Not knowing what happiness is, should we learn from people with "delusional disorder"?

Leviathan Press:

If Harry in the article really felt a great sense of happiness, this would undoubtedly be a very interesting topic. Just like the movie "The Truman Show", when everyone around him knew that Truman was in a huge fake world, Truman's perception of the so-called reality was unique: only he was sure that his connection with the real world was extremely happy.

This can't help but remind people of the "Murti-Bing" pill mentioned by the poet Milosz in "The Captive Mind" - a hallucinogenic drug that makes people feel extremely happy after taking it. "He can at least achieve a certain degree of inner balance, enough for him to engage in a series of activities, which is much better than torturing himself with fruitless resistance and uncertain hopes." Milosz is of course mocking the ambiguous attitude of intellectuals towards freedom here. However, for a person who really suffers from delusional mental illness, is it the right choice to let him/her be forever immersed in beautiful fantasies?

A few years ago, a private moment of British man Harry picking his nose was secretly recorded by a camera and posted online.

Soon, the prank became a global, explosive meme. Millions of people, most of them in the United States, became obsessed with the video. Wherever Harry went, strangers gave him meaningful looks and touched their nostrils, as if to say, "Hey, you're the guy who picked his nose! "

Harry has loved the attention - he describes his unexpected fame as a "security blanket" and says he feels like everyone on the street has become his friend .

However, there was a problem with Harry’s internet celebrity status, and no one was aware of it.

In the real world most of us live in, Harry has been diagnosed with delusional psychosis , many of whose symptoms appear to stem from his obsessive watching of YouTube videos.

His family persuaded him to go to a mental health clinic attached to the University of Birmingham, where he enthusiastically told clinician Rosa Ritunnano that he was "the happiest man in the world".

Harry tells Rito Nanno that he can read and control other people's minds; he uses his telepathy to fight against the Lizard People and the Illuminati, the power centers, who monitor him through hidden cameras and psychic spies.

© Francois Lenoir/Reuters

It all sounds like a nightmare, but Harry welcomes the attention of the imaginary conspirators who are watching him. " I'd be lonely and crazy if I found out they weren't watching me anymore and reading my mind, " he explains to Ritunanno.[1]

Despite the fact that he was involved in an “apocalyptic psychic war,” Harry was also a very nice guy who didn’t seem to be a threat to anyone. He refused prescription psychiatric medications, and when Rittonano and her colleagues asked him if he would take a battery of paper-and-pencil tests, he happily agreed.

So doctors used a number of tools with odd names to measure Harry's sense of self-worth, including the Purpose in Life Test, the Life Regard Index and the Existential Meaning Scale.

Harry performed very well in these tests.

Over the past decade, the Hearing Voices Movement—a coalition of people who experience auditory hallucinations—has pushed the medical community to recognize that their symptoms may be meaningful adaptations to trauma.[2]

One of those caregivers is Ms. Rittonano, who had just begun a doctorate in a field called phenomenological psychopathology, a specialty that places the doctor’s sense of reality on an equal footing with the patient’s, when she met Mr. Harry a few years ago.

In a sense, Harry is Lituananno's teacher. She thinks she can " learn something about happiness" from Harry. At the same time, as Harry's clinician, Lituananno is confused: How should she help people like Harry?

Of course, Harry's mental illness has had some sad consequences for him. Due to Harry's erratic behavior and concerns for his children's safety, he was banned from seeing them for a period of time. But even when he was able to see his children more often, Harry often spent his days on YouTube, obsessed with videos about "flat earth" and other conspiracy theories, which prevented him from working and caused damage to his family life.

© Nautilus Magazine

Yet he revels in his imagined superpowers, which he tells Ritournano connect him to all of humanity. “To me, humanity is like one big family,” he says.

Litunanno is not alone in his concerns. Louise Isham, a research clinical psychologist at the University of Oxford, told me that she first began to think about the ethical dilemmas associated with delusions after she met a female patient who believed she was an undercover MI5 spy.

This patient's "mission" allowed her to imagine herself fighting villains across the globe, giving her a sense of serving her country. So even if the doctors could find a way to bring the patient back to reality, would that be the right thing to do?

