Delusions

If a young person is just beginning to develop early symptoms of schizophrenia, it may be possible to reach her and alter her thought processes before delusions become fixed. Once a delusion is fixed in a patient with long-term schizophrenia, however, you cannot talk her out of believing it.

Like hallucinations, delusions have credibility for people with schizophrenia because there they have no obvious reason to doubt their validity. For example, a person's brain convinces him that he is cold in winter without a coat. There is no doubt the person feels cold. When the same, previously reliable brain tells the person that others are plotting against him, this internally generated misinformation seems just as valid as information about the outside temperature.

The same thought processes that have served a person well for twenty or so years appear to the person to continue to provide reliable information. The delusion seems just as real as valid information provided by the brain. Nothing distinguishes the delusional beliefs from the valid beliefs generated by the brain. There is no reason to doubt one and not the other.

If the person can be reached by positive outside influences, such as therapy, before the “evidence” supporting the delusion becomes overwhelming, it is possible to weaken the basis of the delusion much more easily than if the “evidence” is allowed to accumulate over years of unchallenged illness.

Proof Is Everywhere

A key feature of delusional thinking in a person with paranoid schizophrenia is connectedness. Events that are truly random and unconnected for most people will assume great significance for the patient. If the dominant delusion is that a person is being spied on, then all sorts of random occurrences are incorporated into the delusion. Leave for work and find your tire is flat? It must have been sabotaged by the people who are doing the spying. Hear a noise outside your window? It must be one of “them” moving around out there. Meaningless, random events can be encompassed into other delusions. These events can be unending and only tend to confirm the underlying delusion.

Conviction

Choose a part of your life that is important. It could be your job, a pet, your apartment, or the food you eat. Now imagine someone trying to convince you that that thing does not exist. You know it exists. You interact with it or participate in it every day. Every memory and sense you have attests to its existence. It is important that you understand that the experience of schizophrenia convinces people that their hallucinations and delusions are as real to them as the familiar things in your life are to you.

Fact

Therapy, talk, and reasoning will no more change a person's mind about the reality of her fixed delusion than it could change your conviction that you have a heart. Antipsychotic medication can and does weaken delusional convictions, allowing many patients to begin to examine their thinking processes.

Now imagine that you are absolutely certain other people are controlling you. The prospect is frightening. If you are convinced that someone can read your mind or control your most private thoughts, your reaction is likely to be one of panic. And what if you saw and heard messages delivered just for you in television news broadcasts or in signs in shop windows? It doesn't seem real and you know it is outrageous, but you cannot deny it is happening. To you it is a fact, as real as everything else in your life.

Fright is too weak a description of the feeling you would have if you began to lose touch with reality and you could tell it was slipping away. Most people experience such stresses only by watching horror movies or reading horror stories. For many people with untreated schizophrenia, these experiences are horrible realities. For some, they can happen at any time; for others, they never end.

Paranoia Exercise

Try to remember a time when you misplaced something valuable or something that was important to you. It might have been a favorite pen, a piece of jewelry, your wallet, a watch, or even your keys. Did it ever occur to you, however fleetingly, that someone must have taken it? After all, it was right there where you thought you left it and now it is gone. Try to recall that feeling that someone might have taken it. Usually, you find the item or accept the fact that you misplaced it.

Now imagine that things like this begin happening frequently, routinely. Your brain tells you that weird things are happening to you. This is the same brain that has served you well all your life. It has never betrayed you before. You know those people across the street are talking about you. It is obvious to all your senses that it is happening. What else can you conclude but that something is causing this to happen to you?

You can increase your level of anxiety by realizing that there exist elaborate conspiracies, all directed against you personally. People you see on the street are actually plotting against you. Your life might be in danger because of them. You are 100 percent convinced that the threats are real because your brain tells you it is really happening.

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