In any era of destabilization, people have shown a troubling tendency to embrace absolute certainties despite contradictory evidence. Passionate believers on every side hold their views with unshakeable conviction. Therapists like me could have insight into this phenomenon and may be able to help, if only we'd allow ourselves to do so. I saw a man for an evaluation several years ago, sent by a judge after he applied for a pistol permit. The judge wanted to know if he was mentally stable after having had a DWI ten years before. I sometimes do these evaluations because the people of New York State don't want handguns in the possession of individuals who may pose a risk to public safety. Our tools for assessment, however, remain troublingly inadequate. After talking with him and checking with people who knew him, I found he had quit drinking shortly after his DWI. He had a family, friends, and a stable job. He had never been admitted to a psych ward or had reason to see a counselor. We went through an extensive list of symptoms and did not check off a single one. Then I asked him why he wanted a pistol permit. His response revealed deeply held beliefs about government conspiracies and impending threats to personal freedoms. He wanted to get a firearm while he still could and would not give it up, even if the government forced him to. "They'd have to take it from my cold, dead hands," he said. The question I was hired for and was expected to answer was, is this man dangerously insane? To my mind, he held strong beliefs about government and society that weren't supported by available evidence. He appeared to have limited knowledge about how government institutions function and how policy changes are implemented. He had absorbed narratives from his preferred media sources without applying critical analysis. He wanted a firearm to resist perceived threats. I could have called him delusional, except for one thing. In making a diagnosis, I must do so according to the standards of the American Psychiatric Association (APA). According to them, you’re not delusional if your beliefs are widely accepted by other members of your culture or subculture. This criterion poses an interesting challenge in our current landscape, where various subcultures maintain entirely different versions of reality. I wrote to the judge, stating the man was of sound mind according to the APA, but I had my doubts which were not supported by the standards of my profession. The APA recognizes some shared delusions, but he didn’t meet criteria for any of them. There’s a condition called Folie à deux, or madness for two, when a psychosis is transmitted from one person to some susceptible others. Folie à deux is not supposed to be used when large numbers of people come to believe falsehoods based on hearsay. It, and all delusional disorders are meant to be labels of personal pathologies, not those you share with millions. The APA has in mind a person who is so convinced of an untrue belief, they are willing to go against the opinion of their social circle, not along with it. In other words, believing in extraordinary conspiracies isn't considered delusional as long as your social group shares those beliefs. There's also mass hysteria, like what occurred in Le Roy High School in 2012 when eighteen students came down with what resembled Tourette's disorder. However, hysteria, as the term is properly used, refers to a physical manifestation that has a psychological cause. While my client showed strong emotional investment in his beliefs, it would be a stretch to call his condition hysteria. So, this one man was able to pass my examination and get his pistol permit. He was certifiably, if astonishingly, sane. But can whole countries go mad? Has anyone done an examination of the USA? On the other hand, if a society exhibits mass delusions, who could treat them? I don't see it as my job as a counselor to challenge my clients' political opinions, undermine their religions, question their worldviews, or promote any particular set of beliefs. I’m there for the problems they bring me, whether it be depression, anxiety, trauma, substance abuse, or trouble with their loved ones. However, I have found at the core of every problem is an uncomfortable relationship with life on life's terms. Everyone, to one degree or another, has trouble accepting the way things are and would rather believe it's different. This resistance to reality leads to all the depression, anxiety, trauma, substance abuse, or trouble with their loved ones I've ever seen. Then it obstructs healing. An anxious or a depressed person tunes into all the fearsome, hopeless, and pessimistic parts of her life and is convinced that’s all there is. I’m always directing their attention to the other side. The traumatized get stuck in the past, which, while it may have been real once, is not real now. Addicts have their well-known denial. Many a violent man believes his abuse is justified and many a battered wife ridiculously trusts that her abuser will treat her differently when he says he’s sorry. They all cling to the very falsehoods that keep them stuck. It is well within my scope of practice to gently challenge those falsehoods that keep individuals stuck. But what about beliefs that aren't supported by evidence when they’re widespread? Like the APA, I've always steered clear of mass delusions, but maybe I shouldn't. It’s getting harder to ignore this kind of madness. Not only is it getting more florid, more extreme, and more dangerous, but it’s disrupting relationships. If you’re so devoted to one politician you have never met, who knows nothing about you, that you are willing to alienate your loved ones who aren’t devoted to that politician, then we have something to talk about. You have transformed a mass insanity into a personal one. Now, you’re in my wheelhouse and any therapist who ignores what you’re doing is overlooking a major source of your troubles. The same goes to those engaged in the resistance to the politician. If they become unhinged, it’s important that they acknowledge it. Why? Because it’s the willingness to call out your own madness that gives you the authority to call out the madness of others. Put a spoon in a glass of water and it will appear bent. If someone saw this and started running around, posting on social media that water bends spoons, someone should tell them otherwise. That's how people look out for