It is a given that "bizarre" may be defined differently within different cultures, and even among different clinicians from the same culture. Would the following delusion be considered bizarre: A non-management office worker in a corporation that manufactures plastic products believes that he/she is under constant surveillance by the lead singer of a famous rock band, and his/her activities are being reported to the police?
A delusion is often and usefully defined as 'an unshakable false belief which is not consistent with the holders personal, cultural, and educational history'.
I agree with Prof. Ley and would like to add that such delusion (false belief) is maintained by the person despite presenting evidences contrary to it.
Just a point of clarification. I am interested in what constitutes a "bizarre" delusion. The example given is a hypothetical one, but is realistic based upon my clinical experience with this population.
Hi Neil,
You really must stop asking such fascinating questions.
In discussing delusions, the term "bizarre" is culturally loaded. Ultimately, all human experience is delusional, (in the sense that all human experience is an internal, and non-veridical, representation of an external reality which is arrived at by a subjective interpretation of sense data). It is whether your experience conforms to the consensus reality of your peers that determines whether it is bizarre or not.
I'd suggest that believing you are being surveilled is not that uncommon, or bizarre (after all, the state really does pay people to spy on us all), but that believing that a celebrity you have never met is personally involved in this surveillance does qualify as bizarre, (in the sense of very unusual, odd, extravagant, unusual, eccentric).
When working with someone who is clearly "a little bit more delusional" than average, I will often start by (gently) testing for insight by presenting a conflicting piece of information, always as a suggested possibility, never as an established fact.
People who are not suffering delusions will typically modify their position to accommodate the new information, (although most people will place more importance on any information that appears to support their selection biases and preconceptions than that which opposes it).
People who are heavily indoctrinated into one point of view will typically ignore or discredit the conflicting information, or divert attention from the conflicting data by trying to discredit the source of that data.
People who have well-entrenched delusional architectures will often find a way to adopt any conflicting evidence (or fragments there-of) into their delusions- so that information that should contradict the belief ends up (somehow) supporting it.
(As an aside, if this is happening, DON'T question the delusion directly. Further questioning will not stop the person feeling these things, it will just discourage them from being honest about what they are feeling with you. You need to reassure the person, not confront the delusion directly, but not contribute to it either. This does take some practice).
I work with a lot of people who use methamphetamine regularly in my job, many are "user dealers" and about 1/3 have mental health diagnoses. Delusions of persecution are very common in this cohort. I am acutely aware that thinking the police are following you all the time may actually be an effective self-protective strategy for many of these people, and behaviour that looks like "weapons hoarding" to a comfortable middle class professional may also be serving a protective function. Looking over you shoulder, being suspicious of others, and presenting an appearance of preparedness are adaptive in some life circumstances. Similar thoughts and behaviours are common amongst their social milieu.
However, if any of these people start believing that the CIA are in league with the Illuminati, and monitoring their thoughts via satellites, then the vast majority of their peers will view this as bizarrely delusional.
I'd suggest that it is paying attention to the social and cultural context of the individual that allows you to determine whether delusions are bizarre or not.
Paul.
However, if any of these people start believing that the CIA are in league with the Illuminati, and monitoring their thoughts via satellites, then the vast majority of their peers will view this as bizarrely delusional.
I'd suggest that it is paying attention to the social and cultural context of the individual that allows you to determine whether delusions are bizarre or not.
Paul
Paul, perfectly said....'Ultimately, all human experience is delusional, (in the sense that all human experience is an internal, and non-veridical, representation of an external reality which is arrived at by a subjective interpretation of sense data). It is whether your experience conforms to the consensus reality of your peers that determines whether it is bizarre or not'.....
My take is; nature is benign while people are meaning making machines playing ever expanding complex games.
Paul,
It's interesting you mention that a delusion considered to be bizarre would be the "believing that the CIA are in league with the Illuminati" and having their thoughts monitored.
Is the term Illuminati not a cultural phenomenon referring to very secretive groups of influential people throughout history, who maintain power with the help of fealty etc? To stretch a bit further, would it not benefit an organization like the CIA to maintain ties to profoundly influential figures? Although I deny ever seeing good evidence, it seems to me that this would be more of a conspiracy theory than a bizarre delusion, despite 'regular' culture's ambivalence toward it. When a slew of information drowns a person determined to reach an understanding of things, can they really be categorized as 'delusional'?
Dear Dr. Paul
I really appreciate your views and examples to assess and judge what constitutes 'bizarre' delusion and the one which are not abnormal. The most interesting is your view that delusions at times may be functional and protective in nature.
After such clear exposition of the matter nothing left for further addition except commentary and gloss of it. I would just like to add that defining anything (including delusions) as bizarre in absolute terms is very difficult. It is a relative term dependent on the sociocultural context and norms as well as many other factors.
I very much agree with Paul's account. Eric also makes a fair point that the CIA example can be questioned - indeed I suspect many examples of a delusional belief could be challenged in similar grounds and the traditional caveat about beliefs only being delusional if they aren't culturally normal (whilst politically expedient) can lead to a position not dissimilar to an Orwellian depiction of lunacy (ie being in a minority of one). Moving away from some rather arbitary (and often non-evidence-based) attempts to categorise delusions in traditional psychiatric literature, there is a substantial empirically based literature that I interpret (possibly in a delusional manner!) as supporting the ideas that:
a) beliefs described by traditional mental health literature as delusional are not qualitatively different from other beliefs in terms of psychological processes underpinning them and do appear to be less "fixed" than has traditionally been asserted (e.g. numerous studies by Garety et al, Freeman et al). There's also some evidence that "delusions" may vary from "normal beliefs" more in terms of preoccupation, distress and conviction, rather than content (Peters et al, 1999 etc). Therefore a continuum based approach may be more useful than a categorical one.
b) so-called delusions are often understandable in the context of a person's life experience and normal psychological processes (ie cognitive & perceptual biases rather than deficits). Paul's earlier example highlights that paranoia may be a useful survival strategy in some situations, even if it can develop into a style of thinking that generates fairly extreme (and potentially "delusional") threat appraisals. There is a fascinating literature around how (normal) psychological processes can lead to "delusional" thinking, including guilt, self esteem & defensive & attributional processes (e.g Chadwick & Birchwood; Kinderman & Bentall), trauma, culture metacognitiion and attachment/social cognition (e.g. Morrison et al; Gumley & Schwannauer).
Apologies for not giving full references - I'm just writing this in my lunch break and don't have resources to hand.
A spinoff to this discussion about the nature of delusions relates to examining the whole clinical picture of a patient. A person could indeed have an unusual belief, which many clinicians would not classify as delusional in isolation from other factors. But if the strong belief is accompanied by other signs, symptoms and behaviors characteristic of a psychotic disorder, this may change the interpretation of the belief (ie, the probability that the belief is delusionsal rather than a strongly held, culturally or personally, idiosyncratic belief).
Hi Rakesh,
Avast! I'm not actually a 'real' Doctor.
Most people call me Paul, (although you can call me "Cap'n Paul" if you like).
Hyper-vigilinance, in particular, is adaptive in some life circumstances. It is appropriate for a combat soldier to sleep lightly, to be over-reactive to potential threats, and to be distrustful of the motives of others. (Ditto for people who are refugees from war zones, incarcerated, homeless, or living with the threat of domestic violence, etc etc).
We only call it Post-Traumatic Stress Disorder when these behaviours continue after the person has left the environment where they are functional adaptations.
Neil writes;
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It is also whether others in the person's immediate social circle share similar beliefs that is significant, and whether the person is experiencing (or causing) any problems or distress as a result. So I agree with Eric and Graeme that it is the social and cultural context that is key. There is nothing delusional about considering conspiracy theories. But if everyone around you feels you are obsessed with them, then that may be indicative of a problem. And if every piece of unrelated information you encounter seems (to you) to confirm your pet theory, then you have probably entered the land of the unwell...
I like Graeme's comment (above), especially this bit;
Cap'n Paul your comment on hyper-vigilance opened up an insight for me...... Yes all things mental health would benefit from a continuum basis. And open dialogue as to the back ground or creation of the belief for the individual. Some people really are justified in mistrusting society, medicine, family through lost trust.
