WEBVTT
00:00:00.550 --> 00:00:02.770
Hi, friends, and welcome to Pretty Evil.
00:00:03.279 --> 00:00:08.492
Today's episode's a little bit different from our usual deep dives because this is a side note.
00:00:09.092 --> 00:00:17.012
Every other week, I'm gonna take a little detour from the bigger stories and kinda use these episodes to explore something that I think deserves maybe a closer look.
00:00:17.532 --> 00:00:21.652
Sometimes that'll be a psychological concept that comes up a lot in true crime.
00:00:21.652 --> 00:00:25.271
Sometimes it might be something maybe connected to a case we've already covered.
00:00:25.692 --> 00:00:33.351
Um, and I also was thinking I might even just occasionally cover a current story that I find interesting and wanna talk about.
00:00:33.692 --> 00:00:40.082
So these episodes are gonna be a little bit shorter, a little more relaxed, and probably a little bit less scripted than the main show.
00:00:40.442 --> 00:00:59.072
And my hope is that it would give me some room to kind of follow interesting threads that might not need an entire hour-long episode and I also wanted to add that pa- a big part of the reason I wanted to have these side note episodes is because I want for us to get to know each other a little bit better.
00:00:59.222 --> 00:01:02.072
It sounds so corny, but I, I feel like...
00:01:02.862 --> 00:01:06.242
Listen, Let me kinda rewind a little bit and give you some additional context.
00:01:07.072 --> 00:01:27.685
When I decided to create Pretty Evil, I knew that I wanted a podcast that was going to be very carefully researched, very meticulously written, and I really wanted for the presentation to be as good as it could possibly be for an independent podcaster.
00:01:28.084 --> 00:01:29.254
It's very hard.
00:01:29.454 --> 00:01:46.655
Um, it's a lot of work, but I just, personally, I feel like there are so many of those, like, talk show-style podcasts out there, and no hate to them at all, um, but I was looking for something different that I always sort of felt I couldn't get anywhere else other than Crime Junkie.
00:01:46.885 --> 00:01:48.234
And I love Crime Junkie.
00:01:48.314 --> 00:01:54.055
I loved it for many years, but I also wanted a different perspective and was struggling to find that as well.
00:01:54.055 --> 00:02:12.995
And so while it was really important to me to really put, like, honestly, kind of, like, my heart and soul into something that is, you know, my best possible work, I think anyone who knows me personally can say that that's also just, like, a very small fragment of who I am as a person.
00:02:13.585 --> 00:02:22.115
I wanted to have something that was just a little bit softer, a little bit less scripted, and a little bit more of a window into, like, kinda my natural personality.
00:02:22.125 --> 00:02:32.615
Because I think a big part of what makes us love the creators that we follow and, you know, come back for more each episode is getting to know those people.
00:02:32.615 --> 00:02:49.004
And so while I want to show up and give you a really strong, really well-done show, I also want to show up as myself, and sometimes those two things don't coexist perfectly because I can be a little bit silly.
00:02:49.004 --> 00:02:50.294
I'm a little bit off-the-cuff.
00:02:50.344 --> 00:02:55.354
If you ask someone that knows me personally, I swear like a sailor in real life.
00:02:55.365 --> 00:03:02.365
But I'm not gonna be doing that in our episodes, because I want to be respectful of the content that we are addressing each week.
00:03:02.375 --> 00:03:13.685
So I thought this would be maybe a good way for, you know, us to have a little bit more of an intimate relationship, um, but still discuss things that are important.
00:03:13.858 --> 00:03:16.668
So All right, I'm gonna get off my soapbox now.
00:03:17.008 --> 00:03:20.018
Um, and let's get into it.
00:03:20.198 --> 00:03:22.157
Today I wanna talk about delusions.
00:03:22.228 --> 00:03:29.752
I wanna talk about what they actually are, how they work, and what we really mean when we say that somebody's lost touch with reality.
00:03:30.032 --> 00:03:34.731
And this felt like an especially good place to start after our episode last week on Richard Chase.
00:03:34.762 --> 00:03:40.671
We wrapped up part two, um, and if you didn't catch either of those episodes, make sure that you go and check them out.
00:03:40.794 --> 00:03:46.701
But I felt like that was a really good place to start because delusions play such an enormous role in that story.
00:03:46.942 --> 00:03:55.701
And they're also, at the same time, a psychological concept that gets thrown around a lot in true crime storytelling, and honestly, a lot in our everyday lives too.
00:03:55.701 --> 00:04:00.301
Like, we're always,"Oh, you're delusional." That's a very common thing for people to say to each other.
00:04:00.662 --> 00:04:06.611
Um, and I think we use the word pretty casually without necessarily understanding what it means clinically.
00:04:06.921 --> 00:04:12.301
And it's really interesting when you get into it, because you start to understand that there are...
00:04:12.331 --> 00:04:26.625
Not only are there different types of delusions, which we'll get to, But also, you know, we encounter them a lot more, I think, than we realize, both in our real lives and in the true crime world and stories that we follow along with.
00:04:27.107 --> 00:04:30.764
So like I said, we call people delusional all the time.
00:04:31.764 --> 00:04:33.824
I personally believe I'm gonna win the lottery.
00:04:34.413 --> 00:04:35.473
Not could win.
00:04:35.644 --> 00:04:37.103
I wi- I will win.
00:04:37.293 --> 00:04:38.704
It's really just a matter of time.
00:04:39.053 --> 00:04:40.634
I call that manifesting.
00:04:40.733 --> 00:04:42.444
Some people might call it delusional.
00:04:43.204 --> 00:04:46.634
Except clinically, that's really not what the word means.
