Is truth an exception to delusional disorder?

[dstebbins]

I've been reading this article:

 

https://en.wikipedia.org/wiki/Delusional_disorder

 

And it says that the symptoms of delusional disorder include ...

 

1. The patient expresses an idea or belief with unusual persistence or force.
2. That idea appears to have an undue influence on the patient's life, and the way of life is often altered to an inexplicable extent.
3. Despite his/her profound conviction, there is often a quality of secretiveness or suspicion when the patient is questioned about it.
4. The individual tends to be humorless and oversensitive, especially about the belief.
5. 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.
6. An attempt to contradict the belief is likely to arouse an inappropriately strong emotional reaction, often with irritability and hostility.
7. The belief is, at the least, unlikely, and out of keeping with the patient's social, cultural and religious background.
8. The patient is emotionally over-invested in the idea and it overwhelms other elements of their psyche.
9. 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.
10. Individuals who know the patient observe that the belief and behavior are uncharacteristic and alien.

But you know what I DON'T see in this list of symptoms? That their belief has to be grossly dispraportionate to the evidence they have to support the claims; that they believe these things ... when those things are clearly untrue.

 

I see a symptom that says that their belief has to be unlikely, but sometimes, unlikely things really do happen!

 

And yet ... I would imagine that would be an essential prerequisite to labeling them a lunatic.

 

For example ... would Barack Obama be suffering from gradiose delusional disorder? I mean ... he probably feels like he's a very improtant person. And you know why he thinks that? Because he's the freakin' PRESIDENT!

 

But of course ... he isn't delusional about thinking that he's the president, is he? No ... he really is President! And therefore, his belief in his own self-worth is 100% justified on the evidence.

 

But what about persecutory delusions? Well ... what if the guy really is being persecuted? How do we know he's not? Are we going to label him a lunatic even if he might have some justification or evidence to support it?

 

So ... shouldn't a person be able to escape a diagnosis of this disorder if he proves the belief to be warranted on the evidence?

Edited January 18, 2016 by dstebbins

[kisai]

Public health, which includes determining who is psychologically sane or not, is statistical in nature. As of such, it is pretty successful in diagnosing people who have common conditions, and will usually fail at identifying outliers. If I entered into a psychologist's office and told him or her that I was being hunted by a secret society that thought I was a supernatural being, the psychologist should first highly suspect that the more probable condition, that I'm acutely paranoid and delusional, might be the correct diagnosis, and not that my highly unlikely claims are indeed true.

Edited January 18, 2016 by kisai

[dstebbins]

Public health, which includes determining who is psychologically sane or not, is statistical in nature. As of such, it is pretty successful in diagnosing people who have common conditions, and will usually fail at identifying outliers. If I entered into a psychologist's office and told him or her that I was being hunted by a secret society that thought I was a supernatural being, the psychologist should first highly suspect that the more probable condition, that I'm acutely paranoid and delusional, might be the correct diagnosis, and not that my highly unlikely claims are indeed true.

That doesn't answer the question, though.

 

What if the patient shows irrefutable evidence that his beliefs - unlikely as they are - are indeed true, despite their likelihood? Would you escape diagnosis?

 

What if you really are being hunted down, and it's this "secret society" who has the delusions that you're supernatural, not you with the delusions of being hunted down?

 

From what I've read, delusional disorder specifically rules out physical hallucinations. So ... if you have memories of about five people running at you with shotguns, screaming "Kill the alien! Kill the alien!" then you're either hallucinating the memory of being chased ... or you really are being chased!

 

But one way or another, you aren't delusional, right?

 

Or are you?

Edited January 18, 2016 by dstebbins

[EdEarl]

I think many, perhaps most people, live with some delusions or mistaken ideas, and at the same time have some realistic ideas.

 

To diagnose someone as delusional, doctors should consider whether the person might be harmful to themselves or others. It is, however, a subjective assessment and mistakes will occur. The law waits until someone commits a crime, perhaps diagnosing someone as delusional should await their doing something illegal or clearly irrational and at least potentially dangerous.