Personally my faith in surgeons at the moment is very low due to being booked for two surgeries which were simply incorrect. When they target the correct limb and correct nerve I will go ahead but my family and GP see my reluctance through their filters of conditioned thinking, stigma. They think I am being difficult, somehow they would be more comfortable that I were compliant and have unnecessary surgery than someone who researches, questions and demands rigor.
Trouble is when you question every thing then banking, politics, laws, wars, councils, media, history, psychiatry, GE, fluoride, flu vaccines etc, etc have massive credibility holes that once seen will not go away. For those in society who don't question deeply I am delusional, odd, opinionated, overly honest, outspoken, ill-disciplined, uncomfortable etc. But I cant un-see so I cant leave the hyper-vigilance state, I have to choose between living with existential stress or dim my brain with medication.
Both choices are difficult and both have huge costs. I can only manage myself, as many people do, by avoiding the news, immersing in work, hobbies, study, intense relationships, projects, blog sites, TV watching etc. These are coping mechanisms, self medication in our ever increasing Orwellian world. Some people use drugs, alcohol, sexual cheating, gambling, gaming, smoking, eating disorders.... all distractions to avoid personal or societal pain.... I am not saying all activities are a need, many are choice ie home building, healthy food, exercise, spirituality and many more.
Dear Cap'n Pau
Your comments on this post as well as on another post of Neil relating to difference among illusion, hallucination, and false perception were really very informative.
The others also have contributed in their own ways to enrich the understanding of what constitutes delusion.
I have as a tenant a woman who was diagnosed with schizo-affective disorder shortly after she moved in - and since I've been observing her 24/7 for about six years ,,, it has been an education on the nature of this constellation. Here's a quick answer - the worst is "hallucination" - percieving what is NOT there, or not perceiving what is. The influence of the totality of the world we live in mitigating our thoughts diminishes until their own minds become the source of all reality ... at varying levels. True schizophrenia the hear what nobody else hears, see images that nobody else sees, true hallucinations. A step down is Bizarre Delusions - which is actually bizarre interpretation ' eg: there IS someone on the radio, but he's not talking to you. There IS a pattern in stoplights .. but it's not aliens or angels. Finally, non bizarre delusions which is what kept Jane scrambling for 20 years ... it hit in college, she stopped there, and it was "my employer doesn't like me, he's frowned twice, I;d better quit" .. it comes across as really bad memory, bad planning, irritable and cranky - it's a terrible burden and often goes undetected.. She on Geodon now - it's always going to be a porblem but she does her taxes, has steady low level jobs,fixed her teeth, runs, volunteers, drives normally and has a rich social network life, and even arranged a trip to Iceland and Norway. She'll always be 22 and irritable but with not others,... just those she shares space with We're trying to find her a place, and she'll do fine.
I am becoming more and more convinced that this means there is no real, single disease entity we can call Schizophrenia. Instead, I am tending towards the opinion that the cluster of acute symptoms that identify stress-related psychotic breaks, drug-induced psychosis, Schizophrenia, Schizophreniform disorders and Bi-Polar Affective Disorder are simply a phenotype that humans may express in response to stressors in their physical and social environment, but that the likelihood of any experience triggering this response in any individual is heavily modulated by genetics and experience in-utero and perinataly.
Those people with many co-occurring risk factors, who experience psychosis chronically, get diagnosed with Schizophrenia or a form of Bi-Polar Disorder. Studies into the heritability of both disorders identify the same familial risk factors, and the same factors are also associated with Autism.
>
http://www.medscape.com/viewarticle/528669_3
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This is consistent with the idea that these diagnostic labels are not describing distinct disorders, but instead are describing different expressions of a wide spectrum of potential human behaviour.
http://archpsyc.jamanetwork.com/article.aspx?articleid=1206780
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http://www.medpagetoday.com/Pediatrics/Autism/33589
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Paul.
P.S.
I'm acutely aware that I've diverted from the question that heads this thread, (sorry Neil). However I knew I had links to these articles somewhere, and wanted to share them;
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=3405404
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http://journals.cambridge.org/production/action/cjoGetFulltext?fulltextid=1936780
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http://www.annualreviews.org/doi/abs/10.1146/annurev.clinpsy.032408.153506?journalCode=clinpsy
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http://schizophreniabulletin.oxfordjournals.org/content/38/3/475.short
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Sorry I don't have full text on line.
This conversation has reminded me of an instructive case history, (which hopefully is getting heading back towards the subject at hand);
Twelve years ago I was regularly doing outreach work in the evenings.
I was visiting one client who was a small time user-dealer who had smoked crystalline methamphetamine constantly, 24/7, for periods of weeks, separated by "crashes" of a few days to a week, for a few years. (This isn't a really healthy thing to do).
I'd seen him once every week or so for several months, when he started to become seriously obsessed with the idea that someone was spying on him, stalking him from the six-foot high hedge of shrubs at the back of his garden,and creeping up to the house in the dark.
Whenever I visited him he insisted that I search the back yard with my Maglite thoroughly while he hid inside the house. It was only after I had spent at least 10 minutes making sure there was no-one around that he would calm down enough for me to sit inside and talk with him.
This persisted for three months.
One night I got a phone call that Police were surrounding his house. I drove there, and found the street blocked off by Police and a tactical team in a standoff with a man on the roof.
But it wasn't my client. It was his next-door neighbour, dressed in a full black ninja outfit, complete with a short sword and a kusuri-gama (a sickle with a long weighted chain attached) who was, it turned out, far more delusional than my client. The neighbour had in fact been going out every night dressed like this and stalking my client and residents in nearby houses for many weeks.
Paul.
The Toxic Metal connection to ADD, Aggressiveness, Impulsive ...
http://www.flcv.com/violence.html
More organic cause than you can shake a stick at.... Starting with a claim that 50% of US children are damaged by chemical and heavy metals (in depth description of the process) ...
Genetic damage can not be called genetic disposition as it relays a victim mentality, blame it on the family, rather than blame it on the mad chemists. Its easy to be paranoid when you realize how very damaged humans and the planet are.
I would contend that Neil's second response about the context is critical. Note that a "disorder" is present only in the context that it is significantly interfering with the persons life, is a danger to themselves/others, or causes significant personal distress. Further detail is needed to know if it really is bizarre.
According to DSM-IV-TR, "Delusions are deemed bizarre if they are clearly implausible and not understandable and do not derive from ordinary life experiences." From the perspective of plausibility, the delusion described in your case example will not be considered as "bizarre"; instead, it sounds like a hybrid of persecutory (and grandiose) delusions. Alas, if the surveillance is conducted through a invisible wire inserted in the worker's head, now that's "bizarre."
Just a quick fact-check - Heather, your expert is a Chemical Engineer in Florida who seems to be sort of ODC about the dangers of chemical pollution .. I was tipped when I noticed the connection between autism and mercury which has been soundly refuted .. Mr, Windham is rather off the wall about mercury - I think he has about every horror story on earth at another link http://www.flcv.com/damspr2f.html I wonder if anyone wants to reflect on my claims that humans seem to need something to be afaid of so it's communists, or drugs, or terrorists, or Liberals ,.. or anything as long as they feel they're " looking out for danger"- even if they're warning us about things we have already been warned about - like a barking dog, they feel they have done their bit even through their words will only be read by people like us, Everyone over the age of eight knows about the toxicity of mercury and we know it's no good ,,, or lead ( which is now dropping) ,, but this man seems be a one trick heavy metal dude ,,, and I wonder where he went to graduate school. I doubt if he's ever been hired as a consultant, for example. I do not admit to a doctorate, but I will admit to being paid for my expertise in related fields. I wish we could keep the conversation at the "peer review" level when it comes to footnotes. I'm not the PhD ... but I don't think Mr. Windam is either. He just has lots and ot and lots and lots of references that back up his quest to save us ... thank you sir .. but mercury really doesn't cause autism ...and with all the amalgam in my teeth ,. ... I should be as mad as a hatter,
I suggest you put away DSM IV, Don't bother with DSM IV (coming soon to a cash register near you), and have another look at ICD 10.
Harvey - just a simple question... Why would one put away the DSM-IV-TR when it's still the current manual? Until the new edition is made official - wouldn't it be incumbent upon the mental health professional to stay within current diagnostic guidelines, while being mindful of future "possible" revisions? Remember my friend - cause no harm.
