How to Reason with Someone Who is Delusional | Is Delusional Behavior on a Continuum?

welcome to my scientifically informed insider look at mental health topics if you find this video to be interesting or helpful please like it and subscribe to my channel oh this is dr. grande today's question is how could someone reason with somebody who is delusional now I've heard this question a few times and different versions of this question and I think sometimes the question is really talking about delusions but I think sometimes what people mean is how do I reason with somebody who's not being rational so I'm going to look at different levels of delusions here so I can really answer kind of all the different types of questions all the different ranges being expressed here right so just somebody who's being irrational all the way up to somebody who actually has a true delusion so first let's define delusion right so a delusional belief is a belief that's maintained despite being contradicted by what is generally accepted to be a rational argument or reality so we also see with delusions that no matter what evidence is presented the individual is not going to change their mind that belief is not going to change so you could have a lot of strong evidence that's being repeated by a lot of people who are experts and it wouldn't make any difference now one of the difficult parts about the question how to reason with somebody's delusional is that when you're interacting with people it'd be hard to know if they are delusional that's really the realm of mental health counselors to figure out if somebody has true delusions going on or not we do know that delusions fall on a continuum though and I'll explain more about that in a moment and that kind of covers more of a range here but when we talk about a true delusion of pathological delusion it's really hard to figure this out from a brief interaction there are alternative explanations to why somebody believes something other than them being delusional for example somebody could be misinformed somebody could just be illogical somebody could have a temporary bias based on strong emotions so for example if somebody is rejected by a romantic partner and they say well that person who rejected me this psychopathic even though there's no evidence to support that the reason they believe that of course could be that rejection could be that's an emotionally powerful topic and we would expect that that belief would be temporary now if the belief were not temporary and that person was rejected by more people like say five or ten people and they said that all those people are psychopathic well that looks more like a delusion than just kind of an emotionally-charged reaction to one situation I think - when considering whether something's delusion or not it's important to keep in mind that the belief itself isn't necessarily really important it's the reaction to contradictory evidence so somebody may believe something like they may be rejected and believe that person's psychopathic then they look at like the results of a mental health assessment and I say okay I guess the person wasn't psychopathic after all so it's really that reaction now sometimes of course the beliefs are important and inherent in the belief we can see that a delusion could be operating but a lot of times especially if we're talking about something a belief that's not quite delusional it's really the reaction to evidence to the contrary so this kind of brings me to the idea of the levels of delusions right I mentioned before delusions fall on a continuum so if we're talking about pathological delusions we're talking about delusions that we see with mental disorders like schizophrenia delusional disorder solutions are sometimes present with major mood disorders especially at the highs and lows so like depression or bipolar disorder so with bipolar disorder some is really depressed they could be psychotic if they're really manic they could be psychotic but we wouldn't expect psychosis kind of in the middle range there if somebody's mildly or moderately depressed or if they're hypomanic again we wouldn't expect delusions or psychosis at that level we see delusions sometimes also with substance use disorders and there are a few other disorders as well that have psychosis and delusions associated with them so I'm using the word delusion here and I'm using the word psychosis here just to clarify psychosis that's a break from reality we see both loosen and illusions potentially with psychosis so loose Nations would be seeing or hearing something that other people can't see or hear and again delusions are that fixed false belief so psychosis really covers both of those areas now when we talk about the types of delusions we see that in the DSM the Diagnostic and Statistical Manual there's a good explanation of the types under the mental disorder delusional disorder we see a few mentioned here Erato manic this is when somebody believes that somebody else is in love with them when it's clearly not true and sometimes they believe that somebody famous is in love with them we also see grandiose type this is when somebody believes they have an insight a talent or ability that they just don't seem to have like they believe that they're a great writer but there's no evidence that they're a great writer or a great singer but again no evidence we see the jealous type and this is almost always manifested through this belief that a spouse or romantic partner is cheating right infidelity is really the core of this type of delusion again typically we also see a persecutory type this is when somebody believes they're being conspired against like the CIA or the FBI is following them or monitoring them this is really the most common type of delusion we see with delusional disorder and this is also a fairly common with schizophrenia the last type I'll cover here is the somatic type and we see that there are bodily sensations or functions involved with this type so again there are a number of different types of delusions with delusional disorder and we also see a specifier with this disorder called with bizarre content so this is when the content of the delusion is not derived through ordinary experiences the example given the DSM is if somebody believes that all of their organs were removed by a stranger and replaced with other people's organs right but there's no scars there's no evidence that that happened now this specifier with bizarre content can be used with any of the different types of delusions so in looking at these types of delusions in delusional sorter we see of course that we're talking about pathology here psychopathology so moving kind of down the line down the continuum toward less dilutional behavior we see this construct called subclinical delusional ideation and we believe this is actually somewhat common so this is when somebody has delusional beliefs but they don't rise to the level of a mental disorder like they're not part of a mental disorder not pathological so subclinical delusional ideation it is characterized really by a