We often view delusion as a manifestation of an intoxication state, endogenous or otherwise. This is something worth critical analysis (1). It doesn’t necessarily seem to be the case that delusion is a product of chemically-induced disorientation, but instead there could be hallucinogenic-inducing levels of stress involved in maintaining a belief system that opposes the consensus, especially when such beliefs are highly persecuted.

First, let’s explore a biological element that is crucially important to these points.

As an example, there are correlates shared by schizophrenics and transgenders, that both of these demographics have an occasional immunity to optical illusions (2). The relation of schizophrenia and optical illusions is a topic explored here before, in both The Sanity Illusion and Flicker. The argument here is that NMDA receptors are involved in illusion formation and that disrupting this mechanism could shut down one’s ability to form illusions. A major current theory of schizophrenia suggests that hypoactivity of NMDAr could explain the disorder’s symptoms (3), which are found to be extremely similar to NMDAr blocking drugs like PCP, ketamine, and DXM. Scott Alexander from the popular blog SlateStarCodex, and writer of the article attempting to explain the link between transgenderism and illusion immunity (2), has come to similar conclusions about the biological factors involving illusions as I have posited (NMDA receptors). Check out Desummation to get an in-depth overview of the proposed biology.

I’ve recently been arguing for an expansion of the glutamate hypothesis of schizophrenia in Dynorphin Theory, which functions as a dynorphin hypothesis of schizophrenia. Dynorphin is important because it links together many areas of research on schizophrenia into one nice package. Dynorphin is linked to trauma (4), pain aversion (5), dysphoria (6), depression (7), and anxiety (8). Dynorphin also blocks NMDAr (9) and functions as the endogenous form of the potently hallucinogenic drug Salvia (10).

Since trauma and stress may induce dynorphin activity (7), it is reasonable to wonder if stress and trauma might be hallucinogenic. Due to the way transgenderism is stigmatized so widely, it should be expected that many of them live lives of social struggle, identity stresses, probably parental issues, and so on. If we are to predict which demographics would experience the most predictably traumatic lives, it seems transgenders would be pretty high on the list. Those with a ‘delusional’ belief system might experience similar stigmas and social struggles, but that doesn’t mean that those who experience hallucinogenic stress are always having ‘delusions’. Those who are transgender are not necessarily trans due to psychotic disorder.

Does fear promote delusional thinking?

Fear is an endogenous intoxication state of sorts. Are we ever not under the spell of some kind of mood high? 

Those who are in fear-biased states of mind may be prone to forming judgments that contradict what is accepted by consensus, assuming the consensus isn’t also fearful. This doesn’t necessarily refer to entire ideological systems or conspiracy theories though, rather it seems more likely that someone who forms a judgment based on the idea that some stimuli is threatening will diverge in judgment with those who believe a stimuli is non-threatening. So as one who is schizophrenic becomes increasingly worried, paranoid, and threatened, their judgments should be expected to diverge. This is critically different from threat causing one to form the idea that the earth might be flat. Although, someone with divergent ideas about reality such as flat earth theory might be predisposed to experience very high levels of social stress, and when scared might be notably far off from consensus and appear even worse to outsiders. As fear increases, dissociative and amnesiac effects may begin to seep in. This may reach a point where judgments are made in a temporarily less educated state of mind, due to the decreased access to memory.

But what are delusions really?

Let’s look at the Wikipedia definition of delusion:

A delusion is a firm and fixed belief based on inadequate grounds not amenable to rational argument or evidence to contrary, not in sync with regional, cultural and educational background. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, or some other misleading effects of perception.

This definition includes deviance from cultural, educational, and regional consensus. Consensus ideas seem to be equally as irrational as non-consensus ideas but it will be much easier to build a consensus that non-consensus perspectives are crazy, wrong, delusional, whereas consensus ideas will be defended, accepted, and widespread. The rate of wrong ideas might not differ between the schizophrenic and the mentally healthy, but the rate of non-consensus thinking might. When we assess whether someone is delusional or not, we often dismiss religious ideas or popular cultural ideologies, rather than assessing whether ideas match up to the scientific evidence or philosophical critique. We are much more forgiving to errors of thinking that resonate with the masses, because we view this as a systemic problem in education and access to good information.

Worse, the misinformed masses will be far less equipped to assess the philosophical nature of delusion as a concept (11) when applying their beliefs about delusions to those they label as psychotic. Instead, they will see strange unpopular opinions and misinformation as delusions that emerge as a consequence of unknown chemical origin. But it doesn’t appear to be the case that any of us are born with critical thinking skills or higher education preprogrammed into our minds. Those who are uneducated engage in fallacious reasoning all the time, to the degree that we must actually teach courses on how not to. To assess delusional thinking in mental health based on the criteria of accuracy of information or critical thinking skills seems, well, uncritical.

