Professional Psychologists Help!

FRAP38 · #1 by **FRAP38** » Oct 24, 2011 7:23 am

I am not formally trained in this discipline, but I am currently in a debate with a psychologist that is claiming that delusions, in the clinical use of the word, are not always bad and that this is not her opinion but a general consensus in the profession....true/false?

Thanks

z8000783 · #2 by **z8000783** » Oct 24, 2011 7:38 am

We all have delusions all the time, they arise from our beliefs.

Question is whether they get in the way of living or not.

John

chairman bill · #3 by **chairman bill** » Oct 24, 2011 9:01 am

Subject X has a terminal disease, but is convinced that prayer will aid the medical treatment, and at worst, when X dies, X will ascend to a paradisical state in the company of some deity. X is fucking deluded, but content. Is the delusion a bad thing?

FRAP38 · #4 by **FRAP38** » Oct 24, 2011 2:28 pm

chairman bill wrote:Subject X has a terminal disease, but is convinced that prayer will aid the medical treatment, and at worst, when X dies, X will ascend to a paradisical state in the company of some deity. X is fucking deluded, but content. Is the delusion a bad thing?

Well, my honest answer is I DON"T KNOW. As a layperson hacking into unfamiliar terminology I am acutely aware of the perversion of common usage of such terms by laypeople. I see it in my own discipline of biology, as I know you do as well. Ie "Theory" etc. From my understanding there is a qualifier in diagnosing one as delusional and it is that the false belief must stem from a pathological cause, not mere ignorance. Similarly, someone lacking the mental faculties to adequately engage the disproving evidence would similarly not be classified as delusional.

So in your hypo, based on my understanding, I would say that the premise (that X is delusional) is not sound. Nonetheless, if we stipulate that X is delusional, and then ask is this a bad thing? I see the problem of "bad" as a subjective assesment. Now I know "bad" is how I framed the original post; nonetheless, it posits some problems. I guess, I would look at it as "bad" or "good" from the overall well being of the subject.

Knowing your going to die (soon), certainly ads an interesting variable into the mix. Now, the delusion becomes sort of an elixir, quite similar to an anti-depression drug or other coping agent. But, that aside the fact that X is terminally ill has no other relevance than X's knowledge of his impending death. In other words, no chance for a non-delusional future life etc. It seems if we are going to determine well being, there is no well being for terminally ill versus well being for those not terminally ill. What do you say here, I am not certain, but a double standard seems out of place.

And what of a victim suffering from chronic pain? Certainly, morphine aids in the disguising of the pain; but would we say that being on morphine increases their well being? I don't know, its really not a rhetorical question. It seems highly questionable though and relevant to your hypo. What I think is dangerous is applying this variable of "terminally ill" to make psychological treatment for the delusion seem futile--why bother to mentally heal this person, they're going to die anyway! No, we can't enter that into the calculus.

Chairman Bill....do you have formal training in this field....I think I recall hearing you were a psychotherapist...?

As always, thanks for your time and indulging my response to it. Cheers

Shrunk · #5 by **Shrunk** » Oct 24, 2011 2:36 pm

FRAP38 wrote:I am not formally trained in this discipline, but I am currently in a debate with a psychologist that is claiming that delusions, in the clinical use of the word, are not always bad and that this is not her opinion but a general consensus in the profession....true/false?

I guess it has to do with the definition of "bad". Delusions in and of themselves do not indicate the existence of a disorder. For that, there must also be evidence that the delusions, or related symptoms, cause dysfunction or suffering. So strictly speaking, she could be right.

Now, whether it is a good thing to firmly believe something in the absence of supporting evidence, or even in the face of contradictory evidence, is another question.

FRAP38 · #6 by **FRAP38** » Oct 24, 2011 4:33 pm

Shrunk wrote:... there must also be evidence that the delusions, or related symptoms, cause dysfunction or suffering. So strictly speaking, she could be right.

When would being delusional not be dysfunctional?

z8000783 · #7 by **z8000783** » Oct 24, 2011 4:35 pm

When it cause no harm.

John

chairman bill · #8 by **chairman bill** » Oct 24, 2011 4:56 pm

FRAP38 wrote:...I think I recall hearing you were a psychotherapist...?

No, just a psychologist & boring academic.

As for delusions & deluded thinking - gods, angels, heaven, etc, that's deluded thinking. These things don't exist. The delusion doesn't necessarily constitute a mental illness, lacks 'pathology' in that sense, is within the bounds of cultural acceptability & all that, but still a delusion. Prayer isn't going to work, and you're deluded if you think it will.

