Q: After reading your answer to Michael regarding drug-induced insanity, I began to wonder why almost all descriptions of paranoid delusions seem to involve secret electronic surveillance by government agencies or aliens. Are these themes really so common among people suffering from paranoia, or are they just convenient examples used by writers on the subject? If they are ubiquitous, how would you explain so many people having the same delusion? If not, what other delusions are there? What do people in other cultures delude about? – Mulder
Dear Mulder,
Delusional systems are beliefs that run contrary to what almost everyone else thinks. That isn’t a very elegant way of defining a mental condition, but it’s the best we have so far.
Often, delusions are relatively uncomplicated. A person may believe that the authorities are following him, but the delusion doesn’t incorporate many details. Sometimes, the delusions are quite complex, involving specific people, detailed histories, and complex explanations. Either way, they’re usually no fun for the sufferer or the people around him.
There are different ways to achieve a delusional state. You can get there by way of hallucinations, such as one might experience with schizophrenia or after taking too much speed. You can make a good case that delusions are a normal response to abnormal sensations. Imagine seeing shadows from the corner of your eye or hearing whispers that everyone else denied hearing. Who wouldn’t try to come up with an explanation?
Other ways of developing a delusional state vary from one individual to the next. Some folks see and hear the same things as everyone else, but they make different sense of it. Imagine two people who are shortchanged at the grocery store. One person chalks it up to an honest mistake, while the other believes that the cashier singled him out and tried to steal his money. It’s normal to be curious about the cashier’s intent, but some people travel so far down that road that they get lost.
Getting lost down that road is often influenced by personal history. Someone who never learned about trust in childhood will have difficulty trusting others as an adult; someone who is consumed by anger tends to see the worst in others. And so on. Delusions can also be protective, insulating a person from the harsh reality of the world around him. Sometimes it’s easier to believe that the sexy redhead down the street has a secret crush than to face a less-than-stellar romantic career.
Environment also plays a role. Factors like social isolation (such as a lone immigrant might experience) or vulnerability (a typical experience of infirm elders) can cause a nervous mind to start searching for signs of trouble. When history and environment combine, the world can become a pretty scary place.
Sometimes, as my first clinical supervisor pointed out, the paranoid person is right. In the example that I gave Michael, my patient believed that he was being pursued by the authorities. Having committed several crimes, he was, in fact, being pursued by the authorities. His beliefs turned delusional when he became convinced that the FBI was after him. They had bigger fish to fry than this dude. Still, he wasn’t too far away from the truth.
Not all delusions involve paranoia, and not all involve highly unlikely situations. As delusions go, government agents and little green men aren’t all that common. People tend to base their delusional systems on the world around them, and that’s why most are fairly mundane. Here are some of the more common flavors:
- Delusional jealousy over a partner’s fidelity
- The mistaken belief of being romantically pursued
- The grandiose delusion of special powers
- The belief that one’s feelings, impulses, and actions are under the influence of someone else
- The belief that mundane occurrences have special significance (for example, imbuing radio commercials with special, personal meaning)
- Persecutory delusions of being attacked or conspired against
- Belief in a special relationship with God or someone important
Sadock and Sadock (2003, p. 517) tell the story of a 51-year-old man who believed he was chosen by God to publicize a new religion. He was arrested for carving religious messages into trees and was subsequently hospitalized. Had his followers shown up before the cops, he might have been the next savior. Word to the wise: if you ever have a delusion, try to make it a successful one. It’s much less painful that way.
-IS
References:
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
Sadock, B.J. & Sadock, V.A. (2003). Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, Ninth Edition. New York: Lippincott Williams & Wilkins.