When faced with a global health crisis such as the Covid-19 pandemic, negative impacts on one’s wellbeing are not only limited to the infection itself but also extend to its more insidious neurological and psychiatric sequalae. Psychotic experiences such as delusions are some of these consequences that are currently under-researched yet can have long-lasting effects on an individual’s mental health and functioning.
Delusions are often viewed as the hallmarks of ‘madness’: amongst all the mental illnesses, perhaps none characterises this ‘madness’ more fittingly than schizophrenia, the ‘sublime object of psychiatry’ (Woods, 2011). Delusions are defined as false, often bizarre, beliefs held with absolute conviction that are extremely resistant to correction and counterevidence, if not outright incorrigible and incomprehensible.
As such, psychiatrists are usually very reluctant to discuss in detail the content and origin of their patient’s delusions, for the worry that it will offer some kind of validation and hence further plunge the patient into a psychotic state. Delusions are, consequently, seen as entirely meaningless and empty speech acts out of nowhere, devoid of significance or any kind of usefulness. The bizarreness in schizophrenic delusions frequently adds to the incomprehensibility: how could anyone possibly deny that the thoughts in their head are not theirs, but are transmitted to them by some external, mysterious (and often malicious) force?
A further question soon arises: how are delusions formed in the first place? There are a multitude of cognitive, biological, psychological and social theories when it comes to delusion formation. Sometimes these theories contradict one another to a certain degree whereas others might fall into the trap of reductionism or determinism, but there is one thing upon which all these theories can reasonably agree: that is, delusions are far from random or coming from nowhere. Whether the cause is biological or psychological – in fact there is often a combination of many factors – delusions are indeed products not only of a person’s brain activity but also of their wider personal, societal and cultural contexts.
Such contexts of course do not exist in stasis. Current events have always featured in various delusional themes throughout human history, which evolve and merge into a larger and more persistent delusional system. When the radio was first introduced for public use, individuals with schizophrenia became more prone to having delusions that their minds were interfered with by radio waves. When the tragedy of 9/11 happened, delusional themes were often focused on terrorism. When wireless internet became widespread, patients were more inclined to report delusional themes about Wi-Fi signals sending them personal messages. All these examples mean that it should not be a surprise at all that reports of patients with schizophrenia who complain about Covid-19-related delusional themes are on the rise (Fischer et al., 2020; Ovejero et al., 2020) and such themes are likely to remain for the foreseeable future.
All these examples have one thing in common. That is, these delusions are the products of highly turbulent, unpredictable, tense and above all, uncertain times. Whether it is the Covid-19 pandemic, global terrorism or new digital technology, people are struggling to find meaning and certainty in such situations. To use an analogy, the content of delusions is the fuel and the delusions themselves are the vehicles running on such fuel and granting the fuel usefulness. Humans have a natural desire, if not instinct, to seek meaning and certainty. Uncertain states are very draining on a person’s mental state and are often unsustainable, so the person automatically looks for explanations and meaning – and when we cannot find meaning, we create meaning.
For my research at the Institute of Mental Health, my colleagues and I take a multidisciplinary approach to studying delusions and related psychotic phenomena. Delusions are best viewed in the entirety of a person’s experiences of their self and their interactions with the external world and not simply as isolated fragments or abnormal mental events that must be corrected or even realigned with consensual reality. We believe that even the most bizarre delusions have meaning and are often reflections of a person’s innermost fears and struggles, despite their manifestation in cryptic ways. Clinicians can learn an awful lot about their patients – and even about themselves – by listening to these seemingly ‘un-understandable’ delusional themes, for each delusion tells a story about the person who is suffering and whose mind is no less real than one’s own.