[dstebbins]

To diagnose someone as delusional, doctors should consider whether the person might be harmful to themselves or others

That wasn't in the list of symptoms I noticed.

 

And besides ... my original query has yet to be given a straight answer!

 

Do ... you ... escape ... diagnosis ... if ... the ... belief ... is ... proven ... to ... be ... TRUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUE!

 

Or, alternatively, would truth be completely immaterial to delusional disorder, in much the same way that fault is irrelevant to the diagnosis of a broken leg? For example, if a person is diagnosed with persecutory delusion, could he add that diagnosis to the list of injuries he can sue over, without nullifying his claim of liability?

 

For god's sakes, why is this such a difficult question to answer?!

[kisai]

It isn't a difficult question to answer at all: when faced with evidence that supports a hypothesis once thought unlikely or contrary, a rational person changes his or her mind.

 

You cannot sue someone for acting professionally. A therapist would be seriously amiss if he or she automatically gave credence to a likely delusion.

Edited January 18, 2016 by kisai

[dstebbins]

It isn't a difficult question to answer at all: when faced with evidence that supports a hypothesis once thought unlikely or contrary, a rational person changes his or her mind.

So ... they avoid diagnosis?

 

You cannot sue someone for acting professionally. A therapist would be seriously amiss if he or she automatically gave credence to a likely delusion.

No no no! I'm not talking about suing the doctor for medical malpractice.

 

I'm talking about suing the cops and/or witnesses for false arrest/malicious prosecution, like in this case right here ...

 

https://scholar.google.com/scholar_case?q=White+v.+McKinley&hl=en&as_sdt=1006&case=1962708307400106012&scilh=0

https://scholar.google.com/scholar_case?q=White+v.+McKinley&hl=en&as_sdt=1006&case=6238393862503356077&scilh=0

 

... and claiming that these illegal acts caused such injuries as ... incarceration, loss of work, loss of reputation, depression, and ... in addition to that ... caused you to be diagnosed with delusion. I'm proposing that the delusion might be properly diagnosed, just like the depression, but the cops/witnesses would be liable to you for it.

 

In the case I showed you, I don't know if delusion was one of the plaintiff's injuries; all it says was that he got a million dollars in damages. But would he have been properly diagnosed with delusion, even if his beliefs were true?

Edited January 18, 2016 by dstebbins

[Phi for All]

Do ... you ... escape ... diagnosis ... if ... the ... belief ... is ... proven ... to ... be ... TRUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUE!

 

Doubtful. Have you ever known anyone who was delusional about just the one thing? Delusion is a mechanism, it's not a one-off symptom.

 

And if the single thing is true, there's no delusional diagnosis to avoid, right?

[dstebbins]

Doubtful. Have you ever known anyone who was delusional about just the one thing? Delusion is a mechanism, it's not a one-off symptom.

Again, that's not part of what I read. I read that a patient with delusional disorder might in fact be rational about most other aspects of life except this one belief.

 

The article in my OP says ... "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."

 

 

And if the single thing is true, there's no delusional diagnosis to avoid, right?

Of course he does! If he can't prove that his beliefs are true, he would be diagnosed!

 

That's like saying "If he killed in self-defense, there's no murder conviction to avoid." Of course there is! He's going to be charged, and then he brings up self-defense.

 

Also ...

 

You cannot sue someone for acting professionally. A therapist would be seriously amiss if he or she automatically gave credence to a likely delusion.

No no no! I'm not talking about suing the doctor for medical malpractice.

 

I'm talking about suing the cops and/or witnesses for false arrest/malicious prosecution, like in this case right here ...

 

https://scholar.google.com/scholar_case?q=White+v.+McKinley&hl=en&as_sdt=1006&case=1962708307400106012&scilh=0

https://scholar.google.com/scholar_case?q=White+v.+McKinley&hl=en&as_sdt=1006&case=6238393862503356077&scilh=0

 

... and claiming that these illegal acts caused such injuries as ... incarceration, loss of work, loss of reputation, depression, and ... in addition to that ... caused you to be diagnosed with delusion. I'm proposing that the delusion might be properly diagnosed, just like the depression, but the cops/witnesses would be liable to you for it.

