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Key points
- Among people diagnosed with psychosis, grandiose beliefs appear to provide a sense of meaning in life.
- The idea that some delusions are psychologically beneficial is old but has recently received quantitative confirmation.
- This theory forces us to rethink the traditional biomedical approach that sees delusions merely as a byproduct of a brain dysfunction.
A shipping clerk begins to think he’s been given a secret task of geopolitical significance. A government employee believes that descriptions of a certain actor in the newspaper are actually about her. A young woman listening to The Smiths forms the conviction that Morrissey wrote those songs specifically for her in order to give her a special mission.
Varieties of Delusions
These are all examples of grandiose delusions. Delusions come in different forms. The grandiose kind center around the idea that I have an extraordinary mission, purpose or significance in life. These contrast with delusions of persecution and romantic delusions.
Delusions are one of the most well-known symptoms of schizophrenia. As such, they’re often seen as a brain disease, one that can be reversed through antipsychotic medications.
But what if the standard medical account is causing us to miss something crucial? What if delusions have a purpose or function? What if they provide a sense of meaning in an otherwise meaningless world?
If that's right, it would have powerful implications for therapy, because it would mean you don't always want to bombard the delusions with antipsychotic medications. Instead, you’d want to help the sufferer find alternative sources of meaning in life.
Grandiosity and a Meaningful Life
The idea that delusions could be psychologically beneficial goes back at least two centuries.
The German physician Johann Christian August Heinroth wrote in 1818 that delusions were coping mechanisms. They’re designed to protect the mind from a traumatic experience. Freud and his psychoanalytic followers also recognized that delusions can have a protective function for the mind.
It's only recently, however, that the theory that some delusions are psychologically beneficial has received precise quantitative confirmation.
A new paper by Louise Isham, consultant clinical psychologist and NIHR Clinical Doctoral Research Fellow at Oxford, demonstrates the connection between grandiose delusions and a sense of meaningfulness in life.
A starting point of her research is the idea that “grandiosity,” that is, the belief that "I have an exceptional ability or calling," comes in degrees. All people, not just those we label as having mental disorders, have a greater or lesser sense of grandiosity.
Isham and her colleagues used two sorts of questionnaires. The first is a standard questionnaire designed to capture the degree to which a person holds grandiose beliefs. The second, which Isham and her team developed, measures the extent to which the grandiose belief gives the person a sense that their life is meaningful. They then gave these questionnaires to a group of people who had been diagnosed with psychosis.
What they discovered is that there’s a striking correlation between the degree of grandiosity of a person’s delusions, and the degree to which their experience of feeling exceptional provides meaning in their life.
Of course, the question of how to measure “meaningfulness” raises deep philosophical questions. Isham and her colleagues analyzed meaningfulness into three dimensions: coherence, purpose, and significance.
Isham’s work is complemented by that of Rosa Ritunnano, psychiatrist and philosopher at Birmingham University’s Institute for Mental Health. Ritunnano and her colleagues recently carried out a massive survey of the scientific literature on delusions. They discovered that there’s a certain subclass of delusions that must be understood as a meaningful response to a life crisis.
A New Approach to Treatment
What does this functional approach to delusions mean for therapy?
The first is that the point of therapy should not always be to “deconstruct” the delusion, to try to debunk the patient’s delusion, or to bombard the patient with antipsychotic medications in the way that you might bombard an infection with antibiotics.
Rather, therapy should proceed by recognizing the role that the delusion plays in the psychological life of its sufferer. For example, one purpose of therapy might be to help people find alternative sources of meaning and significance in life.
This is consistent with the use of medications to comfort the client and, if needed, to prevent them from harming themselves or others.
A second lesson is one that I've often emphasized in these posts. As I see it, psychiatry is undergoing a paradigm shift from what I've called “madness-as-dysfunction” to “madness-as-strategy.” We're less inclined to see delusions, hallucinations, depression or depersonalization, as the byproduct of some brain disease. Instead, we’re starting to see them as having a purpose or function.
New work on the nature of depression, borderline personality disorder, and even dyslexia suggest that many mental disorders have a purpose or function that the standard biomedical model leads us to overlook.
The idea that some mental illnesses are functional or adaptive isn't some fluffy “romanticism” about mental distress, but a testable scientific hypothesis — one with profound implications for research, classification and treatment.
