My interest was piqued by this recent article on delusional thinking.

In popular usage, a delusion can be any belief that’s both demonstrably false and yet strongly held by an individual.  The use in psychology is more precise: To qualify, the false belief must be considered abnormal and not accounted for by other factors, such as religious training, culture, or, well, ignorance.

For example, this guy’s attempt at manned rocket flight to “prove” the earth is flat would probably not count as a true delusion, because it’s apparently more widely held than I would have liked to believe.

Delusional disorders often come to light because someone has become alienated or isolated from others, due to the adverse impact of delusions on their relationships.

The first article makes the point that delusional thinking is best understood in terms of human cognitive processes, with their native biases and strong inclination to see the world as we want to see it, evidence notwithstanding.

It made me think about various addiction patients I’ve run into, and the often elaborate belief system that has grown up around their substance use and its effects on themselves and others.

One woman, an accountant by profession, insisted her five DWI arrests were the result of a conspiracy by local police to deprive her of her right to drive. She was convinced of this yet unable to offer a coherent explanation of the motives behind the conspiracy — other than she once dated a police officer in another town and they broke up.

Another steadfastly maintained that the sclera (“whites”) of his eyes got their vivid yellow tint from long-ago exposure to acrylic paints, and not because of advanced alcoholic liver disease. Lab results were disputed on the grounds that they could be faked.

A research scientist was convinced that his severe opioid addiction had been triggered by atmospheric disturbances from a passing comet. He showed me star maps to prove it. An older gentleman insisted that his daughters who brought him to Detox were actually agents of a foreign power eager to make off with his vast fortune (he was indigent). Only when alcohol lifted the veil from his eyes that he was able to detect the truth beneath their disguises. Therefore, he drank in self-defense.

Of course, a mental illness codisorder such as depression is often a factor, but addictive disease has long been known for mimicking the signs and symptoms of psychiatric illness. In each of the above cases, delusional thinking receded significantly with stable recovery. That’s a reasonably good rule of thumb for differentiating results of substance addiction from other illnesses: When the substance use stops for an extended period, the symptoms improve dramatically or go away entirely.

Delusional disorders are believed to be underdiagnosed, for several reasons. One, the delusional individual is aware of the risk of social condemnation. Second, many delusions have some paranoid content to begin with. That helps them remain hidden from view.

As the article notes, arguing is rarely effective, and may reinforce the delusion. A better approach from a therapeutic standpoint is to encourage open expression of delusional ideas and then help the patient explore them in a detached manner, using critical thinking skills.

That’s a way to develop discrepancy between the impact of the delusional thinking and the patient’s own goals and values.