FRAP38 · #9 by **FRAP38** » Oct 24, 2011 4:58 pm

chairman bill wrote:The delusion doesn't necessarily constitute a mental illness, lacks 'pathology' in that sense, is within the bounds of cultural acceptability & all that, but still a delusion.

Interesting, so cultural acceptability is a factor used in diagnosis?

Shrunk · **#10** by **Shrunk** » Oct 24, 2011 5:08 pm

FRAP38 wrote: Interesting, so cultural acceptability is a factor used in diagnosis?

Yup. From the DSM-IV:

A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person’s culture or subculture (e.g. it is not an article of religious faith). When a false belief involves a value judgment, it is regarded as a delusion only when the judgment is so extreme as to defy credibility. Delusional conviction occurs on a continuum and can sometimes be inferred from an individual’s behavior. It is often difficult to distinguish between a delusion and an overvalued idea (in which case the individual has an unreasonable belief or idea but does not hold it as firmly as is the case with a delusion).

FRAP38 · **#11** by **FRAP38** » Oct 24, 2011 5:18 pm

Shrunk wrote:
FRAP38 wrote: Interesting, so cultural acceptability is a factor used in diagnosis?

Yup. From the DSM-IV:

A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person’s culture or subculture (e.g. it is not an article of religious faith). When a false belief involves a value judgment, it is regarded as a delusion only when the judgment is so extreme as to defy credibility. Delusional conviction occurs on a continuum and can sometimes be inferred from an individual’s behavior. It is often difficult to distinguish between a delusion and an overvalued idea (in which case the individual has an unreasonable belief or idea but does not hold it as firmly as is the case with a delusion).

Thanks! Now a person praying to me is delusional (common vernacular usage); adults talking to imaginary friends, however, is culturally accepted (at least here in Kentucky). So then it even would matter who one was talking to? So if two people are in the middle of the park praying quietly and you approach one and hear "Please Jesus help my wife...." he is not delusional; but if you approach the second and hear "Please Zultan heal my wounds..." he is delusional?

chairman bill · **#12** by **chairman bill** » Oct 24, 2011 5:31 pm

Pretty much. It's like the Pope railing against superstition, oblivious to the irony in a purveyor of supernaturalist mumbo-jumbo, pronouncing on something like astrology as superstitious mumbo-jumbo. Like saying that homeopathy works, when it clearly doesn't, but slagging off Bach Flower Remedies as quackery. But all of these are culturally normative, and aren't within the bounds of what might be consdiered disordered thinking, however disordered the thinking!

FRAP38 · **#13** by **FRAP38** » Oct 24, 2011 5:54 pm

Now is there a difference between delusional thought process and psychiatric delusions...these two terms get thrown around and I am unaware of the distinction.

chairman bill · **#14** by **chairman bill** » Oct 24, 2011 6:02 pm

It becomes a mental illness when it starts interfering in normal functioning. It's like hearing voices. Lots of people hear voices, without them being mentally ill. Most keep quiet about it for fear of the men in white coats calling at their house, but it doesn't actually signify mental illness. Hearing the voice, attributing it to God, then killing prostitutes 'cos God told you to, now that's mental illness.

nunnington · **#15** by **nunnington** » Oct 24, 2011 7:36 pm

Somebody on this board has referred to Maori ancestral beliefs (can't remember who). So presumably a NZ psychiatrist would not consider a Maori to be delusional, who was appealing to or speaking to his ancestors. But then it is quite common in the West to dialogue with somebody dead, e.g. by the side of the grave.

chairman bill · **#16** by **chairman bill** » Oct 24, 2011 8:00 pm

If you are convinced that there's an invisible alien entity called Zorg riding on your shoulder, telling you to do certain things, you're deluded. If you think there's an invisible entity called a guardian angel sitting on your shoulder, telling you to do certain things, you're not deluded. Apparently.

Shrunk · **#17** by **Shrunk** » Oct 24, 2011 9:40 pm

chairman bill wrote:If you are convinced that there's an invisible alien entity called Zorg riding on your shoulder, telling you to do certain things, you're deluded. If you think there's an invisible entity called a guardian angel sitting on your shoulder, telling you to do certain things, you're not deluded. Apparently.

