How Hard Is It To Recognize That You Are Experiencing A Delusion?

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How Hard Is It To Recognize That You Are Experiencing A Delusion?
Digital Art and Photo Credit: Hartwig HKD (CC BY-ND 2.0)

When people experience delusions or hallucinations there is usually some loss of contact with reality whereby normal processes of thought and perception are disturbed. As humans, we are all susceptible to experiencing anomalous mental states such as this. In everyday life, for example, mentally healthy people distort reality to enhance their self-esteem and maintain beliefs about their self-agency.

When faced with negative, ambiguous or unsupportive feedback, we often respond with exaggerated perceptions of control and unrealistic optimism. In some life situations – in states of delirium, bereavement, severe lack of sleep and sensory deprivation – it is not uncommon for hallucinations to occur. The idea that delusions and hallucinations are a sign of illness or pathology tends to emerge when the belief or experience occurs outside of such situations and is held to be true in the face of strong contradictory evidence.

In a delusion where a person believes that electronic listening devices are implanted in their brain, for example, the implausibility of the belief is obvious to everyone else around, but is held with an unshakeable conviction by that person. Similarly, when hallucinations occur, such as the hearing of non-existent voices, the person experiencing the hallucinatory speech may nonetheless believe that others can hear the voices too (and are lying when they say they cannot), or even attribute the experience to the possession of a special power such as telepathy.

The Three Christs of Ypsilanti

Problems in the self-recognition of such mind states seem to occur even when they lead to personal distress and severe disruptions to quality of life. But this difficulty in self-recognition does not necessarily come from a lack of rational thought. In a 1960s study, The Three Christs of Ypsilanti, psychologist Milton Rokeach observed what would happen when three people, each firmly believing they were Jesus, lived together in very close proximity for several months.

Rokeach wondered how the three men would react when they realised there was more than one Jesus. Rather than some dawning of reality, Rokeach observed that each of the men retained their delusional identities while at the same time rationalising the existence of the other two. One of the men, for example, thought one was a liar and the other an angel rather than Jesus himself.

More recently, Startup (1997) studied a group of psychiatric patients experiencing delusions and hallucinations. The patients read individual case stories about people experiencing a range of pathological states of mind. They were asked how likely it was that the scenarios depicted a mental illness.

The patients who were most fixed in their own delusional beliefs were able to distinguish between descriptions of delusional and normal beliefs. However, they could not identify anything erroneous or pathological in their own thought processes. It would seem therefore that the capacity to identify hallucinations and delusions in other people might be greater than the ability to see them in oneself.

Self-recognition and help

The appraisal by people with psychotic disorders that their delusional beliefs and hallucinatory experiences are non-pathological may have consequences in terms of how likely they are to ask for or receive help. Put simply, if you do not believe there is anything wrong with your mental state why should you want to receive medication or a spell in hospital?

Refusal to accept treatment is a cause for concern in the care and management of psychotic disorders where delusions and hallucinations are prominent. In a study of patients with psychosis, Olli Kampman and colleagues found that self-recognition of one’s psychotic state was an important factor when predicting engagement with treatment. However, it seems that self-recognition of symptoms is only one of several factors affecting how (or if) someone engages with recommended treatment.

Following a series of interviews with patients with psychosis, it was found that the pathway between the appraisal of delusions and hallucinations and the acceptance of any need for treatment is one of great complexity. Kevin Morgan and Anthony David identified five treatment profile types. One of the treatment profile groups consisted of patients that acknowledged a need for treatment but yet were non-compliant. For example the patient who said: “I need a skunk, spliff and a joint to treat me. The doctor’s treatment is crap.”

In the other treatment profiles, there were patients who did not believe themselves to be ill or in need of medical help but were nonetheless engaging with their prescribed treatment regimens. It was evident that previous experience (or fear) of medication side-effects played a role in these seemingly contradictory stances. It also emerged that emotional states had an impact on treatment behaviour. Interestingly, several patients while appraising their mental states as “abnormal” did not identify them as pathological, in other words as a sign of illness.

The ConversationThe identification of abnormal mental states therefore does not always lead to a belief or acknowledgement that treatment is a necessary or desirable course of action. When it comes to treatment, then, awareness is not the same as acceptance.

About The Author

Kevin Morgan, Senior Lecturer of Psychology, University of Westminster

This article was originally published on The Conversation. Read the original article.

Related Books:

Cognitive-Behavioural Therapy With Delusions and Hallucinations: A Practice Manual (Second Edition) (Mental Health Nursing & the Community)

healthAuthor: Hazel Nelson
Binding: Paperback
Creator(s):
  • Aaron T. Beck

Studio: Nelson Thornes Ltd
Label: Nelson Thornes Ltd
Publisher: Nelson Thornes Ltd
Manufacturer: Nelson Thornes Ltd

Buy Now
Editorial Review: Written in a highly accessible style, Cognitive-Behavioural Therapy with Delusions and Hallucinations gives detailed practical guidance, providing the reader with a range of strategies and techniques, set within a clear, structured framework. Readers are taken through the planning and delivery of the different aspects of the therapy. Issues commonly encountered with people having delusions and hallucinations are considered and strategies are provided to help avoid or overcome these issues. This book can be used as an instruction or practice reference manual as it gives step-by-step guidance on delivering the therapy using case studies and clinical examples to illustrate applications. The foreword is by Professor Aaron T. Beck, a leading figure in cognitive-behavioral therapy in the U.S.




The Mental Health Clinician's Workbook: Locking In Your Professional Skills

healthAuthor: James Morrison
Binding: Kindle Edition
Format: Kindle eBook
Studio: The Guilford Press
Label: The Guilford Press
Publisher: The Guilford Press
Manufacturer: The Guilford Press

Buy Now
Editorial Review:
Rich with compelling case material, this hands-on workbook helps mental health practitioners and students build essential skills for clinical evaluation and differential diagnosis. Renowned diagnostician and bestselling author James Morrison (DSM-5 Made Easy and other works) invites the reader to interview and evaluate 26 patients with a wide spectrum of presenting complaints and ultimate diagnoses. Using multiple-choice questions and fill-in-the-blank exercises, clinicians practice the arts of interviewing and making diagnostic decisions. The convenient large-size format facilitates use. Extensive tables in the appendix provide a quick-reference guide to the interviewing techniques, diagnostic principles, and clinical diagnoses discussed in each case.

See also Morrison's DSM-5® Made Easy, which explains DSM-5 diagnoses in clear language, illustrated with vivid case vignettes; Diagnosis Made Easier, Second Edition, which offers principles and decision trees for integrating diagnostic information from multiple sources; and The First Interview, Fourth Edition, which presents a framework for conducting thorough, empathic initial evaluations.




Delusions: Understanding the Un-understandable

healthAuthor: Peter McKenna
Binding: Hardcover
Studio: Cambridge University Press
Label: Cambridge University Press
Publisher: Cambridge University Press
Manufacturer: Cambridge University Press

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Editorial Review: Delusions, in their many different manifestations, are central to the concepts of madness and psychosis. Yet what causes them remains in many ways a complete mystery. McKenna's Delusions is the first comprehensive attempt to tackle one of the most arresting phenomena in psychiatry: an in-depth and critical review of what delusions are, the forms they can take and how they might be explained from both psychological and biological perspectives. Delusions covers key topics such as the clinical features of delusions, the disorders they are seen in, other oddities that resemble them in both health and disease, and the different approaches that have been taken to try to understand them. It is an essential book for psychiatrists and psychologists who work with delusional patients, as well as being of interest to neuroscientists engaged in research into major psychiatric disorders.




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