Do people with delusions ever/often recognize that?

May 15, 2007 6:37 AM

Do people suffering from delusions ever/sometimes/frequently recognize this without it being pointed out to them?

This question was prompted by this thread, but isn't only about Capgras syndrome.

You often hear about people who suffer some sort of delusion: in Capgras, that people they know have been replaced by dopplegangers. In others, that there are shadow beings, or aliens, or the like. It seems like, whenever you hear about this, it's a given that the person with those delusions believes that they are real.

Is it that there is some sort of adjunct which turns off the "this doesn't make sense; perhaps I'm having delusions" thought process? Is it just that the self-recognized cases don't get much press?

Note: I'm not talking about paranoid folks who believe they're being watched/wiretapped/bugged/etc., because that is technically physically possible, so it's far easier to believe. I'm talking about situations where, normally, a person would possibly think "that isn't physically possible. Therefore, it must be a delusion. I must be seeing things which aren't really there."

posted by bugbread to health (26 comments total)

I have a friend who talks about things disappearing. In the same conversation he'll say that he knows it's impossible for things to disappear but he thinks it happens anyway.

Like, "I put my knapsack on the bed and turned around and then it was gone and when I came back later it re-appeared on the couch. I KNOW I didn't put it on the couch and no one else was there so it must have moved itself."

"That's not possible."

"I know. But it happened."

He also talks frequently about becoming out of synch with time--hours and days "literally disappear". He knows that's not possible either.
posted by dobbs at 6:44 AM on May 15, 2007

Robert Pirsig acknowledges mental health problems and the need for treatment in his pseudoautobiographical Zen and the Art of Motorcycle Maintenance, and had received ECT earlier in his life.

I can't quantify your answer, but some people enter mental institutions of their own free will. Not "free will", like they drag you kicking and screaming and sign your name on your behalf, but free will, of your own volition.
posted by Blazecock Pileon at 6:54 AM on May 15, 2007

I know about the voluntary self-admission to mental institutions, but I don't know how that breaks down along delusion/hallucinatory lines. I had just assumed that it was, for example, folks with heavy depression/murderous thoughts/compulsions/extreme phobias/other things which involve being mentally unwell, but not necessarily "seeing things which aren't there/believing things which can't be true". (Note: I'm not saying that in disagreement, Blazecock. I just mean that I don't know what the breakdown is).

What kind of mental health problems did Pirsig have?
posted by bugbread at 7:00 AM on May 15, 2007

I think people are quite often aware that they are delusional. That's part of what makes it so sad. The mind-split: half of you knows it didn't happen, half of you is convinced that it did. Both sides undermine each other and you end up feeling like crap about yourself. It's not fun.

I think low-grade craziness (being delusional and aware of it) is more common than being a flapping nut. And even flapping nuts sense that there's something wrong with them. This is what makes mental illness, which is sad and scary always, so terribly poignant too.
posted by bluenausea at 7:01 AM on May 15, 2007

According to a few sources I've read on OCD, one of the symptoms is recognizing that what you're doing is not logical but being compelled to do so anyway. So yes, this is not only possible, but sometimes even part of recognizable mental health issues.
posted by mikeh at 7:06 AM on May 15, 2007

bluenausea writes "The mind-split: half of you knows it didn't happen, half of you is convinced that it did."

I had a hard time phrasing my question, so this, and dobbs' friend's experience, are kinda what I'm getting after:

If you have a really vivid dream, you might wake up and think "wow, that really felt like it happened". However, you don't think "I'm sure it really happened". You acknowledge how incredibly real it felt, but aren't actually convinced that it's real. With dobbs' friend, you have someone who knows it didn't happen, but doesn't parse it in terms of "I remember putting the bag on the bed, and later finding it on the sofa, and I don't remember moving it, so it really feels like it moved by itself. But I know that's impossible, and didn't really happen. It just feels like it happened." Instead, he parses it as "it's impossible, and yet it really did happen".

Likewise with the mind-split you speak of: Is there some sort of adjunct with these delusions that not only makes it really seem like something happened, but makes you think that it really did, even though that's not possible?
posted by bugbread at 7:08 AM on May 15, 2007

(Sorry if it seems like I'm moving the goalposts, I'm just having a hard time expressing what I'm trying to ask)
posted by bugbread at 7:09 AM on May 15, 2007

A delusion is an unshakable belief in something. People, being the wonderful, self-contradictory creatures they are, are capable of holding more than one contradictory unshakable belief at the same time. As a case in point, I know that I am uniquely evil and responsible for all the suffering in the world. I know that I am destined to suffer for all eternity in hell. I also know this is a self-centred and ridiculous belief, because my doctor has pointed it out to me more than once. But I still believe it. My doctor tells me this is full-blown delusion. I know full well that logically it can't possibly be true. But at the same time, I also know that it is true, and anyone who tries to convince me otherwise is trying to twist the knife by introducing a glimmer of hope so they can have the pleasure of snatching it away later.

