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A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information,
confabulation In psychology, confabulation is a memory error defined as the production of fabricated, distorted, or misinterpreted memories about oneself or the world. It is generally associated with certain types of brain damage (especially aneurysm in the an ...
,
dogma Dogma is a belief or set of beliefs that is accepted by the members of a group without being questioned or doubted. It may be in the form of an official system of principles or doctrines of a religion, such as Roman Catholicism, Judaism, Islam ...
,
illusion An illusion is a distortion of the senses, which can reveal how the mind normally organizes and interprets sensory stimulation. Although illusions distort the human perception of reality, they are generally shared by most people. Illusions may o ...
,
hallucination A hallucination is a perception in the absence of an external stimulus that has the qualities of a real perception. Hallucinations are vivid, substantial, and are perceived to be located in external objective space. Hallucination is a combinatio ...
, or some other misleading effects of
perception Perception () is the organization, identification, and interpretation of sensory information in order to represent and understand the presented information or environment. All perception involves signals that go through the nervous system ...
, as individuals with those beliefs ''are'' able to change or readjust their beliefs upon reviewing the evidence. However: "The distinction between a delusion and a strongly held idea is sometimes difficult to make and depends in part on the degree of conviction with which the belief is held despite clear or reasonable contradictory evidence regarding its veracity." Delusions have been found to occur in the context of many pathological states (both general physical and mental) and are of particular diagnostic importance in
psychotic Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior ...
disorders including
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
,
paraphrenia Paraphrenia is a mental disorder characterized by an organized system of paranoid delusions with or without hallucinations (the positive symptoms of schizophrenia) and without deterioration of intellect or personality (its negative symptom).Almeida ...
, manic episodes of
bipolar disorder Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...
, and
psychotic depression Psychotic depression, also known as depressive psychosis, is a major depressive episode that is accompanied by psychotic symptoms.Hales E and Yudofsky JA, eds, The American Psychiatric Press Textbook of Psychiatry, Washington, DC: American Psych ...
.


Types

Delusions are categorized into four different groups: * ''Bizarre delusion'': Delusions are deemed bizarre if they are clearly implausible and not understandable to same-culture peers and do not derive from ordinary life experiences. An example named by the
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatric ...
is a belief that someone replaced all of one's internal organs with someone else's without leaving a scar, depending on the organ in question. * ''Non-bizarre delusion'': A delusion that, though false, is at least technically possible, e.g., the affected person mistakenly believes that they are under constant police surveillance. * ''Mood-congruent delusion'': Any delusion with content consistent with either a depressive or manic state, e.g., a depressed person believes that news anchors on television highly disapprove of them, or a person in a manic state might believe they are a powerful deity. * ''Mood-neutral delusion'': A delusion that does not relate to the patient's emotional state; for example, a belief that an extra limb is growing out of the back of one's head is neutral to either depression or mania.


Themes

In addition to these categories, delusions often manifest according to a consistent theme. Although delusions can have any theme, certain themes are more common. Some of the more common delusion themes are: * ''
Delusion of control A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some o ...
'': False belief that another person, group of people, or external force controls one's general thoughts, feelings, impulses, or behaviors. * ''
Cotard delusion Cotard's syndrome, also known as Cotard's delusion or walking corpse syndrome, is a rare mental disorder in which the affected person holds the delusional belief that they are dead, do not exist, are putrefying, or have lost their blood or inter ...
'': False belief that one does not exist or that one has died. Some cases also include the belief that one is immortal or that one has lost their internal organs, blood, or other body parts. * ''
Delusional jealousy Pathological jealousy, also known as morbid jealousy, Othello syndrome or delusional jealousy, is a psychological disorder in which a person is preoccupied with the thought that their spouse or sexual partner is being unfaithful without having a ...
'': False belief that a spouse or lover is having an affair, with no proof to back up the claim. * '' Delusion of guilt or sin (or delusion of self-accusation)'': Ungrounded feeling of remorse or guilt of delusional intensity. * '' Delusion of mind being read'': False belief that other people can know one's thoughts. * '' Delusion of thought insertion'': Belief that another thinks through the mind of the person. * '' Delusion of reference'': False belief that insignificant remarks, events, or objects in one's environment have personal meaning or significance. "Usually the meaning assigned to these events is negative, but the 'messages' can also have a grandiose quality." * ''
Erotomania Erotomania, also known as de Clérambault's Syndrome, named after French psychiatrist Gaëtan Gatian de Clérambault, is listed in the DSM-5 as a subtype of a delusional disorder. It is a relatively uncommon paranoid condition that is character ...
'': False belief that another person is in love with them. * ''
Religious delusion A religious delusion is defined as a delusion, or fixed belief not amenable to change in light of conflicting evidence, involving religious themes or subject matter., cited in: Religious faith, meanwhile, is defined as a belief in God or a religi ...
'': Belief that the affected person is a god or chosen to act as a god. * '' Somatic delusion'': Delusion whose content pertains to bodily functioning, bodily sensations or physical appearance. Usually the false belief is that the body is somehow diseased, abnormal or changed. A specific example of this delusion is
delusional parasitosis Delusional parasitosis (DP) is a mental disorder in which individuals have a persistent belief that they are infested with living or nonliving pathogens such as parasites, insects, or bugs, when no such infestation is present. They usually report ...
: Delusion in which one feels infested with insects, bacteria, mites, spiders, lice, fleas, worms, or other organisms. * ''Delusion of poverty'': Person strongly believes they are financially incapacitated. Although this type of delusion is less common now, it was particularly widespread in the days preceding state support.