00:04:46.954 --> 00:05:07.862
And in true crime, it's really important for us to understand that, because you'll sometimes hear that an offender was delusional, and suddenly that one word is expected to explain everything We kinda treat it as some kind of, like, catch-all for somebody being mentally ill, irrational, unpredictable, or dangerous, even though those are actually several separate things.
00:05:08.290 --> 00:05:18.600
So I wanted to look today at what delusions really are, because I think understanding the clinical meaning can help us to better follow the internal logic of the behavior that stems from that sort of thing.
00:05:19.600 --> 00:05:29.759
Okay, so the basic clinical definition of a delusion is a belief that's held with enough conviction that contradictory evidence doesn't meaningfully change it.
00:05:30.449 --> 00:05:37.029
And the second half of that sentence is probably the most important, because we always believe things that aren't true.
00:05:37.829 --> 00:05:39.939
You know, we misunderstand things.
00:05:39.970 --> 00:05:41.350
We get bad information.
00:05:41.620 --> 00:05:42.860
We make assumptions.
00:05:43.160 --> 00:05:52.050
I'm sure at some point we've all become convinced somebody doesn't like us because they didn't respond to a text for six hours, only to discover they were asleep.
00:05:52.370 --> 00:05:56.040
The point is, being wrong isn't a delusion.
00:05:56.519 --> 00:05:57.170
Okay?
00:05:57.279 --> 00:06:06.939
So, like, for argument's sake, let's say I become convinced that my neighbor stole one of my Amazon packages because I saw him near my porch that afternoon.
00:06:07.439 --> 00:06:11.029
I confront him, and he pulls up his security footage.
00:06:11.319 --> 00:06:14.470
It clearly shows somebody else taking the package.
00:06:14.920 --> 00:06:18.250
At that point, I go,"Oh, well, shit.
00:06:18.339 --> 00:06:18.889
Sorry.
00:06:19.420 --> 00:06:25.529
I was wrong." You know, maybe I was unfairly suspicious, but reality corrected me, and I acquiesced.
00:06:26.279 --> 00:06:33.920
Now imagine I look at that same footage and decide my neighbor obviously hired the person in the video.
00:06:34.540 --> 00:06:40.769
You tell me he was at work when the package disappeared, so I conclude his employer is covering for him.
00:06:41.319 --> 00:06:48.920
The police say there's no evidence connecting him to the theft, and now I'm, I'm almost certain that he's somehow gotten to the police too.
00:06:49.769 --> 00:06:59.459
So the distinction I'm trying to make here is that when it comes to a delusion, every piece of evidence that should weaken the belief gets incorporated into it instead.
00:06:59.699 --> 00:07:00.540
You see what I mean?
00:07:01.050 --> 00:07:12.930
And that is much closer to what clinicians mean when they describe a belief as fixed But even there, you can't diagnose a delusion just because somebody's too stubborn to admit that they're wrong.
00:07:13.370 --> 00:07:14.170
I mean, come on, guys.
00:07:14.189 --> 00:07:18.709
If, if that were the standard, Thanksgiving dinner would qualify as a mass psychiatric event.
00:07:19.110 --> 00:07:23.220
My point is, clinicians have to look at the belief in context.
00:07:23.889 --> 00:07:27.259
How did the person get here, you know, thinking this?
00:07:27.769 --> 00:07:30.889
Also, how attached are they to the belief?
00:07:31.230 --> 00:07:34.930
Is this belief shared by their culture or community?
00:07:35.310 --> 00:07:39.079
Is there some, maybe some plausible factual basis for it?
00:07:39.610 --> 00:07:42.269
And what happens when they're shown evidence against it?
00:07:42.920 --> 00:07:45.529
What, you know, what else is happening psychologically?
00:07:46.389 --> 00:08:00.670
But if we strip all of that down, a delusion is basically a belief someone is deeply convinced is true, even when there isn't good evidence for it, and contradictory evidence usually doesn't do much to shake that belief.
00:08:00.889 --> 00:08:02.540
That's kind of the basic idea.
00:08:03.480 --> 00:08:14.910
Conspiracy theories are probably one of the easiest examples to use to help us find that line when it comes to delusion cause something interesting about conspiracy beliefs is that they're often social.
00:08:15.569 --> 00:08:24.250
There's a community reinforcing them, supplying supposed evidence, interpreting events, and giving a person this framework that others share.
00:08:24.639 --> 00:08:34.820
And in this world, you can believe something that's completely unsupported and highly implausible with little to no evidence without necessarily having a clinical delusion.
00:08:35.190 --> 00:08:44.110
So in this category, we're talking about things like alien life forms and Area 51 or maybe, like, the idea of a shadow government.
00:08:44.570 --> 00:08:51.149
It might sound totally delusional to some, but there's a shared belief in their existence.
00:08:51.769 --> 00:08:58.070
Clinical delusion, on the other hand, tends to be a lot more organized around the individual and kind of more personal.
00:08:58.740 --> 00:09:11.370
You know, for example, uh, instead of just believing government surveillance exists, a person might believe a particular government agency has installed cameras in their home because of something unique about them.
00:09:11.809 --> 00:09:19.700
Or, like, maybe they're convinced a TV anchor is embedding messages intended specifically for them into the evening news.
00:09:20.169 --> 00:09:20.440
Okay.
00:09:20.440 --> 00:09:23.090
So that's kind of a good illustration of the difference.
00:09:23.330 --> 00:09:30.480
The broader culture can absolutely influence the content of a delusion, but the belief itself usually becomes intensely personal.
00:09:31.179 --> 00:09:34.340
And conspiracy theories aren't the only place that this gets fuzzy.
