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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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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.

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