each other. Of course, there are effective ways of telling people they have the wrong idea about things, and ineffective ones. Attacking others, dismissing them as stupid, or treating them with contempt may feel satisfying but won't change anyone's mind. If you think it does, then we've found your own blind spot. There currently exist just a handful of recognized conditions that could make a person profoundly lose touch with reality. Delusions occur in the rare Folie à deux and mass hysteria I mentioned. We see it in those whose brains are damaged by injury, drug use, or medical conditions. It's found in some with such severe depression or mania that they confuse what's real. Anxiety takes some to such extremes they will believe things that aren't true. There's schizophrenia, resulting in hallucinations or bizarre delusions; and there's delusional disorder, non-bizarre type, which I think can be the template for the condition I propose, Certainty-Based Unshakeable Reality Distortion Disorder (CRUDD). A person with delusional disorder typically believes something that could be true, like she's pregnant, or someone is in love with him, or her husband is cheating on him. What makes it delusional is how they inflexibly cling to the weakest of evidence. It's the degree of certainty that tips the clinician off that the patient is out of touch with reality. The patient cannot entertain the possibility they could be wrong. This rigid certainty is the core issue, for it is the patient's assumption of absolute truth that has gotten out of hand. The only things we can be absolutely certain of are mathematical truths like two plus two is four. We know them to be true because four is defined as that which two plus two equals. All other knowledge should be provisional, something you hold until better evidence comes along. If you have a belief, no matter how many people share it, try to test it. If you won't, then you've fallen into the trap of absolute certainty. People who make faith claims do not have CRUDD. Many beliefs cannot be falsified, or proven for that matter. A belief in the existence of God is one of them; it cannot be proven or disproven, it can only be taken on faith, or not. Faith is uncomfortable for many people, they’d rather have certainty; and so, they claim certainty when all they could have is faith. The consequences of confusing the two are dire. To have faith means to be willing to live with uncertainty, to take a step into a void when you don't know what will happen; to be willing to say you don't know everything, you could be wrong, and could be making a big mistake, but act on your belief anyway. When you have faith, you're willing to entertain doubts, knowing all the time your belief cannot be proved or disproved. When people become absolutely certain of their beliefs - whether about politics, religion, science, or society - they often become resistant to any contrary evidence. This psychological rigidity can lead to actions that harm themselves or others. Their certainty makes them, and continues to make them, dangerous. There is one important feature about making diagnoses of all kinds that should be mentioned. For something to be a problem, it must cause harm. No harm, no foul. A belief, no matter how unusual, that picks no pocket or breaks no legs should be left alone. For example, when I'm watching a movie, moved to tears or cringing in my seat over something imaginary that appears to be happening, I'm behaving as if it were real; but it hurts no one. In fact, it may be providing me some catharsis or exercising my capacity for empathy. Many deeply held beliefs are perfectly harmless. Most religious faith is like that. If I believe, for instance, that God loves the world, and take it as an article of faith, it can make me a better or happier person, whether it's actually true or not. Indeed, since there is so much in life that can neither be proven nor disproven, maybe a better way to test for delusions is to look at the consequences of them. Now that I've sketched the outlines of Certainty-Based Unshakable Reality Distortion Disorder (CRUDD), as well as what it doesn’t include. I'd like to say something about treatment. Good luck. Medication may help, but the people who are most afflicted by CRUDD won't take it, and the people who think they have it, don't need it. Furthermore, from what I've learned by working with people with any fixed belief is that it's impossible to argue them out of it. I've learned not to try. They become more entrenched the more opposition they encounter. Sometimes, if I hear them out, they walk away with less compulsion to act on their beliefs, but it is just as likely that listening to them will encourage them. The purpose of identifying CRUDD is not so you can tell the patient, it’s to tell the people around him, so they don’t catch it. This is how us mental health professionals, and the media have failed; and how we can do better. For too long, we’ve allowed nonsense, lies, and distortions to go unchecked, permitting a pandemic spread of misinformation. What we need instead is a culture that values intellectual humility - one that can hold strong convictions while remaining open to evidence and dialogue. Only then can we hope to bridge the deep divides that threaten to tear apart our families, communities, and democracy itself. The mental health profession has a unique perspective on how absolute certainty can distort reality and damage relationships. While we must respect diverse beliefs and viewpoints, we cannot ignore when rigid thinking patterns lead to harmful behaviors. As both individuals and a society, we face a critical challenge: how to maintain strong convictions while staying open to dialogue and evidence; how to bridge the gap between faith and certainty; and how to distinguish between beliefs that enrich our lives and those that poison our connections with others. The health of our democracy - and our relationships - may depend on it. You're currently a free subscriber to The Reflective Eclectic. 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Monday, 3 February 2025
Will Your Therapist Even Notice If You Drink the Kool Aid?
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A cake that tastes like summer
on hydrangeas, rural baking competitions, and peach canning ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ...
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