DSM-5, F??.?: Voluntary Delusional Disorder

Should there be a new DSM diagnosis: Voluntary Delusional Disorder? A delusion is generally defined as a false belief (a “commitment of one’s consciousness”*) that a person is critically invested in. The person is so one with the belief because doubt would cause his entire sense – his feeling – of self to be enveloped in painful blackness and nonexistence. We can see this in non-psychotic delusions: A Narcissistic Personality must believe he is perfect and uniquely special. That belief covers and suppresses deep, childhood-based feelings of failure, inchoateness, nihilism, because his identity never formed in the crucible of a flawed mother-child father-child bond.

 

While delusions are understood to traffic in untruth, there is the possibility of accepting a true fact in a delusional way. If Albert Einstein had had such a precarious sense of self-esteem that he needed to rate himself the greatest genius of physics, this could be seen as a delusion even though it may have been accepted as a given in the scientific community. After all, what if an even greater physicist was working in obscurity and never published his theories? Einstein’s belief must then be conceived as delusional.

 

Many people had such a botched development** in separation-individuation infancy and early childhood that later they must perform certain mental or physical acts to suppress the error. If they don’t have a belief of rightness or glory to mask it, they may need alcohol or drugs or prestige or power as suppressive agents. Destroy the prestige, remove the alcohol (and all the collateral or replacement defenses such as A.A. camaraderie, Higher Power, a sponsor to lean on, coffee and cigarettes), and the person’s inner self would implode to childhood rubble. They need a delusional belief or a delusional behavior.

 

The defense mechanism nature of delusion is more difficult to see in the extreme cases – psychotics and those bordering psychosis – and easier to see in neurotics. Why did the man I worked with in Ohio need to believe, “on his mother’s grave,” that the federal income tax is one-hundred-percent illegal and need not be paid? In most areas of his life he was grounded in reality. He knew that the sun rose in the east, that people need to work for a living to earn their bread. He knew that pornography, while legal, shouldn’t be given to five-year-olds. Yet he had to believe that whatever debatable ambiguity in the law or Constitution left room for questions about the federal mandate, that ambiguity amounted to complete proof of its illegality. Could we trace this quasi-psychotic stubbornness to some defeat or devastation in his childhood? I believe we could. I can imagine adopting his conviction, as in my teens I believed every aspect of Libertarian dogma regarding the sacredness of free enterprise and that “taxation is theft.” By 18, that solipsistic ideology had become my identity, replacing an abyssal chaos that had never grown beyond my latency period. To discover a ready-made system of beliefs and, more importantly, a feeling of deep meaning and, more importantly, an attitude of superiority, was to be not reborn, but born for the first time. On that Mt. Olympus, to entertain the slightest doubt of my new heart and soul would have been to collapse into a black hole of emptiness.

 

It can be quite difficult to see how psychotic paranoia is more self-protective than destructive. The woman I knew who believed that every person and every occupied vehicle, including planes and helicopters, was surveilling her, would not consider the possibility that she was alone in the world. What had, in her youth, been public and private shaming and exposure to her prurient clan, being “read” by them and boundaries obliterated, but was also her protection and identity and place in the family – the self-less child – had to later be her haven: the cushioning and caring eyes of the world on her. Were something in her mind to turn and all the attention disappear, she would become a body with no soul, the most invisible, alone and dying person in existence. The delusion of being seen enabled her to live.

 

Three main facts come into play when we consider the person delusional by choice: Irrational-to-insane belief comes from identity pain that needs to be escaped;  identity pain and emptiness exist on a continuum of extremity; once a self-medicative escape is discovered (alcohol, video games, masturbation, intellectualization, etc.), it becomes entrenched and necessary. In the wide population of individuals who delusionally believe that the sociopathic former president is a person of good character, a related and progressive triad comes into play: unmet needs in childhood cause pain, pain leads to projection.

 

What makes this delusion “voluntary”? My thumb is a good example. When I was five years old, I found that I would relieve built-up tension by squeezing my thumb and snapping it. Had I been somewhat older, I might have thought that the behavior was disruptive or immature and quashed it. I might have gone to my parents with my tension and anxiety and asked for help. These would have been choices. Similarly, a five-year-old child may have to absorb his father’s projected hatred of ethnic groups and individual idiosyncrasies, while a 15- or 20-year-old would have some capacity to engage discernment and choice. Millions of adults in this decade have cast aside this capacity and have chosen to assuage their identity pain in projection: hating individuals, entire populations, memes, cultural trends. They have set aside discernment to admire, to believe in, the sociopathic avatar of their pain and anger. They have chosen their self-medication.

 

At age five, I didn’t have a choice. My delusion was automatic. At 71, I sometimes still squeeze and snap my thumb. The masses who love hate and haters had a choice. They still have it, and they still fail it.

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* Nathaniel Branden's definition: "Faith is the commitment of one's consciousness to beliefs for which one has no sensory evidence or rational proof."

** I’m specifically thinking of James F. Masterson's theory of the origin of Borderline Personality Disorder in "the concept of maternal unavailability for acknowledgment of the self, the resultant abandonment depression, and the developmental arrest of the ego." Psychotherapy of the Disorders of the Self, p. xv.