My leg shook as I sat across from the psychiatrist in the children’s psychiatric unit. He listed off some number of medications asking if I’d tried them until he found one I hadn’t.

“But, all of those made me sick.”

“I’m sorry, Ms. Gerlach, but you are very delusional.”

I was only 13. I wondered why he was asking me what medications I had taken (he had prescribed most of them). At once credited and discredited, I felt demoralized.

 

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I asked myself, how could someone tell me that my reality is wrong? It's a rabbit hole. Everyone's version of reality is a little different. Later, my diagnosis changed. Diagnosis is subjective. Just like reality. My experience has given me a greater appreciation for that. I think we are more in danger when we are very certain of a reality, rather than when we are questioning things.

What Is Delusional?

In psychiatry, delusion is a common term delineating when a person’s understanding of reality has deviated from consensus reality. In popular culture, it is often used as an insult. In both settings, being labeled as delusional has a sharp bite. It is as if some groups of people are intimately in touch with what is true while others are not.

Here’s the question: Who determines what is real and what is delusional? Mental health professionals? I have a lot of respect for fellow mental health professionals, but we aren’t gods. We do not have a monopoly on the truth.

Integration Disorder

In Japan, a condition has been identified when it is named togo shitcho sho a term that translates to integration disorder (Sato, 2006). The disorder is associated with difficulties in integrating information about the world such as sensory data. It’s associated with fixed beliefs, voices, visions, and thought disorganization.

Integration disorder means that we are all integrating information all the time, yet there is an experience some people have wherein the disorganization becomes especially marked. In America, we call this psychosis. Many have advocated that we adopt a similar descriptor for the condition, finding it both more accurate and more kind.

Recovery-Oriented Cognitive Therapy

The term delusion does not foster a therapeutic relationship. In recovery-oriented cognitive therapy, a therapy originally designed for individuals with psychotic disorders, the use of the term is discouraged (Beck and colleagues, 2021). The alternative, unusual beliefs, is given. This term emphasizes the esoteric nature of the belief rather than its basis in reality.

Others have suggested a term of fixed beliefs emphasizing another aspect of the phenomena, that these beliefs tend to be especially unchanging. Indeed, it is often the fixed quality of these beliefs, the preoccupation they spark, that ignites difficulties.

On Popular Use

Anyone who has walked through this experience can attest to its intense and sometimes damaging nature. When used outside a clinical context, it is exploited. There are many other insults and words to be used. Every time it is used as an attack it hurts not only the person attacked but spreads a narrative of individuals who have had such an experience as being other and incompetent. Rarely is it used appropriately in a popular context.

Perhaps the word ought to be replaced altogether, but if nothing else, it is time we stop using it as an offense.