Agreed Shelton. Although the ICD 10 is perhaps a better instrument in any event. It is certainly the code source of choice for CAMHS programs. And is a stated preference amongst colleagues in APAT. It is worth acknowledging that the DSM IV has diagnostic categories which are not universally applicable. And the multi-cultural perspective of culturally-defined mental illness is lacking in the DSM IV. There are (for example) a billion people in China accessing a variety of multi-cultural health assessments and treatments. There is little or no reference to them in the DSM IV... and they can't all be wrong.
Hi Carol;
>
It sure is. (Everyone knows the CIA doesn't use wires, they use mind-control-lasers;
http://www.lbl.gov/Science-Articles/Archive/sabl/2007/Jun/brainSwitch.html )
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Don't know if you folk are familiar with the case of James Tilly Matthews...
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http://www.theairloom.org/text.html#
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http://mikejay.net/articles/the-art-of-mind-control/
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http://www.ncbi.nlm.nih.gov/pubmed/2667883
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Paul.
Paul,
How do you find all this good stuff? The article about UC Berkeley's research on light-activated proteins in specific areas of the brain was fascinating, but I must say I was relieved to see that we still have a bit of work to do there before the CIA, NSA, MI-5 or the FSB is going to be able to turn us into zombies of the state.
Matthews's airloom sounds like it was way ahead of its time, albeit lacking the technology to manipulate some of its elaborate mind control features. Wouldn't the CIA love to get hold of it, especially pumping out, in the direction of enemies of the state, the "gas from the horse's anus."
While working in a prison some while ago, a prison psychiatrist referred someone who had been found wandering the streets. He unconvincingly claimed he spoke Urdu and had been a spy in India. I had time to ask him further about this, and pricked up my ears when he said he had written a book of his exploits. On my way to work the next morning, I called into a military library, borrowed the signed copy of his book, and left it on the psychiatrists's desk!.
Well, of course, the original premis does take rock band exploitation of groupies to a whole new level. And, while the appropriation of (plastic) plectrums may be well intentioned, it won't strike a chord with law enforcement officers. I'm not sure if a good therapist is the answer... perhaps a good lawyer - or a new rhythm section.
Thanks Shelton, I did enjoy that: internal conflict, external conflict, drugs, law enforcement and ethics. When I was (briefly) in law school I realized that law and justice do not work that well together... in fact they are more like distant cousins with little in common. Law and science... yes, that's an improvement, but there'd be a few people around still grieving their death row loss of family members after dodgy lab reports. Science and theology... Shelton you're in quicksand there, and the soon-to-be-released DSM 5 won't save you - no matter how many copies you throw into the sinking pit. They don't have enough substance to stand on. Science AND Theology... scienteology..scientology..? Mmmm. Are creationists just suffering from a mass delusion? Didn't that thinking emerge from a time when people thought the world was flat? Erm, it isn't. But, Shelton, what if collective consciousness is a distortion of reality, based on (rf FZ) the slime oozing out of your TV set? You havent yet mentioned Science fiction Shelton. I think this discussion can boldly go there. Did you hear the story about big banks getting fed money at 0.5% interest, while college students are to get slugged 7% for their education loans? What planet are they on! Oh... and is it true that Merck Sharp & Dhome are working with crack lab representatives to generate a range of medicated realities for those unable to self-determine? Now there's the future of prescripted reality right there. Meantime, I think our plastics factory employee should just get beamed up.
Harvey ... drop "Teen Age Fender Maker" into Google and come along in the last days of pre-Beatle on a summer's journey in '63 to make it big in Los Angeles with the rock band only to end up in Leo Fender's guitar gulag making Stratocasters from beech boards, forget the beach boards ... but two things (1) The fact we're wired with nearly identical DNA means the world you perceive and the world I percieved will hit the brain about the same, giving the illusion that we're all walking about in the same world. Talk about Maya - not possible. Even the first step is idiosyncratic and from there on the road to "meaning" such as we call it, all manner of rock and roll distortions. It's lucky that most of us actually end up on the bell curve at all. In fact we are all profoundly isolated from any other's perception or interpretation of anything at all ,,, close to Neo-in-the-bathtub in The Matrix. The only panacea is to reflect that if we really can't share a thing, well ..THAT we can all share. Also - Merck, Sharpe, and Dohme. The truth is boring. Coca leaves are extracted by the Stepan Chemical Company in Maywood, New Jersey and the purified cocaine processed into the hydrochloride by Merck, producing a product uniformity and great beauty - like a sparkling snow. The flavorings are, yes, sold to Coca Cola and the extracted leaves are baled, weighed, and exported. It's used as a vasoconstrictor and topical anaesthetic for nose and eye surgery and tweaking about. Go in for post nasal drip in the old days, you'd get 10% cocaine solution in gauze stuffed in your nose.
In the world of assessment, and psychological assessment in particular, many of us would rarely think of any form of communication as conveying full meaning. All shared events/exchanges between people have some approximation of shared meaning. Enough that we are able to cooperate and build "society" but not really full meaning. Couple this with cultural and religious differences and many of us would not assume something to be an issue that does not interfere with daily functioning no matter how "bizarre" it seems to us. There is little room for the ICD or the DSM to attempt to claim any sort of superiority. The DSM codes back to the ICD and neither is really very well developed from a research validation perspective. They are each takes on how best we can do things given the state of the profession. As the title suggests the ICD is more internationally used while the DSM is more a product of the USA. As for biological correlates - they are just that really correlates. The whole "chicken and egg" argument often applies for most cases.
I apologize in advance for my extremely tardy response to this question. I agree that "What constitutes a bizarre delusion?" is an extremely interesting question. As I understand it, the difference between a bizarre and non-bizarre delusion is relatively simple when examining these differences within a particular culture. An example of a bizarre delusion would be something that simply could not happen (e.g.,aliens have replaced my brain with a tiny pink chicken). The example you provided in the question about the non-management worker actually appears to be a non-bizarre delusion simply because although extremely unlikely, it is possible that the worker is under surveillance by the rock star and the his/her activities and being reported to the police.
William, I'm so sorry to hear about your pink chicken. I do like your definition.
Hi William,
I also like your definition.
However, is your belief still bizarre if 90% of people in your culture believe in Aliens who regularly replace people's brains with tiny green chickens?
Paul.
It becomes grey quickly really - as I see it. As it is really the persons cultural/social group that is of import here. There may be very few of a subculture or culture who hold a view. Unless it is impacting daily life in some negative way I am not sure I would worry about the tiny chickens (I am am color blind) no matter the color. No matter how bizarre/possible it seemed to me. I am not the arbiter of possible - I hope. The Zietgiest changes and takes with it the definition of possible.
Dale,
Zeitgeists change very slowly and infrequently, do they not? Though there may be a fair amount of cultural diversity in any country or culture, I suspect that a consensus could be found on whether or not many unusual experiences would be considered "bizarre." I vote for tiny chickens, of any color, replacing brains, as bizarre.
Dissenters?
Neil, you've really started something here. But before closure I'd like to explore the zenith of cultural construction - the advertising sector. Ask anyone generating the sales propganda for KFC, I'm sure you'd find evidence of a fixed belief that most people's brains are, in fact, chicken implants. Would you like to get fried with that?
Hi Neil,
I do have to dissent.
Tiny chickens replacing your brain? It's only bizarre if it is a minority belief. There are whole human cultures that have been based on believing things "that simply could not happen"; ie: are equally impossible from a scientific point of view; (transubstantiation of wine and bread comes to mind. What happens if i vomit immediately after receiving communion? Does the flesh and blood transform back again?).
Only the social context can determine if any belief is bizarre or mundane.
At least William's example delusion is a scientifically test-able belief- I could order a scan or dissect William to prove there was no chicken, and that his brain was still there. However beliefs can adapt quickly to conflicting evidence- maybe those Aliens are monitoring all the people they have implanted with chicken McNuggets, and can use their superior technology to reverse the process to thwart any attempt at investigation.