00:09:34.879 --> 00:09:46.080
There are a couple of other psychological experiences that can involve really persistent beliefs, and these come up in crime stories too One of them is something called an overvalued idea.
00:09:46.889 --> 00:09:57.269
An overvalued idea is basically a belief that becomes kind of like disproportionately important to a person, like, to the degree that it affects their identity, okay?
00:09:57.279 --> 00:10:05.200
So usually they're devoting huge amounts of time and energy to it, and the belief can become rigid enough that it's really difficult to challenge.
00:10:05.460 --> 00:10:11.889
But usually you can still trace a psychologically understandable road that led them there, you know?
00:10:12.039 --> 00:10:17.129
And a- actually I think we see overvalued ideas in action a lot in politics.
00:10:17.330 --> 00:10:20.230
And I'm not gonna, I'm not gonna make this like a political conversation.
00:10:20.230 --> 00:10:23.100
I don't particularly care what your political leanings are.
00:10:23.100 --> 00:10:29.240
But I think there are people in every party with overvalued ideas.
00:10:29.720 --> 00:10:44.450
And researchers and clinicians argue a lot about exactly where overvalued ideas end and delusions begin, which is a good reminder that psychiatric categories don't always come with perfectly clean little borders.
00:10:44.830 --> 00:10:46.809
I talk about that almost every episode.
00:10:46.820 --> 00:10:50.470
Human beings are annoyingly committed to being complicated.
00:10:51.470 --> 00:11:02.779
Now on a different note, Another thing I want to separate out here is obsession, especially because OCD can involve thoughts that feel incredibly convincing, but are those delusions?
00:11:03.649 --> 00:11:10.600
If you have like an intrusive thought, like what if I hit somebody with my car and somehow didn't notice?
00:11:10.950 --> 00:11:17.419
That thought, as ridiculous as it might sound to you, can become extremely distressing.
00:11:18.019 --> 00:11:29.029
Someone with OCD might even drive back repeatedly to check the road, you know, search local news, inspect their car, or keep asking other people for reassurance that it didn't actually happen.
00:11:29.509 --> 00:11:35.070
But most of the time, there's still some level of recognition that the fear may not be rational.
00:11:35.429 --> 00:11:40.399
The person is just kind of like tortured by the possibility that it may have happened.
00:11:41.269 --> 00:11:48.879
A delusional belief would be closer to becoming genuinely convinced that it happened despite having no evidence that it did.
00:11:49.210 --> 00:11:56.730
So you can see that there, there is a difference here, but even that distinction can get blurry because OCD also exists on a spectrum.
00:11:57.250 --> 00:12:05.820
So I guess kind of my point here is that it isn't that there's a perfect little diagnostic line dividing every category.
00:12:06.039 --> 00:12:19.470
It's really that things like intrusive thoughts, obsessions, extreme beliefs, and delusions can sound interchangeable in casual conversation when clinically they actually describe very different experiences.
00:12:19.799 --> 00:12:20.200
Okay?
00:12:20.519 --> 00:12:22.379
And then we have everyday paranoia.
00:12:23.240 --> 00:12:31.200
You know, if you're walking through a parking garage late at night and you notice somebody's following you, becoming suspicious of that person isn't pathological.
00:12:31.639 --> 00:12:34.639
Your, your brain is supposed to notice possible threats.
00:12:34.649 --> 00:12:35.970
That's a, that's a good thing.
00:12:36.490 --> 00:12:41.529
Even somebody who's excessively suspicious isn't automatically delusional.
00:12:42.120 --> 00:12:50.009
Where that shifts is when it comes to something called a persecutory delusion, and that takes things further.
00:12:50.419 --> 00:12:58.129
So that's where a person becomes genuinely convinced that somebody's deliberately targeting them without adequate evidence that this is actually happening.
00:12:58.259 --> 00:12:58.559
Okay?
00:12:58.559 --> 00:13:04.220
You know, maybe they think somebody's spying on them or poisoning them, following them, planning to hurt them.
00:13:04.279 --> 00:13:05.110
You get the idea.
00:13:06.029 --> 00:13:10.649
So at this point, we've mostly been sorting out different beliefs that can resemble each other.
00:13:10.899 --> 00:13:24.759
But before we move on, there's another distinction we need to make,'cause I've noticed that true crime coverage tends to sometimes mix up delusions and hallucinations, or at least it kinda makes them sound interchangeable, and they're not the same thing either.
00:13:25.139 --> 00:13:27.480
A hallucination is a perception.
00:13:27.600 --> 00:13:34.779
So that's when, like, somebody hears a voice that isn't actually being produced by another person, or maybe they see something that isn't actually there.
00:13:35.200 --> 00:13:44.379
I think the simplest way to think about it is that a hallucination is where a person has a sensory experience without an external source.
00:13:44.960 --> 00:13:48.100
A delusion, on the other hand, is a belief.
00:13:48.429 --> 00:13:59.779
So if I hear a voice say,"Your neighbor's trying to kill you," the voice is the hallucination, and then if I become convinced my neighbor is trying to kill me, that's the delusion.
00:14:00.009 --> 00:14:00.830
Make sense?
00:14:01.669 --> 00:14:06.769
And I should also clarify, those experiences can 100% happen together.
00:14:07.049 --> 00:14:14.750
Like, if you're repeatedly hearing a voice tell you that somebody's trying to hurt you, obviously that can reinforce a persecutory belief about that person.
00:14:15.190 --> 00:14:24.629
Or you might hear a voice actually telling you to do something, which is what clinicians mean by a command hallucination, if you've ever heard that term.
00:14:25.100 --> 00:14:27.320
That's still a hallucination, though.
00:14:27.419 --> 00:14:29.220
It's, it isn't a type of delusion.