Those who believe in such unpopular opinions as flat-earth theory will be more at-risk for becoming alone. Those who are alone will struggle to assimilate to a culture in which they have restricted access to. There is simply nothing to assimilate to in their world, it is socially and culturally deprived. This would promote further deviation in the individual’s information pool because they are not acquiring information from popular culture or peers, but probably continuing down the only path they’ve known yet, the one that led to their isolation in the first place. This leads one into a state of social defeat. 

Wikipedia defines social defeat as such:

The social defeat model has been extended to include observations of human aggression, bullying, relational aggression, chronic subordination and humiliation.

At this point, it’s worth noting that there is a social defeat hypothesis of schizophrenia (12, 13). It was posited after noticing that stigmatized and less fortunate demographics had higher rates of schizophrenia. Clearly, transgenders are a stigmatized group which fits into this hypothesis well, also aiding in making sense of their immunity to illusions. 

Note: Did you know that solitary confinement is considered traumatic and produces nearly all symptoms of schizophrenia (14)? Even the known genetic correlates that show up in GWAS are for loneliness (15) and trauma sensitivity (16) and solitary confinement is debated to be cruel and unusual punishment, i.e. traumatic treatment.

Furthermore, dynorphin mediates the effects of social defeat stress (17) and upregulates from early childhood social isolation (18), both satisfying the social defeat theory of schizophrenia (12, 13). The link between social defeat and schizophrenia may represent how crucial social support is for dealing with symptoms of stress, potentially from any cause. If you are widely persecuted, it is likely an even worse stressor than many others because not only can you not get social support, but you have social threat and offense.

Schizophrenic symptoms have been found to associate with social patterns throughout the literature. Experimentally-induced social threat was found to bring on paranoia (19). The severity of symptoms in schizophrenia correlates with a lack of friends (20). Frequent interactions with friends was found to be crucial to recovery in schizophrenia, more than the self-reported quality of friendships (21), although this likely doesn’t mean that abusive friends are better than none. Lastly, reducing loneliness reduces paranoia while inducing loneliness increases paranoia (22).

This brings us to the problem of:

Persecution

Those who believe in unpopular opinions and transgenders both experience persecution which could drive someone down a life path of greatly increased risk of being abused, bullied, rejected, unpopular, and ultimately traumatized and stressed more than their ‘normal’ peers. This path of stress may lead to isolation and a lifestyle that is considerably similar to the conditions that produce schizophrenic symptoms, such as solitary confinement. This is important to point out because those labeled schizophrenic are usually said to have delusions of persecution. 

There is a useful analogy that can be made with the deer. Deer are a prey species and they are often stereotyped as fearful, cautious creatures. It makes sense for a deer to be paranoid of predation because of the survivalist conditions they live in. The deer must be ready to react to predators at the first sign of notice. The conditions of life for the deer is very much like trauma. They observe their friends and family die at the hands of monsters throughout their life.

Schizophrenics are a prey species.

The schizophrenic is paranoid of being poisoned or abused often times. We often view the schizophrenic as irrationally afraid or paranoid. Even presenting the idea that prey species are schizophrenic to my friends, they remarked that it is reasonable for the deer but not the human. This is not a fair assessment. If we are to conclude that the schizophrenic is irrational, then the deer is definitely ‘irrational’ as well, in that if I approach the deer with no intent to harm or murder it, the deer will still be afraid of me, it is inaccurate. The deer has delusions that I am a monster. There is no evidence that I am a monster for the deer, much like the schizophrenic may lack evidence that I am a threat. If one is bullied or abused frequently, it is not irrational to predict a recurrence of such problems. 

Could exploring unpopular ideas drive one mad?

galileo

Fun fact: Socrates reported some sort of inner voice which he obeyed. Because it didn’t tell him to escape his fate, he chose to accept his persecution and death, despite being given an opportunity to escape the city (23). There is an interesting paper published exploring whether Socrates could be labeled schizophrenic (24).

Philosophy brings into question whether truth can be attained at all. Consider this blog post titled: How Do You Know What You Know? While I won’t make an argument on whether truth can ever be attained, I do consider epistemological solipsism to be valid. It is the idea that events occurring outside of our minds are unverified, potentially unverifiable. For example, we could be in a lonely simulation in which no one else is conscious, only us. Since we cannot even confirm that other people aren’t scripted AI (an update on the Truman show delusion) or events occurring in external reality, how can we conclude any other information that depends on the truth of external events? There is an interesting paper exploring how solipsism is a common theme in schizophrenic delusions (25). Another paper suggests that excessive thinking could be a model for schizophrenia (26).