 

In the case I showed you, I don't know if delusion was one of the plaintiff's injuries; all it says was that he got a million dollars in damages. But would he have been properly diagnosed with delusion, even if his beliefs were true?

Edited January 18, 2016 by dstebbins

[EdEarl]

For god's sakes, why is this such a difficult question to answer?!

To me it is a complex issue, and I don't think I am alone. At the moment, I believe politicians who deny climate change are either delusional or liars. People they influence to believe climate change is not occurring are also delusional, but they would think I am delusional. Who is right, and who decides? Trying to live a good life requires complex decisions, with appealing sound bytes trying to win sway people to some position. Trying to understand which sound byte is reasonable is not always clear.

 

I think rational behavior is the antitheses of delusional behavior. I don't know how to answer your question.

[dstebbins]

At the moment, I believe politicians who deny climate change are either delusional or liars. People they influence to believe climate change is not occurring are also delusional, but they would think I am delusional. Who is right, and who decides?

In my hypothetical scenario, there is no doubt, in the therapist's head, that the patient's beliefs are true.

 

For example, take a look at this news article:

 

 

Josh Lawson and Christopher Franklyn both believe they're being persecuted by police.

 

But ... their beliefs of persecution are absolutely, 100% true. No no impartial person could possibly listen to that video and draw any other conclusion.

 

Would they nevertheless be diagnosed with delusion, since they hold these beliefs? Or would they test negative for delusion, since their beliefs are clearly true?

Edited January 18, 2016 by dstebbins

[Phi for All]

Of course he does! If he can't prove that his beliefs are true, he would be diagnosed!

 

Forgive me, but your statement precluded it being false. He doesn't need to prove it because you set it up that the statement is "proven to be TRUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUE!"

[dstebbins]

Ok, now you're just talking circles, trying to confuse me.

 

I even gave you a concrete, real-world example. One that actually happened irl. And you STILL can't answer my question!

[Xalatan]

I am not qualified to give an answer because I am not a psychiatrist, but according to DSM V, a diagnosis of delusional disorder does not need to be based on harm to self or others. In fact, if the clinician judges there is a risk for the delusions to leading to self-harm or harm to others, then it may be possible for the diagnosis to be upgraded to schizophrenia. Delusional disorder may be the diagnosis of exclusion when the delusions are not bizarre enough or not severe enough to lead to social dysfunction.

 

Also, the diagnostic manual DSM is called the "Diagnostic and Statistical Manual" because these diagnostic criteria evolved precisely from census and psychiatric hospital statistics. So it's perhaps not surprising that the wording of these criteria uses terms like "Unlikely".

 

In reality it is often difficult to disprove something to be absolutely untrue. Eg. If someone says that he thinks he believes the Martians will come and get him on the 3rd of March, how would you go out and disprove such a notion? But statistically it may be so unlikely that a fixed belief falls outside the 95% confidence interval that it may be considered diagnostic. Of course, if the person could prove that in fact the Aliens will come and abduct him on the 3rd of March, and he in fact is abducted, then he would not be delusional, but statistically speaking the chances of this happening is so low that the clinician may be inclined to diagnose him. It may not be a perfect system but it's the working one.

 

Diagnostic criteria (DSM-5)

The specific DSM-5 criteria for delusional disorder are as follows:^[1]

• Presence of one or more delusions with a duration of one month or longer.
• The criteria for schizophrenia has never been met. Note: Hallucinations, if present are not prominent and are related to the delusional theme (e.g., the sensation of being infected with insects is associated with the delusions of infestation).
• Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd.
• If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods.
• The disturbance is not better explained by another mental disorder such as obsessive-compulsive disorder, and is not attributable to the physiological effects of a substance or medication or another medical condition.