Grandiose delusions

Grandiose delusions Grandiose delusions (GD), also known as delusions of grandeur or expansive delusions, are a subtype of delusion that occur in patients with a wide range of psychiatric diseases, including two-thirds of patients in manic state of bipolar disord ...
or delusions of grandeur are principally a subtype of
delusional disorder Delusional disorder is a mental illness in which a person has delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect.American Psychiatric Association. (2013). ''Diagnostic ...
but could possibly feature as a symptom of
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
and manic episodes of
bipolar disorder Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...
.
Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
Fourth edition Text Revision (DSM-IV-TR)
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involve ...
(2000)
Grandiose delusions are characterized by fantastical beliefs that one is famous,
omnipotent Omnipotence is the quality of having unlimited power. Monotheistic religions generally attribute omnipotence only to the deity of their faith. In the monotheistic religious philosophy of Abrahamic religions, omnipotence is often listed as one ...
or otherwise very powerful. The delusions are generally fantastic, often with a
supernatural Supernatural refers to phenomena or entities that are beyond the laws of nature. The term is derived from Medieval Latin , from Latin (above, beyond, or outside of) + (nature) Though the corollary term "nature", has had multiple meanings si ...
,
science-fiction Science fiction (sometimes shortened to Sci-Fi or SF) is a genre of speculative fiction which typically deals with imaginative and futuristic concepts such as advanced science and technology, space exploration, time travel, parallel univers ...
al, or religious bent. In colloquial usage, one who overestimates one's own abilities, talents, stature or situation is sometimes said to have "delusions of grandeur". This is generally due to excessive
pride Pride is defined by Merriam-Webster as "reasonable self-esteem" or "confidence and satisfaction in oneself". A healthy amount of pride is good, however, pride sometimes is used interchangeably with "conceit" or "arrogance" (among other words) wh ...
, rather than any actual delusions. Grandiose delusions or delusions of grandeur can also be associated with megalomania.


Persecutory delusions

Persecutory delusions are the most common type of delusions and involve the theme of being followed, harassed, cheated, poisoned or drugged, conspired against, spied on, attacked, or otherwise obstructed in the pursuit of goals. Persecutory delusions are a condition in which the affected person wrongly believes that they are being persecuted. Specifically, they have been defined as containing two central elements: The individual thinks that: * harm is occurring, or is going to occur * the persecutors have the intention to cause harm According to the ''
DSM-IV-TR The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
'', persecutory delusions are the most common form of delusions in
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
, where the person believes they are "being tormented, followed, sabotaged, tricked, spied on, or ridiculed". In the ''DSM-IV-TR'', persecutory delusions are the main feature of the persecutory type of delusional disorder. When the focus is to remedy some injustice by legal action, they are sometimes called "
querulous paranoia In the legal profession and courts, a querulant (from the Latin ''querulus'' - "complaining") is a person who obsessively feels wronged, particularly about minor causes of action. In particular the term is used for those who repeatedly petition a ...
".


