What is the proper way to react to another person's delusions?

June 13, 2009 8:41 AM

What is the proper way to react to another person's delusions?

Recently I have struck up a friendship with a person who likely has some form of mental illness - possibly schizophrenia. This person makes intricate drawings of various machines. They are always interesting to look at and talk about, though some are clearly the product of mental illness. Could I be doing harm by taking interest in them and pretending to understand how the machines 'work'? Could the positive feedback be somehow deepening the person's mental illness? If so, what would an appropriate response be?

posted by vorpal bunny to human relations (24 comments total)

I think that there is too much we don't know here..

what is your relationship, how often, in what setting, what is your goal in the relationship, what type of treatment (if any) is this person getting....and so on....
posted by HuronBob at 8:45 AM on June 13

I can only tell you my experience... that the person who I had been indulging politely started showing up at my house uninvited at all hours to talk about his ideas because he saw me as an ally. And he became more manic and scary. He eventually nearly killed himself in a household accident, and I was able to disengage. But tread very very carefully when dealing with people who are delusional.
posted by kimdog at 8:49 AM on June 13 [6 favorites]

I'm not a mental health professional, but it does seem like your actions would be reinforcing this person's delusive reality.
posted by WCityMike at 8:50 AM on June 13

I am pretty sure the individual is homeless - as such I would imagine he isn't receiving treatment. We speak in a local park when I am taking my lunch break. I don't have any goal per se, I suppose I initiated contact simply because we always were hanging around the same area of the park and part of me didn't like seeing that he was always alone. I should also add that, so far, nothing my friend talks about is 'scary' in any way. It is always focused on technology and trying to come up with new ways to generate power. Sometimes the designs even seem vaguely plausible, but more often than not it is clear that they are not the product of normal logic.
posted by vorpal bunny at 8:53 AM on June 13

I should clarify... my friend's ideas weren't scary either. When I met him, he seemed quite stable, if a little eccentric. It was the escalation of his delusional ideas that became scary . At one point he was literally sobbing in my kitchen because he said knew how to cure illnesses like fibromyalgia and lupus, but didn't have the resources to do the research needed, and now millions of people would die because of his failure (this is a man with absolutely no medical background or training).

My point is that even though your acquaintance seems non-threatening now, people with delusions are unstable... and engaging with an unstable person can be dangerous.
posted by kimdog at 9:04 AM on June 13 [2 favorites]

Any advice on how to proceed from here would be greatly appreciated. Should I break off contact, try not to talk about his designs, seek him help from somewhere?
posted by vorpal bunny at 9:11 AM on June 13

I am going to respectfully disagree with kimdog, or at lease qualify the statement about unstable people being dangerous. People with mental illnesses may be unstable, but this does not necessarily make them dangerous to you. I would treat him like you would treat any other person you don't know very well- don't give him your personal contact information, don't agree to go anywhere with him, express interest when it's appropriate but don't indulge him. As soon as he starts disrespecting your boundaries, cut him off. While you may reinforce his delusions, you will not make the mental illness itself worse.

IANA expert on schizophrenia, but my research specialty is violent behavior, so take that for what it's worth.
posted by emilyd22222 at 9:19 AM on June 13 [3 favorites]

It's not necessarily harmful to him for you to collude with his ideas about the machines and so forth. It could, however, turn into a situation that is potentially harmful for you if he were to start believing that you have some sinister motives for talking with him about the drawings and are a threat to him, perhaps. The large majority of people with schizophrenia are NOT violent, and do not ever attack others (contrary to popular ideas/depictions in media), but I also personally wouldn't want to be followed home/to work, or become the subject of some other possibly privacy-violating behavior.

If anything ever becomes uncomfortable for you (sounds like it's possibly getting to this point already), it's perfectly appropriate to just gently excuse yourself from the conversation and stop engaging with him. If you feel like you're at the point where it feels right to you to stop contact, stop contact.

I would strongly recommend against trying to get him help; you are almost certainly not the first person to attempt to get him help, and he almost certainly has a family out there who has tried and failed to keep him in treatment and in a safe environment. Part of the reason why there is such a huge homeless schizophrenic population is that those people have withdrawn from treatment of their own accord, because it is legally necessary for them to give ongoing consent to be treated as adults. He may not exactly hug you and proclaim his gratitude if you were to mention it to him.
posted by so_gracefully at 9:21 AM on June 13

I wouldn't say that all people that have delusions are unstable, though some are. As long this person couldn't track you down and you could terminate the relationship at any time by avoiding that place.. well, I personally wouldn't feel threatened in that situation. YMMV.

If that person is receiving treatment, part of that treatment could involve helping them to realize which ideas are delusional and which are not. On the other hand, an important part of their treatment would also involve social integration, as people with mental illnesses are often socially isolated.

If it were me, I would probably pretend that I'm not very tech savvy, and that I don't understand the machines. This would still give the person some social contact without contradicting what their therapist may be saying, and without passing judgement.
posted by sero_venientibus_ossa at 9:29 AM on June 13 [2 favorites]

I am by no means an expert, but my father has dementia, and this is what I have been told about handling dementia-related delusionary thoughts. You do not need to validate the thoughts as much as you do the feelings. It's important with dementia patients to redirect when there are things they should not be doing or things they are not that they should be. But other things are not as important, and of course with a dementia patient -- which does not apply in your case -- exchanges may be forgotten once completed, sometimes several times a day.

