Delusions of Insignificance

To help others experiencing psychotic delusions, he relies on his own theory of what delusions may mean. In an analysis of 20 delusional experiences, all described by sufferers in the first person, Mr. Greek identifies four story lines.

Among them are the rescuer (on a mission to save a particular group); the self-loathing person (lost in a sense of extreme worthlessness); the visionary (on a journey to spiritual realms to bring back truth); and the messianic (out to transform the world through miracles, or contact with deities) — the last of which is his own psychosis story.

This is from “Finding Purpose after Living with Delusion” a recent New York Times profile of Milt Greek, a schizophrenic who gets by in part by channeling his delusions into charitable work. Greek has also started to write a first-hand account of his experience of the disease. A theme of this account is that delusions are extrapolations of real experiences and emotions.

I find this compelling because it is a possible explanation as to why there appear to be consistent motifs that reappear in schizophrenic delusions. It’s not clear how many of these are more-or-less inevitable products of the disease (paranoids are naturally going to focus on God and the CIA because because of a general consensus as to who wields power), and how many are culturally variable. (Has anyone made an inventory of the household items mind-controlling waves are most likely to emanate from? How does this vary over time, and in different parts of the world?) More generally, what is the structure and taxonomy of schizophrenic delusion? First hand accounts would be a welcome way to shine light on this question. (Elyn Saks’ The Center Cannot Hold is a starting point. I’d love it if people can suggest others.)

One structural feature is self-importance. From my reading and talking to people, I get the sense that a common feature of delusion is an overestimation of one’s importance. The classic paranoid belief is that vast government agencies are devoting effort to interfering with your life, when it is more likely that vast government agencies are unaware that you exist. People with religious delusions suppose that God has picked them out of their six billion or so fellow human beings as being uniquely important.

If delusion were a random phenomenon, you’d expect the distribution about the self-importance axis to be symmetric: for every person with a delusional overestimation of their importance there’d be someone with a corresponding underestimation. And yet this appears not to be the case. I’m not familiar with cases in which a person grows up religious and then with the onset of schizophrenia becomes convinced that God does not exist.  Or someone who believes aspects of life that really are structured with them in mind–hierarchies at work, relationships with family members, bank statements–are just the products of complete happenstance, and have nothing to do with them personally. Nobody has delusions of insignificance.

Assuming I’m right about the surface phenomenon, there are a few explanations for it: 1) people do in fact have delusions of insignificance but these manifest as affectlessness and depression and so are harder to recognize as delusions 2) the asymmetry is an indication of a deep feature of psychological illness or maybe human psychology in general 3) in the big picture we’re all so insignificant that you can never go wrong by underestimating your importance.

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