00:14:30.070 --> 00:14:44.509
So now that we've separated those ideas, there's one other misconception I kinda wanna clear up before we get into different types of delusion, which is that having delusions does not automatically mean somebody has schizophrenia.
00:14:45.509 --> 00:14:54.500
Delusions can happen in schizophrenia and other psychotic disorders, but they can also happen in severe mood disorders like bipolar disorder.
00:14:55.029 --> 00:15:01.440
Drugs or medication can also trigger psychosis and delusions, and even certain neurological and medical conditions can cause it.
00:15:01.899 --> 00:15:04.789
Dementia is actually another one that might be surprising.
00:15:04.799 --> 00:15:06.399
It can involve delusional thinking, too.
00:15:07.399 --> 00:15:18.269
There's also a condition called delusional disorder, and this one's especially interesting in the context of crime, because somebody with this disorder can actually come across as pretty normal.
00:15:18.730 --> 00:15:26.690
They might work, pay their bills, have good relationships, and could probably even have, like, a totally normal and benign conversation with you.
00:15:27.100 --> 00:15:41.200
But then you happen to mention the woman who lives three streets away, and a person with delusional disorder might then calmly explain that she's in love with them, and she secretly communicates her love by changing which curtains she opens in the morning.
00:15:41.809 --> 00:15:54.759
So outside that very specific belief system, their functioning is actually relatively intact, which is kind of interesting, and that's one reason our stereotype of someone in psychosis doesn't really work.
00:15:55.149 --> 00:16:01.080
You know, people in psychosis aren't always visibly disconnected from reality every second of the day.
00:16:01.269 --> 00:16:01.769
Okay?
00:16:02.240 --> 00:16:07.399
So now we know what a delusion is, and we've separated it from a few things that can look similar.
00:16:07.759 --> 00:16:13.100
Let's talk about what delusions actually look like because there isn't just one type of delusion.
00:16:13.870 --> 00:16:20.720
Clinicians say there are actually several recurring types, and you'll probably recognize some of them if you listen to a lot of true crime.
00:16:21.269 --> 00:16:27.529
So I'm gonna run through them pretty quickly, starting with probably the one we hear about most often, and that's persecutory delusions.
00:16:28.250 --> 00:16:32.629
As I mentioned earlier, these are the belief that somebody is after you.
00:16:32.789 --> 00:16:33.169
Okay?
00:16:33.169 --> 00:16:40.659
Maybe you're convinced a neighbor is poisoning your food, the government is watching you, your coworkers are conspiring to get you fired, whatever.
00:16:40.659 --> 00:16:42.509
You know, somebody's planning to kill you.
00:16:42.720 --> 00:16:56.902
Then related to that but slightly different are what we call referential delusions This is when normal things happening around you seem to contain some kind of special message or meaning specifically for you.
00:16:57.412 --> 00:17:00.991
So, you know, the radio host is secretly talking about you.
00:17:01.491 --> 00:17:05.592
Two strangers laughing across a restaurant are actually discussing you.
00:17:06.352 --> 00:17:11.311
Maybe the billboard you passed this morning was placed there because somebody wanted you to see it.
00:17:11.892 --> 00:17:29.082
So this is basically the idea that kind of other people or other scenarios that you encounter in your everyday life that are actually not relevant to you at all, you kind of internalize as being about you or for you.
00:17:30.082 --> 00:17:37.362
Then we have grandiose delusions, which involve exceptional status, power, identity, or ability.
00:17:37.932 --> 00:17:52.491
Somebody might think that they are, like, a prophet or an intelligence operative, maybe the inventor of some revolutionary technology, or they, they think that they possess abilities that nobody else has.
00:17:53.491 --> 00:17:56.801
There are also somatic delusions, which revolve around the body.
00:17:57.082 --> 00:18:11.031
Somebody might become convinced that they're infested with parasites, that one of their internal organs is missing, or that their body's decaying, or maybe some, you know, impossible physical process is happening inside them that they can't control.
00:18:11.442 --> 00:18:15.332
That might sound familiar if you caught an earlier episode of mine.
00:18:15.961 --> 00:18:24.352
Jealous delusions Generally involve absolute conviction that a romantic partner is being unfaithful despite inadequate evidence to the contrary.
00:18:24.842 --> 00:18:30.761
And then there are erotomanic delusions, where somebody believes another person is in love with them.
00:18:31.402 --> 00:18:36.541
Sometimes they've barely met that person, and sometimes they've never even met them at all.
00:18:37.201 --> 00:18:42.662
So those categories, all those categories I just listed, give us the vocabulary.
00:18:43.261 --> 00:18:49.872
The more interesting question for this show is what happens when somebody starts making decisions based on one of those beliefs?
00:18:50.592 --> 00:18:56.152
Erotomania gives us a particularly clear example because we see it sometimes in stalking cases.
00:18:56.622 --> 00:19:05.321
In a Montana case from the 1990s, there was a man named James Cooney, and psychiatric experts testified that he had erotomanic-type delusional disorder.
00:19:05.741 --> 00:19:15.602
According to reports, he had persistently pursued a woman for years despite protective orders, previous legal invention, and her very clear attempts to avoid him.
00:19:16.432 --> 00:19:26.672
But Cooney believed she was in love with him, and once that belief is fixed, every attempt she makes to reject him requires some kind of alternative explanation.
00:19:27.092 --> 00:19:31.561
You know, if she says she wants no contact, maybe she's being pressured by her family.
00:19:32.071 --> 00:19:35.551
If she gets a restraining order, maybe somebody else convinced her to do it.
00:19:36.132 --> 00:19:40.672
And if she avoids him, maybe she's just scared of the intensity of her own feelings.