lot of the same things we see with pathological delusions like hyper reflexivity this is when somebody has an excessive tendency to focus awareness on themselves so they look at a situation and they'll somehow relate it to themselves even when there's no real logical reason for doing that so they might see like a riot taking place on like television like in another country people are rioting and they might say well this is because of me or this is gonna affect me in some way or there's a conspiracy where this riot is gonna somehow be bad for me so hyper reflexivity is really just taking information around us and thinking well this must involve me somehow we also see a reduced weighting of dis confirmatory information so if you challenge somebody who has a subclinical delusional ideation they're likely not going to look at the evidence which runs contradictory to their belief we also see an increased weighting of confirmatory information so if we're talking about like the jealous type for example now again that's talking about a pathological delusion but we can see kind of the same thing sometimes at the sub clinical level somebody's jealous in a romantic relationship and they might look at like texting and they might say well this text is kind of emotionally related so it indicates infidelity but they'll ignore a large number of texts that have nothing to do with infidelity so they'll take just that one piece of information that looks a little suspicious and kind of magnified put a lot of weight a lot of value on that one bit of information so with all this in mind we see the pathological delusion we see subclinical delusional ideation how can we reason with somebody who's delusional so first it's important remember here we're working with a true delusion if somebody has a true delusion of the pathological level it's extremely difficult if not impossible in some instances to change their mind now the reason I don't say impossible for every situation is I have been in situations where I've been able to change somebody's mind temporarily when they have a pathological delusion like there been situations where I've been working with people and they say you know I think there are cameras planted throughout this office I think looking at your like diplomas on the wall that there's a camera behind that and I'll get up and take the Diploma off the wall and say well you can see here you know take a look right and they say oh okay I was wrong but that might satisfy them temporarily but if they really have pathological delusions like again stemming from mental disorder then often what I've seen is like the next time I would see them again they would believe there are cameras in the office so you might be able to make some changes in the belief temporarily but it's extremely difficult when the behavior is truly delusional so in answering this question about how to reason with somebody's delusional I'm really going to be assuming that we're talking about subclinical delusional ideation and not pathological delusional ideation so here's some thoughts on kind of reasoning with somebody who has a delusion I'm going to use a particular delusion as an example for this and and I've used this in Prior videos so some of you may recognize this there's this delusion about the alien lizard people where individuals believe that the government and Hollywood have been infiltrated by reptile humanoids now I know this is more consistent with a pathological delusion like one from schizophrenia or delusional disorder but it's really one of my favorite delusions so I'm gonna go ahead and use it here as if it could be subclinical and I guess technically it could be right i guess somebody could believe that there are alien lizard humanoids in Hollywood and government and it not be a dilution that's really held at a strong level right so technically this could still work but it is important now that usually if somebody believes an alien lizard humanoids I would I would wonder if that would really be subclinical much of the time okay just something to point out that's a let's say a belief that deviates fairly strongly from the evidence that we have available about the nature of humans and you know how lizards could be living among us alien lizards seems pretty unlikely so I'm just gonna use the alien lizard people though for the example so some tips here on how to talk to somebody how to reason with somebody who believes in alien lizard people okay so what we know is that it's important to intervene early when somebody is forming a belief that could be potentially delusional there's actually evidence that supports this if you get in there early before their belief fully forms you'll have a lot better chance of convincing them that their belief is incorrect once that belief fully forms it gets much more difficult so it's not about just how to reason it's about when to recent as well if you see that somebody is starting to take on beliefs that are moving them toward like delusions get in there early if you want to change their beliefs another piece here would be don't judge I don't say somebody is not smart or has poor reasoning skills or has an ulterior motive right judging is just not a successful strategy in trying to reason with people in general so somebody says look I believe in alien lizard people don't have some sort of strong reaction right just hear them out this is my next tip right just hear them out take the time and let somebody explain to you why they believe in alien lizard people or whatever the delusion is and again don't judge just listen to it it's not likely that somebody just explaining their beliefs is gonna make those beliefs dramatically stronger right there's not much risk of that happening they're just trying to explain what their position is and by you hearing them out that actually kind of wins some credibility that earned some credibility for you and it shows that you're not just making a snap judgment like it shows that you're not rejecting the idea of the alien lizard people without thinking it through so after intervening early and refraining any type of judging behavior and listening to them then what you want to do is ask what evidence would change their mind okay so you believe that there are alien lizard people okay what evidence would change your mind if you saw experts testify that there were no alien lizard people if you could go up to the people that you thought were alien lizard people and talk to them and again kind of just see them in person would that help what evidence could change your mind if they say nothing that's really more indicative of a pathological delusion again only a mental health clinician could determine this but I'm just saying if somebody says that nothing's gonna change their mind that's not a great sign in terms of reasoning with them also if they say well yes there's evidence that would change my mind but you look at it and it's clearly impossible to obtain right so if somebody believes that the moon landing was faked and you say okay I doubt that's true but what evidence would change your