Cluster A/Delusional DO/Paranoid Personality and modern psychiatry

[whopper]

Here's the question I got for you all.

We health professionals shouldn't delve into politics with our patients. The problem being is that politics has for years entered the delusional zone. Lizard people, child molestation rings being held in pizza restaurants, Jewish Space Lasers, etc.

So what are we supposed to do then? Ignore it? E.g. your patient comes in claiming there's Jewish Space Lasers and the election was stolen and there's proof cause bags of votes were found (no they weren't found but the guy keeps on it, and when you ask him to show the proof he shows you a tweet from some idiot who lives in his parents' basement).

So what do we do then? We have a professional responsibility of being honest with our patients, but we're not supposed to get into politics.

The DSM recommends we do not pathologize things within a cultural norm, but what if such things just a few years ago were outside that norm and are now pathologically within the norm?

Add to the sophistication of this problem, several delusions such as tracking ability within medical devices, medical implants, ultra-sonic or microwave guns are now becoming a reality. I've for years, at least once a year had a patient convinced someone was shooting microwaves at them, but now there is actually is proof this may have happened for real.

‘Havana syndrome ’ and the mystery of the microwaves

The BBC investigates a mystery illness dubbed "Havana syndrome" that has affected American diplomats and spies.

www.bbc.com

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[Fan_of_Meehl]

Here's the question I got for you all.

We health professionals shouldn't delve into politics with our patients. The problem being is that politics has for years entered the delusional zone. Lizard people, child molestation rings being held in pizza restaurants, Jewish Space Lasers, etc.

So what are we supposed to do then? Ignore it? E.g. your patient comes in claiming there's Jewish Space Lasers and the election was stolen and there's proof cause bags of votes were found (no they weren't found but the guy keeps on it, and when you ask him to show the proof he shows you a tweet from some idiot who lives in his parents' basement).

So what do we do then? We have a professional responsibility of being honest with our patients, but we're not supposed to get into politics.

The DSM recommends we do not pathologize things within a cultural norm, but what if such things just a few years ago were outside that norm and are now pathologically within the norm?

Add to the sophistication of this problem, several delusions such as tracking ability within medical devices, medical implants, ultra-sonic or microwave guns are now becoming a reality. I've for years, at least once a year had a patient convinced someone was shooting microwaves at them, but now there is actually is proof this may have happened for real.

‘Havana syndrome ’ and the mystery of the microwaves

The BBC investigates a mystery illness dubbed "Havana syndrome" that has affected American diplomats and spies.

www.bbc.com

I always explore these beliefs Socratically with patients, pay close attention to developing a good working alliance (and being trustworthy), and help them explore the functionality (or lack thereof) of holding the belief and also what core values underlie the belief. I also explore with them how they may best act in the world in accord with those core values and usually explore how much tv and social media are adding to or detracting from them living the satisfying life they want to live and help them decide how much they want to reduce social media involvement in lieu of more productive and fulfilling activities.

And...finding a way to insinuate the following wisdom doesn't hurt:

"How you gonna save the world from the Global Cabal if you can't set and maintain reasonable boundaries with certain people in your life to reduce your own distress?" Basically, save yourself before setting out to save the world. Most of these folks are frustrated with a lack of control/efficacy in their own lives and some practical focus in these areas could really be beneficial.

I also will commonly take their preoccupation with these topics to indicate that I need to continue to psychoeducate them on what therapy is/isn't and that the focus must be on self-change (patterns of belief or behavior). We are not here to change the world. We are here to help YOU make useful changes. This applies equally to the political Right AND Left, in my experience.

And as far as our professional responsibility to be honest with our patients...to me it's as simple as "I don't lie to my patients," meaning, I don't say that I believe things that I don't actually believe to be true. That can include not believing in Jewish space lasers, that a service dog is "medically necessary" to treat their PTSD, or that they need to have their wife as a paid caregiver to keep them from getting violent.

 

[detritus]

As long as they are not a danger to themselves or others, this is outside the scope of medicine in my opinion. Many delusions later proved to be true. We should approach our patients with humility and try best to help them. Whatever information they may be looking at, it’s probably not that clinically relevant unless they are approaching being violent as a result.

 

[whopper]

Many delusions later proved to be true.

Martha Mitchell Effect.

