Paranoid disorders: The core of truth behind the delusional system

This is the first paper of a series of articles reporting the findings, life course, and psychiatric outcomes of a group of 34 families in which at least one member of the family developed a delusional system. In this study the author discusses chiefly several issues regarding the genesis, ways of reinforcement, and perpetuation of the delusional ideation which, despite their great contributory importance to the success of treatment of the paranoid patient, seem neglected in the professional literature. The author draws attention to two basic findings that appeared consistently in the study group of 34 paranoid patients: (1) there is always a basis of truth and reality behind every delusional system; and (2) authentic past and current interpersonal transactions play a dominant role in generating and activating the paranoid beliefs.     

Paranoid disorders: The core of truth behind the delusional system

This is the first paper of a series of articles reporting the findings, life course, and psychiatric outcomes of a group of 34 families in which at least one member of the family developed a delusional system. In this study the author discusses chiefly several issues regarding the genesis, ways of reinforcement, and perpetuation of the delusional ideation which, despite their great contributory importance to the success of treatment of the paranoid patient, seem neglected in the professional literature. The author draws attention to two basic findings that appeared consistently in the study group of 34 paranoid patients: (1) there is always a basis of truth and reality behind every delusional system; and (2) authentic past and current interpersonal transactions play a dominant role in generating and activating the paranoid beliefs.(1981, Spring)     

Paranoid atmospheres: Psychiatric knowledge and delusional realities

In this paper I investigate the topic of paranoid atmospheres. This subject is especially of interest with respect to persons who are deluded, and also, I will demonstrate, sheds light upon the psychiatrist's "gaze" and knowledge of delusions. In my argument I will follow a path initially outlined by Karl Jaspers (1883-1969): modern psychiatric diagnosis of delusions is a diagnosis of form and not content. Jaspers' emphasis on the form of delusions enables psychiatrists to be self-critical about their professional knowledge and, consequently, prevent the development of dogmatic attitudes. In accord with Jaspers, my argument will focus on the basic structure of delusions and highlight the difference between delusional realities and non-delusional realities, a difference that follows from the possibility of self-criticism of one's own conscious and explicit convictions. I will demonstrate the importance of self-criticism with regard to paranoid atmospheres and also to psychiatric knowledge. In this manner, an understanding of delusions as lived experience will be developed, which argues that an escalation of the influence of delusional convictions, resulting in a profoundly paranoid atmosphere, is most problematic for the deluded person. To acknowledge this insight mirrors the need for a self-critique of psychiatric discourse, encourages an empathic and respectful relationship between professionals and deluded patients, and enables deluded persons to restrict their paranoid atmosphere. It is the main conclusion of my paper that a deluded person cannot do (with respect to his delusional convictions) what a psychiatrist must do (with respect to his psychiatric knowledge and his own existential convictions) in order to prevent a profoundly paranoid atmosphere in their relationship: be self-critical.     

The effects of token reinforcement and feedback on the delusional verbal behavior of chronic paranoid schizophrenics

Prior research with token reinforcement in the psychiatric population has been directed at work adjustment, more than at major symptomatic behaviors. The purpose of the present research, on the other hand, was to investigate the effects of feedback and token reinforcement on the modification of delusional verbal behavior in chronic psychotics. Six male and four female paranoid schizophrenic patients participated in the study. The results indicated that the effects of feedback were effective about half the time in reducing percentage delusional talk, but in at least three cases produced adverse reactions. Token reinforcement, however, showed more consistency and reduced the percentage of delusional verbal behavior in seven of the nine subjects exposed to this procedure. The effects of both feedback and token reinforcement were quite specific to the environment in which they were applied and showed little generalization to other situations. It would appear that using token reinforcement can reduce the percentage delusional speech of chronic paranoid schizophrenics.     

Death in Jonestown: Techniques of Political Control by a Paranoid Leader

ABSTRACT: Jim Jones and Jonestown are discussed from a “political control” point of view. Seven basic techniques of political control are identified: Control of property and income, weaking of family ties, a sociopolitical caste system, control of egression (escape), control of verbal expression, cognitive control and emotional control. Jonestown is identified as a mini-totalitarian state ruled by a delusional and paranoid person.     

Freud's theory of paranoid delusion based on the Schreber case contrasted with related theories

The historic importance of Freud's analysis of the Schreber case is acknowledged, even though the theory it expounds is largely disavowed. The theory ascribes the cause of paranoid delusion to homosexual impulses unresolved in infancy or early childhood. This paper summarizes Freud's monograph on Schreber and contrasts his theory with the views of various revisionists. The writers focus on the Freudian concept of projection, which is intended to explain how much meaning can become reversed under the impetus of stress, and the reversal lead to delusional thinking. Based on their work in family therapy, where they observed one form of pathogenic relating termed learning to be possessed, the writers concluded that this form was also based on a type of projection which could culminate in delusional ideation. A relationship between learning to be possessed and H. S. Sullivan's theory of paranoid transformation is described. A learning factor is present in several of the psychological theories advanced to explain delusion, and the factor is akin to if not identical with Freud's concept of projection.Gerald Zuk, PhD, is in private practice at 25316 Pacy Street, Santa Clarita, California 91321-3343. Carmen Zuk, MD, is a child psychiatrist-partner affiliated with the Southern California Permanente Medical Group at its psychiatric clinic in Van Nuys, California. Both may be reached by telephone at (805) 252-7702.     

