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Listening for the Truth Within Talk that Sounds Delusional: a Key Yet Rare Mental Health Method

Nathaniel Lehrman, M.D. recently posted his story of how he became psychotic, how he was treated, and then how he recovered despite the fact that much of his treatment was misguided.  This story provides some good insight into some of the dynamics that are common in the way our mental health system, which is supposed to help people find their balance, often just gets caught up in an imbalance opposite to the imbalance the consumer is experiencing.

What happened to Nathaniel was that in the middle period of his life he got into a political battle, which resulted in a number of people turning against him and causing him trouble.  His distress about this situation caused him to become hypervigilant for threat or “paranoid” which caused him to see more threat and threatening behavior than actually existed, and this resulted in his hospitalization.  Once in the hospital, he was treated as though all of his perception of threat was delusional, even though he had solid evidence that much of it was real.

In other words, while Nathaniel had become unbalanced in the sense of seeing more threat than actually existed, the hospital clearly took up the opposite sort of imbalance, seeing less threat than actually existed.  This is a very common dynamic when mental health professionals refuse to listen in detail to what consumers have to say, and refuse to acknowledge that real life situations may be quite complex, with real perceptions mixing in with mistaken ones.

In the better psychological approaches, like CBT for psychosis, or Open Dialogue, professionals take an interest in what consumers say, and they don’t assume they know for sure what is real and what is not.  Instead, they encourage looking at the subject from multiple points of view, in a thoughtful, reflective way.  This allows truths to emerge, and imbalances on both sides, within the consumer or the mental health system, are gradually reduced.

Nathaniel was lucky enough to have his psychotic episode when he was already middle aged and a successful psychiatrist, so he was not overwhelmed by those who didn’t take him seriously, and he managed to find his own pathway toward recovery.  But many of those who enter the mental health system don’t have these kinds of strengths, and they are likely to get caught up in a vicious circle, in which they respond to the mental health system minimization of their beliefs by emphasizing their own beliefs more strongly, which causes the mental health system to see them as even more crazy and becomes even less willing to listen for any truth in what they might be saying, etc.  This is one way what might be a temporary imbalance becomes a “chronic disorder” due to poor treatment.

In some other cases, a delusional belief may be literally impossible, but still has a bit of truth in the sense that it is a metaphor for something that is really going on.  A competent mental health system would be curious about this kind of truth as well, rather than just completely dismissing the belief as delusion.

2 comments… add one
  • I’m posting this by permission from the author who left this comment on my facebook notice about this blog post:

    Alice Lombardo Maher Ron, the “truth within the delusional” is exactly what I just wrote about in my own blog post, on the home page of my website, The title of the post, “What Is Government if Words Have No Meaning?” is the question Jared Loughner asked Rep. Gabrielle Giffords in 2007, almost 4 years before he shot her. I know that I use the word “schizophrenia” in a way that might make you uncomfortable, but I think that the kind of audience I’m talking to needs to conceptualize thought process differences and consider the possibility that even the strangest ideas might have meaning, before they can consider letting go of those stereotyping and dismissive diagnostic labels. I’d love to hear your reactions.

    • Hi Alice, I agree with the main point of your post, that we humans have a problem in understanding each other generally, and it is worse with those diagnosed with stuff like “schizophrenia.” I think that rather than try to understand such people, both society and then the mental health system decide it is easier to see them as “non-understandable.”
      Ever since I first heard Jared’s question “What is government if words have no meaning?” I related to it pretty strongly. It reminded me of the perspective of myself and some of my friends during my late teens/early 20’s, when we were challenging everything, even the meaning of words and reason itself, and then had to face the question, how to make any decision at all if nothing has any particular meaning? Questions like this can be part of creative or revolutionary ferment, though such ferment can also lead to a dangerous confusion and fundamentalism such as what apparently led Jared to become a killer.
      I think people often have a fear of understanding people who are different, because if the Other is making sense, then one’s own sense is in some degree questionable. And unless we have skills in facing the unknown and the ungovernable world of Mystery at the heart of our existence, we don’t like knowing that our own sense is questionable. So I think you are touching on some important issues on your blog, and I wish you well with it.