Some peculiarities of the delusional state (The patients described below have been disguised.)
In a way, everything about the delusional state is peculiar. An affected person (usually a paranoid schizophrenic) comes to believe that an outlandish series of events, incredible to everyone else, are taking place in which he/she is the center of attention, usually a malignant attention.
A typical, although severe, delusion:
A 24 year old man, Andrew, with no history of mental illness became over a period of a few weeks increasingly agitated for no obvious reason. In particular, he experienced more and more difficulty sleeping, sometimes, by his account, not sleeping at all. He then began to notice “funny things” going on. Large black cars were driving slowly by his apartment building. Andrew reported this seemingly strange fact to members of his family. He started to think that he was being filmed, perhaps for a television reality show. It came to him suddenly that he might be the son of a famous person. This thought was pleasantly exciting; but, as the days went by, he began to feel threatened by the attention being paid to him by strangers who looked up and smirked as he walked by, or who stopped talking when he came into the room, or who ran away from him up a flight of stairs.
He thought he heard whispering from the adjacent carrel in his college library. The whispers seemed to be alluding to his being homosexual, which he was not. These invisible speakers were also laughing. He thought they might be part of a conspiracy to test him in some obscure way. The conspiracy, he thought, might be run by the Mafia or the C.I.A.
One time, he saw a group of policemen across the street. When he accosted them and accused them of spying on him, he was taken into custody and brought finally to a psychiatric ward in a municipal hospital.
Although placed quickly on high doses of a neuroleptic, Andrew’s condition worsened. At night he could hear his parents screaming. He told the staff that his parents were on the floor above, and they were being tortured. The following morning, his parents came to the ward and told Andrew emphatically that they were fine. They had not been tortured. But that night, and subsequent nights, he continued to hear them screaming and continued to believe that they were being tortured, even though each following day they came to visit him and were manifestly well.
Andrew seemed to improve on increasing doses of the major tranquilizer he was taking; but he was not well enough to leave. He was transferred to a state hospital, where I came to know him.
One day, not long after admission, he called me over to the window. “See those cars,” he said. He was pointing out cars on a highway which was three blocks away. We were on the sixth floor. “They are spying on me.”
I pointed out that the cars were so far away, I could barely see them before they disappeared from view. I explained that no one would set out to spy on him that way. It was impossible. But he nodded knowingly to himself.
Three weeks later, he was well enough to be discharged. He was still somewhat paranoid; but he was less certain of those thoughts.
“I was watching a movie last night,” he told me. “I knew the actors were talking to me, but I couldn’t figure out how that could be since the movie was made ten years before I was born.”
In time, Andrew recovered completely, although he relapsed briefly a number of years later.
Certain particular aspects of Andrew’s psychosis are worth underlining. They are common in the delusions of other paranoid individuals:
Extraordinary elements of the delusional state:
Other paranoid individuals may have the idea that other people are communicating to them telepathically—or even controlling them telepathically.
The boundaries of the individual begin to melt into the world at large.
An elderly woman who had worked all her life as a clerk, and who thought herself the most inconspicuous person in the world, thought that her employer, AT & T, had conspired together with blacks and the mob to make her automobile engine knock. She drove home every night by a circuitous route so that she could not be followed. She had an inordinate respect for me, but when I suggested that she was not, certainly by her own account, important enough to matter to these powerful agencies, and thatit was not reasonable to think they would bother to persecute her, she listened respectfully, but did not believe me.
Another elderly women, seventy-three, to be exact, became convinced that some criminal person was shooting rays of some sort at her from the roof of an adjoining building in order to cause her to become sexually excited. Why would anyone do that? I asked. No such ray exists, I pointed out. She was adamant, however. I told her not to tell anyone but me about these rays. She took my advice and managed the rest of her life to stay out of trouble.
The conversation that Andrew and I had about movie actors talking to him took place when he was getting better! When he was sicker, he would have noticed no contradiction in the idea that dead people were speaking to him.
Some patients never get entirely better, but manage their lives successfully nevertheless:
When I was a resident, a patient was admitted to the psychiatric service after crashing her car into a lamppost. She was driving at high speed because she felt she was safe. She had her neighbor, Joseph, who was really Jesus Christ, she thought, in the car with her. The reason why she was convinced he was Jesus Christ, she explained to me, was that he resembled a picture of a saint that was in her hymn book.
“That was a saint, not Jesus Christ,” I said to her.
“That doesn’t matter,” she replied.
She improved with medication, but the idea that she was chosen by Jesus Christ to have a special status did not leave her. She joined a church where everyone looked up to her for her special relationship with God. She went with her new friends door to door proselytizing. Her husband came to see me a few months later.
“I don’t know what you did to her, Doc,” he said, “but she’s better than ever.”
Whether or not there is group support for a particular delusional idea will determine how well that person does.
There are other varieties of delusional ideas, including jealous delusions; and there are other causes of delusional ideas, including drugs, Alzheimer’s disease, and a great number of other organic states; but they share many of the strange ways of thinking that Andrew exemplified and that I describe above.
It is not known why paranoid thinking takes exactly these shapes. They are, of course, the reflection of a diseased state of mind; but they illustrate by contrast how people ordinarily come to believe those things that they do.(c) Fredric Neuman 2013 Follow Dr. Neuman's blog at fredricneumanmd.com/blog