Causes

Explaining the causes of delusions continues to be challenging and several theories have been developed. One is the genetic or biological theory, which states that close relatives of people with delusional disorder are at increased risk of delusional traits. Another theory is the dysfunctional cognitive processing, which states that delusions may arise from distorted ways people have of explaining life to themselves. A third theory is called motivated or defensive delusions. This one states that some of those persons who are predisposed might experience the onset of delusional disorder in those moments when coping with life and maintaining high
self-esteem Self-esteem is confidence in one's own worth or abilities. Self-esteem encompasses beliefs about oneself (for example, "I am loved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith and Mackie (2007) d ...
becomes a significant challenge. In this case, the person views others as the cause of their personal difficulties in order to preserve a positive self-view. This condition is more common among people who have poor
hearing Hearing, or auditory perception, is the ability to perceive sounds In physics, sound is a vibration that propagates as an acoustic wave, through a transmission medium such as a gas, liquid or solid. In human physiology and psycholog ...
or
sight Visual perception is the ability to interpret the surrounding Biophysical environment, environment through photopic vision (daytime vision), color vision, scotopic vision (night vision), and mesopic vision (twilight vision), using light in the ...
. Also, ongoing stressors have been associated with a higher possibility of developing delusions. Examples of such stressors are
immigration Immigration is the international movement of people to a destination country of which they are not natives or where they do not possess citizenship in order to settle as permanent residents or naturalized citizens. Commuters, tourists, and ...
, low socioeconomic status, and even possibly the accumulation of smaller daily hassles.


Specific delusions

The top two factors mainly concerned in the germination of delusions are disorder of brain functioning and background influences of temperament and personality. Higher levels of dopamine qualify as a symptom of disorders of brain function. That they are needed to sustain certain delusions was examined by a preliminary study on delusional disorder (a psychotic syndrome) instigated to clarify if schizophrenia had a dopamine psychosis. There were positive results - delusions of jealousy and persecution had different levels of dopamine metabolite HVA and
homovanillyl alcohol Homovanillyl alcohol is a metabolite of hydroxytyrosol, which in turn is a metabolite of the neurotransmitter dopamine. See also * Homovanillic acid Homovanillic acid (HVA) is a major catecholamine metabolite that is produced by a consecut ...
(which may have been genetic). These can be only regarded as tentative results; the study called for future research with a larger population. It is simplistic to say that a certain measure of dopamine will bring about a specific delusion. Studies show age and gender to be influential and it is most likely that HVA levels change during the life course of some syndromes. On the influence of personality, it has been said: "Jaspers considered there is a subtle change in personality due to the illness itself; and this creates the condition for the development of the delusional atmosphere in which the delusional intuition arises." Cultural factors have "a decisive influence in shaping delusions". For example, delusions of guilt and punishment are frequent in a Western, Christian country like Austria, but not in Pakistan, where it is more likely persecution. Similarly, in a series of case studies, delusions of guilt and punishment were found in Austrian patients with Parkinson's being treated with l-dopa, a dopamine agonist.


Pathophysiology

The two-factor model of delusions posits that dysfunction in both belief formation systems and belief evaluation systems are necessary for delusions. Dysfunction in evaluations systems localized to the right lateral prefrontal cortex, regardless of delusion content, is supported by neuroimaging studies and is congruent with its role in conflict monitoring in healthy persons. Abnormal activation and reduced volume is seen in people with delusions, as well as in disorders associated with delusions such as
frontotemporal dementia Frontotemporal dementia (FTD), or frontotemporal degeneration disease, or frontotemporal neurocognitive disorder, encompasses several types of dementia involving the progressive degeneration of frontal and temporal lobes. FTDs broadly present as ...
,
psychosis Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior ...
and
Lewy body dementia Lewy body dementias are two similar and common subtypes of dementia—dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD). Both are characterized by changes in thinking, movement, behavior, and mood. The two conditions have sim ...
. Furthermore, lesions to this region are associated with "jumping to conclusions", damage to this region is associated with post-stroke delusions, and hypometabolism this region associated with caudate strokes presenting with delusions. The
aberrant salience Salience (also called saliency) is that property by which some thing stands out. Salient events are an attentional mechanism by which organisms learn and survive; those organisms can focus their limited perceptual and cognitive resources on th ...
model suggests that delusions are a result of people assigning excessive importance to irrelevant stimuli. In support of this hypothesis, regions normally associated with the
salience network The salience network (SN), also known anatomically as the midcingulo-insular network (M-CIN), is a large scale brain network of the human brain that is primarily composed of the anterior insula (AI) and dorsal anterior cingulate cortex (dACC). ...
demonstrate reduced grey matter in people with delusions, and the neurotransmitter
dopamine Dopamine (DA, a contraction of 3,4-dihydroxyphenethylamine) is a neuromodulatory molecule that plays several important roles in cells. It is an organic compound, organic chemical of the catecholamine and phenethylamine families. Dopamine const ...
, which is widely implicated in salience processing, is also widely implicated in psychotic disorders. Specific regions have been associated with specific types of delusions. The volume of the hippocampus and parahippocampus is related to paranoid delusions in
Alzheimer's disease Alzheimer's disease (AD) is a neurodegeneration, neurodegenerative disease that usually starts slowly and progressively worsens. It is the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in short-term me ...
, and has been reported to be abnormal post mortem in one person with delusions.
Capgras delusion Capgras delusion or Capgras syndrome is a psychiatric disorder in which a person holds a delusion that a friend, spouse, parent, or other close family member (or pet) has been replaced by an identical impostor. It is named after Joseph Capgras (1 ...
s have been associated with occipito-temporal damage and may be related to failure to elicit normal emotions or memories in response to faces.