Psychological processes and paranoia: implications for forensic behavioural science

Paranoid delusions have recently become the focus of empirical research. In this article, we review studies of the psychological mechanisms that might be involved in paranoid thinking and discuss their implications for forensic behaviour science. Paranoia has not been consistently associated with any specific neuropsychological abnormality. However, evidence supports three broad types of mechanism that might be involved in delusional thinking in general and paranoia in particular: anomalous perceptual experiences, abnormal reasoning, and motivational factors. There is some evidence that paranoia may be associated with hearing loss, and good evidence that paranoid patients attend excessively to threatening information. Although general reasoning ability seems to be unaffected, there is strong evidence that a jumping- to-conclusions style of reasoning about data is implicated in delusions in general, but less consistent evidence specifically linking paranoia to impaired theory of mind. Finally, there appears to be a strong association between paranoia and negative self-esteem, and some evidence that attempts to protect self-esteem by attributing negative events to external causes are implicated. Some of these processes have recently been implicated in violent behaviour, and they therefore have the potential to explain the apparent association between paranoid delusions and offending.     

Reducing delusional speech in chronic, paranoid schizophrenics

Four schizophrenic patients with paranoid and grandiose delusions who had been hospitalized for an average of 17 yr were exposed to social reinforcement contingencies in a multiple baseline design. During the baseline period, each patient was interviewed for four 10-min sessions each day. The elapsed time from onset of conversation to onset of delusional talk was recorded. At the end of each day, the patients engaged in a 30-min informal chat with a nurse-therapist while relaxing with coffee, snacks, and cigarettes. The intervention introduced two contingencies: (1) The 10-min interviews were terminated as soon as the patient began talking delusionally; (2) The patients earned time for their evening chat by talking rationally during their daytime interviews. Increases of from 200 to 600% in the amount of rational talk exhibited during the interviews occurred as the contingencies were introduced for each patient sequentially over time. These increases were maintained in three patients when the amount of reinforcement was halved, but declined when the patients were confronted directly with their delusional ideas. A modest amount of generalization occurred from the day-time interviews to the evening chats but did not extend to the behavior of the patients on the ward.     

Conditioning and post-hospital generalization of nondelusional responses in a chronic psychotic patient

An operant conditioning approach was successful in getting a chronic psychotic patient to give factual answers to direct questions that had previously elicited only delusional responses. Multiple baseline and reversal controls established that the changes were due to the experimental procedure. The subject was a female patient classified as paranoid schizophrenic who had persisted in giving bizarre responses to direct questions regarding her identity, age, and personal history during 26 yr of hospitalization. She was discharged after factual answers to these questions had been obtained, but operant conditioning trials were continued in the community to promote generalization. Two follow-up interviews were conducted 36 and 52 days after discharge to evaluate generalization. No generalization was found in the first interview, but the second gave evidence of some generalization.     

Bias and Millon clinical multiaxial inventory (MCMI-II) diagnosis

In the current study, the degree of bias is calculated for each of the personality disorder and clinical syndrome scales of the MCMI-II. In general, most of the MCMI-II scales are prone to only mild or moderate biases. However, the paranoid personality disorder, somatoform, bipolar: manic, thought disorder, and delusional disorder scales are prone to severe biases. When the MCMI-II is utilized to make diagnostic decisions, bipolar and schizophrenic disorders are apt to be grossly underestimated. The implications of bias in diagnostic prevalence rates are discussed and an equation is offered which provides for adjustments to be made when the percentage of positive MCMI-II test results are used to determine prevalence rates for clinical or research populations. The observation is made that imperfect sensitivity and specificity for the MCMI-II scales will result in inaccurate estimates of personality disorders and clinical syndromes when the MCMI-II is used to survey various populations.     

