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September 25, 2013

BehindTheMedspeak: What is a delusion?

Below, excerpts from Andrew Marantz's excellent September 16, 2013 New Yorker article on how paranoids used to fear the C.I.A. but now have delusions mirroring "The Truman Show."


Between 1995 and 2004, the International Study on Pschotic Symptoms, a survey of 1,100 patients from seven countries, found that the mind supplies the contours of delusions, and culture fills in the details.

The American Psychiatric Association's Diagnostic and Statistical Manual, or DSM, has long stated that a delusional disorder is characterized by "one or more nonbizarre delusions that persist for at least one month." In its first edition, in 1952, the DSM divided delusions into two categories: bizarre and nonbizarre. The former are beliefs that can't possibly be true; the latter are beliefs that aren't true but could be. "I am dead" is bizarre. "Millions of strangers are obsessed with me" is nonbizarre (and, for Ryan Gosling, nondelusional).

DSM-5, the first major revision in 19 years, came out in May, and for the first time the chapter on psychosis no longer emphasizes the bizarre/nonbizarre distinction. Dolores Malaspina, one of the chapter's authors, says, "Rapid expansion of technology raises questions about the reliability between clinicians in determining which delusions are possible and which ones are bizarre." In 2005, the New York Civil Liberties Union canvassed Manhattan and found nearly 4,200 security cameras south of Fourteenth Street. And, given the recent revelations about the N.S.A.'s domestic surveillance, it is hardly implausible to think that the government monitors your every move.

"The Truman Show" did not single-handedly cause Truman delusions any more than "The Manchurian Candidate" caused Cold War paranoia. In the 15 years since "The Truman Show" was released, its premise has increasingly come to seem nonbizarre.

The human brain has evolved to have a vigilant threat-detection system. If that system becomes oversensitive, however, the result is paranoia.

September 25, 2013 at 12:01 PM | Permalink


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Delusions are almost always cultural in context.


Posted by: clifyt | Sep 25, 2013 1:50:41 PM

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