Diagnosis

The modern definition and Jaspers' original criteria have been criticised, as counter-examples can be shown for every defining feature. Studies on psychiatric patients show that delusions vary in intensity and conviction over time, which suggests that certainty and incorrigibility are not necessary components of a delusional belief. Delusions do not necessarily have to be false or 'incorrect inferences about external reality'. Some religious or spiritual beliefs by their nature may not be falsifiable, and hence cannot be described as false or incorrect, no matter whether the person holding these beliefs was diagnosed as delusional or not. In other situations the delusion may turn out to be true belief. For example, in
delusional jealousy Pathological jealousy, also known as morbid jealousy, Othello syndrome or delusional jealousy, is a psychological disorder in which a person is preoccupied with the thought that their spouse or sexual partner is being unfaithful without having a ...
, where a person believes that their partner is being unfaithful (and may even follow them into the bathroom believing them to be seeing their lover even during the briefest of partings), it may actually be true that the partner is having sexual relations with another person. In this case, the delusion does not cease to be a delusion because the content later turns out to be verified as true or the partner actually chose to engage in the behavior of which they were being accused. In other cases, the belief may be mistakenly assumed to be false by a doctor or psychiatrist assessing it, just because it ''seems'' to be unlikely, bizarre or held with excessive conviction. Psychiatrists rarely have the time or resources to check the validity of a person's claims leading to some true beliefs to be erroneously classified as delusional. This is known as the
Martha Mitchell effect The Martha Mitchell effect occurs when a medical professional labels a patient's accurate perception of real events as delusional, resulting in misdiagnosis.Coleman, A. (2015)A Dictionary of Psychology p441.Alexander, G. J. (1996)International ...
, after the wife of the
attorney general In most common law jurisdictions, the attorney general or attorney-general (sometimes abbreviated AG or Atty.-Gen) is the main legal advisor to the government. The plural is attorneys general. In some jurisdictions, attorneys general also have exec ...
who alleged that illegal activity was taking place in the
White House The White House is the official residence and workplace of the president of the United States. It is located at 1600 Pennsylvania Avenue NW in Washington, D.C., and has been the residence of every U.S. president since John Adams in 1800. ...
. At the time, her claims were thought to be signs of mental illness, and only after the
Watergate scandal The Watergate scandal was a major political scandal in the United States involving the administration of President Richard Nixon from 1972 to 1974 that led to Nixon's resignation. The scandal stemmed from the Nixon administration's continual ...
broke was she proved right (and hence sane). Similar factors have led to criticisms of Jaspers' definition of true delusions as being ultimately 'un-understandable'. Critics (such as
R. D. Laing Ronald David Laing (7 October 1927 – 23 August 1989), usually cited as R. D. Laing, was a Scottish psychiatrist who wrote extensively on mental illnessin particular, the experience of psychosis. Laing's views on the causes and treatment o ...
) have argued that this leads to the diagnosis of delusions being based on the subjective understanding of a particular psychiatrist, who may not have access to all the information that might make a belief otherwise interpretable. R. D. Laing's hypothesis has been applied to some forms of projective therapy to "fix" a delusional system so that it cannot be altered by the patient. Psychiatric researchers at
Yale University Yale University is a private research university in New Haven, Connecticut. Established in 1701 as the Collegiate School, it is the third-oldest institution of higher education in the United States and among the most prestigious in the wo ...
,
Ohio State University The Ohio State University, commonly called Ohio State or OSU, is a public land-grant research university in Columbus, Ohio. A member of the University System of Ohio, it has been ranked by major institutional rankings among the best publ ...
and the Community Mental Health Center of Middle Georgia have used novels and motion picture films as the focus. Texts, plots and cinematography are discussed and the delusions approached tangentially. This use of fiction to decrease the malleability of a delusion was employed in a joint project by science-fiction author
