Delusions, Delusion-Like Beliefs, and Conspiracy Theories Conspiracy theories have flourished in the current cultural moment.

Conspiracy theories are bad for our culture due to their polarizing effect. Assumptions Conspiracy theories have a negative impact on the emotional health of individuals in our culture.

Our culture needs to give serious reflection about how to decrease conspiracy theories. Rigid thinking means an inability to change your mind when all signs point to a change of mind. It also implies an inability to see a situation from a Rigid thinking different point of view. People with rigid thinking see life with blinders on, perceiving only one out of the countless nuances there are. Purpose: To use information about delusions and disorders of rigid thinking to understand the attraction of conspiracy theories and how to reduce their power. A general framework to understand delusions and disorders of rigid thought.

Review of known psychiatric disorders of rigid This talk will thought. be divided Discussion of delusion-like beliefs. into five sections. Discussion of the nature of conspiracy theories.

Strategies for mitigating the harmful effects of conspiracy theories in our patients and the culture as a whole. Limited ability to consider Non-bizarre delusions- alternative hypotheses the secret Russian weapon

Normal flexibility Bizarre delusions- of thought Martians control RC

Ability to consider alternative hypotheses Paranoid personality Non-bizarre paranoia

Normal fears and Bizarre paranoia cautions

Ability to consider alternative hypotheses

Delusions Delusions are defined in DSM-5 as: A false belief based on incorrect inference about external reality that is firmly held despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not ordinarily accepted by other members of the person's culture or subculture (i.e., is not an article of religious faith). When a false belief involves a value judgment, it is regarded as a delusion only when the judgment is so extreme as to defy credibility [Ref. 1, p. 819]. Paranoid Schizophrenia

The peak of John Nash's schizophrenic delusions occurred while he was giving a speech about his mathematical research. During this speech he saw men in suits in the aisles of the lecture room, who he thought were soviet spies who had been ordered to capture him.

A white supremacist, Manson believed that Black people in America would rise up and kill all whites except for Manson and his "Family", but that they were not intelligent enough to survive on their own; they would need a white man to lead them, and so they would serve Manson as their "master". Delusional Disorder Delusional Disorder

Erotomanic. Someone with this type of delusional disorder believes that another person, often someone important or famous, is in love with him or her. The person might attempt to contact the object of the delusion, and stalking behavior is not uncommon. Grandiose. A person with this type of delusional disorder has an over-inflated sense of worth, power, knowledge, or identity. The person might believe he or she has a great talent or has made an important discovery. Jealous. A person with this type of delusional disorder believes that his or her spouse or sexual partner is unfaithful. Persecutory. People with this type of delusional disorder believe that they (or someone close to them) are being mistreated, or that someone is spying on them or planning to harm them. It is not uncommon for people with this type of delusional disorder to make repeated complaints to legal authorities. Somatic. A person with this type of delusional disorder believes that he or she has a physical defect or medical problem.

Paranoid Personality Disorder

Normal Fear or Caution Folie a Deux

Its main feature is a delusion that develops in an individual who is involved in a close Folie a deux or relationship with the “inducer” shared psychotic or “primary case,” who already has a psychotic disorder with disorder prominent delusions. Interpersonal relationships characterized by: 1. being close, 2. lasting, and 3. isolated from a social environment Risk factors for 4. mental retardation 5. suggestibility folie a deux 6. passivity 7. histrionic personality traits

This intimate interaction is an essential factor in the development of shared psychotic disorder. 1. parent-offspring, Most 2. sibling-sibling, or 3. husband-wife constellations often Furthermore, mother-daughter or sister- sister pairs represents fifty percent of the found in psychotic dyads. Religion Religious beliefs Non-bizarre religious delusions

Normal Beliefs Bizarre religious delusions

Ability to consider alternative hypotheses Rigid thinking

Ability to consider alternative hypotheses Delusion-Like Beliefs Overvalued ideas

