The Psychotic Delusion

We all know, or think we know, what being "mad" means. "Mad" people do "crazy" things, think crazy thoughts.

But I don't think I can emphasize too strongly that the psychotic delusion, especially in the early stages of psychosis, is often plausible. When someone like Emma (see previous post) complains about her flatmates talking about her, or watching her, she could be right. After all, people are talked about, people are watched.

She could even be right when she says that her neighbours threatened her. There are "neighbours from hell", as we all know — especially if we have watched the television program of that name. That is why it is so easy to be taken in, to accept what the person says, to go along with the psychotic delusion.

If someone appears "cool, calm and collected", and tells you that he is the victim of a vendetta, why shouldn't you believe him? You might even feel sorry for him, and suggest a legal remedy for his predicament.

Sometimes a considerable length of time has to pass before one becomes suspicious. One hears the complaint too often, in too many situations. Or the allegations become extraordinary, and start to strain credulity. Or the people they are levelled at are people you know to be fair and reasonable.

When I was making my assessment of my daughter's mental condition, I did something that almost no social worker, psychologist or psychiatrist does: I tracked down as many of Tessa's former friends and associates as I could, and questioned them at length.

I even traced a former friend to Western Australia, and was impressed by what she said. As soon as I introduced myself, she blurted out: "What on earth happened to Tessa?"

She then explained that she had initially believed Tessa's stories about her victimization by the members of her sports club. Her response, she said, had been one of "Poor Tessa. How awful for her". But she said that when Tessa told her that her (Tessa's) parents had turned against her, "I knew that something was wrong, because you were always so close".

The above post was originally written on February 15, 2005.