Themes of Delusional Belief Systems in Schizophrenia
Considerations for the NLP Practitioner
The delusional "Themes" can be grouped as follows (adapted from The Concise Oxford Textbook of Psychiatry, p.12):
'Paranoid' refers exclusively to false beliefs about relationships between people. Grandiose, jealous, and amorous delusions are often referred to as paranoid.
Typically paranoid delusions differ from that of extreme low self-esteem in that the paranoid person has to be important enough in someone/some organisation's reality in order to warrant the persecution in the first place.
In some cultures, it is not unusual to find someone blaming witchcraft for the failure of a farm crop or an illness on a hex placed by a neighbour. Where these types of belief are culturally acceptable psychiatry does not consider them to qualify as pathological. The particular difficulty for the NLP practitioner arises in the question of how many people are needed to share the belief in order to make it acceptable.
Many cults appear and disappear whilst some will go on to become multi-million dollar businesses. One common feature between some of the more extreme cults is that of producing a common enemy (a recurring theme throughout the history of bringing people together).
One client presented himself to me claiming to be God.
Now, I have to say that he wasn't quite what I was expecting; he was only about five feet tall. He told me that he expected someone older (I was only 27), I told him that I had expected someone a little bit larger. A beard too, maybe.
It would appear that sometime in the 70's, this man was the almost-charismatic leader of a small band of alternative thinkers and hippies. For a few years he had lived well and whilst his followers moved on and the political-social climate changed, he had not. Despite the passage of time he had managed to hold his convictions constant whilst every one got themselves a shave, a bath and a job.
This client was unusual in that he had escaped medication. Having been seen by various doctors over the years at his own insistence, he had been repeatedly diagnosed as suffering from "paranoid schizophrenia" - he denied this of course and probably because he presented no threat to anyone or himself, he was left unmedicated.
He sought out psychiatrists because he found it difficult being God. He admitted that once he had pondered the thought that he was merely mortal, but after a drug induced experienced in the '70's he had come to realise that in fact he was indeed The Creator of the Universe.
This knowledge was overwhelming and something with which he did not know how to cope with.
This reminded me of the Talmudic paradox of Satan challenging God to create a boulder so large that he would not be able to lift it.
This Delusion of being God highlights the frank incongruency that some delusions present to the third observer. For example, it is not unusual to find "Jesus Christ" handing out tea on the hospital ward and lining up to take his meds. Would the real Jesus please stand up?
However, one must be careful with some things appear or behave like paranoia.
The most commonly cited example is that of the person who comes to believe that his family is poisoning him. It is not unreasonable to assume that this is possible and indeed has happened at least once in human history.
All to frequently, when a "schizophrenic" says that people are out to get him, he is right, but not necessarily for the reasons he states.
Detention without trial (Mental Health Act 'sectioning'), forcible drugging (medication) and brainwashing ("therapy") are all indicators that someone is indeed out to get them. But, a question that can really mess with this is to ask the psychiatric professionals, "Get them where?"
All to often, the intended outcome is lost in psychiatry in a fog of professional conduct and behaviours, todays therapy rota and conforming to care plans.
Just what is the outcome that the psychiatrists and nurses intend to achieve by their treatments? I ask this question frequently and nine times out of ten, the professional had never even considered that. This leaves their patient to fill in the blanks. The running of the ward and fulfillment of legal responsibility takes precedence in modern psychiatric practice and the patients have an annoying tendency to get in the way of this.
No wonder they sometimes get a bit paranoid.
2. Delusions of Reference.
This is where certain objects, events, ideas, etc, hold a special significance. For example, most schizophrenics I have met don't like television much.
Generally, the TV is talking directly to them and them alone.
Bandler gives the example of the guy who believed that car number-plates held special messages for him (he switched the plates on his car to ones that read "STOP IT!")
The movie "The Game" with Michael Douglas and Sean Penn gave me many ideas for working with schizophrenics. In the movie the lead character is thrown in a paranoid schizophrenic world where he does not know who he can or cannot trust and he is rendered unable to discern what is or is not 'real'.
Especially effective for this character is the scene where he is watching TV and the newsreader speaks directly to him.
In my experience many schizophrenics I have met have great difficulties with television sets. The difficulty appears to be that for the schizophrenic the television acts as a representational system within the schizophrenic's map of the world.
I have found that distance, focus, colour, brightness change (submodalities?) can alter the effect for the client, as can shifting the position of the TV relative to the schizophrenic (relocating on the `grid` - see the book 'Time for a Change' and the DHE stuff by Bandler).
3. Grandiose and Expansive Delusions.
These are beliefs of exaggerated self-importance. The person may believe himself to be wealthy when he is not, he may insist that he is addressed as 'Lord' or believe himself to be an important figure like Jesus Christ.
These beliefs are most common in the manic (high) phase of bi-polar affective disorder.
Where these delusions are a constant and stable feature of the person's behaviour, a strategic approach can create a rapid and dramatic shift in the clients behaviour.
4. Delusions of Guilt and Worthlessness.
This is where the person believes that he has done something sinful or shameful.