mind what could you see that could make you believe that the moon landing was something that really happened and they say well I want to go into NASA and I want to have access to all their computers right that's never gonna happen that's impossible to obtain so again not a great sign in terms of how well somebody could be reasoned with on that point so my next thought here on how to reason in this situation would be to present your opinion but in a flexible way that shows that you're not completely sure right so you're willing to believe that there are alien lizard people but you're not convinced and here's your opinion on the subject all right so you're keeping that kind of small window open where okay I'm willing to look at your side of the story I'm willing to look at the evidence but here's what I believe based on the evidence try to avoid making it how many people believe something this is usually not very convincing for people who have subclinical delusional ideation right so if you say well 99% of people believe there are no alien lizard people that's not really the best argument I would focus more on actual evidence like for example if you didn't want some evidence that there were no alien lizard people consider something and this is just one bit there's actually a lot of evidence of course that that's not true so consider this idea that car accidents happen all the time and if the alien lizard people are a stable percent of the population they're going to be involved in car accidents too so if they're taken by ambulance to the hospital and they're x-rayed and they're treated if they were really lizards somebody would pick up on that right physicians would say gee this physiology doesn't look human so yes you could make the argument well maybe alien lizard people or superior drivers and don't get involved in accidents but even good drivers can be run into my another car right even a good driver could be like a stop sign and just hit by another car so alien lizard people aren't immune to what happens in traffic so that could be just like one area of evidence that you could explore so you'd present that without making it about how many people would also believe that but just here's the evidence here's why I think there probably are no alien lizard people another key to reasoning here would be don't insert emotion if you're really angry at somebody or even kind of a positive motion like if you're laughing at them for their belief that's still emotion that's like happiness that's not a good idea if you're trying to reason with somebody you're only going to make it seem like you're biased by the emotion so it's better in this situation to be unemotional just to be logical and lay out the evidence in a reasoned way and this is the last kind of thought I have on reasoning with somebody who's delusional and this is actually really I think good advice for negotiating or reasoning with anybody leave them or win right a lot of times what happens when we're talking to somebody is that we cause a situation where if we're right and they're wrong then they look like they have lost right we haven't left them an opportunity to win you have to leave people or win when trying to reason with them so for example in this situation you could say look you have really thought this through and you've had some interesting insight into this area and you've thought of things that didn't occur to me right which kind of makes sense right I didn't occur to you that there could be alien lizard people this topic is important and I'm really curious to see where you come down on this issue after you looked at this other evidence like for example the evidence with the car accidents and how the lizard people would be discovered that way so what you're really saying is I believe your insightful and your smart and now that you have new information I'm excited to see how you're going to process that and I'm excited to continue this dialogue so now they could come back to you and say you know what I've been thinking about this and I think that you made a good point with the car accidents but I also found other evidence that supports this argument that there are no alien lizard people so now really you know you've just clearly left them a win they could come back and be kind of excited to tell you that they've not only changed their mind but they found other evidence that supports that point of view as well so if you make it about winning and losing very hard to change somebody's mind this is again whether you're talking about delusions or somebody who's not delusional at all it's actually a sign of flexible and logical thinking when somebody can have a strong opinion on a subject and then look at evidence and come to a different conclusion it's not a bad thing it's a good thing and we want to encourage that so that's kind of my last thought there for just ideas of how to reason with someone who's delusional so as I talk about this topic I know there's gonna be a lot of different opinions and I realized that delusional behavior even if the subclinical level can be very challenging to deal with so again I would just say that mental health clinicians are really best suited to deal with individuals who are struggling with delusions and it's important not to get really too far into it if you see that somebody has kind of really strong symptoms right leave that to the professionals I know that sometimes that's really difficult because you might be in a romantic relationship with somebody who has delusions or has subclinical delusional ideation so it's really hard to get away from them and you have to really find some way to relate to them right it can't always be in a clinicians office they may receive treatment for delusions but again you have to live with them you have to interact with them on a daily basis so maybe these kind of ideas I had are something you can take to a mental health clinician and you can see if these ideas make sense to that clinician in terms of reasoning to the person you're really thinking about the person you're in a relationship with so kind of a complex area and an area where we need to really consider the value of professionals and what they can bring to a situation but again I know there gonna be a lot of opinions if you agree or disagree with me please put those opinions in the comments or if you have other thoughts again please put those in the comments again I hope you found this description of how to reason with somebody's delusional or somebody who's not rational to be interesting thanks for watching

Channel: Dr. Todd Grande

Views: 98,233

Rating: 4.9207225 out of 5

Keywords: Delusional, irrational, psychosis, hallucinations, schizophrenia, delusional disorder, major mood disorders, major depressive disorder, bipolar disorder, substance use disorders, erotomanic, grandiose, jealous, persecutory, somatic, with bizarre content, diagnostical and statistical manual, counseling, mental health, delusions, break from reality, conspiracy theories

Id: n1GxFKtxF-I

Length: 21min 5sec (1265 seconds)

Published: Sat Mar 23 2019