Once the belief invokes magic, divine or devilish supernatural forces, or alien technologies beyond our understanding, all bets are off.
eg:
Dale- if you are colour-blind, perhaps it would be helpful if I tell you that the pink chickens are also invisible...
http://www.theinvisiblepinkunicorn.com/
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http://www.venganza.org/
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Paul.
I think this piece, re: Beliefs of Pastafarians, is relevant to the direction this discussion is taking;
Nonbelievers would be better off criticizing only on the negative, damaging parts of religion, and being less judgmental about the idea of religion in general. Nonbelievers get hung up asking for evidence when really we should be looking at why does religion thrive despite evidence? We should be pushing the idea that faith is not equivalent to evidence-based-reasoning without insisting that it’s inferior, only that they are different ways of seeing the world. And that the problems happen when these world views clash.
Pastafarianism is different than most religions in that we explicitly make the point that our scripture need not be believed literally. In other religions this is known but not often said out loud (Many Christians don’t take the Bible literally but won’t volunteer this). Pastafarian scripture has some outlandish and sometimes contradictory components – and unlike the scripture of mainstream religion, these pieces were intentional and obvious, and our congregation is aware of this.
But what I find interesting is that when people object to the idea of Pastafarianism, it’s never with our scripture or ideas they suspect to be tongue-in-cheek. They object to the most intentional, honest, real components of our religion. It’s the times when we break from satire that we’re criticized, the times when I say something tolerant or hopeful about Christians that I’m called names. I am convinced there is a large number of people who need to believe that ours is not a legitimate religion because it can’t exist in their world view.
Well, I can only say this to those people: it’s only because of the insistence that we were *not* legitimate, that there was motivation to *be* a legitimate religion. You see, our religion, like Christianity and other mainstream religions, is based *not* on a foundation of evidence, but of community. The Pastafarian church was built and its legitimacy formed by people tired of being disenfranchised for thinking rationally. We have every right to exist and form a religious community. That many of us don’t literally believe our own superstitions or in the existence of our own God is evidence that we’re thinking. >>>
http://www.venganza.org/about/
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Paul.
I like it.... when I looked at belief there was nothing that escaped it. As a human we add belief and meaning to absolutely everything. We even see, hear, touch, taste and smell according to our conditioning, therefor belief. There are some hypnosis footage of people being burnt with cold coins, others having veins stripped, bones broken and straightened, teeth extracted etc without anesthesia. We are very suggestible creatures indeed.
And that is not the crazy stuff... We have private bankers capable of dictating to governments who get to issue money from thin air. We have chemical giants who get us to pay for our own poisoning and demise. We have crazy scientists who claim to be able to bulge the earths ionosphere even though the effect is unknown. We have gangs of mercenaries who dress up as religious zealots in order to bring down governments who are not conforming to the private bankers... you get the picture....
Only untouched nature free of a human observer may escape belief. A nice thought until you look at the United Nations Agenda 21 sustainability Act which believes that the human population should be reduced to half a billion. Oh that right its delusional to look too deep even if the mad elite are saying this at world summits. http://www.youtube.com/watch?v=gJ8f4RxGbP8
Hi Heather,
Hope you are well.
ALL human experience, (and so all human belief and behaviour), is an internal, subjective interpretation of unreliable sense data, heavily modulated by our individual inherited and conditioned expectations, prejudices and preconceptions.
Whether our own experience is functional or dysfunctional, whether we are delusional or sensible and well adapted, is largely determined by our social context, not by whether we are well informed or logical in any objective sense.
This is exactly why there is no objective and universal definition for a "bizarre" delusion.
High Regards,
Paul.
So the belief should be able to be disproved otherwise it could just be conforming to a social or religious dogma and one should beware of pink food additives in chicken.
Paul,
Long live pasta - I defend your right to believe in the Flying Spaghetti Monster (FSM). Do you have all the doctrinal squabbles that other religious groups do?
Nonetheless, if you show up in my consulting office and start waxing eloquent about the FSM, I am pushing the red button under my desk and waiting for the men in white coats to arrive.
My postmodern perspective only takes me so far. Sorry, but I am a scientist, albeit a social scientist.
Maybe you've all heard about Decarte's Waterloo when it came to the proof of his own belief when his hostess asked if he's like a glass of wine. "I think not," he replied .. and disappeared,
I am so glad to see that my little pink chicken example added to this very interesting discussion. I suppose I was thinking about this issue from a practical perspective. I have to agree with Neil with regard to "pushing the red button" when faced with the FSM. Although from an intellectual, philosophical, socio-cultural standpoint many of the arguments proposed make a lot of sense and foster compelling dialogue, I think it is important to consider how one might provide direction to a clinical practitioner who is interested in providing the most effective nomothetic and ideographic treatment to a delusional client.
Incidentally, I agree with Paul's statement "there is no objective and universal definition for a (bizarre) delusion," however; I feel that there are certain forms of dysfunctional and disconnected thinking that constitutes bizarreness within every culture.
This discussion is more than theoretical, it is very real for some people. In New Zealand we have had 2 women detained and forcibly drugged for their beliefs. One was investigating 9/11 soon after the event for a magazine when her neighbor decided to call the mental health services. It took her 3 weeks to get out and her life was put under a microscope by people who had a belief that she was having bizarre disillusions. If you look at alternative media now there is masses of evidence that 9/11 was a constructed event so her thinking was not bizarre at all just not supported that early on by the media hypnotized sheep.
Another was investigating government corruption and this was probably a convenient way of shutting her up and giving her a chemical lobotomy. This is a well known ploy in countries like Russia. New Zealand likes to portray a clean green and corrupt free imagage which is far from the truth. I had better stop this conversation here for my own safety. My point being that the DSM-5 especially is a powerful political tool which uses subjective evidence to support a huge range of agendas. In the US currently the agenda is gun confiscation and by deeming 50% of the population unwell, by definition in the DSM-5, supported by 'red flag' events and media bias, we are witnessing psychiatry being used in just this way.
I thought one of my clients was suffering from a bizarre delusion until I realized that he too, had been the recipient of a pink chicken implant.
Al,
The reason to make the determination of bizarre vs non-bizarre is that a bizarre delusion does not require accompanying hallucinations to give a dx of schizophrenia. Not my rule, but DSM criteria.
And BTW, I would judge the Cuban lookalikes as bizarre - way outside of normal human experience.
But what if Fidel Castro had complained that the CIA were trying to poison his toothpaste?
As a clinician, and educator of other clinicians, I understand that I need to make a practical call. I would be remiss not to do so. The issue here is that the decision one makes as a professional is always bound to the context of the client. It is not my belief system that should govern "bizarre" in the end. If Castro told me the CIA was perhaps trying to poison the toothpaste - I might not think that an issue if there was not other associated symptoms. If one tells me that there was a pasta god ... it is not an issue for me unless there is other associated pathology. I have watched the H2 History channel, I understand that folks believe that aliens impacted our civilization (if not started it). It is a question of impairment - which as has been pointed out - is not totally divorced from politics. When I worked in corrections settings I am aware that there is a grey line between "treatment" and training others in social conformity (or perhaps "brain washing"). I think the point many of us are trying to make is not that these are not real issues, rather that it is not so clear - out of context - that there is an issue.
I originally posed this question about bizarre vs non-bizarre precisely because I thought it might be difficult to objectively determine, and wondering if there were any research that bolstered the DSM-IV making this distinction. I have not investigated the issue, but I presume that the bizarre delusion criterion was based upon either compelling research and/or clinical experience.
I definitely think Dale's point about the level of impairment and overall presentation of the patient - quite apart from the nature of the delusion - are key factors in whether or not a patient receives a dx of schizophrenia.
Al, you wrote: "I believe that the CIA poisoning the random college student's toothpaste is well outside "normal human experience." I don't believe that anyone has ever proposed that particular decision rule."
Here is a quotation from the DSM-IV-R section on positive symptoms of schizophrenia:
"Delusions are deemed bizarre if they are clearly implausible and not understandable and do not derive from ordinary life experiences."
I propose that "ordinary life experiences" is very close in meaning to "normal human experience." While this phrase is not a decision rule, per se, it is meant to provide a guideline for interpreting accounts and experiences related by patients to clinicians.
