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: 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.     

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.     

Paranoid disorders : the interpersonal perspective

The material included in this article is part of a clinical study reporting the life-course and therapy of a group of thirty-four families in which at least one member of the family developed a delusional system.
Specifically, this paper discusses the rôle played by particular interpersonal transactions in the maintenance and amplification of paranoid beliefs. It is pointed out that the paranoid delusional system never remains a pure intrapsychic issue. In all our case studies, we have been able to show the presence and influence of an interactional feedback system.     

Pharmacotherapy of delusional disorders in the context of offending and the potential for compulsory treatment

Delusional disorder is an uncommon mental illness with an estimated prevalence of 0.03%. Its low prevalence has likely contributed to the paucity of research interest in this area, leading to substantial gaps in knowledge concerning its treatment and management. In the absence of a robust literature, most clinicians rely on their experience and guidelines for treating schizophrenia when treating patients with delusional disorder. This article reviews the available literature that is specific to the treatment of delusional disorder. In addition, it focuses on specific forensic and medicolegal aspects of managing patients with delusional disorder.     

The truth and nothing but the truth,yet never the whole truth: Frege,Russell and the analysis of unities

It is widely assumed that Russell's problems with the unity of the proposition were recurring and insoluble within the framework of the logical theory of his Principles of Mathematics. By contrast, Frege's functional analysis of thoughts (grounded in a type-theoretic distinction between concepts and objects) is commonly assumed to provide a solution to the problem or, at least, a means of avoiding the difficulty altogether. The Fregean solution is unavailable to Russell because of his commitment to the thesis that there is only one ultimate ontological category. This, combined with Russell's reification of propositions, ensures that he must hold concepts and objects to be of the same logical and ontological type. In this paper I argue that, while Frege's treatment of the unity of the proposition has immediate advantages over Russell's, a deeper consideration of the philosophical underpinnings and metaphysical consequences of the two approaches reveals that Frege's supposed solution is, in fact, far from satisfactory. Russell's repudiation of the Fregean position in the Principles is, I contend, convincing and Russell's own position, despite its problems, conforms to a greater extent than Frege's with common sense and, furthermore, with certain ideas which are central to our understanding of the origins of the analytical tradition.     

Assessment of delusional beliefs during the modification of delusional verbalizations

This study examined the strength of delusional beliefs during the modification of delusional verbalizations of a 51 year-old chronically mentally ill inpatient. The changing-criterion design was used to document the effectiveness of a behavioral treatment package to alter the rate of delusional responses to personal background questions. The results revealed a stepwise decline in the frequency of delusional responses. Generalization effects to novel interviewers were obtained. No changes were obtained on the subject's ratings of delusional beliefs, with the subject assigning ratings of absolute conviction to his beliefs throughout the duration of the study.     

The modification of delusional beliefs: A single-subject evaluation

The multiple-baseline across responses design was used to assess the effectiveness of a belief-modification treatment package to alter the intensity of three delusional beliefs of a chronically mentally ill inpatient. Results revealed reductions in belief intensity to zero levels for all three beliefs. Generalization effects were obtained for an individualized interview and psychiatric rating scale. These results were maintained through a 6-month follow-up period.     

The poehlman case: running away from the truth

Eric T. Poehlman, Ph.D., was an internationally recognized, tenured professor at the University of Vermont (UVM) in Burlington when, in October 2000, a junior member of Poehlman’s laboratory became convinced that he had altered data from a study on aging volunteers from the Burlington area. This suspicion developed into one of the most significant cases of scientific misconduct in the history of the US Department of Health and Human Services’ (HHS) Office of Research Integrity (ORI), launching a US Department of Justice (DOJ) civil and criminal fraud investigation and, eventually, to a much publicized guilty plea and felony conviction. In the end, Dr. Poehlman admitted to 54 findings of scientific misconduct made by the UVM and ORI, agreed to retract or correct ten of his publications and to exclude himself from federal procurement and nonprocurement transactions for life. The United States Government’s handling of this case was distinguished by a highly cooperative approach that integrated the resources of the US Attorney’s Office for the District of Vermont (USAO) and both ORI and the Office of the Inspector General (OIG) in HHS in the common goal of prosecuting research fraud. The content of this article represents the personal views of the authors and does not express the opinion or policy of DHHS or its components. A paper on this topic was presented at the 6th International Bioethics Conference on the subject of ‘The Responsible Conduct of Basic and Clinical Research’, held in Warsaw, Poland, 3–4 June 2005.     

