I keep trying to understand why people like Bill Postmus or Michael Ramos seem to see the world in exactly the opposite way that I do. Postmus is on drugs so that explains alot- Ramos I can't figure out. I believe that they have never been questioned by any of the folks that they surround themselves with, so they actually think that they are right every time. No matter how incredibly stupid the thought or theory or excuse. I'm getting close with delusional thinking, but its more than that. They actually think that they are doing a great job by doing nothing. Never doing what they are elected to do, but convincing themselves that they are above the law and cannot be questioned. And that they can fool every one around them. Delusional is very close to their thinking.
Delusion
A delusion is commonly defined as a fixed false belief and is used in everyday language to describe a belief that is either false, fanciful or derived from deception. In psychiatry, the definition is necessarily more precise and implies that the belief is pathological (the result of an illness or illness process). As a pathology it is distinct from a belief based on false or incomplete information or certain effects of perception which would more properly be termed an apperception or illusion.
Delusions typically occur in the context of neurological or mental illness, although they are not tied to any particular disease and have been found to occur in the context of many pathological states (both physical and mental). However, they are of particular diagnostic importance in psychotic disorders and particularly in schizophrenia and mania in episodes of bipolar disorder.
[edit] Psychiatric definition
Although non-specific concepts of madness have been around for several thousand years, the psychiatrist and philosopher Karl Jaspers was the first to define the three main criteria for a belief to be considered delusional in his 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)
These criteria still continue in modern psychiatric diagnosis. In the most recent Diagnostic and Statistical Manual of Mental Disorders, a delusion is defined as:
- A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everybody 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).
There is some controversy over this definition, as 'despite what almost everybody else believes' implies that a person who believes something most others do not is a candidate for delusional thought.
[edit] Diagnostic issues
The modern definition and Jaspers' original criteria have been criticised, as counter-examples can be shown for every defining feature.
Studies on psychiatric patients have shown that delusions can be seen to vary in intensity and conviction over time which suggests that certainty and incorrigibility are not necessary components of a delusional belief.[1]
Delusions do not necessarily have to be false or 'incorrect inferences about external reality'.[2] 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. [3]
In other situations the delusion may turn out to be true belief.[4] For example, delusional jealousy, 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) may result in the faithful partner being driven to infidelity by the constant and unreasonable strain put on them by their delusional spouse. In this case the delusion does not cease to be a delusion because the content later turns out to be true.
In other cases, the delusion may be assumed to be false by a doctor or psychiatrist assessing the belief, 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.[5] This is known as the Martha Mitchell effect, after the wife of the attorney general who alleged that illegal activity was taking place in the White House. At the time her claims were thought to be signs of mental illness, and only after the Watergate scandal 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) 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 which 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, Ohio State University 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.[6]. This use of fiction to decrease the malleability of a delusion was employed in a joint project by science-fiction author Philip Jose Farmer and Yale psychiatrist A. James Giannini. They wrote the novel Red Orc's Rage 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. [7]
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. Similarly, Thomas Kuhn argued in The Structure of Scientific Revolutions that scientists can hold strong beliefs in scientific theories despite considerable apparent discrepancies with experimental evidence.[8]
These factors have led the psychiatrist Anthony David to note that "there is no acceptable (rather than accepted) definition of a delusion."[9] In practice psychiatrists tend to diagnose a belief as delusional if it is either patently bizarre, causing significant distress, or excessively pre-occupies the patient, especially if the person is subsequently unswayed in belief by counter-evidence or reasonable arguments.
Delusional disorder
From Wikipedia, the free encyclopedia
Delusional disorder is a psychiatric diagnosis denoting a psychotic mental illness that involves holding one or more non-bizarre delusions in the absence of any other significant psychopathology (signs or symptoms of mental illness). In particular, a person with delusional disorder has never met any other criteria for schizophrenia and does not have any marked hallucinations, although tactile (touch) or olfactory (smell) hallucinations may be present if they are related to the theme of the delusion.
A person with delusional disorder can be quite functional and does not tend to show any odd or bizarre behavior aside from these delusions. "Despite the encapsulation of the delusional system and the relative sparing of the personality, the patient's way of life is likely to become more and more overwhelmed by the dominating effect of the abnormal beliefs". (Munro, 1999)
The term paranoia was previously used in psychiatry to denote what is now called 'delusional disorder'. The modern psychiatric use of the word paranoia is subtly different but now rarely refers to this specific diagnosis.
[edit] Indicators of a delusion
(Munro, 1999)
- The patient expresses an idea or belief with unusual persistence or force.
- That idea appears to exert an undue influence on his or her life, and the way of life is often altered to an inexplicable extent.
- Despite his/her profound conviction, there is often a quality of secretiveness or suspicion when the patient is questioned about it.
- The individual tends to be humorless and oversensitive, especially about the belief.
- There is a quality of centrality: no matter how unlikely it is that these strange things are happening to him, the patient accepts them relatively unquestioningly.
- An attempt to contradict the belief is likely to arouse an inappropriately strong emotional reaction, often with irritability and hostility.
- The belief is, at the least, unlikely.
- The patient is emotionally over-invested in the idea and it overwhelms other elements of his psyche.
- The delusion, if acted out, often leads to behaviors which are abnormal and/or out of character, although perhaps understandable in the light of the delusional beliefs.
- Individuals who know the patient will observe that his belief and behavior are uncharacteristic and alien.
[edit] Features
(Munro, 1999)
- It is a primary disorder.
- It is a stable disorder characterized by the presence of delusions to which the patient clings with extraordinary tenacity.
- The illness is chronic and frequently lifelong.
- The delusions are logically constructed and internally consistent.
- The delusions do not interfere with general logical reasoning (although within the delusional system the logic is perverted) and there is usually no general disturbance of behavior. If disturbed behavior does occur, it is directly related to the delusional beliefs.
- The individual experiences a heightened sense of self-reference. Events which, to others, are nonsignificant are of enormous significance to him or her, and the atmosphere surrounding the delusions is highly charged.
- Erotomanic Type (see erotomania): delusion that another person, usually of higher status, is in love with the individual.
- Grandiose Type: delusion of inflated worth, power, knowledge, identity, or special relationship to a famous person (e.g. see Jerusalem syndrome, Megalomania, Messiah complex)
- Jealous Type: delusion that the individual's sexual partner is unfaithful (see delusional jealousy).
- Persecutory Type: delusion that the person (or someone to whom the person is close) is being malevolently treated in some way.
- Somatic Type: delusions that the person has some physical defect or general medical condition (for example, see delusional parasitosis).
A diagnosis of 'mixed type' or 'unspecified type' may also be given if the delusions fall into several or none of these categories.
[edit] See also