Martha Mitchell effect - Wikipedia

en.wikipedia.org

I'm shocked this phenomenon is not taught in psychiatric training and have seen several professional violating this effect.
I've told my students this. If the delusion is fantastic, so be it. Patient is likely psychotic. E.g. demons, angels, aliens having sex with them, etc.

If the delusion is within a realm of possibility do some homework before you cast off the person as delusional. I've even had schizophrenic patients say things that seemed outlandish but true such as one of them claiming he was friends with the Dalai Lama (he really was and his family proved it), and he went to Harvard (which also was true, family proved it).

I've had patients who really were related to rich and famous people, had the FBI after them, were key witnesses in most-wanted cases. Several of these same patients were labelled as psychotic and were not so. When I did inpatient and ER I had about one patient every 3 months that was in such a situation.

Getting back to my original question, I had to deal the issue the most with COVID. I had patients ask me, "is there a microchip in the vaccine," and such, and not in a escalatory or hostile manner but wanting a sincere medical opinion. To which I answered, without trying to sound partisan, that while I recommended the vaccine, it is new, there is such a thing as needing to wait on new treatments cause sometimes bad things are found out later on, but in terms of the public, but not individual good, the vaccines are warranted, denied there was a microchip in the vaccine, they could have a bad side effect, but the patient had to weigh the pros and cons themselves based on the facts and not the conspiracies. I also attempted to parse out valid reasons to not take the vaccine (e.g. it was new, the patient may have had bad reactions with other vaccines) vs BS conspiracy theories.

I also noticed I lost a few patients during COVID and I don't know what happened to them, but some of them I suspect stopped seeing me when I refused to adopt a partisan stance that fit their beliefs based on the pandemic. E.g. I had one patient with a TBI and recommended she wear masks and get the vaccine because she had health problems, and her mother, the patient's guardian looked at me as if in horror and I never saw her again after that despite having her for years as a patient without problems.

As a PGY-1, a schizophrenic patient of mine, kept telling me her husband was trying to murder her. To this day I suspect that might've been real. She had been compliant with meds and each time she called the police they just sent her to the hospital, but while in the hospital she was fine even after several days of observation, and showed good insight. She alleged that her husband wanted her out of his life.

Well lo and behold it's the patient's last day and her husband wanted to talk to me, so we talked and he's telling me he wants her out of his life cause he's in poor health and the last thing he needs to worry about is his schizophrenic wife, and begged me to ship her off to the long-term facility to which I refused because she didn't meet the criteria. So then I told my attending who pretty much just blew the situation off without looking into it. The husband did end up dying about a year later. A question I would get is-if he wanted to kill her he likely would've. Not really. He was in very very poor physical health.

Now does that prove he was trying to kill her? Of course not, but the hypothesis that he was trying to kill her IMHO wasn't outlandish either, but was hardly actionable either. If this happened again and I was the attending I would've called the hospital lawyer but I already know what the lawyer would've said-warn her, tell her to call the police, but then the cycle would've just continued. She's back in the hospital and no legal action would be taken, and understandably so cause there was no physical evidence.

 

[Fan_of_Meehl]

Martha Mitchell Effect.

Martha Mitchell effect - Wikipedia

en.wikipedia.org

I'm shocked this phenomenon is not taught in psychiatric training and have seen several professional violating this effect.
I've told my students this. If the delusion is fantastic, so be it. Patient is likely psychotic. E.g. demons, angels, aliens having sex with them, etc.

If the delusion is within a realm of possibility do some homework before you cast off the person as delusional. I've even had schizophrenic patients say things that seemed outlandish but true such as one of them claiming he was friends with the Dalai Lama (he really was and his family proved it), and he went to Harvard (which also was true, family proved it).

I've had patients who really were related to rich and famous people, had the FBI after them, were key witnesses in most-wanted cases. Several of these same patients were labelled as psychotic and were not so. When I did inpatient and ER I had about one patient every 3 months that was in such a situation.

Getting back to my original question, I had to deal the issue the most with COVID. I had patients ask me, "is there a microchip in the vaccine," and such, and not in a escalatory or hostile manner but wanting a sincere medical opinion. To which I answered, without trying to sound partisan, that while I recommended the vaccine, it is new, there is such a thing as needing to wait on new treatments cause sometimes bad things are found out later on, but in terms of the public, but not individual good, the vaccines are warranted, denied there was a microchip in the vaccine, they could have a bad side effect, but the patient had to weigh the pros and cons themselves based on the facts and not the conspiracies.

I also noticed I lost a few patients during COVID and I don't know what happened to them, but some of them I suspect stopped seeing me when I refused to adopt a partisan stance that fit their beliefs based on the pandemic. E.g. I had one patient with a TBI and recommended she wear masks and get the vaccine because she had health problems, and her mother, the patient's guardian looked at me as if in horror and I never saw her again after that despite having her for years as a patient without problems.

Sounds like you were earnestly trying to tell your patients what you actually knew (and what your opinion was) without pushing an agenda. Not sure how anyone could improve upon this approach.

People too often forget that 'fallibility is the hallmark of science' (not certainty).

It also occurs to me that in the past several decades the media and traditional educational systems have largely taught people what to think (at the extreme ends of which is indoctrination) rather than how to think. Advanced training in medicine and psychological science should have taught us how to think, how to entertain and test hypotheses, and how to keep an open mind without our brains falling out (thanks, Carl Sagan). Nothing wrong with sharing with people how we come to hold the beliefs that we do and how we test our own theories about the world out. Even one as prosaic as, 'I wonder if that woman is into me' or 'I wonder if I am going to have enough money this month to pay all my bills.' The beautiful thing about cognitive-behavioral therapy (and perhaps all therapies) is that it basically is modeling/teaching people to become their own scientists...studying themselves, what works and what doesn't work.

Another semi-famous quote about science is that it is basically, 'organized and trained common sense.'

Found the quote:
"Science is nothing but trained and organized common sense, differing from the latter only as a veteran may differ from a raw recruit: and its methods differ from those of common sense only as far as the guardsman's cut and thrust differ from the manner in which a savage wields his club." - Thomas Huxley

​

 

[calvnandhobbs68]

I always find the "Martha Mitchell effect" kind of a dumb example (even though it's a sensational one) because it was basically a coordinated effort by the Nixon administration to keep her quiet and institutionalize her. Whole lot of other political and power balances going on there in terms of pressure to call this person "delusional" rather than just a random patient showing up to a random inpatient unit or outpatient clinic.

Although I totally agree that the only delusions one should dismiss pretty readily are the ones that are pretty clearly not possible/fantastic as noted above (although who knows what actually could be possible....), this is also the reason it's important to gather a lot of collateral if possible.

I'm much more inclined to believe that it's at least in the realm of possibility that someone in a high profile or government/political job is actually being surveilled than the random car mechanic who works down the road unless there's some feasible reason for this.

 

[PikminOC]

Here's the question I got for you all.

We health professionals shouldn't delve into politics with our patients. The problem being is that politics has for years entered the delusional zone. Lizard people, child molestation rings being held in pizza restaurants, Jewish Space Lasers, etc.

So what are we supposed to do then? Ignore it? E.g. your patient comes in claiming there's Jewish Space Lasers and the election was stolen and there's proof cause bags of votes were found (no they weren't found but the guy keeps on it, and when you ask him to show the proof he shows you a tweet from some idiot who lives in his parents' basement).

So what do we do then? We have a professional responsibility of being honest with our patients, but we're not supposed to get into politics.

The DSM recommends we do not pathologize things within a cultural norm, but what if such things just a few years ago were outside that norm and are now pathologically within the norm?

Add to the sophistication of this problem, several delusions such as tracking ability within medical devices, medical implants, ultra-sonic or microwave guns are now becoming a reality. I've for years, at least once a year had a patient convinced someone was shooting microwaves at them, but now there is actually is proof this may have happened for real.

‘Havana syndrome ’ and the mystery of the microwaves

The BBC investigates a mystery illness dubbed "Havana syndrome" that has affected American diplomats and spies.

www.bbc.com

Yes overton window keeps moving along. Things in Dsm 3 are acceptable now

 

[clausewitz2]

I always find the "Martha Mitchell effect" kind of a dumb example (even though it's a sensational one) because it was basically a coordinated effort by the Nixon administration to keep her quiet and institutionalize her. Whole lot of other political and power balances going on there in terms of pressure to call this person "delusional" rather than just a random patient showing up to a random inpatient unit or outpatient clinic.

Although I totally agree that the only delusions one should dismiss pretty readily are the ones that are pretty clearly not possible/fantastic as noted above (although who knows what actually could be possible....), this is also the reason it's important to gather a lot of collateral if possible.