00:19:41.662 --> 00:19:50.061
The evidence of rejection doesn't necessarily weaken the delusion because the delusion finds a way to reinterpret the rejection.
00:19:50.721 --> 00:19:55.781
That's what I mean when I say some delusional behavior has an internal logic.
00:19:56.311 --> 00:20:07.541
You know, another good example is, like, if you believe there's a fire in your house, running outside makes perfect sense, but your behavior is irrational to everybody else around you because there isn't actually a fire.
00:20:07.971 --> 00:20:12.551
And that same basic idea can become extremely important in criminal cases.
00:20:13.061 --> 00:20:22.592
We've already covered Richard Chase on this show, so I'm not gonna turn this into, like, an extension of that episode, but he's a really useful example because his psychosis was extensively documented.
00:20:23.071 --> 00:20:29.791
If you remember, if you listened to the episode, Chase had severe somatic and persecutory beliefs involving his body and his blood.
00:20:30.011 --> 00:20:37.561
He believed something was catastrophically wrong with him, and over time, those beliefs became connected to his consumption of blood.
00:20:38.061 --> 00:20:42.491
That tells us something important about why his behavior was so bizarre.
00:20:42.781 --> 00:20:47.311
He wasn't operating from a sound understanding of what was happening inside his body.
00:20:47.422 --> 00:20:53.821
He was responding to a physical crisis that, from his perspective, was completely real.
00:20:54.821 --> 00:21:12.195
There's also an Illinois case involving a man named Branden Napolitan, and I think that one highlights this same principle maybe even more directly According to the forensic evaluation discussed in his case, Napolitan believed another man intended to kill him.
00:21:12.536 --> 00:21:16.645
He was also hearing voices telling him to stab that person.
00:21:17.105 --> 00:21:22.855
So in that case, you have two separate psychotic symptoms happening at the same time.
00:21:23.425 --> 00:21:30.406
The voices were hallucinations His belief that the other man intended to kill him was a persecutory delusion.
00:21:31.406 --> 00:21:45.936
The evaluator concluded that Napolitan understood, like generally speaking, that stabbing somebody was illegal, but experienced the situation through a psychotic belief that he was defending himself from imminent threat, right?
00:21:45.936 --> 00:21:57.247
So basically,, for Napolitan, what was happening was real, and so his response, in his mind, was entirely appropriate given the circumstances.
00:21:57.946 --> 00:22:05.416
And so I think it's helpful for us to talk through these cases because they show us how a delusion can influence behavior.
00:22:05.826 --> 00:22:09.426
But they also lead us into a much bigger question.
00:22:10.076 --> 00:22:12.676
How much does any of this actually have to do with violence?
00:22:13.067 --> 00:22:16.366
The research doesn't give us a satisfying one-word answer.
00:22:16.757 --> 00:22:28.457
Most people with schizophrenia or other psychotic disorders aren't violent, and actually, people with serious mental illness are also disproportionately more likely to become victims of violence themselves.
00:22:29.136 --> 00:22:36.957
Big picture, though, psychotic disorders have been associated with an increased risk of violence compared to people who don't have them.
00:22:37.426 --> 00:22:50.047
And I think kind of the easiest way to make sense of these two competing facts coexisting is to stop treating the presence of psychosis as the whole explanation and look at the circumstances surrounding violence instead.
00:22:50.896 --> 00:23:07.146
Okay, so a large review published in twenty twenty-five looked across longitudinal studies involving more than two hundred thousand people with psychotic disorders, and that means these were long-term studies following the same people over a period of time.
00:23:07.616 --> 00:23:14.237
And what they found is that some of the stronger predictors of violence weren't unusual psychiatric symptoms at all.
00:23:14.656 --> 00:23:20.817
Previous criminal behavior, substance misuse, and treatment-related factors all mattered more.
00:23:21.606 --> 00:23:24.967
And older research actually yielded similar results.
00:23:25.076 --> 00:23:53.681
The relationship between psychosis and violence becomes substantially stronger when substance misuse is also present, and studies repeatedly identify things like previous violence, hostility, intoxication, poor impulse control, and treatment disruption as relevant pieces of the risk picture So if I hear that somebody in a criminal case was delusional, the first thing I wanna know is what the delusion actually involved, right?
00:23:53.691 --> 00:23:57.030
Were they convinced somebody was threatening them, for example?
00:23:57.820 --> 00:24:13.080
Then I want the broader context,'cause substance use, acute agitation, hallucinations, previous violence, and whether somebody was receiving treatment may tell us way more about risk than the word delusional all by itself does.
00:24:14.030 --> 00:24:21.721
There's also evidence that the content of the belief can matter, and this is where persecutory delusions become especially interesting.
00:24:22.471 --> 00:24:37.161
There was, um, this group of researchers analyzing data from the MacArthur Violence Risk Assessment Study, and they followed psychiatric hospital patients after they were discharged and looked at the relationship between delusions and later violence.
00:24:37.550 --> 00:24:41.641
What they found was actually a little more complicated than I expected.
00:24:42.188 --> 00:24:52.621
If researchers looked at somebody's delusions at one point in time and tried to use them to predict whether that person was going to become violent over the next several weeks, it actually didn't work very well.
00:24:53.020 --> 00:24:59.560
So just knowing that somebody was experiencing delusions wasn't enough to tell you what they were gonna do next, basically.
00:25:00.040 --> 00:25:08.280
But when researchers looked at what was happening around the same time as an act of violence, some specific delusions showed up more often.
00:25:08.451 --> 00:25:17.830
In particular, beliefs that somebody was following them, spying on them, plotting against them, or somehow controlling them were associated with serious violence.