The problem is that during the process of psychosis, toxic shock as I call it, you are not experiencing life as it is normally. The cycles per second in the brain have gone up to Gamma, 35+, most areas of the brain are all lit up, the body is flooded with stress chemicals and senses are on high alert. Time and normal events are no longer experienced as normal. Like a near death experience that wont stop, predictions, suddenly psychic, information that is not usually available crashes in.
In my experience (of mercury induced psychosis) I was 3 seconds ahead of time for 30 minutes, I couldn't travel in a car without energetically hitting the car in front so needed a huge stopping distance. I thought of words and they were immediately said on the radio, even if I changed channels, or they were written on the next truck that drove by, my garden became the planet and my animals acted weirdly etc. I was lucky I had the hypnotherapy training behind me and a reasonable understanding of quantum mechanics, observer effect, holographic universe theory and spiritual understanding. Real or not I was able to use this knowledge to put aside fear and notice what a unique and interesting experience I was having.
Humans are meaning making machines and when there is no explanation for our wacky experiences we look around for someone to blame or some feasible or even way out explanation. Yes its paranoia but what would you become if 'normal' disappeared and you were feeling lost in wacky experience? Again this is the state Shaman seek but our society has made it dangerous which ramps up the fear compounding the effect. Open dialogue from peer workers is so successful because we understand that the laws of nature, normal, are not fixed when in this experience. I feel if psychosis was normalized as an human experience instead of being treated as it was in the dark ages we would see far fewer people experiencing it.
Heather,
It certainly sounds like you've had some interesting experiences, and I presume you are human, so we'd have to say that your experiences are part of human experience. However, I can't relate to them since I haven't experienced mercury-induced psychosis.
This is really the issue, isn't it? How do we relate as clinicians to others, since no clinician will have had even a small percentage of all possible human experiences.
Yes Neil... Check some of Lawrence Kirmayer's stuff on Cultural Responsiveness; being open to diversity, walking with respect and curiosity. And google Explanatory Models as a means of learning to explore the worlds of those whose experience and meaning are different to our own.
Poison toothpaste?
Thanks Anthony.
>>
http://io9.com/5838255/every-crazy-cia-plot-youve-heard-of-originated-with-one-man
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More recently;
http://news.bbc.co.uk/2/hi/uk_news/6180682.stm
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Paul.
Imagine plotting all of human behaviour and belief on a graph.
You would end up with a bell curve. The closer you are towards the bulge in the centre, the closer you are to the main body of "consensus reality". The further you get out into the thinner outliers, the more unusual and less widely accepted your beliefs and practices.
An instrument like the DSM is drawing a dotted line towards each end of this curve, and labeling everything inside the lines as "normal", and everything outside the lines as "illness".
Where the lines are drawn is indeed culturally, (and to some extent arbitrarily) determined.
The closer you are to the centre of this curve, (and the better insulated you are socially or economically) the harder it is for life stressors to push you down the slope towards those dotted lines.
If you are particularly well insulated by your status, economic position and life circumstances, you will never be diagnosed as mentally ill, no matter how crazy your behaviour. (Tom Cruise springs to mind).
People can migrate back and forth across these lines.
Someone who is unwell can get well, through good treatment or simply through improved life circumstances. Conversely, people who are usually very healthy and resilient can slide across the line into illness if placed under enough stress.
(Liability to psychosis, for example, is highly heritable, but psychosis can occur to anyone who is placed under serious physical and/or psychological stress. Psychotic disorders run in families, but psychosis is a phenotype distributed throughout the population, not a genotype limited to certain families).
And of course sometimes we just decide to move the lines...
This is why I mentioned that homosexuality used to be listed as a mental disorder in the DSM. Until 1974 it was a psychiatrist's job to "cure" homosexual people. Then the APA met (just before Christmas) and decided that perhaps homosexuality wasn't an illness after all, but rather part of the normal range of human sexuality.
Think about what that means. On Christmas eve, 1974, if you were gay you had a mental illness. By Boxing Day you were normal and healthy. You hadn't changed at all. The goal posts had just been moved.
I believe a continuum-based phenotypic model, informed by the ‘stress-vulnerability” model, is probably the best way of trying to describe the frequency distribution of these kinds of behaviours and beliefs across the entire human population, and the recognition of dysfunctional extremes of them by all human cultures.
http://www.google.com.au/url?sa=t&rct=j&q=understanding%20dual%20dignsois%20paul%20dessauer&source=web&cd=2&ved=0CDcQFjAB&url=http%3A%2F%2Fwww.aivl.org.au%2Ffiles%2Fagm2007%2FDualDiagnosis_PaulDesseaur.ppt&ei=Hd2eUaOiNoKriAex_4H4Bg&usg=AFQjCNHEkBdX_2Fxjh0oKAOJd-gSZ91-sA&bvm=bv.47008514,d.aGc
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As Dale and others have pointed out, the real issue is not the content of someone’s delusions. It is whether these delusions are causing distress, suffering, or increased risk of injury or death to the person suffering them, their family, and the community they live with.
Regards,
Paul.
Hi Al,
Actually, it was Neil who wrote that.
I meet people suffering "non-bizarre" delusions all the time. Sometimes they even ride their bicycles to my house, knock on my door, and ask permission to try and persuade me to share their beliefs.
Paul.
Paul,
I have also noticed a correlation between bicycles, white shirts, gender, and badges. For some reason they don't visit my house - perhaps word is out that I am a lost cause. Similar, perhaps, to the reason psychologists (including myself) are rarely selected be serve on juries, either civil or criminal. Too much skepticism?
Hi Al,
Personally, I also view the beliefs of the Church of LDS as bizarre. Big time bizarre business.
However, there are some communities in Utah where I might be considered the strange one.
If I believe that God talks to me, and that I can talk to him, and if I believe that he heals people through my hands when I ask him to, AND if I can convince, say, 30 or 40 other people that this is true, then I am not unwell. I am probably a pentecostal minister with my own church. (In fact, here, in Australia, I could get tax-free status for any business I chose to set up).
However if I believe all these things and NO-ONE ELSE IN THE WORLD believes them, and especially if I am walking barefoot through the city loudly trying to convince others of these things, then I will probably get a short ambulance ride to a very secure ward where I will be forcibly sedated and then diagnosed with a psychotic disorder.
Context, not content, determines whether any belief or behaviour is bizarre.
Hi Neil,
I was asked to present for pre-selection for jury duty a while ago, but when they worked out what my job involved they told me not to bother turning up.
The last time Mormons came to my house was actually quite a few years ago. I saw them through the window, so as I opened the door, before they had a chance to speak, I smiled and said enthusiastically "Hello! Do you believe in God?"
They looked confused, then one said; "Yes, actually that's why we're here..."
I butted in and replied "Great, he's just in the lounge room at the moment, he's got a few minutes to spare, would you like to come in and meet him?"
This resulted in considerably more confusion. Eventually one stammered; "Wh wh wh what did you say?"
So I said; "God; he's in the lounge room, has a couple of minutes to spare, would you like to meet him?"
They left VERY swiftly, muttering polite goodbyes then glancing over their shoulders as they pedalled erratically down the street.
It was much quicker and easier than being rude to them or engaging in an argument about the contradictions inherent in their beliefs, or asking them what a "Jack Mormon" or an "8 cow wife" is.
I haven't been bothered by door-knocking proselytising evangelist missionaries ever since.
And I'm sure they had a wonderful story to tell their fellow missionaries when they got back to their LDS house that evening.
Paul.
Jumping back to something Dale wrote,
>
When a person expresses views that are seriously at odds with the consensus reality, we say they are experiencing delusions. (Unless they occupy an important social or economic position, in which case we may just see it as an eccentricity).
As several people have pointed out, the significant fact isn't really the floridity (or "bizzaro-rating") of the delusion(s).
“There is no delusional idea held by the mentally ill which cannot be exceeded in its absurdity by the conviction of fanatics, either individually or en masse”…Hoche
The significant factor is the level of distress, impairment, or risk of harm associated with the delusion(s). This determination will always be based on subjective criteria;
>
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016695/
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As Dale points out, the subjective nature of this diagnostic process is open to cynical political use. Have you read much about "sluggish schizophrenia"?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1341504/pdf/bmjcred00251-0003.pdf
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http://en.wikipedia.org/wiki/Sluggishly_progressing_schizophrenia
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Paul.