That question led Isham to search the psychiatric literature for ideas on how to treat patients with “grandiose delusions,” a psychological term for delusions involving imagined powers or secret knowledge. It turned out that there were no clear guidelines.

Isham realised that “this was an extremely under-researched area,” she told me. “I was seeing a real problem in clinical settings where you could see the harm that patients were experiencing from delusions of grandeur, but there were also clear benefits to believing in those delusions , and there wasn’t enough real research in the literature to tell us how to deal with that.”

Patients with "superpowers" might decide to fly off the top of a building or baptize strangers, and they often lose their real-life jobs and become socially isolated because they're so busy with their fictional characters. However, Isham said that given the benefits people can gain from their delusions, "you have to be very careful not to make the situation worse."

© Nautilus Magazine

To learn more about this condition, Isham and her colleagues identified patients with grandiose delusions and asked them about their experiences as messiahs, secret agents, and conspiracy investigators.

You might think that people described as “egomaniacal” would imagine themselves as billionaires and indulge their own desires – if you had unparalleled superpowers, why not take an imaginary yacht to Macau and win every round of blackjack?

But Isham and his co-authors found[3] that most patients had created a fantasy world in which they were generous and selfless, even performing miracles, to help others. About 70% of patients reported that their “special powers” ​​helped them make other people happy and protect them from harm.

Perhaps the inner lives of these patients can tell us something about the more general search for meaning: For most of us, self-worth depends on being useful to others. And we, like Harry, are always striving for human connection, but people like Harry and others with mental illness may satisfy this need through telepathic communication with imaginary strangers rather than face-to-face interactions with family or friends.

As Isham puts it, “This is a very misunderstood group of people.”

Caroline Mazel-Carlton would agree. She told me that she first began hearing disembodied voices after being abused by a daycare worker. The woman, who had beaten young Caroline and burned her with chemical cleaning agents, then chatted with another adult and said, “It’s a beautiful day today. There’s not a cloud in the sky.”

At that time, a voice started to ring in young Caroline’s head: “She’s lying. I hate her.” Metzger-Carlton told me that the voice—which she later called “Frank”—didn’t frighten her at first. He seemed to be protecting her. But then the voices became a group of people talking. As a teenager, Metzger-Carlton was transferred from a mental hospital to a prison, where doctors used drugs to numb it.

In her 20s, Mazer-Carlton came off psychiatric medication and learned how to tame and soothe the most frightening voices in her head, including "Frank." If Frank told her to throw a chair across the room, for example, she could "satisfy" him by simply touching the chair or flipping it over.

Caroline Mazer-Carlton. © Danna Singer

Today, Mazer-Carlton uses her personal experience to coach others as the training director for the Wildflower Alliance of Western Massachusetts, a support network associated with the Hearing Voices Movement that brings together a group of peers to cope with voices, hallucinations and other “extreme states.”

Years ago, when Mazer-Carlton was on the other side of the consultation table, the doctor would ask her if she heard voices, yes or no? And then the conversation would usually end there, with a diagnosis and a prescription for medication.

But now, as a caregiver, she probes her clients' hallucinations with probing questions her own doctor would never ask: "Do you want to share what the voices are saying? How do they make you feel? Do the voices remind you of anyone you knew in the past?"

“ As mental health professionals, we’re not actually fulfilling our role if we’re not looking for meaning, ” said Metzger-Carlton, who stressed that caregivers should recognize that mental illness can be a survival tool.

She gave me an example. She met a man in a mental hospital who declared himself to be the president of the United States. The patient had "experienced horrific institutional trauma. He had been stripped naked and handcuffed to a sink by police," she said. And now, psychiatrists in the psychiatric ward were trying to bring this "president" back to a painful reality with drugs.

Mazer-Carlton had different ideas. She invited the patient to walk with her down the hallway of the psychiatric ward, then asked him, “What is it like to be president of the United States?” She wanted to know if he regretted becoming the most powerful man in the world. If he felt overwhelmed by his responsibilities.