00:25:18.320 --> 00:25:21.560
And even then, the belief itself wasn't the whole story.
00:25:22.080 --> 00:25:32.280
Those threat-related delusions were also strongly associated with anger, and once researchers accounted for the anger, much of the relationship between delusions and violence weakened.
00:25:32.721 --> 00:25:49.080
So the pattern isn't so much this person has delusions, therefore they're more likely to become violent, and it's more like certain delusions can create a very immediate sense of threat, and when that threat also produces intense anger, the risk level can change.
00:25:50.080 --> 00:25:56.691
So someone believes they're under threat, and that belief produces fear, anger, or some combination of the two.
00:25:57.290 --> 00:26:09.931
Then that person's history, substance use, impulse control, treatment status, access to the supposed persecutor, and whatever else is happening in the moment determine what they actually do.
00:26:10.790 --> 00:26:19.010
And when you think about it from inside the person's experience, the pathway isn't as mysterious as, you know, it might have appeared to us on the outside.
00:26:19.891 --> 00:26:29.224
And what I mean is if I sincerely believe you're planning to kill me, my nervous system is responding to a threat, whether that threat exists in an objective reality or not.
00:26:29.851 --> 00:26:30.421
You know?
00:26:30.711 --> 00:26:33.800
Maybe I hide from you or stop leaving the house.
00:26:34.060 --> 00:26:36.260
Maybe I repeatedly call the police.
00:26:36.461 --> 00:26:41.921
I might even confront you because m- maybe I'm frightened and really desperate to make the threat stop.
00:26:42.451 --> 00:26:51.060
In a much smaller number of cases, especially when other risk factors are present, somebody may decide that they need to attack first.
00:26:52.060 --> 00:26:58.401
The important thing here is that the delusion isn't creating some generic appetite for violence, okay?
00:26:58.641 --> 00:27:07.881
In those particular cases, it's creating a perceived reality in which violence may feel defensive or necessary to the person experiencing it.
00:27:08.760 --> 00:27:18.941
And researchers have actually spent years debating this idea, specifically whether certain threat-related psychotic experiences are especially important when assessing violence risk.
00:27:19.441 --> 00:27:22.451
The research hasn't been perfectly consistent.
00:27:22.931 --> 00:27:44.881
Some studies have found meaningful associations with violence while others haven't, which is another reason it makes very little sense to hear something like persecutory delusion and automatically translate that into,"This person is dangerous." Timing, emotion, and the rest of the person's circumstances matter way too much for us to jump to that conclusion.
00:27:45.881 --> 00:28:07.612
And then there's one final piece of this that I think matters specifically because we're talking about true crime, And that's the sample of people we're exposed to in the first place So true crime gives us a very distorted view of psychosis because we're usually starting with cases where something really terrible has already happened.
00:28:08.152 --> 00:28:08.602
Right?
00:28:08.612 --> 00:28:18.832
It's like nobody ever makes an eight-part documentary about the man who became convinced his neighbors were spying on him, got terrified, withdrew from everybody, eventually received treatment, and never physically harmed anyone.
00:28:19.432 --> 00:28:22.932
There's no homicide investigation in that story.
00:28:23.201 --> 00:28:24.731
There isn't a dramatic trial.
00:28:24.951 --> 00:28:26.731
You've probably never heard about him.
00:28:27.162 --> 00:28:31.721
Instead, we meet psychosis through people like Richard Chase.
00:28:32.041 --> 00:28:35.301
We encounter erotomania through stalking cases.
00:28:35.632 --> 00:28:40.432
We learn about persecutory beliefs because someone attacked the person they believed was after them.
00:28:41.332 --> 00:28:51.781
So we're learning about an entire category of mental health experiences through a very tiny and unusually violent subset of people who have them.
00:28:52.781 --> 00:29:04.001
Even research on first-episode psychosis, which real quick, that's what we often consider to be a period of elevated risk because people might be, you know, acutely unwell and not yet receiving effective treatment.
00:29:04.721 --> 00:29:12.842
Research on first-episode psychosis starts from the recognition that most people experiencing psychosis do not commit serious violence.
00:29:13.251 --> 00:29:19.172
And I think that's probably the biggest change in how I think about the word delusional when it shows up in a crime story.
00:29:19.551 --> 00:29:24.281
If somebody tells me an offender was delusional, I don't really feel like I've learned very much yet.
00:29:24.672 --> 00:29:30.590
I wanna know what they actually believed and whether there's good evidence that they genuinely held that belief.
00:29:31.010 --> 00:29:36.111
Then I wanna understand whether it had any meaningful connection to the behavior we're trying to explain.
00:29:36.751 --> 00:29:38.922
Sometimes it absolutely does.
00:29:39.442 --> 00:29:44.851
Someone who genuinely believes another person is trying to murder them may experience an attack as self-defense.
00:29:45.351 --> 00:29:59.134
Similarly, an erotomanic belief may help explain why repeated rejection doesn't actually stop a stalking campaign another case, somebody may happen to experience delusions that have virtually nothing to do with the crime they've committed.
00:29:59.714 --> 00:30:04.595
That's why I think the word gets used too casually in true crime.
00:30:04.964 --> 00:30:09.924
It sounds explanatory when often it's really just the beginning of the explanation.
00:30:10.394 --> 00:30:17.414
Bizarre behavior isn't automatically evidence of psychosis, and irrational behavior isn't necessarily delusional.
00:30:17.845 --> 00:30:23.654
People can also commit horrific crimes while having a perfectly intact understanding of reality.
00:30:24.545 --> 00:30:34.994
So the next time somebody in a documentary says an offender became increasingly delusional, I'd pay attention to what comes after that sentence.
