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Psy 08/03 P418-423 Bell Et Al Delusional thinking ) OBAL K OURTESY (C Beliefs about ICTURES P OLUMBIA .C RIVER D AXI T delusions ROM F VAUGHAN BELL,PETER HALLIGAN and HADYN ELLIS on the sometimes fine line between normality and abnormality. ARLY in his third month of office, from the delusion that the assassination The sprawling and eccentric VALIS is a President Reagan was on his way would cause Jodie Foster, the actress from novel based on delusions resulting from his E to address a conference when John Taxi Driver (a film which Hinckley was own psychotic breakdown, which he drew Hinckley fired six gun shots at point blank obsessed with), to fall in love with him. on for much of his prolific career (see box). range, wounding the president and three of In the same year the award-winning author From these and many other examples, it his entourage. In the controversial trial that Philip K. Dick, whose books have been would appear that unusual or unlikely followed, three defence psychiatrists turned into major Hollywood films, such beliefs have significant consequences and successfully argued that Hinckley was not as Blade Runner, Total Recall and Minority continue to captivate the interest of many guilty, on the grounds that he was suffering Report, published one of his last books. of us. But to examine such claims we need to know what is meant by a delusion. How do delusions differ from other abnormal beliefs? Does the study of delusions provide PHILIP K. DICK a productive way of understanding beliefs? Many novels and short stories by Philip K. Dick contain elements from the delusions he suffered regarding identity and the nature of reality. Dick described many bizarre experiences and came to believe that human Defining issues development was controlled by an entity called VALIS (Vast Active Living Intelligence System) and that his Delusions are one of the most important perception of Orange County, California was an illusion disguising the fact that he was really living in first- constructs used by psychiatrists to diagnose century Rome.There were multiple reasons for Dick’s bizarre beliefs, given his share of trauma, phobias and patients who are considered to have lost drug abuse, but it is likely that many of the delusions he wrote about stemmed from psychotic episodes he touch with reality (Maher, 1988). For experienced as a sufferer and as an observer of others.This alone makes his work of great psychological Jaspers (1963), one of the founders of interest. However, Dick also seems to have some knowledge of contemporary psychology himself, modern psychiatry, delusions constituted incorporating as he did the work of Penfield,Vygotsky and Luria (among others) into his stories. the ‘basic characteristic of madness’ despite being ‘psychologically irreducible’. 418 The Psychologist Vol 16 No 8 August 2003 Delusional thinking foremost, a form of belief: a belief whose acceptance and subsequent behaviour can THE MARTHA constitute the grounds for insanity. But no justification is offered and the statement MITCHELL EFFECT itself amounts to a belief in delusions. Sometimes improbable patient reports are More explicitly, the standard definition erroneously assumed to be symptoms of mental characterises delusions as false, based on illness (Maher, 1988).The ‘Martha Mitchell effect’ an incorrect inference about external reality referred to the tendency of mental health and different from what almost everyone practitioners not to believe the experience of the else believes (APA, 1994). Other features wife of the American attorney general, whose such as degree of conviction and persistent reports of corruption in the Nixon imperviousness to persuasion do not set White House were initially dismissed as evidence delusions apart from other beliefs (Garety of delusional thinking, until later proved correct & Hemsley, 1994). by the Watergate investigation. Such examples demonstrate that delusional Delusions – An abnormal pathology can often lie in the failure or inability to belief by any other name verify whether the events have actually taken Despite differences in emphasis, most definitions consider two criteria to be place, no matter how improbable intuitively they significant when establishing a delusion: might appear to the busy clinician. Clearly, there falsifiability and bizarreness. Simply are instances ‘where people are pursued by the described, ‘bizarre delusions are generally Mafia’ or are ‘kept under surveillance by the impossible, whereas non-bizarre delusions police’, and where they rightly suspect ‘that their are generally improbable’ (Sedler, 1995, spouse is unfaithful’ (Sedler, 1995).As Joseph H. p.256). The DSM-IV distinguishes these Berke (1998) wrote, even paranoids have as follows: a non-bizarre delusion may enemies! For