Maintaining a relationship with a loved one who may be experiencing delusions is like walking on shaky ground. Every step you take could land you in an argument or adversarial position. Whether you intend to argue your points or attempt to bring reality to the attention of your loved one, you will always be on the opposing side. Delusions are strong beliefs held to be true despite evidence to the contrary.
There are two ways to distinguish delusions:
- Bizarre: This type of delusion is likely to be unrealistic or have no logical base. It is different from faith and other religious systems of thought. However, some entertain delusions that have a religious element. For example, some individuals may believe that they are being watched or followed in order to be recruited into a religious group.
- Non-bizarre: This type of delusion is logical and has the power to influence. These delusions are difficult to unravel because they feel real. For example, a man may believe that he has a chance to marry a public figure he has been emailing. While the public figure may have responded kindly to his emails, there is no concrete proof that the public figure has any feelings for him.
The difficulty inherent in delusions is that they can occur in a once very normal, logically thinking individual. A person does not have to have a severe mental illness to entertain a strong, unmovable belief. But you do want to monitor the severity of that person’s delusion(s) and their intensity. If your loved one begins acting on their delusions, you will want to reach out for a mental health evaluation.
Here is a listing of types of delusions to be watchful of:
- Grandiose type: Delusions involve inflated worth, power, knowledge, or identity. This is not the same as narcissistic thinking. Grandiose delusions might sound like this: “I am usually more intelligent than most, so I must rid the world of people not as smart as me.”
- Erotomanic type: Strong belief that another person of higher status (celebrity, congressman, etc.) is in love with them. This can occur even when there has been no relational ties with the person.
- Jealous type: Strong belief that an intimate partner is being unfaithful, despite evidence to the contrary.
- Persecutory type: Delusions or strong beliefs that the person is being persecuted or malevolently treated.
- Somatic type: Delusion that the person has a physical defect or medical condition. This is different from hypochondria.
- Mixed type: Delusions that may entail all of the above.
There are a few things you can do to cope with this behavior:
- Don’t argue: It is going to be very difficult to unravel the entanglement of delusions that your loved one is entertaining. Keep in mind that they truly believe what they believe and they have a “deficit” in deciphering truth from fiction. This person needs a certain level of compassion.
- Don’t directly reject the delusion: I’ve learned from experience that delusions are strongly connected to emotions, so it will be difficult to reject that person’s belief without becoming confrontational. You want to take a neutral stance. You can do something simple such as getting off the topic or redirecting the conversation in a subtle manner.
- Don’t jump to pathologize: Don’t label your loved one’s delusion(s) as psychiatric just yet. There are cases in which delusions are part of medical or neurological conditions and also what I call “conditions of human nature.”
While working with older adults suffering from both medical and psychiatric conditions, I learned that most of what was deemed “delusional” was really a strong attempt at sustaining an emotional connection to something or creating a reality they could feel good about. An elderly women who has lost all of her friends and spouse to death, may begin to strongly believe that her husband and friends “are still alive.” This is more like strong denial and refusal to accept the truth.
This is a very difficult situation to live with. It is difficult to view reality from your loved one’s perspective when you know their perspective is skewed. It may be helpful for families and caregivers to discuss this situation with a therapist and ask for a consultation. In any event, make sure to take care of yourself and remember: do not argue with them. You won’t win.
I wish you all the best