Yes. It's a simple recognition of the degree to which beliefs are formed by social and cultural factors. One practical result of that recognition is that one can identify a condition that will respond to medical treatment. Antipsychotic medication will most likely remove the belief in Zorg, but not the belief in the guardian angel.

chairman bill · **#18** by **chairman bill** » Oct 24, 2011 9:58 pm

It will remove the belief in Zorg, but Zorg will still be there. There's no escaping the power of Zorg.

Mazille · **#19** by **Mazille** » Oct 24, 2011 10:27 pm

chairman bill wrote:If you are convinced that there's an invisible alien entity called Zorg riding on your shoulder, telling you to do certain things, you're deluded. If you think there's an invisible entity called a guardian angel sitting on your shoulder, telling you to do certain things, you're not deluded. Apparently.

To be fair, psychiatrists do make a distinction between just "regular" religiosity and religious mania (I think that is the correct term in English. Do speak up if you know the actual terminus technicus). One is just what you see in your everyday believer, the other is coupled with severe faults in self-assessment and other things. For one, a regular believer can distance her-/himself from his beliefs and critically assess them, whereas the pathological version is incapable of losing the egocentric, unchangeable, unassailable point of view. Similar to other delusions there is no reasoning with those patients.
Now, personally, I would put the line between "believer" and "bloody lunatic" far below where it is considered to be these days. We all know plenty of people who would not be considered loons but - by rights - should be. This is where societal conventions come into play, however. As long as your state of mind doesn't make you dysfunctional or doesn't cause suffering it is not considered pathological, no matter how far removed the person is from reality. It really all depends on just how far society as a whole has gone down the drain.

In short, don't argue with that psychologist. From a certain point of view you are both right, but if you don't agree on the basics from the beginning neither of you will prevail, so to speak.

Mr.Samsa · **#20** by **Mr.Samsa** » Oct 25, 2011 12:57 am

nunnington wrote:Somebody on this board has referred to Maori ancestral beliefs (can't remember who). So presumably a NZ psychiatrist would not consider a Maori to be delusional, who was appealing to or speaking to his ancestors. But then it is quite common in the West to dialogue with somebody dead, e.g. by the side of the grave.

That was probably me. Maori people (even some non-religious, non-traditional ones) will often see ghosts, or signs, of their dead ancestors and speak with them - sometimes they appear as warnings of bad things to come, or as punishment for breaking "tapu" (sacred rules), etc. But since these "visions", as they call them, don't affect their functioning in everyday life, they aren't considered part of a mental disorder.

Mazille wrote:
chairman bill wrote:If you are convinced that there's an invisible alien entity called Zorg riding on your shoulder, telling you to do certain things, you're deluded. If you think there's an invisible entity called a guardian angel sitting on your shoulder, telling you to do certain things, you're not deluded. Apparently.

To be fair, psychiatrists do make a distinction between just "regular" religiosity and religious mania (I think that is the correct term in English. Do speak up if you know the actual terminus technicus). One is just what you see in your everyday believer, the other is coupled with severe faults in self-assessment and other things. For one, a regular believer can distance her-/himself from his beliefs and critically assess them, whereas the pathological version is incapable of losing the egocentric, unchangeable, unassailable point of view. Similar to other delusions there is no reasoning with those patients.
Now, personally, I would put the line between "believer" and "bloody lunatic" far below where it is considered to be these days. We all know plenty of people who would not be considered loons but - by rights - should be. This is where societal conventions come into play, however. As long as your state of mind doesn't make you dysfunctional or doesn't cause suffering it is not considered pathological, no matter how far removed the person is from reality. It really all depends on just how far society as a whole has gone down the drain.

Exactly. The important difference between religious beliefs and belief in Zorg is not that one is commonly accepted, but rather that one has less chance of negatively affecting your life. In other words, this isn't a hard and fast rule, and it's entirely possible for the person who sees the angel on his shoulder to be diagnosed with a mental disorder, and the person with the Zorg to be declared mentally "healthy" (albeit probably a bit odd). This would happen when the religious belief leads to difficulties functioning in daily life, like if the angel told the person to sacrifice their first born son, or to blow up a building, and the belief in Zorg had no negative impacts (e.g. the person affected could still hold down a job, and maintain relationships with friends and families, etc).

Mental health fields are there to help people with problems, not to correct weird or wacky beliefs that are otherwise harmless. This isn't to say that these beliefs couldn't be changed using psychological techniques, but simply that it's not really necessary.

Mazille wrote:In short, don't argue with that psychologist. From a certain point of view you are both right, but if you don't agree on the basics from the beginning neither of you will prevail, so to speak.

I think you meant to say, "Don't argue with a psychologist because they are always right"... :grin: