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Diagnosing delusion
angst kitten
danaeris wrote in psychology
So, I have a question. This is the second time I've run into it (with separate people -- first a friend, and now a relative), and I'm kind of at a loss as to how to handle it.

Essentially, when a person has beliefs that are potentially delusional, how does the mental health professional determine their validity? Some beliefs are clearly delusions (tinfoil hats and aliens, for example). But others are not so clear.

With my friend, she was clearly bipolar with some paranoia, and yet she was clever enough that her doctors never seemed to see what was really going on. It was never clear to me how we, as her friends, were supposed to get her the help she needed when the mental health professionals didn't seem to be catching on.

With my relative, she says that A is happening, and her immediate family says that it is a delusion. I'm not there on the ground, so I can't judge for myself, but A is in the realm of possibility. Her family is insisting on being present for her appointments with the psychiatrist they chose, and she feels like she can't trust that psychiatrist because she didn't choose him/her. My initial instinct is that she has a right to a therapist and/or psychiatrist who she believes is on her side. But then I think about my friend and the frustration of knowing that her doctors couldn't see what I could see, and I'm not sure.

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However, in your example you assume that Science has clearly established what is real and what is "delusion". You are assuming that our knowledge of reality is complete as it is now, and it is not. I'm just saying, your example is bad because you assume that you clearly know what is right and what other people experience. Can what people may claim to experience be entirely delusional? Yes. But sometimes people experience things, real things, that are not fake - but not explained yet either. Be careful where you draw the line.

You personally don't handle anything, if the psychologist is a good psychologist then they will be able to determine their patient's mental state despite how they may try to trick them. Your friend might think that she completely fooled her therapist, but sometimes therapists have a way of going about things that are in the best interests of the patient and not what the friends and family of the patient believes is best. Your relative has a right to a therapist that is "on her side" and doesn't deserve going through a therapist who only cares about what your relatives want them to say.

Delusions aren't the priority. Don't presume the client has fooled the therapists, in a manner of speaking, the client is entitled to their delusions - we all believe things that cannot be quanitated and qualified, including our religions and spiritual beliefs.

The issue with delusions are simple - 1st, do they lead the client to harm themselves or others? If the answer is no, then they aren't important clinically. Benign delusions are just that. If the delusions are harmful, then appropriate steps will be taken - medication, inhouse treatment, appropriate outpatient treatment. Then next question is - do they impede our ability to live our life to our fullest ability to do so? If that answer is yes, then again, appropriate steps will be taken.

Please do not enable any excuse your Aunt may be using to discontinue treatment. I have no doubt that getting her to treatment is a huge burden for the family. She may require supervision to the therapy sessions, they are most likely NOT in those treatment sessions, but outside in the waiting room. Whether your Aunt chose the therapist or not in the beginning has no bearing on whether the therapist is "on her side", but instead was likely chosen for their background, training and ability to handle your Aunt's problem. It does not sound like your Aunt is capable of choosing a care provider on that sort of level, by herself.

This comment is amazing. It kinda blew my mind and gave me some great insight. Thanks.

Sometimes it's not about what's real, it's about what's right for the person. If someone wants to come to therapy and talk about their delusions and it helps them, this is progress. On the other hand, if someone is forced to talk about "reality" as defined by someone else and it's damaging or frustrating to them, it's counterproductive.

Then, of course, there are the millions of gray areas in between.

I think we all define our own realities, and unless someone's delusions are causing actual damage to themselves or others, it's no different than a white lie or a selective memory. I think that a therapist/client relationship is important, and people should work with someone they feel comfortable with.

It is important to remember that your friend and your relative must want to change in order for them to accept any help, whether you believe that the helpers are competent or not. The only information missing from your post is whether your friend and/or relative are harmful to themselves or to someone else and in what ways - the answer to this should determine the urgency of your friend and relative in seeking the appropriate treatment. Other than that, patience and empathy will serve your friend and relative to benefit them. Therapy takes time and it is important to build trust between the therapist and the client to ensure collaborative effort in finding the right type of treatment that works, long-term rather than getting a quick fix.

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