In a previous memo, I summarized the work of two English groups (Tony Morrison in Manchester and Dan Freeman in London) which showed in two separate studies that approximately 75% of individuals who acknowledge delusions also have imaginal intrusions detailing the content of the delusions. This represents a unique opportunity for clinicians to not only understand what is behind the delusions but to get to the core conflicts of these individuals. I am presenting in condensed form how one might go about questioning the meaning of the delusion and then translating that and the solution of the core problem into a remedial intervention. I believe that this is a powerful strategy and believe that our group should start to administer this.
It can be surmised that the delusions have some meaning although it is expressed in a graphic symbolic way. For example, the feeling of being boiled in oil may be related to the person feeling as though he is in a cauldron which is related to real life issues in that he feels helpless and out of control. Certainly, an individual who has the belief that the doctor wants to kill him is reacting to having to take medicine in a symbolic way. Being forced to take medicine is the same thing as having the doctor shoot bullets at him with a gun. The doctor handled the situation by saying, “I do not have a gun but I can help you do the things that you want to do and feel restrained from doing.”The patient then snapped into an adaptive mode and was able to address the real issues in life.
It is apparent that these individuals who have delusions are predisposed, perhaps thru a tangle in their brain cells or a mix up in their neurotransmitters, to express important issues in their lives in these symbolic ways. Therefore, it is possible to address the issues in the individual’s life and thus “suck the juice out of” the delusions.
We hypothesize that the actual imagery of the delusion is precipitated by stress. However, these contents are very useful in understanding the meaning of the delusion. Let us take an example of how you can translate the delusion into a real-life situation that the individual can then confront and work his way through example:
An individual experiences an image of the self-being boiled in a cauldron.
The clinician: “What does it feel like being in the cauldron?”
Patient: “I feel as though I am being suffocated. I feel this in my chest and all through my body.”
Clinician: “I am so sorry to hear that you are having such a hard time. Can you tell me more about what you are feeling?”
Patient: “I feel overwhelmed. I can’t catch my breath. I feel suffocated.”(The clinician repeats what patient says).
Clinician: “You are feeling this sensation right now as you experience this image right?”
Patient: “Yes.” Clinician: “Is there any other time in your life when you experienced this same feeling of being suffocated, unable to breathe and so on?”
Patient: “I feel this way sometimes when I am with my family.”
Clinician: “So when you are with your family at times you start to feel suffocated and unable to breathe and so on?”
Clinician: “What sort of things are going on with your family?”
Patient: “They keep telling me to do this and do that and I hate being pushed around and dictated so much (regarding) what to do.”
The clinician has now arrived at a real life situation that he can help the patient with. In other words, the delusion was a dramatic symbolic demonstration of the feelings the person has when he encounters a particular experience with the family instead of interpreting this experience in terms of the psychological feeling of being suffocated, he translates the feeling into a delusion.