Donald Trump is delusional, so is Vladimir Putin. Then again, both Hillary and Bill Clinton, as well as Barack Obama are delusional. How do I know? I typed in their name with the word “delusional” into a Google search. Guess what, this week two countries were identified as delusional…North Korea and Saudi Arabia. In all my training, the notion of complete countries being mentally ill has never been introduced.
I am not ragging about fake news, there are plenty of other news sources covering those claims. However, I am disturbed by the number of people who are misusing psychiatric terms, such as labeling people (and countries) with mental illnesses. I am equally dumbfounded by the number of so called “professionals” (psychiatrists, psychologists, social workers, therapists) who proclaim they know a person’s mental health diagnosis without having had a face to face assessment with that person.
Have you ever been called delusional? Have you ever referred to someone else as delusional? Well, are you delusional, was the other person? Probably not. As a law enforcement officer, you have undoubtedly encountered citizens who are truly delusional. The truth is that by understanding the symptoms of delusions, the type, and the theme should affect your interaction with these subjects who suffer from these disorders; possibly preventing a violent encounter.
Delusions
Definition: A delusion is a belief that is held with strong conviction despite evidence disproving it that is stronger than any evidence supporting it. 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 are a symptom of either a medical, neurological, or mental disorder. Delusions may be present in any of the following mental or physical disorders:
- Psychotic disorders, or disorders in which the affected person has a diminished or distorted sense of reality and cannot distinguish the real from the unreal
- including schizophrenia
- schizoaffective disorder
- delusional disorder
- schizophreniform disorder
- Substance-induced psychotic disorder
- Bipolar disorder
- Major depressive disorder with psychotic features
- Delirium
- Dementia
Types of Delusions
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. For example, a person believes that aliens have removed all his organs and have replaced them with someone else’s without leaving a scar.
- Non-bizarre delusion: A non-bizarre delusion is where the content of the belief is mistaken, but it is at least possible. For example, it is possible for someone to be under constant police surveillance.
- Mood-congruent delusion: Any delusion with content consistent with either a depressive or manic state. For example, a depressed person believes that news anchors on television highly disapproves of him, or a person in a manic state might believe she is a powerful deity.
- Mood-neutral delusion: A delusion that does not relate to the individuals emotional state. For example, a belief that an extra arm is growing out of the back of one's head is neutral to either depression or mania.
Delusional Themes
10 of the Most Common Themed Delusions
1. Persecutory Delusions: Persecutory delusions are the most common type of delusions and involve the theme of being followed, harassed, cheated, tormented, poisoned or drugged, conspired against, spied on, sabotaged, tricked, ridiculed or attacked, or otherwise obstructed in the pursuit of goals. Most importantly, people with persecutory delusions are frequently schizophrenic with paranoid features. They may come to the station to report stalking by many nefarious governmental agencies.
2. Referential Delusions: Another common delusion in which the person believes that certain gestures, comments, passages from books, television, newspapers, song lyrics, or cues are specifically directed at the individual.
3. Delusions of Control: This is a false belief that another person, group of people, or other external force has control over the individual’s thoughts, feelings, impulses, or behavior. Individuals with delusions of control believe that their thoughts have been involuntarily taken from their mind and that their thoughts are not their own.
4. Religious Delusions: Religious delusions center on misguided beliefs about one's relationship with God or other higher power. Schizophrenic individuals with this type of delusion may believe they have a special relationship with God, that God has given them special powers, or that they themselves are God, Jesus, Allah, Krishna, Buddha, a saint, a disciple, etc. They may report having the ability to speak directly to God or a responsibility to carry out God's plans. However, it is crucial to realize that beliefs that would be considered normal for an individual's religious or cultural background would not be considered delusions.
5. Jealousy Delusions: False belief that a spouse or lover is having an affair, with no proof to back up their claim.
6. Erotomania: A delusion in which one believes that another person is in love with them. It is common for individuals with this type of delusion to attempt to contact the other person and sometimes stalk them.
7. Delusions of Being Able to Mind Read: The false belief that other people can know and read your thoughts.
8. Delusions of Grandeur: Grandiose delusions are mistaken beliefs that the individual is better than others. A grandiose individual exaggerates his/her sense of self-importance, and is usually convinced that he/she has special powers/talents/abilities. People with this type of delusion may believe they are a popular, powerful political figure or a celebrity. It is this type of delusion that most people refer to when they label politicians, celebrities, and even Law Enforcement Lieutenants.
9. Somatic Delusions: Somatic delusions involve a preoccupation with the individual’s body. Most typically they consist of false beliefs that they are suffering from a severe physical condition, such as cancer, despite exhaustive negative diagnostic testing. The perceived source of the disease is usually bizarre, such as having a foreign substance in one's body, or believing that his/her body is infested with parasites.
10. Nihilistic Delusions: A delusion related to the belief centered on the nonexistence of self, others, or the world. Individuals with this type of delusion commonly believe that the world is ending – the doomsday prophets. Again, we are not talking about survival preppers.
Tips for Law Enforcement
Unfortunately, as a society, we have become proficient in labeling people as mentally ill, without the training to back up our Monday morning diagnosis. As an officer, you will routinely encounter mentally ill individuals. Here are some tips for safely interfacing with someone who presents to you as delusional. Remember, you are not expected or encouraged to diagnose anyone with psychiatric disorders. As with any mentally ill subject call, your primary concern is safety: yours, theirs, and the community’s. If they are a danger to themselves, to others, or are grossly unable to care for themselves, transport them to the nearest facility that accepts petitions for 72 hour psychiatric evaluations. If they don’t meet the criterion for an involuntary commitment, refer them to their primary physician or a mental health clinic in the community. There are treatments for schizophrenia and delusional disorders.
- Bear in mind that delusions are deeply fixed beliefs; you will not be able to convince a delusional individual that what he/she believes is not true. Do not reason, argue, or challenge the delusion. Attempting to disprove the delusion is not helpful. Don’t even try; you will probably just agitate him/her further, potentially escalate the situation, and increase the risk for violence.
- Assure the person that s/he is safe and no harm will come to them; do not leave the person alone –
- Try to identify the type and content of the delusion. Clarify any confusion of the person’s verbalization by asking what they are saying. If you do not attempt to clarify confusion, the result may be even greater confusion, anxiety and reaffirmed delusion. This information should be included in a premise history. Chances are pretty solid that someone in your department will have contact with this person again (and probably not in the too distant future)
- People with persecutory delusions are often not sure who is plotting against them; they may believe that it is police. They are also not likely to share their suspicions with others; they tend to isolate. Additionally, any individual who has a delusion that someone is trying to harm or kill them can be dangerous to others, including you. Do not let your guard down!