They can begin as an innocent concern that do not cause guilt at the time. For example a person may begin to worry about an innocent and minor error on an income tax form that will be discovered.
A friend of mine - who is a policeman - often finds that he has psychiatric patients that coming into his station to confess to any murder that has recently received big media coverage.
One client a few years ago had confessed to just about every crime in history. He also telephoned the police one morning when he missed his bus on the way to see me. For him, the police represented the ultimate power/authority figure and he seemed to feel that the police force existed solely for him.
He also sought out their presence in order to feel safe.
With him, I never challenged his thing with the police but working at removing his underlying anxiety and problem solving behaviours/strategies enabled him to change his behaviour.
Often, I see clients who tell me that nobody likes them. Classically these clients have received counselling and therapy where the therapists have attempted reframes suggesting that the client needs to learn to like himself first and then the rest will follow.
Well in my experience, all too often these clients are totally correct....
Nobody likes them and this is the issue that really needs addressing. They are unlikeable people - face it, some people are just horrible in the way they dress, sound, speak, stand, eat, their beleifs and attitudes. These clients tell me that their therapists tell them that of course people like them, that it's all in their minds etc. But i tell them the truth - nobody likes them - which is something we can really change quite easily.
I suspect that people we come into contact with do not necessarily measure us by who we are (they do not know who we are).
They measure us by the quality of the relationships we form with them.
Watzlawick give a good explanation of the difference between analogue and digital communication in 'Pragmatics'. All to often, once people are in the position of having low self esteem or low self worth the analogue relationships they establish are so poor that it is no wonder that people avoid them.
Often, I take my clients out to pubs and nightclubs; an activity frowned upon by my contemporaries. I will show them how to stand, what to say, how to say it etc. I will build experiences for them that exist outside of the psychiatric-treatment frameworks. I will build experiences that the client would not normally get to have sitting inside therapy groups on the ward.
5. Nihilistic Delusions
Most common in severe depressive states where the person is about to die or meet some personal catastrophe.
Like suicidal depressives, nihilists can see no real point in living. All too often they often are miserable cynics who will see themselves as being perfect and the world at large as being faulty.
One chap told me that there was no job that had any worth. Which was interesting because he slept all day and stayed up all night surfing the web.
The paradox was that he told me that he despised computer programmers (he didn't know any, of course) and the "capitalistic structures" that just so happened to enable him to own a computer -i.e. the benefit system he was happily defrauding. What he had of course was an interesting reframe of being a lazy pessimist.
Classically nihilists have a greater fear of living than that of dying.
They usually have totally screwy timelines and extreme 'away from' motivation strategies.
One client I saw recently was dreadfully afflicted with seriousness believed that if she didn't create catastrophe movies inside her head then catastrophe would be invited onto her. She also carried the classic "Don't expect anything nice, or you will only be disappointed" injunctive (unsurprisingly coded with her mother's critical-voice submodalities). She felt that if she was happy about anything, then it would be taken away from her.
Her past and future timelines ran parallel in front of her. She told me that her life was mundane and that she couldn't tell one day from the next.
Not surprising, really.
6. Hypochondriacal Delusions
These are false beliefs about illness. Despite effective medical evidence to the contrary the patient may believe that he is dying of a mystery illness, is rotting deep inside or is just generally ill.
Similar are delusions about having a misshapen body part (Bodily Dysmorphia) - usually that of the nose. This is where plastic surgeons can make a lot of money.
Hypochondriacal delusions are incredibly common amongst the non-psychiatric population and are commonly observed in Accident Departments and Clinical Neurology Units and must be differentiated from other syndromes such as Munchausen's (and it's variations), factitious disorders and people who are just blatantly faking it for whatever reason.
With factitious related disorders the delusion itself may actually be faked.
These customers can be divided into two categories for working purposes:
- Those who only have symptoms when other persons are present.
- Those who will continue to behave as though they have symptoms even though there is no possibility of another observer being present. It is a lifestyle.
I suspect that there are a great many therapists who have seen patients like this and have never realised it.
In neurology where the staff are regularly conned by these people who often are only identified by chance ie via relocated staff who have previously seen the patient in other hospitals.
Quite recently, I was 'had' by a patient who had 'factitious factitious-disorder.'
He was seeking help for his factitious disorder, "I want help for my compulsion to seek help, even though there is nothing wrong with me."
Naively, I didn't spot the potential paradox in this and it was only when I obtained this man hospital records that the extent of his "hoax" was revealed to me. Oh boy, did I feel like a bozo!
Check out Dr. Marc Feldman's web site on factitious disorders for more on this.
7. Delusions of Jealousy.
According to the psychiatric texts these are most common in men. One female client I saw was complaining of what she described as an "insane jealousy". She would consistently search her husbands clothes, diaries, hire private detectives etc etc in order to catch her husband out in his infidelities. The lack of presentable evidence was proof to her at his level of ability to hide his extra marital affairs and pointed towards a conspiracy involving her friends and family.
She was convinced that everyone else knew what was going on but that she was the only one that didn't.
