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When Is a Crazy Thought a Crazy Thought?

Friday, January 18, 2013

The other day I was reading a chapter-in-progress from Sally's schizophrenia memoir. It's a chapter describing "a day in the life" from her most florid psychotic period twelve years ago. In it, she describes seeing "coded messages" in the arrangement of everyday objects (like toothbrushes and bars of soap), "messages" that were being crafted just for her by nameless spies intent on messing with her head.

(By the way, if you want to see the book chapter I'm talking about, in draft form, Sally and I will be sending it out in a few days to everybody who has signed up for book updates. See the form at the bottom of this page if you want to be on our mailing list.)

Sally's cognitive parsing process, when she was in the midst of psychosis, was undeniably bizarre, but there was always logic behind it. Her delusional thoughts weren't just random, fleeting figments. They were reasoned thoughts. The schizophrenic mind puts a huge amount of effort into trying to decipher sensory reality according to rules (rules that make sense to the schizophrenic mind).

Many of Sally's delusions were persecutorial in nature: They're out to get me. The idea that a nameless, invisible "them" (or "they") might be "out to get you" sounds laughable to those of us who consider ourselves "sane." And yet, this type of thinking is actually quite common. When you listen to far-right-wing rhetoric on talk radio (or coming from commentators on the Fox News Channel), what do you hear? Quite often, you hear paranoid rants about how "the government" is trying to take away your basic freedoms (or your money, your gun rights, your right to worship, or what have you). If it's not the government that's out to get you, then it's those pesky secular humanists, or perhaps the Trilateral Commission, or maybe the Freemasons acting in concert with the Illuminati, or maybe nameless, faceless forces sympathetic to the New World Order.

Paranoid thoughts of this general type are extremely common. A 2006 study by researchers at the Institute of Psychiatry, King's College London found, in surveying 1,200 "normal people," that 
  • over 40% of people regularly worry that negative comments are being made about them
  • 27% think that people deliberately try to irritate them
  • 20% worry about being observed or followed
  • 10% think that someone "has it in" for them
  • 5% worry that there's a conspiracy to harm them
These sorts of thoughts are qualitatively no different than thoughts that someone with paranoid schizophrenia would have. They're "crazy thoughts."

When do paranoid thoughts become pathological delusions? For someone with schizophrenia, paranoid thoughts tend to be greater in number; more frequent in occurrence; more elaborate; and more believable, than for the rest of us. A person with schizophrenia usually believes fervently in the factual basis of his or her most bizarre thoughts, to the point of becoming obsessed with them; and the overall effect is to leave the person confused and full of fear, to the point where the person might be terrified to step into the next room, let alone leave the house.

One of the things I've learned from talking to Sally (and reading her book manuscript) that has fascinated me is the extent to which "normal people" think crazy thoughts.

Perhaps it shouldn't be so surprising. After all, societal norms establish the limits of "normal" thinking and behavior (by definition). Sanity is thus, to a degree, socially constructed. Words like "sane" and "insane" are artificial constructs that have no objective meaning. We all live somewhere on a sane/insane continuum.

Consider the fact that schizophrenia sufferers often associate specific meanings with individual numbers (perhaps associating "anger" with the number four, say). Many clinicians consider this sort of illogical association to be a hallmark of psychotic ideation. And yet, most "normal" people believe thirteen to be an unlucky number, which is fundamentally no different from a schizophrenic person believing that four means anger. (There are hundreds, perhaps thousands, of very tall buildings in the United States that have no thirteenth floor, precisely because so many people are convinced of thirteen's potential for evil.) Believing thirteen is "unlucky" doesn't make you mentally ill. Western society accepts the idea that thirteen is unlucky, even though it's a profoundly bizarre concept, qualitatively no different from a "crazy person's" thoughts. But if you believe that all whole numbers from one to fifty have specific individual meanings, that doesn't fit with society's norms. And if ideas about numbers are coming into your head all the time, out of control, causing you to feel so much anxiety that you can't go about your daily business, that's a problem; that's mental illness.

I thought I knew a lot about these sorts of things before reading Sally's book, but as I read each freshly written chapter, I find I'm still learning new things, making fresh associations, filling in the gaps of (mis)understanding; having new ideas. Some of them a little crazy.

It's exciting to see Sally's book coming together. When she finishes it, it'll be quite a read.

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