Trying to pin down what makes schizophrenics, schizophrenic seems very problematic when assessed critically. What seems to be the case is that stress is hallucinogenic at some threshold, probably near traumatic levels of stress or even just sleep deprivation (27). Silly ideas about how reality works can lead one into a tragic life of rejection and ostracization, most likely even by one’s own family. Ostracization by one’s family and peers is traumatic. There are genes that make one suffer worse from traumatic stress and loneliness. A huge amount of people turn schizophrenic under conditions of traumatic loneliness: solitary confinement.

The nature of psychosis shouldn’t inherently include delusional belief systems, although this may be one quick path to the states we recognize as psychotic. In this sense, holding a belief system that is unacceptable to the public (delusion) may be able to induce other psychotic effects, such as hallucinations. Though, we must also acknowledge the degradation of one’s judgment that may occur due to the amnesia induced by fear-states. This is distinct from long-term ongoing delusional frameworks for reality and this distinction is important. Both the fear-induced haze and the ongoing erroneous belief systems may sing together in a duet of wrongfulness to create the experience we colloquially refer to as psychosis.

Special thanks to the two patrons, Abhishaike Mahajan and Charles Wright! Abhi is also the artist who created the cover image for Most Relevant. Please support him on instagram, he is an amazing artist!

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The discussion that evolved out of the SlateStarCodex subreddit was suberb. I am really enjoying the way this dynamic conversation with Redditors is growing. Thank you all! You may also find discussion in the comments just below, on this very article.

Delusion1 (2)

CITATIONS

  1. Cermolacce, M., Sass, L., & Parnas, J. (2010). What is bizarre in bizarre delusions? A critical review. Schizophrenia Bulletin, 36(4), 667-679.
  2. Alexander, S. (2017). Why Are Transgender People Immune To Optical Illusions? SlateStarCodex
  3. Moghaddam, B., & Javitt, D. (2012). From revolution to evolution: the glutamate hypothesis of schizophrenia and its implication for treatment. Neuropsychopharmacology, 37(1), 4-15.
  4. Bailey, C. R., Cordell, E., Sobin, S. M., & Neumeister, A. (2013). Recent progress in understanding the pathophysiology of post-traumatic stress disorder. CNS drugs, 27(3), 221-232.
  5. Massaly, N., Copits, B. A., Wilson-Poe, A. R., Hipólito, L., Markovic, T., Yoon, H. J., … & Klaas, A. (2019). Pain-induced negative affect is mediated via recruitment of the nucleus accumbens kappa opioid system. Neuron, 102(3), 564-573.
  6. Land, B. B., Bruchas, M. R., Lemos, J. C., Xu, M., Melief, E. J., & Chavkin, C. (2008). The dysphoric component of stress is encoded by activation of the dynorphin κ-opioid system. Journal of Neuroscience, 28(2), 407-414.
  7. Knoll, A. T., & Carlezon Jr, W. A. (2010). Dynorphin, stress, and depression. Brain research, 1314, 56-73.
  8. Crowley, N. A., Bloodgood, D. W., Hardaway, J. A., Kendra, A. M., McCall, J. G., Al-Hasani, R., … & Lowell, B. B. (2016). Dynorphin controls the gain of an amygdalar anxiety circuit. Cell reports, 14(12), 2774-2783.
  9. Chen, L., Gu, Y., & Huang, L. Y. (1995). The mechanism of action for the block of NMDA receptor channels by the opioid peptide dynorphin. Journal of Neuroscience, 15(6), 4602-4611.
  10. Maqueda, A. E., Valle, M., Addy, P. H., Antonijoan, R. M., Puntes, M., Coimbra, J., … & Barker, S. (2015). Salvinorin-A induces intense dissociative effects, blocking external sensory perception and modulating interoception and sense of body ownership in humans. International Journal of Neuropsychopharmacology, 18(12), pyv065.
  11. Kiran, C., & Chaudhury, S. (2009). Understanding delusions. Industrial psychiatry journal, 18(1), 3.
  12. Selten, J. P., van der Ven, E., Rutten, B. P., & Cantor-Graae, E. (2013). The social defeat hypothesis of schizophrenia: an update. Schizophrenia bulletin, 39(6), 1180-1186.
  13. Van der Ven, E. (2017). The social defeat hypothesis of schizophrenia: an update. European Psychiatry, 41(S1), S66-S66.
  14. Grassian, S., & Friedman, N. (1986). Effects of sensory deprivation in psychiatric seclusion and solitary confinement. International journal of law and psychiatry, 8(1), 49-65.
  15. Gao, J., Davis, L. K., Hart, A. B., Sanchez-Roige, S., Han, L., Cacioppo, J. T., & Palmer, A. A. (2017). Genome-wide association study of loneliness demonstrates a role for common variation. Neuropsychopharmacology, 42(4), 811-821.
  16. Duncan, L. E., Ratanatharathorn, A., Aiello, A. E., Almli, L. M., Amstadter, A. B., Ashley-Koch, A. E., … & Bradley, B. (2018). Largest GWAS of PTSD (N= 20 070) yields genetic overlap with schizophrenia and sex differences in heritability. Molecular psychiatry, 23(3), 666-673.
  17. Donahue, R. J., Landino, S. M., Golden, S. A., Carroll, F. I., Russo, S. J., & Carlezon Jr, W. A. (2015). Effects of acute and chronic social defeat stress are differentially mediated by the dynorphin/kappa-opioid receptor system. Behavioural pharmacology, 26(7 0 0), 654.
  18. Karkhanis, A. N., Rose, J. H., Weiner, J. L., & Jones, S. R. (2016). Early-life social isolation stress increases kappa opioid receptor responsiveness and downregulates the dopamine system. Neuropsychopharmacology, 41(9), 2263-2274.
  19. Saalfeld, V., Ramadan, Z., Bell, V., & Raihani, N. J. (2018). Experimentally induced social threat increases paranoid thinking. Royal Society open science, 5(8), 180569.
  20. Giacco, D., McCabe, R., Kallert, T., Hansson, L., Fiorillo, A., & Priebe, S. (2012). Friends and symptom dimensions in patients with psychosis: a pooled analysis. PLoS One, 7(11), e50119.
  21. Bjornestad, J., ten Velden Hegelstad, W., Joa, I., Davidson, L., Larsen, T. K., Melle, I., … & Bronnick, K. (2017). “With a little help from my friends” social predictors of clinical recovery in first-episode psychosis. Psychiatry Research, 255, 209-214.
  22. Lamster, F., Nittel, C., Rief, W., Mehl, S., & Lincoln, T. (2017). The impact of loneliness on paranoia: An experimental approach. Journal of behavior therapy and experimental psychiatry, 54, 51-57.
  23. Socrates, Plato, Translated by Jowett, B. (380 B.C.E.). Socrates and Moral Theory and Apology.
  24. Skodlar, B., & Jørgensen, J. P. (2013). Could Socrates be diagnosed within the schizophrenia spectrum? Could schizophrenia patients be considered in the light of Socratic insights?. Psychosis, 5(1), 17-25.
  25. Humpston, C. S. (2018). The paradoxical self: awareness, solipsism and first-rank symptoms in schizophrenia. Philosophical Psychology, 31(2), 210-231.
  26. Yang, L. H., Phillips, M. R., Lo, G., Chou, Y., Zhang, X., & Hopper, K. (2010). “Excessive thinking” as explanatory model for schizophrenia: impacts on stigma and “moral” status in Mainland China. Schizophrenia bulletin, 36(4), 836-845.
  27. Waters, F., Chiu, V., Atkinson, A., & Blom, J. D. (2018). Severe sleep deprivation causes hallucinations and a gradual progression toward psychosis with increasing time awake. Frontiers in psychiatry, 9, 303.