I'm much more inclined to believe that it's at least in the realm of possibility that someone in a high profile or government/political job is actually being surveilled than the random car mechanic who works down the road unless there's some feasible reason for this.

Usually the people who are actually being surveilled can provide some plausible account of why it might be happening when you ask them, like 'my husband is the attorney general', or 'I'm a high profile political dissident in exile' or 'I am the biggest coke dealer in three counties'

EDIT: Someone I went to HS with and his entire family were murdered by two individuals who had been spotted following them around for some time and who were in retrospect almost certainly Iraqi intelligence agents. This ended up on America's Most Wanted. Anyone who pushes the most likely theory would have sounded delusional until of course the police found a bunch of photos of the kid's dad with Saddam Hussein.

 

[whopper]

I learned a new term. "Overton Window." Looked it up and didn't know there was a term for the concept.

 

[Alemo]

There’s some good research in JAAPL recently regarding the difference between delusions and extreme overvalued beliefs and obsessions.

The extreme overvalued belief symptom is a good way to conceptualize “conspiracy theories” and radical, untrue political ideas being held by someone with paranoid personality traits (often in the absence of other psychotic symptoms).

 

[clausewitz2]

There’s some good research in JAAPL recently regarding the difference between delusions and extreme overvalued beliefs and obsessions.

The extreme overvalued belief symptom is a good way to conceptualize “conspiracy theories” and radical, untrue political ideas being held by someone with paranoid personality traits (often in the absence of other psychotic symptoms).

If this is Rahman et al from June of this year I don't think their attempt to separate delusions and overvalued beliefs really holds water philosophically. It depends on Jasperian ideas of un-understandability that are very difficult to defend when scrutinized. It also makes the assertion that a belief being shared by a group necessarily makes it not a delusion. The Targeted Individual community is a great example of why we should be very suspicious of this assertion.

If you want to re-define delusions as being intrinsically limited to the individual and not shared with a social group, sure, go ahead, but this puts it at variance with important aspects of what other approaches tend to take as central to what a delusion is. I think we are trying to find precision in the distinctions between these terms that is not really there most of the time.

EDIT: I agree that obsessions per se are usually much more separable from delusions or overvalued ideas, although not always.

 

[calvnandhobbs68]

If this is Rahman et al from June of this year I don't think their attempt to separate delusions and overvalued beliefs really holds water philosophically. It depends on Jasperian ideas of un-understandability that are very difficult to defend when scrutinized. It also makes the assertion that a belief being shared by a group necessarily makes it not a delusion. The Targeted Individual community is a great example of why we should be very suspicious of this assertion.

If you want to re-define delusions as being intrinsically limited to the individual and not shared with a social group, sure, go ahead, but this puts it at variance with important aspects of what other approaches tend to take as central to what a delusion is. I think we are trying to find precision in the distinctions between these terms that is not really there most of the time.

EDIT: I agree that obsessions per se are usually much more separable from delusions or overvalued ideas, although not always.

Right, there's unlikely to be anything compelling that hasn't been debated over and over previously anyway.

To quote Augustine in "The City of God" (who claimed to be quoting Seneca)...

"If any one has time to see the things they do and the things they suffer, he will find so many things unseemly for men of respectability, so unworthy of freemen, so unlike the doings[Pg 254] of sane men, that no one would doubt that they are mad, had they been mad with the minority; but now the multitude of the insane is the defence of their sanity.""

 

[mistafab]

I disagree. The framework of overvalued beliefs tends to do a better job of splitting apart non-delusional, but popular (even bizarre) ideas (such as jewish space lazers) than the delusion/non delusional dichotomy.

Things like eating disorders among teens online, even the salem witch trials, these lend itself more the the Rahman overvalued idea than "delusion" even though we all think the ED and Salem trials were not "based in fact" - yet most would not consider them 'delusional.'

If this is Rahman et al from June of this year I don't think their attempt to separate delusions and overvalued beliefs really holds water philosophically. It depends on Jasperian ideas of un-understandability that are very difficult to defend when scrutinized. It also makes the assertion that a belief being shared by a group necessarily makes it not a delusion. The Targeted Individual community is a great example of why we should be very suspicious of this assertion.

If you want to re-define delusions as being intrinsically limited to the individual and not shared with a social group, sure, go ahead, but this puts it at variance with important aspects of what other approaches tend to take as central to what a delusion is. I think we are trying to find precision in the distinctions between these terms that is not really there most of the time.