G'day Harvey,
Thanks for the suggestion re: Lawrence Kirmayer. I hadn't seen any of his work and now I've found a couple of excellent articles authored by him.
eg:
http://tps.sagepub.com/content/49/2/149.full.pdf+html
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A few years ago I was referred an inpatient at the psychiatric hospital. He was a recent migrant from Belarus, who was in his fifties. He'd been hospitalised for several years in the old soviet Union, and escaped to the west before the fall of the iron curtain.
The hospital assigned him to a Russian psychiatrist as this was deemed "culturally appropriate". They thought he'd be far more comfortable with someone who spoke Russian. But he wouldn't talk to his treating doctor at all, or to the Serbian registrar they assigned either. They asked me to see if I could get him to engage.
He was very happy to talk to me- in fact he had something incredibly important to warn me about. When I'd spoken with the patient I went back to the team meeting and said "Of course you realise that the Russian Secret Service have infiltrated our mental health systemn, specifically to persecute this poor guy?"
The Russian psychiatrist (who has a pretty dry wit) immediately face-palmed and said "Oh no, my terrible secret has been revealed- Alexander Putin himself dispatched me with orders to destroy your health system from within! But soon I hope to return to the motherland...
...So, I think now we reassign this patient to a team with an Aussie doctor, agreed?"
The patient was subject to delusions and to hallucinations. He did have a mental illness. But given his background, I'm not sure if you could describe the content of his delusions as bizarre. (And I'd suggest that whether he had those symptoms of mental illness before being held for years as an involuntary patient in a Soviet hospital is also unclear).
The brief scan I've done so far of Kirmayer's work looks very sound.
Cheers Harvey.
Regards,
Paul.
I have a similar story, Paul. Many years ago I went to a lecture on the abuse of psychiatry in the Soviet Union. Half way through, the doors were flung open to reveal a very famous dissident then in the UK. He loudly demanded to know why he had not been properly informed about this lecture, why it had started without him, it was all a plot, etc.
Aren't we all limited in what we call bizarre and non-bizarre? There were certain beliefs that I would call bizarre some 10 years ago, which given my experience now, they won't be so bizarre to me! After traveling to many countries, interacting with many cultures, speaking to many people, some sharing similar beliefs and sometimes completely "strange" thinking, what qualified to be a delusion (forget about whether bizarre or not) started to become narrower and narrower in my view! This underscores the point of context that has been made in several contributions above. Just before you label a delusion bizarre or non-bizarre, get opinions of more people in your team. Otherwise, you may turn out to be the bizarre one, yourself.
The usual answer is that a delusion is bizarre if it could not possibly be true. A man who believes that his head is missing would be considered to have a bizarre delusion. However, a woman who believes that hidden enemies are plotting her downfall, or that government agents are keeping her under surveillance, might be considered delusional (depending on the context), but if so would not be said to have a bizarre delusion because the belief possibly could be true.
The specific delusion that started all this is NOT a bizarre one. Surveillance does happen, and it could be directed by a wealthy individual. Sure, it's extremely unlikely, but that just makes it easier to spot as a delusion in the first place!
The cultural specificity of what constitutes the bizarre is quite important. It maps onto what would be considered "odd or unusual beliefs" in a schizotype (or during a prodromal or residual stage of schizophrenia). I cannot consider an uneducated resident of the rural southern USA to be "bizarre" for believing in "root magic," but if a middle class New York suburbanite expresses fears over their neighbor's attempts to curse them, I am much more concerned.
This goes double for the atheistic bigots in this comment stream. You may well be correct to deny the existence of a deity or any supernatural entities, but as clinicians you are way off base in deriding believers as subject to bizarre delusions. Sorry if that sounds rude, but it isn't half as rude as the attitude expressed ad won't lead to nearly as many misdiagnoses.
I agree with Paul Dessauer about the importance of some sort of social consensus, and about the constructed nature of reality. That said, some realities seem more plausible to me than others.
I met a person at a social event who identified as a trans woman, although her gender presentation included a full beard and clothing I could only interpret as clownish. But dressing like a clown and gender-bending isn't necessarily evidence that her trans identity is a delusion. It was when she explained that the Pope and the Illuminati were in a secret pact with Jesuit doctors to deny her appropriate care that I concluded we might not be sharing an overlapping reality. Of course that could just be what the Illuminati want me to think.
I'd be more likely to label something a delusion if it seems out of sync with the rest of a person's life. I know a man who used to be a high ranking member of a criminal organization. He reports that he has been followed, or that men have attempted to kill him. While I don't necessarily think his interpretation of events is true, I'd be hesitant to see them as bizarre delusions since such expectations (e.g., that he's in danger) aren't that odd, given his cultural context.
Firstly the one big change for the schizophrenia diagnosis in DSM V is that the bizarre delusion criteria has regrettably been removed because of this kind of difficulty for borderline cases like this. But when the DSM IV was active, the definition of bizarre was not just highly improbable, but outright impossible: it's unlikely that the worker was under surveillance by the lead singer of a rock-band, but under some circumstances it just may be possible. A bizarre delusion might be the Cotards delusion: the belief that "I am dead" or beliefs not that I'm being watched by the rock-star, but being controlled by the rock-star. The latter is a step more unlikely, and while both are typical symptoms of schizophrenia, the latter is unlikely to be any other kind of delusional disorder.
The beliefs about the rock-star are the bizarrest bit, but as another writer says, these are grandiose, rather than bizarre, and two or more delusions of this kind were needed to make an accurate diagnosis of schizophrenia under the DSM IV criteria.
I have a paper explaining the origins of delusions and what makes some so much more bizarre than others - take a look at Golembiewski, J Golembiewski J A (2013) The Subcortical Confinement Hypothesis: A Neurological Model for Schizotypal Hallucinations . Cureus 5(5): e118. doi:10.7759/cureus.118 - it's open access and it's on my profile.
The label schizophrenia is more problematic than useful and leads to misdiagnosis and frequent inappropriate treatment of patients. Delusions are considered symptoms of the non-specific categorisation of people in spite of the fact that delusions, even what some might call bizarre delusions are common in people without any diagnosis of mental illness.
I have met a number of Jesus Christ's, people who control the weather by their thoughts, Celtic gods etc. most of which had been blighted by being labelled schizophrenic. The most 'bizarre' delusion about self identity that I ever heard was when speaking to a man who had several ideas about who he was. He had a Celtic god identity and referred to himself on occasions as Dagdah but he also had even more interesting ideas.
On one occasion he was explaining the big bang theory to me (his version of it was rather different to the current model) He was describing how Hydrogen was the first element formed, at the conclusion of which he proudly announced that I was "talking to Hydrogen". On another he explained to me that he could prove that he was the Daghda (Celtic god) because he had an aunt Irene who had been born on the 2nd of March 1921 (2/3/21) He explained that 2+3+21 = 26, which is the atomic number for Iron. He concluded that since his aunt's name was Irene and that her birthday added up to the atomic number of Iron, that such evidence proved that he was definitely the Dagdah. At the time I thought this very 'bizarre'
Many years later and having read huge numbers of scientific papers, especially ones on psychiatry his theories look eminently reasonable and his hypothesis was certainly much more scientific than some that get through peer review.
It would be great if people dug a little deeper into what is happening during an episode... and not in isolation. Investing all belief into a concept based on a symptom is like believing the tip of an ice burg above the water is the whole thing....
For example why do we have these experiences when under stress, be that temperature induced, shock induced, through toxicity, inflammatory illness, nutritional deficiency, sleep deprivation, hallucinogens, near death experience as well as extreme positive experience like spiritual emergence and profound love... in other words why do we 'trip'?
After all so much of what 'holds us in reality' is not really real... society, debt, governments, education etc.. its all made up, a collective agreement. Left brain conditioning which becomes very shaky when you have an extreme right brain experience. See Dr Jill Bolt Taylor's account of near death during a stroke and its lasting impression on her.