Pseudohallucinations occur when the sufferer sees and hears things that aren't there, but is able to realise that what they're experiencing is a hallucination and not reality. Fortunately I don't get these any more.
posted by talitha_kumi at 7:12 AM on May 15, 2007

A friend, who happens to be a psychiatrist, had hallucinations while on an antibiotic. She saw uniformed police officers coming right through the walls of her bedroom. She wasn't frightened, since her son is a cop. She was fascinated to see what patients who'd been delusionary had told her about. So, she saw what wasn't there, even as she knew it wasn't there.
posted by Carol Anne at 7:14 AM on May 15, 2007

Mike Corley was very active on the UK Usenet groups in the 90s (and probably still is). He was convinced MI5 were spying on him and dropping little hints into TV shows and daily life to let him know they were watching him. On his better, I-just-started-new-medication days he did acknowledge that he was delusional. You can probably dig most of his posts out of Google Groups, but it does get monotonous.
posted by Leon at 7:17 AM on May 15, 2007

Well, delusions are, by definition, a believed mental construct that isn't in accord with reality. In other words, in order for a belief to be technically a delusion the person having it must believe it.

But that does not mean that it's always present. One could have the delusion that everyone on the street is talking about you, be utterly convinced of it when you go out on Tuesday afternoon, but on Weds morning realize that you were wrong and that your previous belief doesn't make sense. People often seek treatment at those times, much like someone with Alzheimer's can be quite distraught about their illness when lucid, but not distraught at all when they're doing most poorly.

Hallucinations, on the other hand, do not require belief in their veracity in order to be diagnosed or described. You may believe in the hallucination, but you may also say to yourself "I need to get some sleep, there's no way there's a pink elephant riding a bicycle in the next lane."

Broadly, your question comes down to the difference between ego syntonic and ego dystonic phenomena. Things are syntonic when they accord with our view of ourselves in the world and do not cause us the distress of questioning whether or not they are real. They may cause us distress because we believe them to be true, but not because we are experiencing them but knwo them to be false. Dystonic things are those which cause us distress because we they do not make sense to us.

All of this is for psychiatric issues. There may well be different understandings in neurology.
posted by OmieWise at 7:18 AM on May 15, 2007

wire taps etc are totally possible

but so are aliens, shadow beings etc when you're in that mental state

that shit IS real to you, no two ways about it

sure, there is stuff that just doesn't make sense, or really just can't be happening, but those aliens, i tell you, they're real!

that's how it feels anyway
posted by Salvatorparadise at 7:24 AM on May 15, 2007

Hmm... looks like the symptom (and google search term) you're looking for might be "lack of insight".
posted by Leon at 7:24 AM on May 15, 2007

Talitha_kumi:

Thanks. That helps a whole lot. So my initial question, regarding delusion, is a non-starter, because one part of the definition of "delusion" is "something you believe is true". Hence, by definition, you can't identify a delusion as non-true.

I'd never heard the term "pseudo-hallucination" before. Googling it, there's a plethora of stuff about exactly what I was wondering about.

So, if I'm parsing things right:

- No, people don't recognize hallucinations and delusions as "realistic but obviously not real", because "believing them to be real" is part of the definitions of hallucination and delusion. (Er, with the obvious caviat that they may retroactively recognize them as not having been real when on medication, during treatment, etc.)
- Yes, people do sometimes, perhaps often, recognize "things that seem really real but obviously aren't" as such. These are referred to as pseudo-hallucinations.

Is that parsing correct?
posted by bugbread at 7:25 AM on May 15, 2007

Hi. I'm a psychiatrist, that said, here goes:

I think the question you are asking, in more formal terms, is whether a person can have a perception or idea that is false, but have the insight to know that it is false. The answer is yes, and it speaks to what might be wrong with the person.

"Delusion" by definition means the person "knows" it with certainty. So, a person with a delusion could not know it was false.

The reason these definitions are important is because of their implications: delusion= pathological process. Believing in aliens, or ghosts is not definitionally a delusion, and thus not definitionally pathological.

Similarly, an illusion is a misperception, whereas a hallucination is a newly created false perception. If the firelight flickers and it looks like Satan, that's an illusion. If there's no other sensation that could be converted into Satan, it's a hallucination.

So answering your formal question: it is indeed possible for someone to have a false perception and have insight to know it was false. In that case, the false perception would lead a doctor to examine, say, the vision pathways. For example, the hallucination of shapes is anatomically different than what causes the hallucination of, say, light, or people.

So, in your question, the guy likely has a neurological disorder, broadly defined; and not a psychaitric disorder (as defined by an impairment of insight and thought.)