00:30:35.394 --> 00:30:40.515
What did the person actually believe, and did that belief genuinely help drive what happened?
00:30:41.045 --> 00:30:48.954
Because once you know what a delusion actually is, I think it becomes much harder to accept the word itself as an explanation for their behavior.
00:30:49.444 --> 00:30:52.085
And I'm curious whether it changes anything for you too.
00:30:52.545 --> 00:31:03.144
You know, if you know somebody genuinely believed they were reacting to a reality that doesn't exist, does that change how you understand their behavior, even when it doesn't change how you feel about what they did?
00:31:04.144 --> 00:31:05.744
Something to think about this week.
00:31:06.605 --> 00:31:12.255
Anyway, thanks for hanging for the side notes, and I will see you guys next week with another full-length episode.
00:31:12.775 --> 00:31:16.835
Don't forget to leave a review or follow the show if you're enjoying the podcast.
00:00:00.550 --> 00:00:02.770
Hi, friends, and welcome to Pretty Evil.
00:00:03.279 --> 00:00:08.492
Today's episode's a little bit different from our usual deep dives because this is a side note.
00:00:09.092 --> 00:00:17.012
Every other week, I'm gonna take a little detour from the bigger stories and kinda use these episodes to explore something that I think deserves maybe a closer look.
00:00:17.532 --> 00:00:21.652
Sometimes that'll be a psychological concept that comes up a lot in true crime.
00:00:21.652 --> 00:00:25.271
Sometimes it might be something maybe connected to a case we've already covered.
00:00:25.692 --> 00:00:33.351
Um, and I also was thinking I might even just occasionally cover a current story that I find interesting and wanna talk about.
00:00:33.692 --> 00:00:40.082
So these episodes are gonna be a little bit shorter, a little more relaxed, and probably a little bit less scripted than the main show.
00:00:40.442 --> 00:00:59.072
And my hope is that it would give me some room to kind of follow interesting threads that might not need an entire hour-long episode and I also wanted to add that pa- a big part of the reason I wanted to have these side note episodes is because I want for us to get to know each other a little bit better.
00:00:59.222 --> 00:01:02.072
It sounds so corny, but I, I feel like...
00:01:02.862 --> 00:01:06.242
Listen, Let me kinda rewind a little bit and give you some additional context.
00:01:07.072 --> 00:01:27.685
When I decided to create Pretty Evil, I knew that I wanted a podcast that was going to be very carefully researched, very meticulously written, and I really wanted for the presentation to be as good as it could possibly be for an independent podcaster.
00:01:28.084 --> 00:01:29.254
It's very hard.
00:01:29.454 --> 00:01:46.655
Um, it's a lot of work, but I just, personally, I feel like there are so many of those, like, talk show-style podcasts out there, and no hate to them at all, um, but I was looking for something different that I always sort of felt I couldn't get anywhere else other than Crime Junkie.
00:01:46.885 --> 00:01:48.234
And I love Crime Junkie.
00:01:48.314 --> 00:01:54.055
I loved it for many years, but I also wanted a different perspective and was struggling to find that as well.
00:01:54.055 --> 00:02:12.995
And so while it was really important to me to really put, like, honestly, kind of, like, my heart and soul into something that is, you know, my best possible work, I think anyone who knows me personally can say that that's also just, like, a very small fragment of who I am as a person.
00:02:13.585 --> 00:02:22.115
I wanted to have something that was just a little bit softer, a little bit less scripted, and a little bit more of a window into, like, kinda my natural personality.
00:02:22.125 --> 00:02:32.615
Because I think a big part of what makes us love the creators that we follow and, you know, come back for more each episode is getting to know those people.
00:02:32.615 --> 00:02:49.004
And so while I want to show up and give you a really strong, really well-done show, I also want to show up as myself, and sometimes those two things don't coexist perfectly because I can be a little bit silly.
00:02:49.004 --> 00:02:50.294
I'm a little bit off-the-cuff.
00:02:50.344 --> 00:02:55.354
If you ask someone that knows me personally, I swear like a sailor in real life.
00:02:55.365 --> 00:03:02.365
But I'm not gonna be doing that in our episodes, because I want to be respectful of the content that we are addressing each week.
00:03:02.375 --> 00:03:13.685
So I thought this would be maybe a good way for, you know, us to have a little bit more of an intimate relationship, um, but still discuss things that are important.
00:03:13.858 --> 00:03:16.668
So All right, I'm gonna get off my soapbox now.
00:03:17.008 --> 00:03:20.018
Um, and let's get into it.
00:03:20.198 --> 00:03:22.157
Today I wanna talk about delusions.
00:03:22.228 --> 00:03:29.752
I wanna talk about what they actually are, how they work, and what we really mean when we say that somebody's lost touch with reality.
00:03:30.032 --> 00:03:34.731
And this felt like an especially good place to start after our episode last week on Richard Chase.
00:03:34.762 --> 00:03:40.671
We wrapped up part two, um, and if you didn't catch either of those episodes, make sure that you go and check them out.
00:03:40.794 --> 00:03:46.701
But I felt like that was a really good place to start because delusions play such an enormous role in that story.
00:03:46.942 --> 00:03:55.701
And they're also, at the same time, a psychological concept that gets thrown around a lot in true crime storytelling, and honestly, a lot in our everyday lives too.
00:03:55.701 --> 00:04:00.301
Like, we're always,"Oh, you're delusional." That's a very common thing for people to say to each other.
00:04:00.662 --> 00:04:06.611
Um, and I think we use the word pretty casually without necessarily understanding what it means clinically.
00:04:06.921 --> 00:04:12.301
And it's really interesting when you get into it, because you start to understand that there are...
