Judith Lautner (judith) wrote,
Judith Lautner
judith

delusions

The other day I listened to This American Life on RealAudio, from their web site (thislife.org). I chose a program called "Desperate Measures", about people who try desperate things to fix a problem or get somewhere. One of the measures involved a psychiatric student who encountered a delusional man who called himself "The Terminator" and who had helped many mental patients escape.

The student recalled something about a therapist named Erickson. When faced with a delusional patient, he had accepted the delusion rather than tried to counter it. So the student decided to try this with this particular patient, who had been on the ward for years, with no improvement. The student asked the man his name. The patient replied, "You can call me the terminator". The student clarified: "The Terminator or Terminator?" The patient again said "You can call me the terminator". The student thought he might have a way in: "Are you really the Terminator or are you actually Arnold Schwartzenegger?"

"How did you know that? Nobody else knows that."

The student proceeded to suggest that the patient might be interested in looking at a new role, more difficult than the Terminator role. Ultimately he led him to the role of "mental patient" and the patient said "I can do that". He did. And he did so well in it that he had no need to continue the delusion and was released within days.

I remembered reading about Soteria and other places where the therapist or lay therapist accepts the delusion, does not deny it or try to rationalize the person out of it. It seems to have a good success rate, from what I have read. The person on the radio show mentioned that the reason the patient took on the Terminator role was that he understood it, he knew that others could relate to it, and he did not know how to relate in his previous incarnation as himself. So by leading him to a different role and helping him to understand how to play it the therapist helped him learn how to play himself ultimately.

That seems one way to look at delusions: the taking on of an identity that makes sense, while your own does not.

One other thing this psychiatry student mentioned (he was not, at the time of the radio broadcast, any longer a student) was that persons working in mental hospitals often do not recognize when they are failing with a case. The old adage, "The definintion of insanity is to continue to do the same thing and expect different results" actually seems to apply to the therapists. If a small dose of meds doesn't help, maybe more will work. If some type talk therapy doesn't work, they give more of the same. Rather than try a completely different tack.

There are many out there who have taken the different tack. For various reasons most of them have been branded as nut cases themselves or not true therapists or something like that. They don't get no respect.
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