When you have such an experience its very hard trying to fit back into society and be fully believing of all its 'stories'. This leads to exploring and when you find the wacky world of quantum physics which shows all is connected, vibration and bent light then things make sense again... that's my experience anyway, I cant speak for other people. Personally I have been 'delusion' free since the removal of my failed root canal tooth in 2012 yet I still see the world in a different way. My short experience of delusions simply showed me a much bigger version of myself in a metaphoric way and led to a bigger version of the world and its more subtle energies.
Heather. You are quite right in your observation on reality and that we need to examine the whole episode not just the isolated symptoms. Much of what passes for science in psychiatry is itself a delusion. Bizarre behaviour is defined by cultural norms and collective agreements (consensus) determine the mental health or otherwise of many.
Personality disorders are perhaps the worst example of this where an individual is measured by a set of societal norms and determined 'disordered' if they don't fit in. A set of subjective stereotypes define the 'personality disordered' designed in the main to isolate and in many cases incarcerate them.
Delusions may or may not be a sign of an underlying psychiatric disorder but merely categorising them as a symptom is preposterous. One of the 'symptoms' of personality disorder is "a grandiose sense of self worth", methinks that may be a 'delusion' that affects the majority of scientists.
Barry,
While I am not a big proponent of personality disorders as a diagnostic class, the example you gave of grandiosity is taken out of context. Grandiosity is really only mentioned as a key factor in Narcissistic Personality Disorder, though it can be a factor in Borderline and Antisocial PD. Moreover, one symptom is not enough to give a DSM diagnosis - there must be a cluster of symptoms that have been in place over time and causing significant impairment in social, academic, or vocational domains.
Neil, I admit to the slight omission of context when considering personality disorder. The categories in the DSM and ICD are virtually all value judgements based on a non-specific 'normal'.
Even the language is judgemental and sounds more like a judges summing up in a criminal trial than any 'diagnostic' definition. What would be a normal academic domain? When I joined the academic world I found myself surrounded by narcissists, anti-social characters (bullies) and no shortage of those with a callous unconcern for the feelings of others and an incapacity to experience guilt. Plausible rationalisations for nasty and even ridiculous behaviour seemed common. In my previous 'vocational domain' there was no shortage of this either. How is it possible that so many are 'disordered'.
The clusters of 'symptoms' described in the two handbooks for the justification of labelling people are as absurd as the diagnoses. Personalities are made and many and varied. Some are nice personalities (meaning most people get along with them) some are nasty (politicians, CEO's, and all those with a feeling of a right to rule others) Good personalities and bad personalities.
We should not medicalise every manifestation of human behaviour simply to make it tidy for ourselves. After all preoccupation with details, rules, lists, order, organisation or schedule, excessive pedantry and adherence to social conventions and rigidity and stubbornness are themselves symptoms of Anankastic Personality disorder!
Barry,
You make some valid points, and I certainly agree that personality as a domain is quite varied. However, with all due respect, I do not believe you are a clinician. PDs have been in the DSM because at least some clinicians and/or researchers have found them to be of some use. The main thing that is important to note in assigning the diagnosis is the dysfunctional level of these individuals. It is certainly the case that many individuals with a DSM PD may also be in the workplace, but are likely causing great turmoil and leaving havoc in their wake. In my opinion, such an individual would be diagnosable as having a PD. The issue, of course, is that many such individuals would not necessarily seek treatment on their own (they may need to be referred by an employer or family member) and they tend to not have good treatment outcomes. This is because their condition is often ego-syntonic, meaning they don't consider that they have a problem. But all it takes is personal experience with an individual with Borderline Personality Disorder to know that this individual has some major clinical problems that need to be addressed.
Neil. I am not saying that the types of behaviour described in clinical terms should not be addressed I am saying that the describing aberrant (socially constructed) behaviour as a disease is faulty.
It is not, and never has been a necessity to be a clinician to make an observation on mental illness. I am in fact a lawyer and former mental health social worker and I have a great deal of experience of mental illness (30 years) and the so called personality disorders. Presumably because of a personality disorder of my own I studied biomedical science too and now work in both the law and life sciences as a teacher. As a lawyer I do not consider the knowledge and experience of the law to be the exclusive domain of lawyers anymore than the manifestation of mental illness is only understandable by physicians/clinicians. As a scientist I know that scientific theory is often the product of dogma and the 'science' of PD is very flaky.
I have met many people who have been 'diagnosed with personality disorders but I have never met anyone with an ordered personality. It is the virtual impossibility of drawing a dividing line between normal and abnormal that is the confounder here. Yes, of course we can see in extreme cases that there may be need for a medical/social intervention, such as locking up the dangerous. However applying this extremely destructive label to many non dangerous people forces them into a world where aberrant behaviour is more likely.
I have many friends and colleagues who are clinicians/psychiatrists/clinical psychologists. Many of them think that PD is a convenient fabrication to justify intervention in those who do not conform and that the DSM is a handbook for snake oil salesmen. I am not so harsh on it, the DSM and ICD-10 are useful reference works but scientific they are not.
Love it.... normal is a setting on a washing machine and does not apply to any human being. A human trait is that those who find disorder in others are often attempting to hid their own.
Apparently during the creation of the DSM series various panels discussed the issue of defining disorder in depth and in the early days the panels were mostly made up of men. Women objected to the bias which found neurosis to be a female issue and when women eventually joined the boards some balance was restored. However traits such as sexism were rejected as disorders by the males. Later a coloured man joined the ranks and put forward the notion that racism be listed as a disorder, this too was dismissed.
Now we have ODD, oppositional defiance disorder which should have serious political, social and legal concerns. Rape is now a phallic cohersive disorder and drugging tiny children is seen as normal... Yet there is hardly a whisper. Interesting the tiny fraction of society who is so wealthy they own more than 50% of the worlds resources and behave like megalomaniacs are never mentioned either.
Thanks Heather Howes. You've nailed it!
Obscene wealth could be a symptom of a grandiose delusional disorder - where the patient believes they are entitled to excellent health, social status, political power, community influence and the unrepentant exploitation of world resources over and above the best interests of most other human beings.
If racism or sexism don't make it into the DSM V as disorders... this must be an indication that such behaviours are considered 'normal' and therefore do not require a good dose of ECT. However, for those subjected to either or both of these patriarcal cancers, who later become disallusioned about societal norms, marginalised and disempowered by the legitimacy of a racist rape culture, who have periods of social fear or overwhelming sadness and despair... they can certainly expect someone will suggest electrodes is the answer.
Is there a trend? Of course. While we are looking for precedents of DSM (incorporated) getting it wrong... Was it DSM 2 or 3 that had homosexuality listed as a psychosis?
Hi Harvey,
It wasn't until 1974 that homosexuality was removed from the DSM, before then it was a psychiatrist's job to "cure" homosexual people.
Then the APA met (just before Christmas '74) and decided that perhaps homosexuality wasn't an illness after all, but rather part of the normal range of human sexuality. This was a great x-mas present for same-sex attracted people all over the world.
Think about what that means. On Christmas eve, 1974, if you were gay you had a mental illness. You could be subjected to 'treatment' against your will. By Boxing Day you were normal and healthy. Your feelings, thoughts, beliefs and behaviour had not changed at all. The goal posts had just been moved.
In the 19thC Doctors in the Southern States of the US diagnosed fugitive slaves with a psychiatric disorder called "Drapetomania" (an irrational urge to run away from their "master"). The slaves were suffering from the delusion that they were "as good as a white man".
The "evidence-based" treatment prescribed for this disorder involved "whipping the devil out of" the sufferer. There was also a more intensive treatment for any patients who relapsed; one or both big toes were surgically removed, which invariably "cured" the condition.
http://en.wikipedia.org/wiki/Drapetomania
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It is obvious to a modern reader that this diagnostic category was a pseudo-scientific justification for racist oppression. But it is far from being an isolated or parochial example.;
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http://en.wikipedia.org/wiki/Sluggishly_progressing_schizophrenia
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1341504/pdf/bmjcred00251-0003.pdf
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http://bjp.rcpsych.org/content/148/3/247
Black men in the US began being over-diagnosed with schizophrenia at just the same time that the civil rights movement began growing strong. Although there is no significant difference in per-capita rates, Black Men in the US are still diagnosed with schizophrenia at 5 times the rate of other races;
http://jama.jamanetwork.com/article.aspx?articleid=185867
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>
http://www.annarbor.com/news/black-men-over-diagnosed-with-schizophrenia-university-of-michigan-research-says/
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http://psychcentral.com/news/2010/01/07/black-men-more-likely-to-be-diagnosed-with-schizophrenia/10602.html
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http://en.wikipedia.org/wiki/The_Protest_Psychosis:_How_Schizophrenia_Became_a_Black_Disease
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Paul.
