The ignorance in the public understanding of schizophrenia and related disorders is shockingly poor, with a survey by the National Alliance on Mental Illness indicating that 64% of Americans are unable to recognize its symptoms or incorrectly think the symptoms include split or multiple personalities. Misunderstanding schizophrenia is a key driver of the stigmatization of individuals with the condition, which has detrimental consequences, such as reduced housing and employment opportunities, diminished quality of life and health, low self-esteem, more symptoms and stress – which only further exacerbates the condition and reduces chances of recovery.

While misportrayal in the media and the name itself (schizo = split, phrenia = mind) are partly to blame, schizophrenia continues to be largely misunderstood as many of us think we are unable to relate. We are unable to put ourselves in the shoes of someone with the disorder. So let’s take the time now to set the record straight.

What you are about to discover is that we may be more able to relate to people that have experienced schizophrenic episodes than we think. Both new and not so new research reveals that the symptoms of schizophrenia are more common in non-schizophrenic individuals than we like to think.

The first criteria in the DSM-V for a schizophrenia diagnosis lists five main symptoms, at least two of which must be present for at least one month. One of the two symp­toms must be delu­sions, hal­lu­ci­na­tions or dis­or­ga­nized speech.

• Delu­sions
• Hal­lu­ci­na­tions
• Dis­or­ga­nized speech (e.g., fre­quent derail­ment or inco­her­ence)
• Grossly dis­or­ga­nized or cata­tonic behav­ior
• Neg­a­tive symp­toms (i.e., dimin­ished emo­tional expres­sion or avolition)

Yet having only one symptom is sufficient for meeting symptom criteria if the delusions are considered bizarre (totally and utterly impossible, not understandable to same-culture peers and not derived from ordinary life experiences), or if auditory hallucinations involve a voice keeping up a running commentary of thoughts and behaviors or two or more voices talking with each other.

The key question is how common are these symptoms in the general populace? For the first part in the series we will consider delusions.

Symptom 1 – Delusions

Delusions are classified in the DSM-V as:

“…fixed beliefs that are not amenable to change in light of conflicting evidence. Their content may include a variety of themes (e.g. persecutory, referential, somatic, religious, grandiose)… The distinction between a delusion and a strongly held idea is sometimes difficult to make and depends in part on the degree of conviction with which the belief is held despite clear or reasonable contradictory evidence regarding its veracity.”

Have I ever had beliefs that I believed to be true despite conflicting evidence ? Or, although no proof against the truth of my belief can be found, did I believe with my mind, body and soul despite other people finding the idea implausible? Check! And have I ever had these beliefs persisting for a month or more? Check! Have I ever had schizophrenia or a related disorder? No.

A large body of evidence supports this idea, that we all have experienced non-pathological delusional beliefs throughout our lifetime and even generally in day to day life, and some delusions may actually be good for us (see the end of this article). For example one study found that over 10% of the non-clinical general population experience grandiose beliefs, i.e. that they are extraordinarily special in some way, although the belief is typically held with less conviction, less resistance to change and causes less significant social and occupational impairment than in those diagnosed with schizophrenia.

Professor of Clinical Psychology at Oxford University, Daniel Freeman, published a review of the literature in 2006 stating that:

“Approximately 1% to 3% of the nonclinical population have delusions of a level of severity comparable to clinical cases of psychosis. A further 5% to 6% of the nonclinical population have a delusion but not of such severity. Although less severe, these beliefs are associated with a range of social and emotional difficulties. A further 10% to 15% of the nonclinical population have fairly regular delusional ideation.”

Moreover, there is an inverse relationship between our age and how common and strongly held our delusional beliefs are. I don’t think anyone would argue that children are inherently delusional creatures: Magical, superstitious, bizarre, grandiose, paranoid and all kinds of delusions are not unusual for their rapidly developing yet immature belief systems.

Who here believed monsters lived under their beds or in the closet despite being shown repeatedly that there is nothing there? When I was around four or five, I believed I was a magical being that faeries had gifted sacred magical dust for super powers like flying off of the couch. I was so frustrated and furiously upset when no one would believe me that I tried to run away with the faeries, quite literally!

Similarly, delusional beliefs are pretty common in adolescents and young adults. In comparison to our previously mentioned grandiose delusions held by 10% of the general population, some studies have shown that the same beliefs are experienced by up to a colossal 75% of 15-26 year old’s. What’s more is that another study has shown that this subset of highly delusional individuals experience more distress and preoccupation associated with their delusional beliefs than the general population, as found in schizophrenia.

Interestingly, the extent to which a delusion is believed, how much it interferes with a person’s life and its emotional impact are what researchers often use to set pathological delusions apart from non-pathological ones, as these factors are typically more extreme in schizophrenic patients. If you can recall however:

“Approximately 1% to 3% of the nonclinical population have delusions of a level of severity comparable to clinical cases of psychosis.”

Herein lies the rub, “normal” and seemingly non-pathological delusions can be highly distressing, make you and perhaps others question your sanity and have huge emotional and life changing impacts.

Let’s say one day you have a profound religious experience where you believed that God was talking directly to you, reminding you of your sins or your importance and offering you a chance to repent by sending you on a personal mission. This is not an overwhelmingly uncommon experience in religious communities. You might believe in your mission to the core of your being, quit your job, feel overwhelmingly distressed, leave your family and friends despite their pleas, abandon everything and head off into the unknown on your religious mission.