No, he told her, he’d love to be president. “He told me he was thinking about who his cabinet would be and asked me if I’d like to be in it,” she said. “He hoped Beyoncé would be in another cabinet position, and that gave him a lot of joy.” To Mezer-Carlton, the patient’s fantasy seemed like a heroic act — he had reclaimed his personal dignity and found a reason to go on living.

According to Mazer-Carlton, the last thing you should do is tell someone that their voices and hallucinations aren’t real. “If I do that, I’ll be cutting them off,” she said. “Why would they turn to me for support if I can’t validate their fears and concerns?”

So, like an improvisational actor, she joins them in their story. This enables her to help patients change potentially dangerous narratives to be harmless. “If the CIA asks them to spy on their neighborhood, and they end up breaking into people’s yards or looking through mailboxes, then I ask them to imagine other ways to accomplish the task. Like, could you get to know your neighbor?” If Jesus or Allah wants to gouge out an eye as a sacrifice, then Metzger-Carlton suggests other ways to perform the holy sacrifice. She might encourage clients to draw a picture of the sacrifice, or say a prayer.

© Medical News Today

“Anything that makes someone feel powerful without hurting them is good,” she said. “If lining a hat with tinfoil makes someone feel powerful, great. Let’s do it. Buy a cell phone jammer for the room? Yeah, let’s do it. Because when we are given a little bit of empowerment, we can often start conversations about deeper truths and meanings. ”

She acknowledges that her approach is out of step with mainstream psychiatry. She and others in the Hearing Movement are “dedicated to the Overton Window,” hoping to expand the range of acceptable treatments for those struggling with mental health issues.

This seemingly radical approach has its critics.[4] Ian Gold, a professor of philosophy and psychiatry at McGill University, told me that clinicians may need to make judgments on behalf of patients who are suffering. “There’s a wide range of patients,” he noted. “Someone might say, ‘I’m happy and I have this delusion,’ but they’re not actually that ill.”

If a patient is struggling with depression or is suffering from auditory hallucinations, clinicians may need to treat the underlying pathology causing their distress, he noted.

Ritunanno expressed a similar sentiment. “It’s not about actual beliefs, it’s about the individual and their social context,” she told me. If a patient with severe bipolar disorder suddenly became afraid of black cats, that could be “a precursor to a serious deterioration, and they will need intensive support to avoid hospitalization.”

On the other hand, she said, when a patient who has long believed he is being tortured by aliens suddenly stops talking about UFOs, it could be a sign that he is slipping into depression and needs medication to treat his depression, not his delusions.

Still, many clinicians are now using approaches that allow patients to choose to accept their voices and hallucinations, including a form of cognitive behavioral therapy that teaches patients to cope with hallucinations. In a recent paper, for example, researchers noted that clinical guidelines from around the world recommend that people with mental illness should have a say in their own treatment—even if that means refusing medication.

© Georgetown Behavioral Hospital

Which brings us back to Rittonanno’s question: What can we learn from Harry’s well-being? Working with Harry, she told me, challenged the way she thinks as a clinician.

“For Harry, it was all about being able to face uncertainty,” she says. “While our work as clinicians is often focused on treating ‘symptoms’ and managing risk, Harry’s case reminded me that we are always faced with the existential dilemma of health and illness. What do you do when eliminating ‘disease’ also means eliminating meaning? ”

Harry has no complaints, and there are no current concerns about him or anyone else being hurt. So, as long as his happiness lasts, it’s Ritsunanno’s job to believe it, not to see it as a symptom to be stifled. Harry is discovering that his best life may be in his fantasy. As he once told Ritsunanno, “ I feel like Jesus. Of course I’m not. But why not believe it? ”

References:

[1]www.ncbi.nlm.nih.gov/pmc/articles/PMC9074152/[2]www.ncbi.nlm.nih.gov/pmc/articles/PMC9074152/[3]www.thelanc et.com/journals/lanpsy/article/PIIS2215-0366(22)00236-X/fulltext[4]www.medscape.com/viewarticle/838764?form=fpf
[5]www.sciencedirect.com/science/article/abs/pii/S0920996418301622

By Pagan Kennedy

Translated by tim

Proofreading/Rabbit's Light Footsteps

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