Monday, December 6, 2010

Demystification Monday: Delusional Much?

Have you ever accused someone of being delusional? Or, since many of you are writers (and I believe this sometimes goes with the territory)—have you ever been accused of being delusional?

Yeah. I hear that a lot. Oh, wait. I meant I hear it on television. Or I’ve read it. People don’t actually say that to me.

Not to my face, at least.



So, do you know what being delusional actually means?

A delusion, according to the DSM-IV-TR, is a false belief that:
1. Is based on an incorrect interpretation of reality

2. Persists despite evidence to the contrary

3. Is not ordinarily accepted by other members of the person’s culture or subculture (for you atheists out there, this is why people of faith are not considered delusional on that basis alone)

You can’t talk a truly delusional person out of his/her delusion. Probably best not to try. In fact, I’m telling you: Don’t do it.

Delusions are either:

Nonbizarre—these are beliefs based on things that could *technically* happen, like a belief your significant other is cheating on you, your best friend is secretly a government agent, you've been infected with a flesh-eating disease, etc.

OR

Bizarre—these are beliefs that stray far from the realm of plausibility within one’s culture, like thinking aliens break into your room every night and remove your memories one-by-one by inserting a pipe cleaner into your left nostril.

[Oh, there’s another way to distinguish delusions—mood-congruent vs. mood-incongruent, but I’ll get into that when I discuss MANIA! WHOOPEE!]

Ahem, moving on.

Delusions can involve just about anything under the sun, but I summarize a few of the more common themes below.

Persecutory—someone is doing something really, really bad to you. You know, like poisoning you, drugging you, harassing you, stalking you, spying on you, conspiring against you, or some combination of those. Imagine how frightening that must be.

Erotomanic—not nearly as fun as it sounds. You believe someone “of higher status” is in love with you, wants to marry you, etc.. When you hear on the news about some woman breaking into Leonardo DiCaprio’s home because she thinks they’re married … yep, probably an erotomanic delusion.

Grandiose—you have a special, unrecognized talent or ultra-exclusive knowledge! Jonathan Franzen has you on speed dial and calls you to brainstorm ideas for his novels! You know the secret to the universe! The special sauce!  Your invention can fix the economy, copy-edit a manuscript, AND grill you a sandwich! I read a thread on AbsoluteWrite recently that brought this kind of delusion to mind. For fear of being sued, I won’t paste the link, but it was sorta sad. And kind of jaw-dropping.

Somatic—oh, this is a rough one. You believe something really bad is going on with your body, like you’re infested with parasites, giving off a terrible odor, or have a body part that is not functioning or strangely misshapen.

There are some shades of grey, of course. Not everyone with weird beliefs is delusional! For example, there's something called "overvalued ideas": a belief that's strong, kinda strange and illogical to the average observer, and persists in spite of some evidence to the contrary. However, these can be differentiated from delusions by a professional--delusions are even more implausible, start more abruptly (as opposed to developing gradually over time), and the person who has the delusion won't care as much about what people think.*

If you’re writing a character who is delusional, you might want to check out a more in-depth article here. It will even tell you characteristics of folks who present with certain types of delusions, other conditions associated with delusions (schizophrenia, medical illnesses, etc.)… in other words, it’s a lot of good, reliable info.

From the realm of fiction, Wally Lamb did an amazing job of portraying a character experiencing all sorts of delusions in I Know This Much Is True. He captures Thomas’s genuine fear as a result of the delusions, as well as his brother Dominick’s intense frustration with his twin’s unshakeable beliefs in some truly bizarre things. 

Now, are you wondering if YOU are delusional?  Don’t worry. If you’re actually asking that question, you’re probably not deluded (uh, but do keep in mind that this blog is no substitute for assessment and treatment by a licensed mental health professional).

*Mullen & Linscott, 2010, Journal of Nervous and Mental Disease

12 comments:

  1. Hey! Your blog is awesome!!! I'm so happy I found it. Your insights are going to be very useful.

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  2. I knew a girl (who happened to be the manager) who was delusional. It wasn't even amusing by the end of things because she was also kind of violent, and we all actually believed that she might come in and kill us one day - partly because we weren't 'supporting her' in her fight with the 'undiagnosed disease' that she was certain was killing her...

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  3. Stina--was it in doubt? ;)

    Lisa--thanks!!

    A. Grey--yes, one of the things about delusions is that the person wouldn't think the problem was with her thinking--she'd think the problem was with everyone else. This is why confronting a person with delusions can be so frustrating and not the best thing to do. It's often hard to get such a person into psychological treatment for that exact reason. This is particularly painful when the person is someone you love (because of the amount of distress and fear delusions often produce), but I guess it would also be really difficult if it happened to someone with authority over you! I'm sorry--that sounds like a tricky situation!

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  4. Matt...please don't talk me out of my delusion - I'm enjoying it too much.

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  5. LOL! Wait! You're Sarah, not Matt. I though I was on his blog. Really, I'm not delusional, just an idiot.

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  6. wait! so- if you don't believe the same things as the mainstream population, you can technically be labeled delusional???
    that doesn't seem right. like what you said about people of faith...
    delusions would change as readily as the cultural zeitgeist...
    strange.
    very interesting as usual!

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  7. So then I'm not delusional! Oh, but the poor saps who are. So sad. And serious.

    ~JD

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  8. Aspiring_X--no, it's "culture" or "subculture"--not "mainstream culture." And no one should diagnose delusions except a competent mental health professional, like a psychologist or a psychiatrist, who performs an in-depth assessment. And keep in mind delusions have other characteristics--they persist in spite of direct evidence to the contrary, for example. In other words, it takes a lot more than not going along with cultural zeitgeist. Of course, culture does have an impact on this type of diagnosis (and all diagnoses, for that matter), so we shouldn't pretend it doesn't and must take that into account when we diagnose. But the diagnostic criteria (though NOT perfect) are designed to detect true, impairing psychopathology rather than someone with some different beliefs than the mainstream. Thanks for your comment! I hope that helps.

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  9. eeks! i had to go back and read that sentence again! i missed the word "not" !!! sorry!!! three little letters- so much difference! :)
    sorry again! just the misread blew my mind! :)

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  10. It was, indeed, tricky. Things almost got entirely out of hand because the girl's family refused to admit that she was delusional - they insisted that WE were the ones 'seeing things' because the girl was bipolar and we just didn't understand her. I have friends that are bipolar. Yes, it can be difficult, but my friends are not delusional. This girl had backed herself off of her meds, and was self medicating and drinking heavily and that behavior only got worse with the progression of the delusions.

    The worst was when she and her mother arranged a meeting with the owner of the farm and wanted all of us under-employees to vouch for the manager's 'continuing undiagnosed' disease, and swear that all of her symptoms were true. None of us would, and that's when things got crazy because the girl was then fired, but since she lived on the farm she had 30 days to move out and we had to be around her for that time...

    To this day, 5 years later, I meet people she knew and they ask me how her chemo is going or if she had to have surgery on her brain tumor, and I have to explain that she's totally fine and living with her mom, still convinced that she's dying... And the very worst part is that her mom is now convinced that she's dying and reenforces all her delusions, rather than working to get the girl back on meds and stabilized emotionally/mentally.

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  11. Great information, and thanks for the links!

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