Is there any point arguing psychotics?

[Dredred]

I've tried arguing with a friend of mine about his delusions when he went through a psychotic episode. He believed every disaster or accident he saw on the news was caused by his evil thoughts. I'm not sure whether he even attempted to consider my point of view, communication was very difficult. He got better eventually, probably thanks to his therapy and medication.

Anyone ever tried to argue with psychotics? Is there any point?

[oglommi]

No point arguing with them. I think the best thing to do is encourage them to take their medication and stimulation other fields of interest for them than their delusions. The less time they spend philosophyfing(?) the better.

[jmercer]

Yeah, arguing with psychotics is attempting to employ rational thought to modify the behavior of someone who can't help how they act. There's no point to it - they need treatment.

By the way, that damned avatar of yours is disturbing, all the more so because she's obviously a beautiful girl. :D

[Nucular]

I'm assuming you mean in order to help them realise their delusions are, well, delusional?

Cognitive therapy (http://www.beckinstitute.org/InfoID/220/RedirectPath/Add1/FolderID/223/SessionID/{DF9EF153-C867-4457-8C2C-11D5243779F9}/InfoGroup/Main/InfoType/Article/PageVars/Library/InfoManage/Zoom.htm) can be effective (http://nhscrd.york.ac.uk/online/dare/20013971.htm) in treating the symptoms of psychosis, including delusions, and very often this type of therapy will involve considerable discussion of the delusional thoughts. However, although parts the CT approach can be thought of as in a sense a 'debate' of sorts, and can include processes familiar to us as sceptics such as evaluation of evidence for and against certain ideas, etc., its form is actually very different to your standard "actually, I think you'll find..." sceptic vs. believer argument.

One of the reasons for this is that if challenged too strongly, many people with delusions will reach a state of cognitive dissonance (http://www.learningandteaching.info/learning/dissonance.htm), and dig their heels in on their belief. They often have a great deal invested in their belief (I've known people who have spent decades quietly obsessing about some classic delusional belief), and understandably don't take kindly to someone saying "nope, actually it's like this...", or "the CIA? You are a buffoon."

The process of cognitive dissonance, of course, happens with "non-delusional" believers (illustrates how fine the lines are around these issues, hey) too, but given that they (hopefully) don't have other symptoms too, and aren't talking to us because they really need help (usually), we can afford to match their bluntness with our own if we want to.

On the other hand, of course, it's not particularly helpful to reinforce delusions either, whether passively ("erm, yes, quite agree with you there...") or actively ("The snipers are back on the roof! Look out!"), so it can seem quite a tightrope.

I used to find, in a mental healthcare assistant capacity (i.e. talking to and being with people with psychosis all day long, but receiving little instruction on how to actually deal with them), that honesty and respect were the best ways to walk that tightrope - not as abstract concepts, but translated into sentences like "I can see you really do believe that, and I guess you must have reasons - but I suppose I just don't see things that way myself." Not having a debate, but being honest about one's own views.

I don't think it's really, in that scenario (if you're the chap with delusions), evidence that is presented to you that will be helpful, but the simple fact that someone who seems to like you, and hopefully you like back, simply doesn't agree. It can sometimes be their first taste of someone who's not "in on it" presenting a different view, in a take-it-or-leave-it fashion. That is, of course, unless you are "in on it" (i.e. part of the delusion), in which case simply stick to the weather :p

[Paul C. Anagnostopoulos]

My first wife was psychotic off and on. The longest episode was about two months where she thought she was the second coming of Christ. I don't believe conversation did much of anything to relieve the problem. If anything helped, it was meds.

Of course, it was precisely during these episodes that she stopped seeing her therapist.

~~ Paul

[UrsulaV]

While I am no therapist, psychologist, or anything else, and have exactly one anecdotal case to base this on (when a college friend had a psychotic break and turned up at my apartment to dance aimlessly and shower with his clothes on) my gut feeling is that trying to talk around somebody who's actually, genuinely brain-chemistry-gone-wrong insane, is sorta like trying to talk around a broken leg.
There's something actually physically wrong that needs to get dealt with.

[Dogdoctor]

I find that it might be beneficial to talk to psychotics but more as a sounding board. Let them tell you everything and let them lead you back to reality. I have not had a lot of conversations with psychos but it seems to me that some of them if they aren't too far out will land back down in reality on their own. I talked to one guy who thought he was Jesus Christ. He apparently got that way when he smoked marijuana. If you let him go on about his being Jesus eventually he will realize that he only feels this way when he is high. However he liked being Jesus so much he kept smoking dope. Eventually he checked him self into a mental hospital. So is it useful to argue with them? I doubt it but it might be useful to talk to them. I also spoke to a guy who thought he was George Harrison's avatar but then I think he really was( joke). He said that George was going to give him 7 million dollars (this was before his death) and that the first thing he was going to do was to buy GH's Darkhorse album. I asked if he had a record player and he responded like he suddenly realized there was a reality and calmed down then told me about his situation...homeless derelict and wanted a to know if I had an extra burger which I actually did due to 2 for one sale so I gave him one and we ate together and I heard he went on to go get some help shortly after I talked to him. Maybe just a coincidence but I know he was a homeless derelict for years before I took the time to talk to him. Anyway psychotics are not tracking in reality when they are psycho so talking to them at those times would be pointless other than giving them a sounding board to help them land back down in reality.