Eventually her husband left the marital home because he could no longer cope with his wife's behaviour.
Thus, she interpreted this as final proof that she had been right all along but it was at this point that she came to me for help.
When I worked in the Accident department we had a lot of regular attendees who were in abusive relationships where they would be regularly beaten black and blue. Many of these women we would see several times a week. Often they would attend the department purely as an escape from the situation.
One particular couple we would see about 2-3 times a week. She would come in, bleeding and bruised, usually in a taxi. He would arrive, drunk, about half an hour later. She would refuse to see him. He would demand to see her and get abusive to the staff.
This game would carry on for about 23 surreal minutes until she would relent and agree to see him.
He would apologise, she would hug him, she would tell him how much she loved him, he would say the same.
They would then leave the department.
I saw this same game played out 2-3 times a week for a year and a half. I scripted out the game and wrote out rules of play. I asked management if we could start giving this couple appointment cards with the aim at spoiling the game. I thought that when they next came in, maybe we could interrupt the game with an emergency, ask them to wait a minute and then pick up where we left off.
I was told that I was thinking unprofessionally again.
That professionalism displayed by the department management enabled the game to be played out to its inevitable conclusion. She was killed by a head injury. He is now languishing in a prison. The children are in care and will probably be suffering from therapy for the rest of their lives.
8. Sexual or Amorous Delusions.
These are more common amongst women.
I have never encountered this and so have no direct experience of it. But apparently the person believes that he/she is loved by a person to whom he/she has never before spoken to and/or by a person who is inaccessible.
Several years ago, I did some work with a female client who began to turn up outside of her appointment times and began writing long detailed letters of her feelings towards me.
She was confident that I would feel the same way towards her - I did not.
This is not an uncommon scenario for therapists and seems to demonstrate a misinterpretation of the therapeutic relationship that the [na•ve] therapist establishes.
Experience has enabled me to be more congruent in my work so that there is no possibility for any misunderstanding to occur. I advise every baby-therapist to read up on case studies for this occurance, so you can handle the situation well when it arises. It will eventually.
9. Delusions of Control.
This is the popular classic - "Moonbeams are controlling my thoughts" delusion.
These may be primary or secondary delusions (see below) and form two main variations on the theme: (a). Hearing auditory hallucinations that must be obeyed. (b). Culturally acceptable beliefs that there is a divine presence orchestrating fate.
As a student I met one man who had the primary delusion that he was being controlled by moon beams yet he lacked auditory hallucinations. His psychiatric nurse had rather amusingly made him a tin foil helmet that he wore under a hat. It didn't change any of his beliefs or make any big turn around in his beliefs but it gave the man reassurance and he certainly functioned better.
More commonly and frighteningly well accepted by some shrinks is that belief of the alien implant. The novice practitioner needs to be cautioned that alien abductees have a tendency to move about in herds.
As a word of warning - they seem to function a bit like vampires; once you let one across your threshold to your office, they all suddenly come pouring in at once, waving the latest edition of 'Abduction Monthly' and jabbering on about how important they are because they got the anal probe.
Every little splinter and every little scar will be evidence of the abduction and they will show you these gleefully, expecting a great interest.
One of these guys broke into my house early one morning after turning up to one of my seminars the previous evening. Strangely, I found him destroying my vacuum cleaner looking for alien stuff, babbling about how he knew that I was part of "The Conspiracy".
I expressed a great interest in his nasal implant. Then I went and got my meat cleaver and rubber gloves.
10. Religious Delusions.
These may be guilt orientated (fear of some divine punishment for something minor) or expansive (having magical/divine powers).
One psychology student friend of mine experienced a relatively short-lived psychosis by combining excessive amounts of LSD and amphetamine with Qabalistic ritual and a gross misinterpretation of the works of Aleister Crowley.
It was his mission to find God and call him to account for the mismanagement of the universe.
Contextually this may not seem such an insane concept, but this guy tried to kill the priest by flinging lightening bolts at him from his fingertips. When this didn't achieve the desired effect, the student fled. God had clearly manifested himself in the priest and proven Himself to be All-Powerful. My friend was defeated.
Naturally this man went on to become an educational psychologist.
11. Delusions concerning the possession of thought.
This again is typical some of some the alien abductee types. Termed 'thought insertion', some schizophrenics will feel that their thoughts are not their own but have been inserted by some external agency.
Also, there is thought withdrawal, where thoughts have been taken away (something I have never come across arising spontaneously in clients but is something I have often used to my advantage - see below).
Another variation on the theme is that 'the delusion of thought broadcast' - the schizophrenic finds that his thoughts are known to other people via telepathy, through radio broadcast.
These typically reflect a deeper experience for the schizophrenic and are not likely to constitute a primary delusion.
Sitting on the bus one day, a beautiful moment passed between myself and a schizophrenic I was with that day. A beautiful young woman got onto the bus and passed where we were sitting. She passed us as I was lost silently in my own erotic thoughts. As she got level, she swung around and glared at us both. My client looked at me and gasped, "Whoops! She heard us!".