Tag Archives: Delusions

Exploring Delusions

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.

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On Understanding Dylann Roof

By Dr David Laing Dawson

Dylann Roof suffered from two delusions. The first was that the actions of others, that specific groups of others were responsible for his own distress and failures, his limitations, his hopeless future. From the little we know of him, I think we can assume his target might have been a different group of others, perhaps Jews, in another place and time and context.

The second delusion was that he, an undereducated, unemployed 21 year-old boy, could and should engage in a single act of violence that would, he believed, change the course of history.

How should we think of this, beyond such words as racism, terror, evil, horror, derangement, and tragedy?

If we want to prevent this happening again we do need to try to understand it. We do need to understand if this was a singular inexplicable event, ultimately unpredictable and not preventable, or the failure of the mental health system, the correctional system, the educational system, the policing system, or one vulnerable kid acting on both the subliminal and overt attitudes of many others.

The human brain, especially the 21 year-old human brain, craves explanation, organization, ways of understanding its perception and experience. It especially demands ways of understanding failure, distress, fear and limitations. And up to a point it is natural in the adolescent phase of development to blame others: teachers, parents, rules, cops, peers, the referee, bad luck. In different times and different contexts this young brain is easily directed by propaganda to blaming Jews, Infidels, Apostates, Indians, Chinese, The Government, Hispanics, Blacks.

One of the jobs of parents and teachers is to adjust these assumptions and conclusions, sometimes gently, sometimes decisively.

By 21 we hope our children have learned to assume some personal responsibility, that their brains are figuring out and accepting the nuances and subtleties of cause and effect, of external and internal control, of responsibility. We hope that they are developing some empathy for others, even others quite different from themselves.

We also hope that their assessments of themselves within this world are beginning to be grounded in reality.

That first delusion. We can arrive at that first delusion, the belief that a group of relatively disenfranchised others (not crooked politicians, recessions and depressions, wall-street barons, lack of educational opportunities) are ruining our lives, through two routes.

The first may be actual, definable, treatable, mental illness: The inability to engage with others, to share information, to process all the complex nuances of interpersonal life, an inability to understand messages of avoidance, of intimacy, of competition, of friend or foe, and because of this, an inability to gain a realistic appreciation of how I fit in, of who is responsible for what.

A delusion satisfies the craving for explanation. But when a delusion is the product of illness it is usually very autistic, a conclusion that one’s life is being controlled by a microchip or radio waves, for example. Though it is quite possible for an ill person to further conclude that certain person(s), or a non-human for that matter, are behind this nefarious plot. The delusion derived from illness, from schizophrenia or depression or mania, does not need corroboration. It does not need anyone agreeing with it. It does not need sanction. And thus it is usually seen by everyone else as crazy, improbable, if not impossible. It is usually suffered privately. It is usually only harmful to self and family. And, of course, it is treatable.

But it is not necessary to have a brain illness, a biological cognitive deficit to come to terrible conclusions. It can arise from reaching 21 still blaming others, still searching for external answers to explain one’s limitations, fears and failures. And from a failure of parents to nudge that teen to healthier schemata, and from access to information, propaganda, symbols and persuasive people who tell this boy, “It is not your fault that you are helpless, useless, hopeless, that you can’t get a girl or a job. It is their fault.”

And then this boy looks around his neighbourhood and sees that many others quietly believe the same. And now on the Internet he can find a revisionist history and many persuasive (persuasive if one’s knowledge and maturity are limited) voices exhorting the same viewpoint. “It is their fault. They are taking away my power, control, my future.”

So for Dylann Roof this was, in a non-clinical sense, a delusion. The externalization of control and blame. A belief shared by too many others. But it was not the autistic delusion that emanates from a treatable psychotic illness.

The second delusion is more problematic. Dylann came to believe that he could and should engage in a single violent act that would change the course of history. Without this second delusion he might have spent his life sober, drunk, employed or unemployed, living with someone, or living alone in a cabin in the woods, occasionally, especially when drunk, upsetting people with a racist rant.

But he came to the manic, grandiose conclusion that he, an uneducated unemployed boy with an average I.Q. and no notable skills or talents, no formal allegiances, should do this thing. But he didn’t behave in a manic fashion, simply grandiose and narcissistic, and without empathy. Perhaps he was simply sufficiently narcissistic, sufficiently naïve, sufficiently sociopathic, to believe he could do this thing, cause a revolt, change the course of history, and be hailed as a hero.

He could read the symbol on the flagpole of the South Carolina Statehouse. He could fill himself with hate propaganda on the Internet, all of which would overtly or covertly demand action. And he could absorb the subliminal messages all around him, even in the street names of Charlestown.

The tool to do this thing was easily available. He did not need a complex plan to acquire and conceal a gun. He bought it and carried it.