Cognitive functioning in delusions: a longitudinal analysis

BACKGROUND: This study explored the longitudinal course of the relationship between delusions and different aspects of cognitive functioning. METHODS: Deluded patients were compared to psychiatric and non-clinical controls on three tasks: negative priming, a probabilistic judgement task (the 'beads' task), and the pragmatic inference task (PIT). All groups were tested at two time points, once when actively symptomatic, and once when in remission. RESULTS: Deluded individuals exhibited a 'jump-to-conclusions' (JTC) reasoning bias: i.e., they made decisions on the basis of limited evidence and were more likely to revise their estimates when faced with disconfirmatory evidence. This JTC bias remained stable over time, although probability judgments seemed to normalise in remission. No deficits in cognitive inhibition were found on negative priming. The deluded group displayed an excessive self-focus on the PIT at both time points, but did not show a depressive attributional style. Only a small sub-sample, characterised by the "bad-me" type of paranoia [Trower & Chadwick, 1995 Clinical Psychology: Science and Practice, 2, 263-278.], demonstrated depressive schemas when symptomatic, but no longer did so when remitted. Few relationships were found between tasks, suggesting that different areas of functioning are relatively independent. The only measures associated with delusion symptom scores were from the 'beads' task. CONCLUSIONS: Overall these findings suggest that the JTC bias is a stable factor associated with delusional thinking, while the depressive attributional style characteristic of a small sub-sample of paranoid patients fluctuates with delusional course.     

Paranoid disorders: family sources of the delusional system

Several family transactional patterns seem to play a critical rôle in the creation of the patient's paranoid constructions. A philosophy of life characterized by inflexible rules, irrational beliefs, distrust, apprehensive-ness and hate is prominent in a great number of families with paranoid patients. The family members typically intrude on each others' actions and feelings with mutual reinforcement of the paranoid ideas. Schreber's family appears to be a characteristic demonstration of the important implications of interactional transactions within the family in the genesis of a paranoid system.     

On the nature of intuitive and delusional thought: Its implications in clinical work with psychotic patients

The author tries to differentiate intuitive imagination from delusional imagination and hypothesises that psychosis alters the system of intuitive thinking, which consequently cannot develop in a dynamic and selective way. Scholars of different disciplines, far removed from psychoanalysis, such as Einstein, Hadamard or Poincar, believe that intuitive thinking works in the unconscious by means of hidden processes, which permit a creative meeting of ideas. Thanks to Bion's work, psychoanalysts have begun to understand that waking thinking is unconsciously intertwined with dream‐work. The delusional construction is similar to a dreamlike sensorial production but, unlike a real dream, it remains in the waking memory and creates characters which live independently of the ‘dreamer's’ awareness. It is a dream that never ends. On the contrary, the real dream disappears when it has brought its communicative task to an end. In the analysis of psychotic patients it is very important to analyse the delusional imagination which dominates the personality and continuously transforms the mental state, twisting emotional truth. The delusional imagination is so deeply rooted in the patient's mental functioning that, even after systematic analysis, the delusional world, which had seemed to disappear, re‐emerges under new configurations. The psychotic core remains encapsulated; it produces unsteadiness and may induce further psychotic states in the patient. The author reports some analytic material of a patient, who, after a delusional episode treated with drugs, shows a vivid psychotic functioning. Some considerations are added on the nature of the psychotic state and on the therapeutic approach used to transform the delusional structure. This paper particularly deals with the difficulty in working through the psychotic episode and in ‘deconstructing’the delusional experience because of the terror connected with it. In the reported case, the analytic work changed the delusional construction into a more benign one characterised by phobic qualities. The analysis of the psychotic transference allowed the focus to be on the hidden work which had been continuously influencing the transferential picture of the analyst and the patient's psychic reality.     

Gaze,dominance and humiliation in the Schreber case1

In this paper the author reviews Freud's study of Schreber's Memoirs and the Memoirs themselves from a perspective of nearly 100 years. He argues that Schreber's illness began as a melancholic depression but quickly developed paranoid features which subsequently escalated into a gross paranoia which nevertheless retained its depressive and hypochondriacal base. Finally the chaotic fragmentation became organized under the dominance of an omnipotent narcissistic organisation which led to a clinical improvement without any relinquishment of his delusional beliefs. As a subsidiary theme he examines the role of gaze in Schreber's object relations and argues that gaze was used to project into his objects, then to scrutinise the object to see if the projections had been received and tolerated, and finally as an expression of dominance. His urgent demand for relief provoked an omnipotence in his objects which he was then able triumphantly to frustrate and which ushered in a struggle over dominance in the course ofwhich Schreber was abused and humiliated. He was unable to find an object who could contain his distress and these factors contributed to the failure to tolerate guilt and to work through his depression.     

��ber das Wesen der psychotischen Wahnbildung

The aim of this paper is to explore the nature of the delusional construction so as to render it susceptible to a therapeutic approach. Particular attention is devoted to the nature and structure of delusion and its relation to the healthy part of the personality. In the author??s view, delusion is a psychopathological construction that makes it impossible for the patient to understand his own experience. The delusional construction is similar to a dream-like sensorial production but, unlike a real dream, it remains in the waking memory and creates characters which live independently of the ??dreamer??s?? awareness. It is a dream that never ends. The delusional imagination is so deeply rooted in the patient??s mental functioning that, even after systematic analysis, the delusional world, which had seemed to disappear, re-emerges under new configurations. This paper particularly deals with the difficulty in working through the psychotic episode and in ??deconstructing?? the delusional experience because of the terror connected with it.