Or let’s say that you less extravagantly “find God/Jesus”, believing that God/Jesus can hear you and is watching you and that you can influence real-life world events through praying to God/Jesus. This belief is not considered a delusion seeing as millions of other people believe the same – despite their being no way to conclusively prove this is true.

But if you replace God with the all-powerful Mars alien Lord Ziltoid, and there is not a group of individuals believing this too, it could easily be considered a pathological delusion. Unless you are a child of course, then we just chalk it down to an overactive imagination or a phase.

The same goes for non-religious beliefs that may or may not be considered delusional. For a little perspective, here are a few examples of common delusion themes, and a typical related question used in research-based diagnostic tools like the Peters et al. Delusions Inventory (PDI):

• Delusions of grandeur – Do you ever feel that you are a very special, unique or unusual person or are destined to be someone important?
• Delusions of control – Do you ever feel as if electrical devices such as computers can influence the way you think, or that there is a force, power or other people that can interfere with your thoughts or actions?
• Delusions of guilt – Do you ever feel that you have sinned more than the average person?
• Delusions of reference – Do you see any special meaning for yourself in everyday objects?
• Delusions of persecution – Do you ever feel there is a conspiracy against you?
• Delusion of jealousy or paranoia – Do you ever think that someone/your spouse is talking about you, hiding things from you or being unfaithful to you behind your back?
• Magical delusions – Do you believe in the power of witchcraft, voodoo or the occult?

Some of these delusions are relatively commonly held beliefs that can cause high levels of distress, make life difficult to live and socially isolate you from others that don’t share your belief, all while not having schizophrenia.

For example delusional jealousy, is an all too common phenomena. We all know someone has let their social media stalking green-eyed monster rear their ugly head, despite having no proof or justifiable reason to believe anything untoward is going on. Likewise, delusions of reference are pretty standard day to day operations for many healthy individuals, where a person falsely believes that insignificant remarks, events, or objects in one’s environment have personal meaning or significance:

“the clock read 3:33 today, the 33 bus broke down right in front of me and then I was handed 33 cents change. Doo do doo do doo do doo do – the universe is trying to tell me something!”

So ultimately, no matter how bizarre a belief might seem to some, no matter how distressing and life-shattering, it seems that ultimately it is the cultural context which dictates whether a belief is truly delusional or not.

Can delusions be good for us?

On a final note, there is actually evidence suggesting that a certain amount of delusional thinking might actually be good for us! Often we cling onto delusions that make us feel good, or prevent us from feeling bad, whether they are about ourselves, other people or any aspect of life.

For example students may choose to believe more job offers and higher salaries upon graduation are in store for them despite statistics saying otherwise, aiding motivation to complete their studies. Take marriage as another example. Although researchers estimate that 40–50% of all first marriages end in divorce, we marry anyway, many believing unshakably of being together until death do us part, which presumably enhances our feelings of security in the relationship and validates the purpose of the commitment.

Moreover, self-delusional overconfidence in ones abilities and importance, i.e. believing you are better than you are in reality, has been outlined as advantageous in numerous studies as:

“…it serves to increase ambition, morale, resolve, persistence or the credibility of bluffing, generating a self-fulfilling prophecy in which exaggerated confidence actually increases the probability of success.”

In light of this, delusions are not always cognitive flaws, or indeed indicative of schizophrenia and related disorders. They can be life, emotion and peace disrupting; be purposeful and useful features of cognition; or simply be culturally acceptable quirks in our collective thinking and belief system.

“Respect the delicate ecology of your delusions.”
~Tony Kushner, Angels in America

References

Armando M, Nelson B, Yung AR, Ross M, Birchwood M, Girardi P, & Fiori Nastro P (2010). Psychotic-like experiences and correlation with distress and depressive symptoms in a community sample of adolescents and young adults. Schizophrenia research, 119 (1-3), 258-65 PMID: 20347272

Freeman D (2006). Delusions in the nonclinical population. Current psychiatry reports, 8 (3), 191-204 PMID: 19817069

Hatzenbuehler ML, Phelan JC, & Link BG (2013). Stigma as a fundamental cause of population health inequalities. American journal of public health, 103 (5), 813-21 PMID: 23488505

Johnson DD, & Fowler JH (2011). The evolution of overconfidence. Nature, 477 (7364), 317-20 PMID: 21921915

Knowles R, McCarthy-Jones S, & Rowse G (2011). Grandiose delusions: a review and theoretical integration of cognitive and affective perspectives. Clinical psychology review, 31 (4), 684-96 PMID: 21482326

Lincoln TM, & Keller E (2008). Delusions and hallucinations in students compared to the general population. Psychology and psychotherapy, 81 (Pt 3), 231-5 PMID: 18426692

Peters ER, Joseph SA, & Garety PA (1999). Measurement of delusional ideation in the normal population: introducing the PDI (Peters et al. Delusions Inventory). Schizophrenia bulletin, 25 (3), 553-76 PMID: 10478789

Peters E, Joseph S, Day S, & Garety P (2004). Measuring delusional ideation: the 21-item Peters et al. Delusions Inventory (PDI). Schizophrenia bulletin, 30 (4), 1005-22 PMID: 15954204

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