EDIT: I agree that obsessions per se are usually much more separable from delusions or overvalued ideas, although not always.

Right, there's unlikely to be anything compelling that hasn't been debated over and over previously anyway.

To quote Augustine in "The City of God" (who claimed to be quoting Seneca)...

"If any one has time to see the things they do and the things they suffer, he will find so many things unseemly for men of respectability, so unworthy of freemen, so unlike the doings[Pg 254] of sane men, that no one would doubt that they are mad, had they been mad with the minority; but now the multitude of the insane is the defence of their sanity.""

 

[clausewitz2]

I disagree. The framework of overvalued beliefs tends to do a better job of splitting apart non-delusional, but popular (even bizarre) ideas (such as jewish space lazers) than the delusion/non delusional dichotomy.

Things like eating disorders among teens online, even the salem witch trials, these lend itself more the the Rahman overvalued idea than "delusion" even though we all think the ED and Salem trials were not "based in fact" - yet most would not consider them 'delusional.'

One issue with this approach is that you now make the categorization of someone's belief system dependent on sociological facts about the world or on how persuasive the person who first entertained the idea is. If I and I alone believe I control hurricanes with my mind without any demonstrable proof and no one else believes this, okay, it is a delusion. But the moment I get 5-10 people to believe I can control hurricanes, suddenly it is a different kind of belief?

 

[Fan_of_Meehl]

There’s some good research in JAAPL recently regarding the difference between delusions and extreme overvalued beliefs and obsessions.

The extreme overvalued belief symptom is a good way to conceptualize “conspiracy theories” and radical, untrue political ideas being held by someone with paranoid personality traits (often in the absence of other psychotic symptoms).

Even though, as convenient shorthand, I employ the term 'conspiracy theory' in communication, I'm really coming to despise our use of that term. It functions as a 'thought-terminating cliche' that tends to shame or discourage further inquiry or discussion into the topic at hand. Personally, I believe that--if anything--collectively we haven't been skeptical ENOUGH of the people in charge of government agencies, multinational corporations or the (often) Machiavellian socialized psychopaths who appear to be overly represented near the tops of power hierarchies.

Since a 'conspiracy' is merely a situation in which two or more people are collaborating in secret to influence some state of affairs in the world, all one has to do is examine the corpus of work on the entirety of human history to discover actual conspiracies beyond count, often largely or entirely unknown to the general public at the time that they were in operation. Price-fixing, monopolies, Enron, the concentration camps in Germany, the Manhattan Project, planning of Operation Overlord...the list of actual conspiracies is endless.

Of course theories vary greatly in terms of their plausibility, evidence for/against them, etc. but someone entertaining the possibility of a 'conspiracy,' should not cause us to engage in such automatic knee-jerk reactions like it often does (and I'm preaching to myself here, too).

The 'Jewish space laser' thing is interesting.

Is it possible that one or more goverments have orbital space lasers that remain classified projects? Hardly strikes me as bizarre.

Are people who happen to be Jewish happen also to be statistically over-represented in the technical sciences (and aerospace engineering)? Not sure. But it wouldn't surpise me in the least if this were true.

Is there a specific secret Jewish cabal operating space lasers to set fires right now all around the world? That's a much tougher sell.

 

[Liquid8]

It’s a really interesting question.

I think I’ve only had a few patients who have exhibited such features – the most notable one wanted to change her medications due to it being manufactured by Pfizer (and not wanting anything from big Pharma who lied about vaccines etc...) which led to her husband writing an email complaining about the negative consequences, despite him also having similar beliefs and pushing for the change.

There have been a few others who were convinced there was a left-wing government conspiracy (sluggate) and that a recent state election was rigged which peaked during Covid. I’m fairly reluctant to classify or treat this as a pathology, as these kinds of stories are constantly being pushed by a very anti-government local media. On further followup these ideas might not be present at all, or if so not as pervasive or distressing. In short, most have either accepted that whatever has happened has happaned, and been able to leave those thoughts behind.

The more extreme stuff seems to be limited to the online space, and this doesn’t appear to shift which is probably due to the self-selecting nature of social media. There are still some conspiracy theorists who are protesting government lockdowns despite all this stuff having ended more than a year ago. But it’s not limited to patients either. There are some rather high-profile figures, such as this doctor who was suspended.

https://www.news.com.au/national/queensland/news/suspended-doctor-william-bay-to-face-court-following-protest-arrest-outside-medical-regulators-office/news-story/8dea136af0597e71921f8d73714db5be

There has been a psychiatrist who joined one of our craft discussion groups who is always going on about vaccine injuries, the influence of big pharma and is always saying she has to be careful otherwise she’ll get reported to the medical board. There is a strong paranoid flavour to her posts, and her reviews are littered with complaints about her mocking patients for wearing a mask or getting Covid vaccinations.