• An overvalued idea is an unreasonable and sustained belief that is maintained with less than delusional intensity (i.e., the person is able to acknowledge the possibility that the belief may not be true). • The belief is not one that is ordinarily accepted by other members of the person's culture or subculture 1. A belief shared by others in a person's cultural, religious, or subcultural group. 2. The belief is often relished, amplified, and defended Extreme by the possessor of the belief. 3. The idea fulminates in the mind of the individual, Overvalued growing more dominant over time, more refined, and more resistant to change. Belief 4. The individual has an intense emotional commitment to the belief and may carry out violent behavior in its service. 5. It is usually associated with an abnormal personality. Conspiracy Theories Stab in the back conspiracy

• The stab-in-the-back myth was an antisemitic conspiracy theory, widely believed and promulgated in right-wing circles in Germany after 1918. The belief was that the German Army did not lose World War I on the battlefield but was instead betrayed by the civilians on the home front, especially Jews and the republicans who overthrew the Hohenzollern monarchy in the German Revolution of 1918–1919. Advocates denounced the German government leaders who signed the Armistice on November 11, 1918 as the "November criminals“. • When Adolf Hitler and the Nazi Party came to power in 1933, they made the legend an integral part of their official history of the 1920s, portraying the Weimar Republic as the work of the "November criminals" who stabbed the nation in the back to seize power while betraying it. Reptilian Conspiracy: British conspiracy theorist David Icke

Tall, blood-drinking, shape-shifting reptilian humanoids from the Alpha Draconis star system, now hiding in underground bases, are the force behind a worldwide conspiracy against humanity. He contends that most of the world's ancient and modern leaders are related to these reptilians, including the Merovingian dynasty, the Rothschilds, the Bush family and the British Royal family. Icke's conspiracy theories now have supporters in up to 47 countries and he has given lectures to crowds of up to 6,000 people. JAMA Intern Med. 49% of Americans agree with 2014;174(5):817-818 at least 1 medical conspiracy theory Factors that make conspiracies more likely Usually Preceded by Distrust of the People Felt to be Conspiring Against the Makers of the Conspiracy Theory Tribalism Paranoid Quality: The Conspirators are doing Something Bad or Evil Enhanced by Prominent People Confirmation Bias Social Media as Echo Chamber Pandemic-Social Isolation Excitement that they have special knowledge. They have figured things out causing a dopamine charge. Conspiracy Theory vs Delusion

• Usually conspiracy theories are • By definition, delusions are false beliefs false, but occasionally prove to • Usually arise “from within,” based on be true idiosyncratic response to external • Origin lies mostly in externally and/or internal stimuli; often a provided information, news, component of disease process social media, etc. • Sharing is generally not possible; • Marked sharedness; often linked delusions are too self-referential, to community of like-minded personalized individuals Conspiracy Theory vs Delusion

• Information is received in a • Information is processed quite biased way, with respect to the aberrantly with respect to the content of the conspiracy content of the delusion • Often pervasive mistrust of • Mistrust more localized around a authority, “experts,” science, specific, core delusion; identified government, etc. individual ; or group • Hallucinations are rare • Hallucinations are common • Social-vocational impairment is • Social-vocational impairment is minimal, but may be present often significant, especially in Schizophrenia Characteristics of conspiracy theorists: Journal of Personality Characteristics of Conspiracy Theorists Karen Douglas, University of Kent

Epistimic Existential Social

Crave knowledge, desire safety and need to maintain security, and positive self- esteem.

Violence as dividing line How might responsible people address the conspiracy theory epidemic?

1. Make it a point to let people who have beliefs that look like conspiracy theories know that you don’t see things the way they see them. Not saying anything tacitly endorses the conspiracy theory. Telling people their beliefs are wrong does not work, but telling them how you see things may be helpful. 2. Suggest that people consider other sources of information as they think through their beliefs. Getting information from a variety of sources may give them other ways of viewing issues. How might Responsible People address the conspiracy theory epidemic?

3. Encourage diverse interactions. It is hard to hate people who are not like you if you have a personal relationship with them. 4. Identify respected leaders and encourage them to push against conspiracy theories. 5. Encourage the teaching of critical thinking, intellectual inquisitiveness, and intellectual humility in our schools. How might responsible people Address the Conspiracy Theory Epidemic?

6. Encourage responsible use of social media. 7. Develop rules for social media which encourage intellectual honesty. Make it important for people to show scientific or other verifiable facts to support their statements. 8. Devaluing people who believe in conspiracy theories pushes them into their echo chambers. Engage with them and encourage fact-based discussion.