So, how do we prevent another of these events?

  • A better mental health system would be fine, but might not have helped Dylann. This was probably not, strictly speaking, the product of a treatable mental illness.
  • A more functional and stable family? Yes. But we have no way of making this happen.
  • A better educational system? Yes. Definitely. And one that offers alternative programs for those inclined to drop out.
  • Good, dignified employment. Yes. Let’s work on that through social policy at all levels of government.
  • Gun control? Yes. Definitely. It is social and legislative insanity to let a 21 year old buy any guns, let alone handguns. Pure and simple. It should not happen. And while murder can be committed by other means, those other means are not as deadly, not as easy, and not as amenable to a momentary impulse.
  • And then we have communal attitudes, overt attitudes, subliminal attitudes, and symbols of hatred, fear and racism. They have a lot of work to do down there. Leaders need to watch the language they use (e.g. “Take back our country”) lest it be mistaken for a call to arms by the less stable among us. And the symbols. The State could quickly remove those symbols of defiance and racism and confine them to the museum. And the State could take a leaf from Germany and ensure the present generation understands and appreciates the truth of their country’s past.

Well, so far, though it looks like Dylann Roof’s name will be long remembered, his actions may have brought about something quite opposite to what he imagined.

David Laing Dawson is the author of The Adolescent Owners’ Manual

To better understand what delusions from a serious mental illness look like, read Katherine Flannery Dering’s blog about her brother

Criminals, Terrorists, and Delusions – The Differences

David Laing DawsonBy Dr David Laing Dawson

Thomas Mulcair, the leader of the Canadian opposition, said that Michael Zehaf Bibeau, the Ottawa shooter, was a criminal, not a terrorist.

This somehow implies to me that being a criminal is even worse than being a terrorist, a “common criminal” rather than an ideologically driven terrorist.

But it does speak of our confusion with this language, and our use of the terms “mentally ill”, “terrorist”, “troubled”, and “criminal” to imply our sympathy, our disdain, or our disgust, rather than a finely tuned definition of each term.

This is the stuff of whole lecture series in the psychological and social sciences but these distinctions might help:

Delusions are explanations for that which is either unacceptable to us, or terrifyingly inexplicable.

The delusion that is the consequence of a mental illness is an explanation for a terrifyingly inexplicable experience.

It can be an explanation, an organization of information when the brain is otherwise impaired in its social information processing, (e.g. schizophrenia, brain injury, dementia), an explanation, or organization for an unusual feeling state, (e.g. mania and grandiose delusions), or an explanation/organization for an otherwise inexplicable sensory experience (e.g. hearing voices, crawling or touching sensations). Such delusions are usually autistic in nature. That is they do not conform to an accepted belief system. (They are not “I have come to believe in God”, but rather, “I am God’s messenger”, or, “I am God”). But they do tend to incorporate the technology and fads and fears of the day. (In 1960 a delusion might include being controlled by radar, or microwaves; today it is more likely having an implanted microchip, or of being pursued by terrorists). Such mental illness-derived delusions usually preclude someone from joining a group, participating in a joint venture, being, for example, part of a terrorist cell – but for a brief span of time, a mentally ill deluded person might find the tenets of Extreme Islam to be satisfying, captivating, and then act upon them.

But one can certainly arrive at this kind of belief and action from different pathways. One can be raised in it, otherwise uneducated, know nothing else but this belief system, and then be pushed to hatred and action by experience, the experience of hatred, loss, failure and grief. It is a delusion of sorts, but one shared by one’s teachers and comrades.

And some troubled young men may,  without the presence of a true mental illness-derived delusion,  find the tenets of Extreme Islam, the call to action, the promise of significance, the promise of reward and martyrdom, a very convenient solution to their failures, their narcissistic anger and disappointment.

The first hypothetical person, the mentally ill man, is not criminal. At least he will not be considered criminal under the law if it can be demonstrated in court that his delusion, his mental illness, prevented him from having the capacity to know right from wrong and appreciate the consequences of his actions. In the language of Canadian law, he might be found guilty of the act, but not criminally responsible due to mental illness.

The second hypothetical man has been raised within a strict educational and religious system, kept apart from the rest of the world, and been pushed to extremism by the intense propaganda of his teachers (both online and offline) and by his own experiences of loss, hatred, and tragedy that seem to prove them right.  He may join IS or a terrorist cell. He may be a true believer in Jihad. A bona fide terrorist.

The third hypothetical man? It would take a psychiatric assessment and a court of law to make a determination.  Are his troubles sufficient to warrant a diagnosis of mental illness? Was embracing Extreme Islam a convenient way of channeling his rage? Was he suicidal, or deluded about the outcome of his actions? Would a court of law determine that he had the capacity to know right from wrong and find him criminally responsible? Probably.