Philip Jose Farmer Philip, also Phillip, is a male given name, derived from the Greek (''Philippos'', lit. "horse-loving" or "fond of horses"), from a compound of (''philos'', "dear", "loved", "loving") and (''hippos'', "horse"). Prominent Philips who popularize ...
and Yale psychiatrist A. James Giannini. They wrote the novel ''
Red Orc's Rage ''Red Orc's Rage'' (1991) is a recursive science fiction novel by American writer Philip José Farmer, part of his " World of Tiers" series . The plot of the book was inspired by the work of American psychiatrist A. James Giannini, M.D, who use ...
'', which, recursively, deals with delusional adolescents who are treated with a form of projective therapy. In this novel's fictional setting other novels written by Farmer are discussed and the characters are symbolically integrated into the delusions of fictional patients. This particular novel was then applied to real-life clinical settings. Another difficulty with the diagnosis of delusions is that almost all of these features can be found in "normal" beliefs. Many religious beliefs hold exactly the same features, yet are not universally considered delusional. For instance, if a person was holding a true belief then they will of course persist with it. This can cause the disorder to be misdiagnosed by psychiatrists. These factors have led the psychiatrist Anthony David to note that "there is no acceptable (rather than accepted) definition of a delusion." In practice, psychiatrists tend to diagnose a belief as delusional if it is either patently bizarre, causing significant distress, or excessively pre-occupying the patient, especially if the person is subsequently unswayed in belief by counter-evidence or reasonable arguments. Joseph Pierre, M.D. states that one factor that helps differentiate delusions from other kinds of beliefs is that anomalous subjective experiences are often used to justify delusional beliefs. While idiosyncratic and self-referential content often make delusions impossible to share with others, Dr. Pierre suggests that it may be more helpful to emphasize the level of conviction, preoccupation, and extension of a belief rather than the content of the belief when considering whether a belief is delusional. It is important to distinguish true delusions from other symptoms such as
anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
,
fear Fear is an intensely unpleasant emotion in response to perceiving or recognizing a danger or threat. Fear causes physiological changes that may produce behavioral reactions such as mounting an aggressive response or fleeing the threat. Fear ...
, or
paranoia Paranoia is an instinct or thought process that is believed to be heavily influenced by anxiety or fear, often to the point of delusion and irrationality. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy concer ...
. To diagnose delusions a mental state examination may be used. This test includes
appearance Appearance may refer to: * Visual appearance, the way in which objects reflect and transmit light * Human physical appearance, what someone looks like * ''Appearances'' (film), a 1921 film directed by Donald Crisp * Appearance (philosophy), or p ...
, mood, affect,
behavior Behavior (American English) or behaviour (British English) is the range of actions and mannerisms made by individuals, organisms, systems or artificial entities in some environment. These systems can include other systems or organisms as wel ...
, rate and continuity of speech, evidence of hallucinations or abnormal beliefs, thought content, orientation to time, place and person, attention and
concentration In chemistry, concentration is the abundance of a constituent divided by the total volume of a mixture. Several types of mathematical description can be distinguished: '' mass concentration'', ''molar concentration'', ''number concentration'', an ...
, insight and judgment, as well as short-term
memory Memory is the faculty of the mind by which data or information is encoded, stored, and retrieved when needed. It is the retention of information over time for the purpose of influencing future action. If past events could not be remembered, ...
. Johnson-Laird suggests that delusions may be viewed as the natural consequence of failure to distinguish conceptual relevance. That is, irrelevant information would be framed as disconnected experiences, then it is taken to be relevant in a manner that suggests false causal connections. Furthermore, relevant information would be ignored as counterexamples. See section "A New Definition of Delusional Ideation in Terms of Model Restriction".


