Delusions Archives - A Digital Garden

Delusions

Delusions are fixed beliefs that cannot be changed by evidence that contradicts them. That’s the official definition, I’m going to add the qualifier I learned from my abnormal psych teacher. In order to qualify as a delusion, a belief must be abnormal within your culture. Sorry, atheists, your theist friends don’t qualify as delusional because they believe in an invisible sky man. Nor do people of the opposite political party qualify as delusional because they believe that obviously idiotic thing you can prove is wrong without even trying. You may be right—their belief may be categorically wrong. But if their culture supports their belief, it isn’t a delusion. The cultural matrix itself functions as “evidence” supporting the belief.

A stereotypical delusion is the belief that the someone, usually the government, is spying on the person. One real delusion I’ve run into—someone who believed that one day ninjas would sneak through his window and drag him back to live with his parents. These two together illustrate something I’ve noticed about delusions—they tend to have a basis in reality. While it is extremely unlikely that the FBI is monitoring your partner to keep them from revealing the secrets of the mole people, the FBI does spy on people. The person who feared ninjas coming through the window had run away from an abusive home as a teenager and been forcibly returned to it. The delusion is false, but built on something real.

Most delusions won’t directly impact your relationship. Having a partner who lives in fear of ninja’s coming through the window (or fearing ninjas yourself) isn’t going to have much impact on dates, meeting people, or communication. It may make your partner tired and grumpy in the morning from sitting up looking for ninjas. Other delusions, like a delusional belief that your poly partner is plotting against you, will have a large impact on a relationship. Someone with this delusion will have a hard time letting their partner out of their sight and will want to monitor everything they are doing. Not a recipe for a healthy monogamous relationship, never mind polyamory. (Side note: NEVER plan a surprise party for someone who believes people are plotting against them. It will not end well.)

Delusions are easier to deal with when they are recognized. An old shrink told me that all mental problems are easier to deal with when you know they are there. Anyone else remember the old G.I. Joe cartoon that always ended with an “educational” skit and Sargeant Slaughter saying “And knowing is half the battle!” ? Think about jealousy. A person who knows their jealousy is irrational will try to deal with the feeling without making demands of their partners. They may or may not know what will help, but they know they need to work on their own feelings and it is not their partner’s fault. Someone who is irrationally jealous but doesn’t realize they are irrational will blame their partner and try to fix the relationship by demanding their partner make changes.

Someone who believes their partner is plotting against them but knows they are delusional will need reassurance. They may ask invasive questions about your schedule and conversations with other people. But they know the problem is in their head. They will not be interrogating you to prove that you are after them, but will be seeking reassurance to quiet their delusion.

Someone who believes their partner is plotting against them and doesn’t realize it is a delusion… honestly, I don’t think you can HAVE a healthy relationship in that circumstance, no matter how willing you are to be supportive and try to work with them.

Hallucinations

A hallucination is seeing, hearing, or otherwise sensing something that isn’t there. From people I have spoken with who have delusions, they can be obviously false or impossible to distinguish from reality. Delusions can range from seeing Barney dancing on the lawn in a Richard Nixon mask to hearing your poly partner call your name to having the entire world turn into goo.

Someone who suffers from hallucinations and knows they have hallucinations will put a lot of their mental energy into telling what is real and what isn’t. They may be a bit fanatic about always being right—if they are wrong about where they left their coat they may also be wrong about what is and isn’t a hallucination. If they are wrong about things, like thinking they left their coat on the chair when they actually fell asleep wearing it, this can feed into delusions in scary ways. If they left the coat on the chair, and they woke up wearing, someone must have put the coat on them, right?

Hallucinations can have some interesting impacts on a relationship. For instance, if someone is constantly hearing a voice whispering in their ear, it can be hard to get their attention. They will have trouble following a discussion when Barney pops up and begins dancing in the middle of the room. Waving to get someone’s attention doesn’t work very well when their view of you is blocked by a hallucination of someone else. These all have huge implications for communication.

When hallucinations mimic reality that adds another layer. If you see your partner come home from a date and go straight to bed completely ignore you, you are likely to be hurt and angry. But what if your partner is still on the date? Their coming home was a hallucination. A half hour later they walk in and you are an emotional mess about how they ignored you—when it wasn’t even them! The hurt doesn’t magically disappear, you saw them ignore you, you lived through it. To your partner, you are upset over something that never happened.

As with delusions, someone who knows they have hallucinations and works to try to recognize them will do better in a relationship than someone who believes all their hallucinations are real.

This post and others discussing specific mental disorders will reference the Diagnostic and Statistical Manuel of Psychiatry and Psychology, Edition Five (DSM-V). Apologies to my international readers, I’m just not familiar enough with the ICD to use it as a reference.

Please note: everyone’s experience of mental illness is different. This is general information meant to give you an idea of what to expect. Nothing in this blog is intended to diagnose or treat. Please see a psych professional if you or someone you love may be suffering from a mental illness.