 

[Candidate2017]

So what are we supposed to do then? Ignore it? E.g. your patient comes in claiming there's Jewish Space Lasers and the election was stolen and there's proof cause bags of votes were found (no they weren't found but the guy keeps on it, and when you ask him to show the proof he shows you a tweet from some idiot who lives in his parents' basement).

There's an element of truth to these things.

We have a Space Force and destroying enemy satellites is part of 21st century war doctrine. Some of our scientists are also Jewish. So, yeah. And election stealing and ballot stuffing has been around since democracy. If people buy into things sold by media/social media, then it just means propaganda works. The average patient thinks psychiatrists get paid by Big Pharma. It's partially true, especially the familiar big names. Me? I get a sammich and a pen every now and then.

It's also common for people to have weird beliefs. But patients feel more comfortable divulging to their psychiatrist than their orthopod. Since we actually talk with people, we also hear some strange stories that sometimes are true.

From our side, as mundane as it is, most people would think we're paranoid if we told them in a non-psychiatrist capacity, how many people are sexually abused in childhood or that they need to watch out for "mom's boyfriend".

Long story short, the average person can't tolerate two competing ideas, and ends up picking a side to go all in. But us? We should be ok with the fact many people are weird and have weird ideas. Especially since some of the weirdest people are well to do psychiatrists shilling things like chakras.

 

[calvnandhobbs68]

Things like "psychiatrists are getting paid by big pharma" actually has some element of reality, there are actually objectively verifiable physicians who have been paid by pharmaceutical companies to give talks (I get flyers about them every few weeks) or as recently as a couple decades ago it was even more blatent, physicians getting flown to all expense paid vacations sponsored by Pfizer or whatever.

This debate comes up all the time, it's been going on for forever in terms of what's the cutoff for a delusion vs "overvalued beliefs". I agree that making how "pathologic" something is dependent on how many people exhibit that pathology is odd but also really exhibits how dependent many of our symptoms in psychiatry are on social constructs and norms.

The classic example is religion, it's almost the cliche example. (I know this is a touchy subject but comes up not infrequently on inpatient units...) Someone shows up in the 13th century saying they want to dedicate their life to God and that's why I stand outside naked all day just wearing a hairy goatskin talking about God and living in a cave...they get called a saint.

Barsoum El-Erian - OrthodoxWiki

orthodoxwiki.org

Now someone does that in the middle of chicago and they get taken straight to the psych ED.

 

[Alemo]

First of all, I would define a delusion as an idiosyncratic, fixed (firmly held) false belief. To the extent that anything is actually false, being poisoned by the FBI (when you are a 23-year-old sales associate at Walmart living in Parma Ohio) is just vanishingly unlikely. Also, I subscribe to the idea that delusions are completely logical (that is, if you had the same vibes/sensations going on in your consciousness, the only thing that would explain them-the lowest common denominator- would be some crazy ass idea involving an all-powerful entity using some form of mind control (whether it's a demonic possession or secret government technology). You can use science fiction or fantasy to get to the impossible.

But the idiosyncratic nature of a delusion isn't the only thing that separates it from an EOB, it's the overvalued piece. It's perfectly rational to have an agnostic view about various "conspiracy theories," especially if proving them true or false is difficult to do (as would be in the case of any hidden or deliberately obfuscated operation like a military exercise or an illegal business scheme). I don't diagnose delusions or overvalued beliefs based on the veracity of the information because we are not fact finders. The diagnosis comes more from the circumstances from which the belief evolved, how firmly held it is, how it is part of other delusions, and how multiple domains of one's life seem to be affected by the belief.