Definition

Although non-specific concepts of madness have been around for several thousand years, the psychiatrist and philosopher
Karl Jaspers Karl Theodor Jaspers (, ; 23 February 1883 – 26 February 1969) was a German-Swiss psychiatrist and philosopher who had a strong influence on modern theology, psychiatry, and philosophy. After being trained in and practicing psychiatry, Jasper ...
was the first to define the four main criteria for a belief to be considered delusional in his 1913 book ''General Psychopathology''. These criteria are: * certainty (held with absolute conviction) * incorrigibility (not changeable by compelling counterargument or proof to the contrary) * impossibility or falsity of content (implausible, bizarre, or patently untrue) *not amenable to understanding (i.e., belief cannot be explained psychologically) Furthermore, when beliefs involve value judgments, only those which cannot be proven true are considered delusions. For example: a man claiming that he flew into the
Sun The Sun is the star at the center of the Solar System. It is a nearly perfect ball of hot plasma, heated to incandescence by nuclear fusion reactions in its core. The Sun radiates this energy mainly as light, ultraviolet, and infrared radi ...
and flew back home. This would be considered a delusion, unless he were speaking figuratively, or if the belief had a cultural or religious source. Only the first three criteria remain cornerstornes of the current definition of a delusion in the
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatric ...
. Robert Trivers writes that delusion is a discrepancy in relation to objective reality, but with a firm conviction in reality of delusional ideas, which is manifested in the "affective basis of delusion."


Treatment

Delusions and other positive symptoms of psychosis are often treated with
antipsychotic medication Antipsychotics, also known as neuroleptics, are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but also in a range of oth ...
, which exert a medium effect size according to meta-analytic evidence.
Cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...
(CBT) improves delusions relative to control conditions according to a
meta-analysis A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each individual study reporting me ...
. A
meta-analysis A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each individual study reporting me ...
of 43 studies reported that
metacognitive training Metacognitive training, (MCT), is an approach for treating the symptoms of psychosis in schizophrenia, especially delusions, which has been adapted for other disorders such as depression, obsessive-compulsive disorder and borderline over the ye ...
(MCT) reduces delusions at a medium to large effect size relative to control conditions.


Criticism

Some psychiatrists criticize the practice of defining one and the same belief as normal in one culture and pathological in another culture for cultural
essentialism Essentialism is the view that objects have a set of attributes that are necessary to their identity. In early Western thought, Plato's idealism held that all things have such an "essence"—an "idea" or "form". In ''Categories'', Aristotle sim ...
. They argue that it is not justified to assume that culture can be simplified to a few traceable, distinguishable and statistically quantifiable factors and that everything outside those factors must be biological since cultural influences are mixed, including not only parents and teachers but also peers, friends, and media, and the same cultural influence can have different effects depending on earlier cultural influences. Other critical psychiatrists argue that just because a person's belief is unshaken by one influence does not prove that it would remain unshaken by another. For example, a person whose beliefs are not changed by verbal correction from a psychiatrist, which is how delusion is usually diagnosed, may still change his or her mind when observing
empirical evidence Empirical evidence for a proposition is evidence, i.e. what supports or counters this proposition, that is constituted by or accessible to sense experience or experimental procedure. Empirical evidence is of central importance to the sciences and ...
, only that psychiatrists rarely, if ever, present patients with such situations. Anthropologist
David Graeber David Rolfe Graeber (; February 12, 1961September 2, 2020) was an American anthropologist and anarchist activist. His influential work in economic anthropology, particularly his books '' Debt: The First 5,000 Years'' (2011) and ''Bullshit Jobs ...
have criticized psychiatry's assumption that an absurd belief goes from being delusional to "being there for a reason" merely because it is shared by many people by arguing that just as genetic pathogens like viruses can take advantage of an organism without benefitting said organism,
memetic Memetics is a study of information and culture. While memetics originated as an analogy with Darwinian evolution, digital communication, media, and sociology scholars have also adopted the term "memetics" to describe an established empirical study ...
phenomena can spread while being harmful to societies, implying that entire societies can become ill. David Graeber argued that if somatic medicine did not have higher scientific standards than psychiatry's way of defining delusion, pandemics like the plague would have been considered to transsubstantiate from an illness to "a phenomenon that benefits the people" as soon as it had spread to a sufficiently large portion of the population. It was argued by Graeber that since
deinstitutionalisation Deinstitutionalisation (or deinstitutionalization) is the process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder or developmental disability. In the late ...
made sales of
psychiatric medication A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. These medications are typically made o ...
profitable by no longer needing to spend money on keeping the patients in mental hospitals, corrupt incentives for psychiatry to allege "needs" for treatments have increased (in particular with regard to medicines that are said to be needed in daily doses, not so much regarding devices that can be kept for longer periods of time) which may itself be a harmful memetic pandemic in society that leads to diagnosing and medication of criticisms of widespread beliefs that are actually absurd and harmful, making the absurd belief that is not labelled as an illness profitable anyway by attracting criticisms that are labelled as illnesses.David Graeber (May 2018). "Bullshit Jobs: A Theory"


See also


References

;Cited text *


Further reading

* * * * *


External links

{{Authority control Psychosis Communication of falsehoods Belief Deception