The Psychotic Disorders

Delusional disorder
Brief psychotic disorder
Schizophreniform disorder
Schizophrenia
Schizoaffective disorder
Other

Delusional disorder, as the name says, involves delusions specifically. Brief psychotic disorder is for what seems to be an episode of schizophrenia that lasts less than a month. Schizophreniform is if it lasts less than 6 months. Schizoaffective disorder is when the primary diagnosis is mood related (primarily depression or bipolar) but there are psychotic symptoms. And of course schizophrenia a long term disorder manifesting multiple symptoms of psychosis.

Symptoms of Schizophrenia and Psychotic disorders

There are five features that define psychotic disorders in DSM-5. Delusions are fixed beliefs that cannot be changed by evidence that contradicts them. Hallucinations are sensing something (usually seeing and/or hearing, but sometimes tactile or taste/smell) that isn’t there. Disorganized thinking (speech) means not being able to follow a conversational topic, lack of coherence in speech, or loose associations. Grossly disorganized or abnormal motor behavior (including catatonia) is when the body doesn’t move right and/or doesn’t move at all, when there is no physical illness to explain the problem. Finally what are called negative symptoms–lack of emotional expression, lack of speech, inability to motivate or direct oneself in completing tasks, not being able to feel pleasure from normally pleasurable experiences, and lack of motivation to socialize/interact with other people.

Interestingly, the way symptoms manifest can change depending on the culture a person is living in. In the US today, hallucinations from psychotic disorders are often terrifying experiences. Voices telling you to kill someone else or kill yourself, threats, personal attacks, and other really nasty things are common. However, 100 years ago most hallucinations where benign. The voice of your dead relative, or a saint, or an angel were common. And in other parts of the world, hallucinations often continue to be benign, usually harmless but sometimes actually supportive.

Society has a long history of demonizing people with schizophrenia and psychotic disorders. We need to remember that, like all mental illness, schizophrenia and other psychotic disorders grow out of healthy (or at least normal) mental processes. Most people have had that time walking home at night when they would swear someone was following them–but if you turned around you were alone, many of us got home and locked the door “just to be safe” (delusion). Almost everyone, at one time or another, has heard their name called when no one was calling them (hallucination). Everyone I’ve ever met has had days where their thoughts are disorganized and they can’t follow a conversation. For most of us, these things pass in a few moments or a few hours and laugh at ourselves and go on with our lives. We all have days when we just don’t want to deal with other people or have trouble motivating ourselves to get shit done (I know I’m not the other person who procrastinated my entire way through Freshman year.)

People with psychotic disorders can be scary. Not gonna lie about that. But the world they are living in is far more frightening for them than they are for you. So if you do meet or know someone who has a psychotic disorder, please start with compassion.

Treatment

Medication

Medication is the primary treatment for psychotic disorders. Antipsychotic medications are divided “conventional” and “atypical.” Conventional antipsychotics are older medications with a higher rate of severe side effects. Atypical antipsychotics are newer medications with significantly reduce side effects. Unfortunately, conventional antipsycotics are much cheaper. When dealing with a medication which will likely be lifelong, price can be a significant concern.

Therapy

So far, no therapy has been found that helps the symptoms of psychotic disorders. However, therapy has been very effective in helping people manage their symptoms. It is especially important for people with schizophrenia to recognize when stress in their life might trigger an acute phase. Preventing the occurrence of an acute phase by managing stress and recognizing early warning signs can be key to successfully managing schizophrenia.

Social skills training and vocational rehabilitation can be important treatments as well, especially for people with long term psychotic disorders.

Other treatments

I don’t know enough about alternative treatments (either alternative therapies such as art and music therapy or alternative medicine such as meditation, herbs, and massage) for psychotic disorders. If you or a loved one wants to explore alternative treatments, start by talking with your psychiatrist and psychologist.

Schizophrenia and Bipolar Disorder

I don’t know what the relationship is between schizophrenia and bipolar disorder. Officially, there isn’t one. But there has to be some reason they are so consistently misdiagnosed as each other. Again, culture seems to play a role–an American diagnosed as schizophenic who moved to Britain will usually be diagnosed by a British doctor as bipolar. The opposite often happens when a British person comes to America. With in America, it is very common for someone to go years thinking they have schizophrenia, make little or no progress in treatment, then have a new doctor diagnosis them with bipolar and the treatments for bipolar start working. Again, the opposite (someone diagnosed bipolar gets a new diagnosis of schizophrenia and stars seeing improvement) happens just as frequently.

If you look at the diagnostic criteria for schizophrenia and bipolar this makes no sense. There is nothing in bipolar about hallucinations or delusions or general motor problems. And nothing in schizophrenia’s criteria about mood swings. I don’t get it. But it’s something to be aware of.

Okay, usually I’d start talking about the impact of psychotic disorders on polyamory here, but that’s gonna be a very long discussion, so we’ll save it for next week.

Thanks to Richard Sprott for providing the diagnostic criteria for schizophrenia.

This post is part of the Polyamory and Mental Illness blog series.

Tag: Delusions

Polyamory and Psychotic Disorders, Part 2