The naked truth: mindfulness and the purification of religion

To arrive at an understanding of what drives the much debated spiritual turn in Western Europe, we study the spiritual trajectories and identifications of mindfulness practitioners in the formerly predominantly Roman Catholic context of Flanders in Belgium. Fifteen semi-structured interviews addressed their religious and spiritual biographical trajectories as well as the symbolic boundaries they draw with adjacent religious and spiritual groups. We find marked evidence of a process of ‘religious purification’, which unfolds as a critique of the formal and external aspects of both religion (organisations, dogmas, ritual) and spirituality (woolly and frivolous New Age word games). To validate and justify, alternatively, the ‘pure’ and ‘grounded’ spirituality that results, those concerned consistently invoke the authority of science.     

The action dynamics of overcoming the truth

A convincing deceiver must act in discordance with their knowledge of the truth. To do so requires the deceiver to resolve competition between what is known to be true and what is intended to be false. We investigated the temporal signature of this competition by examining the action dynamics of arm movement while participants responded falsely or truthfully to autobiographical information. The participants answered no or yes by navigating a Nintendo Wii Remote to no and yes regions on a large projector screen. Trajectory analyses of the fine-grained arm movements show increased complexity in false responding relative to truthful responding, with the greatest difference in false yes answers. The dynamic motor movements also reveal greater strength of competition during the act of false responding, thereby extending traditional response time measures that capture latent competition alone. These results suggest that deceptive processes may be detectable when action is allowed to covary with thought. Supplemental figures and a list of the sentence stimuli may be downloaded from http://pbr.psychonomic-journals.org/content/supplemental.     

Reversing the truth effect: learning the interpretation of processing fluency in judgments of truth

Repeated statements receive higher truth ratings than new statements. Given that repetition leads to greater experienced processing fluency, the author proposes that fluency is used in truth judgments according to its ecological validity. Thus, the truth effect occurs because people learn that fluency and truth tend to be positively correlated. Three experiments tested this notion. Experiment 1 replicated the truth effect by directly manipulating processing fluency; Experiment 2 reversed the effect by manipulating the correlation between fluency and truth in a learning phase. Experiment 3 generalized this reversal by showing a transfer of a negative correlation between perceptual fluency (due to color contrast) and truth to truth judgments when fluency is due to prior exposure (i.e., repetition).     

The sinister attribution error: Paranoid cognition and collective distrust in organizations

Recent social psychological research on paranoid cognition has shown that when individuals are self-conscious or feel under evaluative scrutiny, they tend to overestimate the extent to which they are the target of others' attention. As a result, they make overly personalistic attributions about others' behavior. These personalistic attributions, in turn, foster a pattern of heightened distrust and suspicion regarding others' motives and intentions. Drawing on this research, the present work investigates antecedents and consequences of paranoid cognition in groups and organizations. Results of two studies are presented. Study 1 investigates how tenure in a group or organization affects individuals' self-consciousness and susceptibility to paranoid cognition. Study 2 replicates and extends the results of the first study using a new laboratory analog for studying paranoid cognition in small groups. Implications of the findings are discussed in terms of their contribution to theory regarding the origins and dynamics of collective distrust and suspicion.The development of these ideas benefitted greatly from an interdisciplinary seminar on trust and norms organized by Jim Baron. I am also grateful to Susan Ashford, Steve Barley, Bill Barnett, Jon Bendor, Bob Bies, Joel Brockner, Bob Cialdini, Jane Dutton, Alice Isen, Roy Lewicki, Jim March, Joanne Martin, Maureen McNichols, Michael Morris, Jeff Pfeffer, Joel Podolny, Rick Price, Sim Sitkin, Phil Tetlock, Tom Tyler, Kathleen Valley, Karl Weick, and Mayer Zald for thoughtful comments and suggestions they provided at various stages of this research. Earlier versions of this research were presented at the University of Michigan School of Business Administration, the Asilomar Conference on Organizations, Academy of Management meetings, and the Fifth Conference on Research on Negotiation in Organizations.