Pathological lying, interestingly, is right in the middle of a true delusion (no insight) and full insight.


http://thelastpsychiatrist.com/2007/03/pathological_liars.html
posted by TheLastPsychiatrist at 7:48 AM on May 15, 2007 [2 favorites]

The excellent book Operators and Things: the inner life of a Schizophrenic gets into this quite a bit in the author's account of her own delusional experiences. The chilling part to me was that for her, rational judgment was malfunctioning as well. She would sense menacing presences and hear voices giving her commands or discussing her. But the parts of her brain and mind that should have been telling her "this can't possibly be real" were instead telling her "THIS IS VERY REAL", essentially working in concert with the hallucinations. Her rational mind was actively validating the unreal the exact same way it would the pedestrian and everyday. This was utterly terrifying to me, as I'd always thought you might at least have a fighting chance to rationalize your way out of a hallucination.
posted by Lentrohamsanin at 7:52 AM on May 15, 2007

Thanks, all. My question was poorly phrased, but you've answered what I was getting at nonetheless.
posted by bugbread at 7:58 AM on May 15, 2007

This isn't too far from my comment in that thread. The professor knew the more outrageous things were delusions, but the condition has potential dangers if the hallucinations are realistic enough.
posted by dr_dank at 8:19 AM on May 15, 2007

the "this doesn't make sense; perhaps I'm having delusions" thought process

This process that you refer to is the thing that's broken. In my conversations with seriously mentally disordered, delusional, hallucinating people, I can occasionally get them to use words to shape the concept that their experiences may not be real. As soon as they do say something like that, I've found, they backpedal; they twist the words around and make them say that the delusion is true. Trying to convince someone that their delusion is false by reasoning with them is one of the more interesting ways to completely waste your time in a psychiatric unit.

The folks in the business call this a disorder of "reality testing." Apparently there's a way that most people have of evaluating proposed ideas to see if they make sense in the context of reality. Your question presupposes that this process is switched off in the delusional. Based on my experience with them, I don't agree; it's more like, for these particular ideas, the process is broken in such a way that it automatically actively validates them, no matter what input comes along to the contrary.

The last part of your question was something I was taught as a matter of nomenclature: if a sensory percept is experienced but a person is aware that it isn't real, that is called an illusion, to distinguish it from the hallucination which is an illusory sensory percept along with an underlying thought disorder that forces it to be evaluated as true.
posted by ikkyu2 at 10:18 AM on May 15, 2007

I knew a fellow in Omaha who worked at a halfway house for schizophrenics, and part of his charge was training the patients to recognize when they might be going into a delusional state -- to recognize their own symptoms, as it were. I don't think he was successful every time, but it is possible to give people keys to recognizing when their perception of reality veers away from reality.
posted by Astro Zombie at 11:42 AM on May 15, 2007

this question reminds me of the movie _A Beautiful Mind_, which i think is based on a true story about a brilliant mathematician who becomes schizophrenic. he has very powerful delusions that cause him to become dysfunctional, then he takes medication which helps but he doesn't like it and at the end he is able to get off the medication and function somewhat by using a very rigorous process of thinking logically about his own situation, including asking others to verify whether something is or isn't happening. i was really interested to see this happen in the movie because i'd never heard of someone being able to logically manage their own schizophrenia before, but i'm not sure how much of that is part of the true story.
posted by lgyre at 12:07 PM on May 15, 2007

i'm not sure how much of that is part of the true story.

I believe that the untrue part of the story is the medication part. I think Nash never took medications when he could choose not to.
posted by OmieWise at 12:17 PM on May 15, 2007

I was going to say something very similar to lgyre's comment about "A Beautiful Mind". The professor in the movie believed he saw and interacted with real people for much of his life, and wouldn't believe it when others told him they didn't exist. But at one point he suddenly realized 'They never get any older! They can't be real, because they've always been the same age'. I also don't know how "true" that part of the "true story" is, but I believe that's the phenomenon you're describing.
posted by Vorteks at 12:21 PM on May 15, 2007

From what I have read, the film version of "A Beautiful Mind" fictionalized Nash's mental illness to the point where it must be considered pure fiction. His hallucinations, as an example, were exclusively auditory.
posted by Astro Zombie at 2:59 PM on May 15, 2007

To continue the Beautiful Mind derail, I remember when it came out that a friend who was involved with mental health patients (she either worked with them, or had a relative who was one) felt that the movie did a disservice to mental illnesses by popularizing the idea that patients can just think themselves better, whereas in fact this is usually not possible and is the equivalent of believing that someone with depression can just cheer up (she admitted that it may well be possible for some people, she didn't think the attitude needed spreading).
posted by jacalata at 7:49 PM on May 15, 2007

"A Beautiful Mind" was not a realistic portrayal of any mental illness.

except perhaps the Hollywood delusion that anything that exists can be made marketable with enough script revisions.
posted by ikkyu2 at 9:19 PM on May 15, 2007