World Mental Health Day 2008 at Kozhikode (Calicut)

My earlier post on the same program on 11th October gives the details of the program. The last photos show Drawing competiton ans Quiz program on Mental Health conducted for school student as part of the WMH Day.

More on delusions ---Form and content.

Another distinction made by psychiatrists is between 'form' and 'content' of the symptom. A person believes that neighbors are plotting to harm or kill him. He may have some reasons for this, as there were some disputes between them and his family over boundary of the plot or something else. But of all the family, only this person believes that there is a plot against him. The other family members might say "It is true that we are not on good terms with them. But that was because our father had a case against them in the court over the boundary. Now that is over, but we are not very cordial to them. Our children play and talk with each other. We do not see any reason why they should conspire to harm or kill us. They are ordinary people without such malicious intent". Now what can the psychiatrist do. He looks at the form and the content.

Content is explainable (explaining and understandability are term used in phenomenological psychology) from the antecedent event of previous conflict. It means that you can reasonably explain the circumstances and the logic behind the belief. But the form (the false unshakable belief, which is not shared by his family members - that is a delusion) is not understandable (understandability is the ability to empathize with him based on the person's situation). Why does he believe so, when even his father (who filed the case) does not believe so ? This is how the belief is labelled as a delusion. Presence of a delusion is conclusive proof of a psychotic illness. Now this is done by looking at other parameters. The person may get one of the psychotic diagnosis - Delusions (paranoid)psychosis, paranoid schizophrenia, or mood disorder (either mania or depression) with psychotic features.
There are two aspects in analyzing any symptom. The Dynamic psychology, which explains the content of the symptom - Why this person is showing this particular symptom now ?. This is based on psychological theories - psychoanalysis or others.
The other is the phenomenological school. The task of Phenomenology is to describe any phenomena that is manifesting in a person's mind by making him to describe it in as much detail and accuracy as possible. This helps to explain the belief baesd on cause and effect logic. Ability to understand and empathize will help to form the therapeutic alliance. In the case of delusions, explanation may be possible based on antecedents, but the form, that is, how a man could be convinced of a patenlty false ideas is not understandable.

Freud and psychoanalysts stressed on the dynamic line of thinking. Emil Kraepelin (the father of psychiatric classification) stressed on accurate description and labelling of the symptom. It was Karl Jaspers (psychiatrist who later turned a philosopher) who highlighted the importance of the use of Phenomenology (a branch of existential philosophy) in Psychiatry.
The dynamic approaches were very popular as everybody wanted an explanation for the errant behavior. But this approach met with only limited success as a therapeutic tool. Later most of the underlying psychological theories used to explain behaviors fell into the category of pseudoscience, as empirical evidence for support was lacking. The current classification systems (both DSM - IV TR and ICD - 10) give more emphasis to accurate descriptions of symptoms. This is why their manuals become a list of symptoms. Used sensibly, this helps to increase objective agreement between different clinicians seeing the same patient. But superficial approaches can do more harm than good.
One more issue is the role of insight. A person with a delusion does not have the insight that his belief is false, or that it does not hold up on objective scrutiny. This is why Esquirol (is it not him ?) remarked "Delusions are the hallmark of insanity". Hence presence of a delusion merits the diagnosis of psychosis (Insight is lost in psychosis, contrary to neurosis). So Sashi's fond hope that a person with a delusion will voluntarily seek treatment does not happen usually. On the contrary they turn hostile to anybody who attempts to correct their belief. Yesterday I Happened to see a lady send by the CJM court Thalassey, who was abusing even the accompanying police constables alleging that they are also a party to the big conspiracy against her.

On Delusions....

It is indeed heartening to follow the discussions on the basis of psychiatric diagnosis, and the relationship between creativity and mental illnesses. Let me go into a little more details on delusions. A delusion is defined as a false and unshakable belief that is not explainable by the persona's socio cultural factors. It can be explained
1) False belief - the belief in question can be shown to be false by objective methods or verification by others.
2) Unshakable - The person refuses to accept any proof contrary to his belief and holds on to it.
3) Not explained by socio cultural factors - This criterion may have been added for social or political reasons than based on science. The most difficult issue at that time may have been 'how to keep religious belief out of the domain of psychopathology'. Without this criterion it will be difficult to do this. Cultural beliefs (for example, a local belief that God resides on top of a nearby mountain) may have to be labelled as psychopathology.

Richard Dawkins explains why he chose the title of his book as 'The God delusion'. He admits that delusion is a technical word used by psychiatrists, but justifies his title seeing no reason not to call belief in God as a delusion. We need not discuss this further. What I am trying to convey is that psychiatric diagnosis have a social/ political/ cultural angle to it and safeguards should be there to prevent abuse of psychiatry by totalitarian regimes.