So if my dad were to want to start talking as if his childhood dog were present, it would probably be wrong for me to reject that and say "Your dog isn't here. You are 71 years old and you are in a nursing home". On the other hand I could say "What a good dog! You really love him, don't you?"

My father's frontotemporal dementia is a bit unusual in comparison to the common conception of Alzheimer's, as his memory did not initially suffer. He developed logorrhea and a very mechanical story-telling compulsion. We would have to listen to the whole story -- no summarizing, no getting to the point. It was fatiguing. But we had success in changing the subject and moving on to something else in a way that didn't make him feel like we weren't listening to his important story.

Now, we argue with him, but rational argument is not really possible.

In your case, you may want to consider an approach that doesn't engage you in the actual logic of his creations, but something more along the concrete or emotional lines. Why does he do these drawings? What gave him his ideas? Where does he get his materials? I think this could be very emotionally validating for him, and you might even use discussions with him to get him some assistance. I'm thinking particularly of Ryan, the movie about Canadian animator Ryan Larkin.
posted by dhartung at 10:06 AM on June 13 [3 favorites]

Generally, it is safe to talk to delusional people. In the vast majority of crimes involving the mentally ill, the mentally ill person is the victim. Sure, this goes against everything Law and Order tells you, but people spouting gibberish make fun criminals to watch for entertainment. If the person shows no signs of violent tendencies, and they have been unmedicated for a while, chances are they will stay nonviolent.

Seconding others, don't get into his life too far, don't let him know where you live etc. But you don't have to run screaming when he approaches either.

As for dealing with delusions. You would never be able to convince him he is wrong, but you don't have to agree he is right either. The best approach is just to take it as you and he have different beliefs. respect his right to believe something a bit off, and he will respect you as someone that believes differently. Should he ever get worse, don't try to convince him he is delusional, ask him to get help to make you feel better, that is much more likely to work, he will likely never shake from his delusions without meds.
posted by Antidisestablishmentarianist at 10:46 AM on June 13

Never tell someone who suffers from delusions that what they are experiencing or how they understand the world isn't real or is wrong or bad. Delusions to people with psychotic disorders like schizophrenia are entirely real, your insistence that the things they perceive are illusory will simply sow distrust between you or make the person experience intense anxiety at the fact that your worldview and theirs cannot resolve. This is coming from someone who was trained to work with people with severe mental health disorders, you are instructed repeatedly to never, ever fight the delusion. Always work inside it, this way you can establish trust with your client. If you do this, and you are patient, even someone who is highly suspicious of professionals and resistant to treatment may eventually let you help them.
posted by The Straightener at 11:11 AM on June 13 [2 favorites]

A previous comment of mine discussing some experiences working with people who are experiencing delusions.
posted by The Straightener at 11:21 AM on June 13

In the vast majority of crimes involving the mentally ill, the mentally ill person is the victim.

While true, this doesn't actually say anything about whether people with severe mental illness are more likely than the general population to be perpetrators of a violent crime. Which, it appears, they are, somewhat. Mental illness may not itself be a predictor of violent crime, but substance abuse seems to increase the likelihood that someone with severe mental illness will engage in violent crime more than it does among the general population. (And while I haven't found any studies which explicitly say this, it seems like a lot of them imply that severe mental illness is a predictor for poverty and homelessness, which is a predictor for substance abuse.) And among victims of violent crime perpetrated by the severely mentally ill, the majority are acquaintances or family members.

So, yes, this guy is way more likely to be the victim of a violent crime than he is to make you the victim of a violent crime. But he's also somewhat more likely to do you violence than he would be if he weren't mentally ill. Especially if you get to know him. And extra especially if he's a substance abuser.
posted by hades at 11:38 AM on June 13 [1 favorite]

Are you female? I'd exercise additional caution, especially since you don't know his full history, what he's like if/when he decompensates further, etc. I've had kindness backfire spectacularly on me in this scenerio, sadly.
posted by availablelight at 12:21 PM on June 13

I am male so hopefully that will make it less complicated
posted by vorpal bunny at 12:46 PM on June 13

Ah, OK.

Some of the same principles may apply (minus an ugly sexual/unrequited undertone): if you're literally one of the only people on his radar due to his isolation from the rest of society and/or a lack of family, friends, providers, or even eye contact from strangers-- you may be the person he fixates or turns upon if things go pear-shaped with his mental status.
posted by availablelight at 1:05 PM on June 13

I don't think it necessarily follows from the fact that he likes to draw weird machines that you may need to be concerned for your safety around him unless you know from some reliable outside source that he has a history of violent behavior. I was trained on safety procedures when working on an Assertive Community Treatment team that had a caseload of the most severely mentally ill men and women in the entire city, many of whom had verified histories of extremely violent behavior, and even then you only utilize these procedures once in a blue moon. It's not like we were constantly under attack, maybe a couple times a year there was a situation where there was a chance of a case manager getting assaulted. If you like him, hang out with him like you would anyone else. If you think his machines are neat, tell him so, ask him how they work, see where it goes. If it gets weird, disengage. However, no, you are not making his mental illness worse by entering his delusion, in fact, you are probably helping him tremendously by keeping him socially engaged as opposed to isolated and alone.
posted by The Straightener at 2:20 PM on June 13 [2 favorites]