[Twilek]

When it comes to things the psychotic is presently obviously upset about, I see no problem in arguing on behalf of reality.

I have a sister who is ... well, we're not sure, she won't get treatment long enough to tell. She hears voices she claims come from the NASA scientists on the ISS who are experimenting on her via the remote satellite "mind weapons" we have orbiting the planet.

All calm, polite and sane responses are easily rebuked by the fact that my family has never been known to be "calm" or "polite", and that we're just "ignorant and stuck on 'stupid'." I also agree that it is wrong to gloss over the claims, as in "ok...whatever you say", or even to just write them off as "well, maybe you should see a doctor about that". Of course she should see a doctor, we tell her that often.

But when she confronts me with something like her most recent ridiculousness: fabric wrinkle-induced markings upon her arms (after sitting for an hour in front of her computer looking up the latest Clifford Carnicom or MKULTRA induced conspiracy-theory blurred reading of some Discovery Magazine article) and tells me they're made by the latest experiment NASA is indulging itself in, I have to speak up.

I tell her they are creases formed by pressure against wrinkled cloth formed by her sitting with her arm in her lap, and they can last for up to an hour (who hasn't arrived at work with the remnants of the pillow-case creases upon one's face?). I even sit for 15 minutes with my own arm against my clothing to reproduce them. She calls me stupid and get's pissed off because I don't believe her.

Well, I don't, duh. And I'm not going to play along just to prevent any confrontation. I just tell her "I don't come here to be insulted...speak to me nicely, or don't speak to me at all. I am showing you how this is done. You can try it and reproduce it yourself, or you can continue to walk around scared".

It doesn't stop the delusions, but it does stop the rude and disruptive behavior they can cause. And when a psychotic person is unwilling to get treatment, sometimes that's the best they, and we, can do.

[c4ts]

Sure there is a point. You can trigger delusions and record them on DVD as they have psychotic breakdowns! You can even have psychotic races, taking bets on which psychotic will have a breakdown first.

No, wait, that's not fun at all.

[Flo]

Originally posted by c4ts
Sure there is a point. You can trigger delusions and record them on DVD as they have psychotic breakdowns! You can even have psychotic races, taking bets on which psychotic will have a breakdown first.

No, wait, that's not fun at all.


No, it's not fun at all, but it's the only way my brother-in-law could convince his psychiatrist that my ex really was off his rocker and needed treatment ... :(

[Flo]

Originally posted by Nucular
On the other hand, of course, it's not particularly helpful to reinforce delusions either, whether passively ("erm, yes, quite agree with you there...") or actively ("The snipers are back on the roof! Look out!"), so it can seem quite a tightrope.

I used to find, in a mental healthcare assistant capacity (i.e. talking to and being with people with psychosis all day long, but receiving little instruction on how to actually deal with them), that honesty and respect were the best ways to walk that tightrope - not as abstract concepts, but translated into sentences like "I can see you really do believe that, and I guess you must have reasons - but I suppose I just don't see things that way myself." Not having a debate, but being honest about one's own views.

I don't think it's really, in that scenario (if you're the chap with delusions), evidence that is presented to you that will be helpful, but the simple fact that someone who seems to like you, and hopefully you like back, simply doesn't agree. It can sometimes be their first taste of someone who's not "in on it" presenting a different view, in a take-it-or-leave-it fashion.


Couldn't agree more ...

[luchog]

Originally posted by Dogdoctor
So is it useful to argue with them? I doubt it but it might be useful to talk to them.
The accepted belief in the mental health community is that it is not only not useful to argue with psychotically delusional individuals, but it's actually counterproductive. Their congnitive dissonance is so strong that any contradiction merely serves to make them more adamant in their own beliefs, and it strengthens their paranoia and feelings of persecution. It is about the worst thing that one can do with a psychotic disorder; particularly since the internal conflict, if pushed by contradiction, will often manifest itself in violent ways, against others or against self.

What is currently considered the best way is to simply listen, and to talk to them from a viewpoint of not-committal acceptance. Gain the trust of the patient, and then work on gradually circumventing the mental blocks, until the patient is amenable to treatment.

[Jas]

Originally posted by luchog


What is currently considered the best way is to simply listen, and to talk to them from a viewpoint of not-committal acceptance. Gain the trust of the patient, and then work on gradually circumventing the mental blocks, until the patient is amenable to treatment.

My mother is mentally ill, and that is what has been recommended.

You don't want to reinforce the delusion, however, arguing is going to elevate their level of stress, and that's not a good idea with someone experiencing mental health difficulties, and will only exacerbate the problem.

What is generally a good idea is to sympathize with the emotional aspects of the situation. Ie, instead of "There's obviously is no international drug cartel, because of a, b, and c, so stop worrying about that", try, "Wow, that must be so stressfull. I couldn't imagine going through that".

Essentially, you want to validate their emotions, without encouraging the delusion.