Issue 05 – August 2008
Author: Christine Collinson (firstname.lastname@example.org)Key points
- The idea that delusions can be separated from non-delusional beliefs and are a sign of an underlying illness is controversial, as is the notion that they are a problem to be removed.
- Delusional or unusual beliefs may hold an important function and have meaning.
- What we consider to be unusual beliefs reflect life concerns and goals.
- We need to try to understand “delusions” as relating to personal history, life goals and social difficulties.
- There is also a need to take time to understand the content and meaning of people’s beliefs, rather than challenge head on.
Defining “Delusions”1, 2, 3In the contested area of mental health, defining what is considered to be ‘delusional’ is problematic. Traditionally, delusional beliefs are often seen as a problem and an expression of an underlying illness, they are therefore seen as different from normal beliefs. Yet beliefs that are labelled as delusional may be commonly held beliefs in our own or other cultures (e.g. telepathy, the presence of spirits or aliens, belief in government conspiracies), and research has found that “delusional” beliefs exist on a continuum with other beliefs. Separating delusional from non-delusional beliefs is therefore actually very difficult. That isn’t to say that people don’t have beliefs that many of us would find highly unusual, or that may cause them a great deal of distress. These are the beliefs we often encounter in our practice. Perhaps the key questions are not: Is it delusional? Can it be proven wrong? Instead perhaps the pertinent questions are: What is the impact? How can the associated distress be lessened?
A Search for Meaning 1, 2, 3The identification of a delusion or unusual belief is usually associated with a judgement that the belief is the problem and that the individual’s view should be changed to remove the distress. An illness model would indicate that the belief is merely a product of pathology, and medication is needed to blunt the belief or the perceptions that have led to it. However, “delusional” beliefs contain the same features as “non-delusional” beliefs, which are a product of our life experiences and our social and cultural context. Far from being irrational or an indication of pathology, “delusional beliefs” appear to hold important functions for people in difficult circumstances. These functions may include the protection of self-esteem, an explanation for ongoing high levels of emotions such a fear, a diversion from impossible life problems or significant loss and distress. Defining delusions as ‘pathology’ separates them from a person’s context and personal experiences, and thus any hope of understanding any meaning within them. If a belief is difficult for an observer to understand then perhaps we do not have all the necessary information to make it understandable. More recent research is clarifying the view that beliefs considered delusional to an observer have social causes4. Levels of ‘paranoia’ are very high in people who have experienced victimisation or powerlessness in a social context. Paranoia is also commonly reported where people experience high levels of stress at work. Discrimination is increasingly cited as a cause of later psychological distress, particularly persecutory beliefs5, which also appear to develop in social isolation and exclusion. Research highlights how the content of beliefs and delusions relate to an individuals life purpose and goals 6. That idea that the content of ‘psychotic’ experiences is meaningful is a longstanding view, proposed by Jung and Freud among others. Recent rigorous qualitative research by Rhodes and Jakes7 establishes this further, showing that the “fundamental concerns of a person manifest themselves somehow in the content of delusions”. The study demonstrated significant overlap of delusional themes with life-history themes. As examples, they suggest that 1) delusions of pregnancy and love relate to a desire for attachment, 2) grandiose delusions relate to a desire for achievement or power, 3) persecutory delusions relate to feeling an outsider in a group and to an unfulfilled need to belong.
Implications for Clinical PracticeMany of us hold beliefs that are of high importance for us, but are difficult to prove or even justify to others. In everyday life the concept of happy irrationality is broadly accepted and adds colour and meaning to our lives. What we describe as our identity or personality contains many such beliefs, and to have these questioned and challenged, or dismissed and ignored, causes anger and distress. Though unusual beliefs link to life concerns or goals, it seems unlikely that individuals are immediately aware of this link, and to question or challenge the beliefs before fully understanding them can be unhelpful. Having our beliefs challenged head-on can push us into a position of stating the belief even stronger, perhaps minimising our own doubts about it in the process. What is likely to be more helpful is to take a curious approach and try to understand the themes and meaning of beliefs, even if these links are not discussed directly with the client. This analysis or formulation should help our understanding of their distress and help to build a good working therapeutic alliance. It would inform how we work with them, and what may be important issues in their life. This could also indicate broader approaches aimed at taking small steps towards achieving personal goals, or tackling social problems to achieve an increased quality of life.
- British Psychological Society. (2000). Recent advances in understanding mental illness and psychotic experiences. A report by the British Psychological Society Division of Clinical Psychology. Leicester: British Psychological Society.
- Georgaca, E. (2000). Reality and discourse: a critical analysis of the category of ‘delusions’. British Journal of Medical Psychology, 73, 227-242,
- Harper, David J. (2004). Delusions and discourse: Moving beyond the constraints of the modernist paradigm. Philosophy, Psychiatry & Psychology, 11, 55-64.
- Cromby, J. & Harper, D. (2005). Paranoia and social inequality. Clinical Psychology Forum, 153, 17 – 21.
- Coles, S. (2008). Discrimination, ethnicity and psychosis. Clinical Psychology Bite-size, Issue 2.
- Roberts, G. (1991). Delusional beliefs systems and meaning in life: A preferred reality. British Journal of Psychiatry, 159 (suppl. 14), 19 – 28.
- Rhodes, J.E. & Jakes, S. (2000). Correspondence between delusions and personal goals: A qualitative analysis. British Journal of Medical Psychology, 73, 211-225.
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