I truly appreciate the input. This has given me a great deal more perspective on the situation and much more confidence in how to move forward.
posted by vorpal bunny at 3:00 PM on June 13

When I was a kid my father opened a homeless shelter, so I grew up in pretty constant contact with homeless and mentally ill individuals. Probably as a result, I ended up working for a law firm that specialized in representing disabled poor people. Sometimes this was physical, more often it was mental disability.

I think one interview I conducted in particular is useful to your situation. Our client was being evicted and I needed to get the intake interview completed so that we could move on. He was clearly not well medicated at the time, and kept telling me about how he was the reincarnated John Lennon, who was just trying to make contact with the recording industry so that he could start making music again. Being a Lennon fan, I looked at this as a great opportunity to talk to him about something he really cared about. I complimented his work, and the interest I showed helped bring him into the moment. Ultimately, it helped me refocus him on our conversation and helped me get the information we needed to represent him. Indulging in his delusions of being John Lennon might not have been helpful for treating his delusions. But it was helpful for making sure that he wasn't evicted improperly.

Another firm I worked for had a similar story. A woman named Judith wandered the streets of my hometown wearing an old judge's robe and holding court in her own little way. (There were many Judith stories. One time, while registering her for a free clinic, I asked her for her name which she gladly gave. But she wanted to make sure I included her title: Major General Brigadier Special Commander Number Two. And she watched to make sure I wrote it down, which I did with no hesitation. You pick your battles. And I was much more concerned with getting Judith a hot breakfast and in to see the doctor.) Judith would occasionally walk into the legal aid firm I worked for and ask for a legal pad. She would then sit down and proceed to inform us of all the new laws that she had passed. And, most interestingly, she would draw all the legal pleading formatting on the page fairly accurately. Nobody knows who she is or where she came from, but it is pretty clear that at some point in her previous life she knew something about the law. Whenever she arrived in the office, my coworkers would politely give her a pad and a pen and let her sit there writing down all her new laws. Then Steve, the boss would check to make sure that she was okay. And when she was done, he'd send her on her way taking a moment to call my dad to keep him updated on her whereabouts and activities and current status. Judith was a tough old cookie. And I'd hate to have seen her riled up. So I can't imagine anything would have been gained from REFUSING to indulge her delusions.

I suspect that the times when it is most appropriate to refuse to engage in a delusion is when the person is or was recently well treated and grounded in reality. Helping someone remain focused and aware of reality is probably the best. People like Judith and John Lennon aren't going to gain a whole lot from being told that they're not thinking clearly. I suspect your friend might fall into this category.

The best thing that I think you can do is to do a quick search for some of the resources in your area for low-income, homeless, mentally ill people. Then, if the opportunity presents itself to make a suggestion, you'll have the necessary tools. (It could be as simple as, "Yeah, you keep mentioning that you'd really like someone to fund your energy conversion machine - but I've noticed you're wearing the same clothes you wore yesterday, and I know a really great place that can help out by giving you some free clothes if you'd like.")

Best of luck. And sorry for the wall of text.
posted by greekphilosophy at 11:50 PM on June 13 [4 favorites]

More on violence and mental illness. Summary - you're in more danger crossing the road than talking to this guy.

Talking to this guy is probably more fun than crossing the road :)

The only problems I've ever had with talking to people about delusions and obsessions is disengaging - no, really, I have to go home now, we have been talking for two hours and while interesting I need to leave. There was no suggestion of violence and intimidation, just problems getting over the idea that I wanted to leave!
posted by Coobeastie at 3:46 AM on June 14

You're also in more danger of being run over than of being attacked by a wild elk. That doesn't mean I'm going to go around petting any elk I happen to come across.

I've been stalked and harassed by a probable schizophrenic to whom I'd been kind, and he was a lot more higher-functioning than your guy. He escalated. That was not a lot of fun, to put it mildly.

Guard your privacy carefully -- at least as carefully as you would if you were a professional provider of mental health services, and perhaps more so. Keep your antennae up: be willing to admit to yourself when it's gotten too weird, and be prepared to disengage abruptly without second-guessing yourself. When someone is as obviously vulnerable as that, it can be very tempting not to take as much care of your own safety as you need to. But his vulnerability does not mean that he is necessarily no threat to you.
posted by sculpin at 1:49 PM on June 14

what did ol' bill burroughs have to say about this? lemme see...

'do not offer sympathy to the mentally ill. Tell them firmly, "I am not paid to listen to this drivel. You are a terminal fool."'
posted by Philby at 9:14 PM on June 14

You know what? That Burroughs quote has been dealt with before. It is not a valid answer to this question, nor any other question regarding mental health issues.
posted by The Straightener at 5:43 PM on June 15 [1 favorite]