understandable and obvious involve situations that in principle could reasons, however, little effort is invested by occur in real life but are thought (by the clinicians into checking the validity of claims of psychiatrist) to be highly improbable and persecution or harassment, and without such therefore potentially falsifiable; a bizarre evidence the patient could be labelled delusional. More significantly, the detection of or fantastic belief, however, is considered delusions has ‘enormous implications impossible and therefore assumed to be for diagnosis and treatment, as well as one not normally held by others in the consulting room, or lies beyond the complex notions concerning responsibility, culture or society. forensic capabilities of the clinician. As prediction of behaviour, etc.’ (David, 1999). The problem with each of these pointed out by Young (2000), ‘many of the Yet, as pointed out by many commentators definitions lies not with the differential beliefs considered to be delusions do not (see Jones, 1999), the clinical usage of the distinction, but with the absence of agreed meet these criteria (or are not tested against term delusion and its distinction from other operational definitions as to how these them) in practice’ (p.47). This can have abnormal beliefs involve a host of semantic criteria are arrived at clinically. The DSM some curious consequences (see ‘The and epistemological difficulties. definition does not specify how one might Martha Mitchell Effect’, above). Predominant amongst these is our belief set about establishing the falseness or Accordingly, this falsity criterion has that delusions are (to a large extent) self- bizarreness of the belief; nor how one been rightly questioned (Spitzer, 1990). evident; that is, that they constitute a type could know whether the belief was the Moreover, it is unclear what level of of belief that (almost) everyone else would product of an impaired inference, such evidence would be required to consider recognise as pathological. This, however, as occurs in paranoid patients, who show a belief ‘incontrovertibly false’ and whether is more apparent than real, and is not even a tendency to jump to conclusions in judgements should be based on the reflected in the many different opinions situations requiring probabalistic reasoning ‘balance of probabilities’ or the more that surround the definition of the construct (Bentall, 1994). Here we turn to some stringent test of ‘beyond reasonable doubt’. (Berrios, 1991; Garety & Hemsley, 1994; specific problems. ‘Delusional’ beliefs, consequently, may not Spitzer, 1990). Indeed, David (1999) has be false (Heise, 1988) or even firmly suggested ‘there is no acceptable (rather Falsifiability Non-bizarre delusions sustained (Myin-Germeys et al., 2001). than accepted) definition of a delusion’ involve situations and events that could (p.17). occur in real life, such as believing that Bizarre beliefs The attribution that For most of us, however, these thorny one is being followed, infected, poisoned a delusion is bizarre is typically defined issues of definition can be sidestepped by or deceived by another. Therefore the in terms of beliefs considered not normally choosing to adopt the descriptive and ‘falsifiability’ criterion can mean that held by other members of a person’s widespread characterisation offered by psychiatrists are often required to make culture or society. This, however, often first the American Psychiatric Association’s judgements on claims of marital infidelity, involves the psychiatrist’s own evaluation Diagnostic and Statistical Manual of persecution or conspiracy in the workplace as regards the plausibility of the belief; Mental Disorders (DSM-IV). This (Jones, 1999), where the available relevant after which the psychiatrist considers established psychiatric nosology text evidence is either limited, cannot be whether it is one typically sustained by considers a delusion to be, first and ascertained within the confines of the the others in the person’s culture. Although 419 August 2003 The Psychologist Vol 16 No 8 Delusional thinking conceptual basis for the criteria of THE THREE CHRISTS OF YPSILANTI falsification or impossibility clearly breaks In 1959 social psychologist Milton Rokeach brought together three schizophrenic patients in the same down under scrutiny. It is also problematic psychiatric ward in Ypsilanti,Michigan, all of whom suffered from the Messiah complex – each believed he because psychotic symptoms such as was Jesus Christ. Rokeach was interested in seeing whether these mutually exclusive delusions would delusions and hallucinations are not interact and affect the extent of conviction and content of each patient’s delusional beliefs. In his book inevitably associated with the presence Rokeach
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