4 thoughts on “Delusion

  1. Literally everybody who believes in a religion could be considered clinically insane if analyzed by objective third parties, at least according to Wikipedias parameters. Yet because the religious delusion is POPULAR, we “give it a pass” and don’t lock up all the religious people. Apparently it’s totally OK to be completely insane and have beliefs that dont have a single scrap of evidence, as long as those delusions are shared by the masses.

    Yet if *I* say that on aggregate colonialism had good long-term outcomes for the colonized societies, people think I’m a racist nutcase, even though I can show far more evidence supporting my view than a religious person could show to justify their belief in God. Isn’t that weird?

    It seems obvious to be that any society which possesses such a double standard is deeply sick and in need of correction.

    Like

    1. Would you consider Einstein delusional for believing that quantum physics is rubbish? We also have no access to actual truth in reality. The notion is almost completely absurd. If we are honest we should all be mostly unsure about whether humans are real.

      We can argue which ideas are better to have, but to diagnose people with a rare disorder on the basis of having incorrect views seems wrong. We have not really uncovered much actual truth about reality and have very little evidence about anything to have any beliefs. We cannot even believe that our doctors aren’t imposters who found a way into the hospital and stole outfits to play doctor. There is no reasonable evidence that our doctors are doctors. We could refute the weak evidences such as “well look there’s a degree hanging in his office and their name tag says doctor” but obviously this is very weak.

      But society wouldn’t operate if we were truly skeptical as we are in science or philosophy.

      Every single person would eventually fit into the notion of “delusional” at some point.

      Like

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