royalty, while shopping, working and playing Canasta with your friends. It is quite another to introduce yourself as Queen Victoria.
So a delusion as a symptom of illness is all that Karl Jaspers described, but it is also a conviction that over rides current social reality, that obsessively dominates all thought and interactions, and puts self and others at risk.