Reality is what the majority believes it is

In 10 years of psychiatric nursing, I met a lot of unique people, but one particular young lady has always stuck with me. I think her story can help us understand what's going on in the world right now.

In the mid-2000s I was working as a nurse on a psychiatric inpatient unit (also known as a "psych ward"). It's where people go when they end up in hospital, and have psychiatric issues that can't be managed easily on other units. I had depressed and suicidal patients, psychotic patients, manic patients, panic disorder patients, addicted patients, old, young, all colours and creeds. We saw the sickest of the sick, the ones that can't be managed in the community, that need intense care to keep themselves and others safe. I got out of nursing in 2009, on the eve of the swine flu pandemic. Psych nursing was never boring, I'll tell you that much. I may recount other nursing adventures a different time. For now, I want to tell you about Amy.

NOTE: I don't remember her name, and wouldn't use it even if I did. I'm just going to call her Amy. But everything else about her is real.

Amy was about 30 with long wavy brown hair. She was well-groomed and dressed appropriately. She was an office assistant, unmarried. She had come to psychiatry from home, voluntarily, during my days off. I met her one evening when I had been assigned to her care.

I engaged Amy for a 1:1, for which she was keen. I wanted to check her mood. There was a concern about self-harm or erratic behaviour, because she was quite distraught and didn't know if we could help her.

You see, Amy believed there was something tied around her intestines. Or maybe clamped. Or constricted with rubber bands. She was absolutely 100% convinced of it. To her, it was the truth. She was beyond annoyed that almost nobody believed her. She'd been to literally dozens of doctors, and emergency rooms, and psychiatrists. She'd been for bloodwork, x-rays, CT scans, even an MRI. Nobody could find the source of her intestinal constriction.

She felt she was having symptoms related to the constriction, like digestion issues, pain, inability to eat certain foods. She felt if she wasn't careful, she would get a blockage, so she avoided raw veggies and other food that might not fit through her narrowed gut. She became desperate and depressed, when specialist after specialist told her they couldn't do anything for her. She even got a surgical consult, but the surgeon wouldn't operate. Finally, she came to psychiatry, skeptical that we could do anything, but willing to give it a try.

To be honest, after about 20 minutes talking to her, I felt like she was right. She talked about it as though it was hard fact. She didn't have a doubt in her mind that there was something tied around her intestine, causing all kinds of problems. She was willing to be sliced open, she was that sure it would vindicate her and get the constriction removed. Her conviction was, at least to some degree, contagious.

I checked her chart for more details. Her psychiatrist had spent quite a bit of time getting to know her, as well as researching her medical history. It became clear to him that she wasn't physically ill, and he was going to do whatever he could to help break her out of these fixed, false beliefs. That's actually the definition of "delusion" - fixed, false beliefs.

The doctor had diagnosed her with "delusional disorder". This is when someone has fixed false beliefs, but isn't psychotic. They're normal and unremarkable in every way, except that there's some belief they hold on to that can't be substantiated. This disorder is not very common, as most people with delusions are also psychotic (disorganized, not functioning well, hallucinating, etc). Amy seemed completely credible and kept up her end of the conversation well. She was friendly, and her story made you feel badly for her. You wanted to try and help her, but she had been like this for years, and nothing could convince her that her gut wasn't tied off.

I even asked her how it happened, hoping to talk some sense into her. "That's the thing, I have no idea. Maybe somebody slipped me something at a party, and they operated on me? Or maybe there's some new technology that allows it to be done remotely? Or I swallowed something that ruptured my intestine and got stuck there somehow?"

It was a very fixed (stable) delusion. We worked on her for days, then weeks. She took antipsychotic medications to help break the delusion, but we made little or no headway. She attended group therapy, fitness time, made friends with co-patients, came and asked for her medications right on time, and so on. There seemed to be nothing wrong with her, except that very strange belief, which appeared to be complete fantasy.

There are others like Amy

Delusional disorder isn't common, but it isn't unheard of. There are other people out there, with various fixed, false beliefs. Some of them are currently in hospital, but some of them aren't. Some hide their beliefs, knowing others don't see things that way, and might even try and get them into treatment over the beliefs. They seem normal and generally function well. There's just something they've come to believe, that isn't true, and they can't get past it.

Wikipedia says 3 people in 1000 have delusional disorder, and there are several subtypes: erotomanic, grandiose, jealous, somatic (like Amy), persecutory, etc.

What if 2 people shared a fixed, false belief? Surely even by coincidence, out of the millions of people with delusional disorder, the focus of their strange thinking can't all be different.

Now, imagine several people with a fixed false belief were together in one place. Imagine they rally around their common delusion. Imagine they get organized.

What if I were to suggest most of the bizarre, unprecedented, and horrible things happening in the world right now are because there are massive numbers of people out there, all sharing the same delusional belief?

Like Amy, they don't know their beliefs aren't supported by evidence. They can't be convinced. But unlike Amy, they're backed up by others who have exactly the same fixed false belief system. It's even more likely you will maintain your delusional thinking when others around you think the same way and constantly back you up.

Delusional disorder tends to be lifelong. It can be put into remission, but the person generally maintains some degree of focus on the false belief. Many who suffer with it will do so all their lives. I'm reminded of the Covidians, those sleeve-rolling cultists who still mask, while alone, outside or in a car. Let's hope they can be cured, or at least eased into remission.

As for Amy, she and her psychiatrist eventually decided to send her back to home and work. Upon discharge, she admitted some of her thinking about the bowel constriction didn't make sense, although she was still certain something wasn't normal, and planned to look for other doctors and specialists who would help her finally discover the rubber bands or clamp around her gut.

Reality is what the majority believes it is.

DRutter