Many forensic patients perceive injustice or outright prejudice/persecution from court/LE officials who have placed them in psychiatry's care, which may or may not be true. But the overvalued component causes some of them to be unable to work within the system in order to extricate themselves/resolve the case/ get out of the hospital. Or they might spend a significant portion of their time and energy on frivolous civil suits that ultimately aren't found to have any merit. The usefulness of the overvalued concept comes in when describing the devotion to the idea that is unwarranted (causing someone who believed the 2020 election was stolen to move from simply going on with their life to storming the Capitol). Many religious beliefs are quite extreme and certainly bizarre, but we as a society have delegated some degree of acceptable action for these beliefs (praying, speaking in tongues, and ayahuasca ceremonies are acceptable, child sacrifice and violent jihad is not).

I think in some sense people without mental illness don't act on their sensations/vibes/beliefs/theories (that is, they sit with them, or perhaps explore further). If you perceive your neighbor doesn't like you, you might not invite them to dinner, or you might stop waving to them. You might even ask them, "Hey, are you mad at me?" The mental illness comes in when you confront them about it (belief/vibe immediately followed by "Why don't you like me?") or worse, shoot them.

Feelings aren't facts, but we all can have intuitions that turn out to be true.

Also, the Targeted Individual community is a fascinating modern phenomenon of the Internet amplifying and scaffolding individual paranoid sensations/vibes/beliefs. It's essentially a folie-a-deux turned folie-a-couple hundred thousand (I don't speak French). You may have heard patients tell you about V2K ("voice to skull") technology tracking them and giving them messages...you may have heard about fusion centers...it's just a variation on the "chips in your brain" spiel that every inpatient psychiatrist has heard for the past 40 years. Except now there's an online forum where everything gets amplifed. The gangstalking subreddit has 48 thousand members....

If anyone wants to write about them, DM me.

Also fusion centers are real...

 

[whopper]

I've theorized this for a few years. Cluster A used to be stuff like healing crystals, but just as psychiatry will change with culture (e.g. instead of the FBI trying to watch you King George was watching you), but what's going on is political parties, thanks to social media data, has been able to exploit this into making these people a voting bloc.

 

[aim-agm]

This might resolve some of the consternation in this thread: Despite what the DSM says, it doesn't matter whether the belief is true or false to whether it is a delusion. Much of what the DSM talks about are really indicators that something might be a delusion (i.e. be more suspicious that it is a delusion if it is false, culturally atypical, etc.) but don't actually speak to the delusional vs. non-delusional nature of the belief. Remember, this is a problem of reality testing, not reality accuracy. To be even more exact, it is a problem of being unable to reality test, rather than consciously or subconciously influencing or ignoring their process of reality testing in service of other goals (e.g. protecting their current worldview).

Rule of thumb for discriminating between delusions and otherwise: Given an infinite amount of time and resources (and allowing for lying to and deceiving the patient), could you convince the person to change their beliefs?* For example, most people who believe in Jewish Space Lasers might hold on to the belief in face of objective evidence that these weapons do not (or even could not) exist. But they would probably change their belief if you told them that Jews are actually avid Trump supporters and Biden is spreading the Jewish Space Laser story in an attempt to split Trump's base against itself. Hence, not a delusion but probably indicative of some other pathology.

 

[Ceke2002]

He was never officially diagnosed, but I grew up with a Dad who likely had some flavour of cluster A personality disorder, and as distasteful as I found some of his beliefs I don't think all of them were automatically connected to whatever mental health issues he had. This is where I (as a layperson) would think a different approach based on the underlying issues/pathology was warranted.

For example my Dad believed that Doctors had their own mafia and were putting hits out on patients who complained, and no amount of evidence to the contrary could convince him that was simply not correct. He also believed people were planting listening devices in the backyard, so would spend the weekends digging through the garden looking for these hidden devices. Again there was absolutely no convincing him otherwise, so Mum would just hand him a wheelbarrow and gardening tools and tell him what she needed in the way of gardening. I mean if he's gonna be out there digging through the garden beds looking for listening devices anyway, might as well give him something productive to do at the same time.

He also believed I was made of porcelain when I was born, and would shatter if he touched me or picked me up. In that situation several weeks to months of family support and reassurances eventually lead him to overcome that belief and interact with me more normally. Now obviously thinking your infant daughter is made of porcelain is a pretty bizarre belief, but the ideas behind it were understandable; he had experienced a lot of neglect and loss of family structure as a child, so when he finally had a family of his own he became extremely anxious that we would be taken away from him as well, hence the idea that he had to be careful not to 'shatter me' and thereby lose his only child.

If he had been in any sort of treatment of therapy program when he was alive, I would have probably expected there to be a different approach with the first two examples than there was with the second.

Hope that makes sense?