One of the interesting things about psychiatry as a branch of medicine is the way that various 'illnesses' came to be in the diagnostic manual. ADHD was 'voted' into existence at the APA conference. Homosexuality was first voted into the DSM and then voted out. It is high time that general medicine started to use this innovative approach to tackling the diseases that blight mankind so much. At the next major oncology conference perhaps the attendees would like to vote cancer out of existence. Endocrinologists should perhaps cancel diabetes. At the next conference on infectious diseases there will be a golden opportunity to rid the world of Malaria.
Infectious diseases are typically diagnosed by detecting the discreet disease causing agent.
Mental illnesses are not. They are labels which are diagnosed by clusters of symptoms.
I'd suggest that many of the labels are mislabels, but that the symptoms do actually exist. Whether the symptoms are considered a sign of illness or not is largely determined by the social and cultural context of the person. As several people have already pointed out, the real issue is not the content of someone’s delusions. It is whether these delusions are causing distress, suffering, or increased risk of injury or death to the person suffering them, their family, and the community they live with.
Way up the top of this thread I wrote that "there is no objective and universal definition for a (bizarre) delusion," however; as several others have pointed out, there are certain forms of dysfunctional and disconnected thinking that constitutes "bizarreness" within every culture.
Even in cultures that actively encourage altered states of consciousness and belief in spirits and/or magic, there are still words to describe what we would call "psychosis".
For example in Yoruba the word "were" describes a "disease" that encompasses; "hearing voices, trying to get others to hear or see something that isn't there, smelling seeing tasting hearing or feeling things that other say aren't there, laughing for no reason, talking too much or not at all, piling sticks for no reason, fear of JuJu (ie witchcraft) when no-one else believes there is any JuJu".
Amongst Inuit people the term "nuthkavihak" means "talking to oneself, answering oneself, talking to people who are not there, believing a child or partner was killed by magic when no-one else believes this, believing oneself to be an animal, not talking at all, running away for no reason, getting lost, hiding in strange places, drinking urine, becoming strong and violent for no reason, killing dogs or threatening people for no reason."
See Readings in Abnormal Psychology
edited by Jill M. Hooley, John M. Neale, Gerald C. Davison
Link to relevant pages;
http://books.google.com.au/books?id=jYhnhQ4X-e8C&pg=PA22&lpg=PA22&dq=nuthkavihak&source=bl&ots=nHaFfsem9K&sig=KcjhDG5Qp7_x6_pPuMmm8xv4nvs&hl=en&sa=X&ei=gNCeUZ-9CfC4iAflyIHYBQ&ved=0CC4Q6AEwAA#v=onepage&q=nuthkavihak&f=false
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Note that in both theses cultures, people are only described as “mad” if they exhibit three or more such symptoms. Note also that most of these symptoms are only considered "madness" if nobody else believes in them- (your whole community may unite to kill a neighbor if enough of them believe s/he is a witch who is poisoning people- it’s only a symptom of illness if you are the only one holding the belief).
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People experiencing “unrest of mind that prevents sleep”, or “shaking and trembling all the time” or isolated symptoms of ‘were’ or ‘nuthkavihak’ visit the shaman or witchdoctor to be cured. Yet the same people also exhibit some symptoms that might be considered indicative of ‘were’ or ‘nuthkavihak’ regularly, were these not being expressed as part of ritual or shamanic performance.
The boundary between being a visionary spiritual or political leader, a shaman or a healer and being "crazy," (indeed the boundary between what is “normal” and what is an “illness”), is culturally determined. This is true of all cultures, (as the 1974 excision of homosexuality from the DSM clearly illustrates).
Now I think I may be repeating myself. Apologies,
Paul.
Paul, you may be repeating yourself.
You may be repeating yourself Paul.
You - Paul - may be repeating yourself.
You may be, Paul, repeating yourself.
You yourself Paul, may be repeating.
You yourself may be repeating Paul.
Yourself may be repeating you Paul.
Repeating Paul, may be you, yourself.
OCD gets a lot of bad press, don't you think? Where would classical music be without mirrored musical phraseology? ... Why, it would be over there - yes, there somewhere, I think. Along with DSM Incorporated... slithering on the floor.
Or Jazz phrasing... or three chord rock and roll... !
Is it any wonder the non-management office worker in the plastics factory thinks they are under surveillance by the lead singer as a conduit for police investigation?
"In the 19thC Doctors in the Southern States of the US diagnosed fugitive slaves with a psychiatric disorder called "Drapetomania" (an irrational urge to run away from their "master")."
This is considered to be a paradigmatic example of pseudoscience. I wonder instead if it is rather an example of pseudoscholarship, the repetition of second or third hand versions of the original source. Although some quotations appear on Wikipedia, they have nothing to do with psychiatry as far as I can see. Can we have some evidence from a primary source that any doctor used this diagnosis? And what was the definition in the primary source of drapetomania from the person who coined the term?
"It wasn't until 1974 that homosexuality was removed from the DSM, before then iit was a psychiatrist's job to "cure" homosexual people."
I don't think psychatrists then saw this as a moral problem, rather they felt an obligation to try and help someone who came to them in distress. Likewise, today, some would see it as part of their job to refer to a surgeon someone who was very distressed by their feelings about their leg in order that that it could be amputated.
"the nosological approach in the Moscow psychiatric school established by Andrei Snezhnevsky (whom Danilin considered a state criminal) boiled down to the ability to diagnose schizophrenia; psychiatry was not science, but a system of opinions by which millions of lives were affected by a diagnosis of "sluggish schizophrenia". "
I think this is an area where there should be more historical research and less politics. I once attended a meeting in the UK on the topic, when halfway through the doors were flung open to reveal a very prominent USSR dissident. He immediately started to complain than no one had told him about this meeting, this was all a big conspiracy against him, etc. This did nothing to convince me that he had been wrongly diagnosed by Soviet doctors.
"Although there is no significant difference in per-capita rates, Black Men in the US are still diagnosed with schizophrenia at 5 times the rate of other races"
Where does this figure come from? I am a regular reader of the US psychiatric journals, and I am sure I would have remembered something like this had I read about it, and had anyone such data they would be sure to publish this in a major journal. If correct, then a lot of black psychiatrists must be diagnosing them.
Hi Anthony,
The primary source for the pseudo-scientific diagnostic category of Drapetomania is here,
Original article by Dr Samuel Cartwright,
De Bow's Review
Southern and Western States
Volume XI, New Orleans, 1851
http://www.pbs.org/wgbh/aia/part4/4h3106t.html
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Interestingly, Cartwright was also a vocal opponent of the germ theory of infectious diseases.
Paul.
Here is a description of "sluggish schizophrenia".
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http://schizophreniabulletin.oxfordjournals.org/content/15/4/533.abstract
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These diagnostic criteria for sluggish schizophrenia may possibly represent a real class of psychiatric disorder- (certainly I have met a few people with a dx of schizophrenia who very rarely exhibit any acute positive symptoms at all, but who chronically suffer crippling negative symptoms).
However they also allow anyone at all who expresses ideas contrary to the state ideology to be described as suffering an acute psychotic episode which would justify them being held for long periods with no contact with family or friends and medicated against their will.
I would suggest that this sort of treatment might well induce "chronic negative symptoms", and "delusions of persecution" in otherwise healthy individuals. So the fellow who interrupted your lecture may have been a very different person before his "treatment for dissidence" back in the Soviet Union.
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(follow link to BMJ article, below)
The diagnostic category "Sluggish Schizophrenia" led to the Soviet bloc countries having between two and three times higher rates of schizophrenia than any other industrialized countries on the planet.
The fact that these rates of diagnosis dropped dramatically when former Soviet Republics dropped the diagnostic category, but remain high in Russia where the diagnosis is still used, strongly suggest that we can't examine the history of this alleged disorder without examining the underlying political motivations.
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