Our feature this week
is about a guy who government psychiatrists have diagnosed with "delusional disorder, grandiose type
Despite the fact that he's never raced competitively, he believes himself a world-class cyclist, and has repeatedly threaten to murder those who seem to have gotten in his way.
But he's also a bright person, by all accounts. So Daily RFT
wondered: If you're delusional, can you realize it? And if you realize it, wouldn't you stop believing the delusion? (A similar thing came up in A Beautiful Mind
, you may recall).
So we interviewed Dr. Alistair Munro
, a professor emeritus in the psychiatry department of Dalhousie University in Nova Scotia, who wrote a book on the subject
. Daily RFT: Is self-awareness possible with this diagnosis? Dr. Alistair Munro
: One outstanding characteristic about the illness is the person's denial of it, although that denial is not always complete.
Often the delusion is all-consuming while the person is fixated on it. But there may be periods when the belief is not so front-and-centre and
then it's sometimes possible to discuss the delusional material. In some
cases, the individual may even concede that the beliefs are unlikely. Nevertheless he/she will always find a justification to defend them
and act them out.
Psychiatrists have suggested that,
particularly with grandiose delusions, the sense of self-importance and
even exaltation may be a perpetuating factor. But I think this illness
basically exists at a biological, rather than a psychological, level.
Is it possible for someone with the disorder to lie about their
delusion? Could they, in theory, pretend not to suffer from it?
DD patients do have the ability to conceal their strange ideas and, at
least for a time, suppress any overt acting-out. However, the more
urgent the beliefs, the more likely is the person to express them, even
in the most inappropriate situations.
Worst-case scenario is when the
person acts the delusions out in an antisocial, violent way, often
having an explanation for this behaviour which he firmly believes but
no-one else can. What effect does intelligence have on
delusions? Specifically, what if the person with this diagnosis is very
intelligent? What kind of behavior would you expect to see?
In general, intelligence affects the content of the delusion rather than
the form of the illness. As you might expect, a highly intelligent
individual will have much more subtle beliefs and justifications and
will be able to act out more subtlely, whereas a person of limited
intelligence will have a simpler, more concrete, set of beliefs.
seen patients from a variety of ethnic and social backgrounds and I have
been impressed by how true the illness's form remains despite
variations in cultural and intellectual background.Just to
confirm what I read in your book: The research and literature on this
particular diagnosis is scant because the diagnosis is so rare? Do you
have any sense on how much more rare it is than the other types
My belief is that the illness is not
that rare but that it is rarely diagnosed.
Many individuals are
sufficiently well held-together to avoid getting into trouble or being
forced to accept treatment. I suspect that a study of loners,
eccentrics and consistent troublemakers would show up a significant
number of cases of DD, as would a study of dictators, demagogues and
unscrupulous tycoons. I think that serial murderers and people who
commit unprovoked mass murders may also have a high proportion of DD
sufferers in their midst.
Also, psychiatrists in general are not
well-schooled in diagnosis and, in addition, have accepted an old canard
from the psychoanalytic school that 'paranoia' (i.e. DD) is untreatable
and occurs in nasty people you wouldn't want to deal with.
I am willing
to bet that our prisons have a significant number of cases within them.
The grandiose form may be misdiagnosed as mania or delirium, but I
think that, again unless the behaviour becomes actively antisocial, it
may just be put down as noisy and a nuisance.