00:04:12.331 --> 00:04:26.625
Not only are there different types of delusions, which we'll get to, But also, you know, we encounter them a lot more, I think, than we realize, both in our real lives and in the true crime world and stories that we follow along with.
00:04:27.107 --> 00:04:30.764
So like I said, we call people delusional all the time.
00:04:31.764 --> 00:04:33.824
I personally believe I'm gonna win the lottery.
00:04:34.413 --> 00:04:35.473
Not could win.
00:04:35.644 --> 00:04:37.103
I wi- I will win.
00:04:37.293 --> 00:04:38.704
It's really just a matter of time.
00:04:39.053 --> 00:04:40.634
I call that manifesting.
00:04:40.733 --> 00:04:42.444
Some people might call it delusional.
00:04:43.204 --> 00:04:46.634
Except clinically, that's really not what the word means.
00:04:46.954 --> 00:05:07.862
And in true crime, it's really important for us to understand that, because you'll sometimes hear that an offender was delusional, and suddenly that one word is expected to explain everything We kinda treat it as some kind of, like, catch-all for somebody being mentally ill, irrational, unpredictable, or dangerous, even though those are actually several separate things.
00:05:08.290 --> 00:05:18.600
So I wanted to look today at what delusions really are, because I think understanding the clinical meaning can help us to better follow the internal logic of the behavior that stems from that sort of thing.
00:05:19.600 --> 00:05:29.759
Okay, so the basic clinical definition of a delusion is a belief that's held with enough conviction that contradictory evidence doesn't meaningfully change it.
00:05:30.449 --> 00:05:37.029
And the second half of that sentence is probably the most important, because we always believe things that aren't true.
00:05:37.829 --> 00:05:39.939
You know, we misunderstand things.
00:05:39.970 --> 00:05:41.350
We get bad information.
00:05:41.620 --> 00:05:42.860
We make assumptions.
00:05:43.160 --> 00:05:52.050
I'm sure at some point we've all become convinced somebody doesn't like us because they didn't respond to a text for six hours, only to discover they were asleep.
00:05:52.370 --> 00:05:56.040
The point is, being wrong isn't a delusion.
00:05:56.519 --> 00:05:57.170
Okay?
00:05:57.279 --> 00:06:06.939
So, like, for argument's sake, let's say I become convinced that my neighbor stole one of my Amazon packages because I saw him near my porch that afternoon.
00:06:07.439 --> 00:06:11.029
I confront him, and he pulls up his security footage.
00:06:11.319 --> 00:06:14.470
It clearly shows somebody else taking the package.
00:06:14.920 --> 00:06:18.250
At that point, I go,"Oh, well, shit.
00:06:18.339 --> 00:06:18.889
Sorry.
00:06:19.420 --> 00:06:25.529
I was wrong." You know, maybe I was unfairly suspicious, but reality corrected me, and I acquiesced.
00:06:26.279 --> 00:06:33.920
Now imagine I look at that same footage and decide my neighbor obviously hired the person in the video.
00:06:34.540 --> 00:06:40.769
You tell me he was at work when the package disappeared, so I conclude his employer is covering for him.
00:06:41.319 --> 00:06:48.920
The police say there's no evidence connecting him to the theft, and now I'm, I'm almost certain that he's somehow gotten to the police too.
00:06:49.769 --> 00:06:59.459
So the distinction I'm trying to make here is that when it comes to a delusion, every piece of evidence that should weaken the belief gets incorporated into it instead.
00:06:59.699 --> 00:07:00.540
You see what I mean?
00:07:01.050 --> 00:07:12.930
And that is much closer to what clinicians mean when they describe a belief as fixed But even there, you can't diagnose a delusion just because somebody's too stubborn to admit that they're wrong.
00:07:13.370 --> 00:07:14.170
I mean, come on, guys.
00:07:14.189 --> 00:07:18.709
If, if that were the standard, Thanksgiving dinner would qualify as a mass psychiatric event.
00:07:19.110 --> 00:07:23.220
My point is, clinicians have to look at the belief in context.
00:07:23.889 --> 00:07:27.259
How did the person get here, you know, thinking this?
00:07:27.769 --> 00:07:30.889
Also, how attached are they to the belief?
00:07:31.230 --> 00:07:34.930
Is this belief shared by their culture or community?
00:07:35.310 --> 00:07:39.079
Is there some, maybe some plausible factual basis for it?
00:07:39.610 --> 00:07:42.269
And what happens when they're shown evidence against it?
00:07:42.920 --> 00:07:45.529
What, you know, what else is happening psychologically?
00:07:46.389 --> 00:08:00.670
But if we strip all of that down, a delusion is basically a belief someone is deeply convinced is true, even when there isn't good evidence for it, and contradictory evidence usually doesn't do much to shake that belief.
00:08:00.889 --> 00:08:02.540
That's kind of the basic idea.
00:08:03.480 --> 00:08:14.910
Conspiracy theories are probably one of the easiest examples to use to help us find that line when it comes to delusion cause something interesting about conspiracy beliefs is that they're often social.
00:08:15.569 --> 00:08:24.250
There's a community reinforcing them, supplying supposed evidence, interpreting events, and giving a person this framework that others share.
00:08:24.639 --> 00:08:34.820
And in this world, you can believe something that's completely unsupported and highly implausible with little to no evidence without necessarily having a clinical delusion.
00:08:35.190 --> 00:08:44.110
So in this category, we're talking about things like alien life forms and Area 51 or maybe, like, the idea of a shadow government.
00:08:44.570 --> 00:08:51.149
It might sound totally delusional to some, but there's a shared belief in their existence.
00:08:51.769 --> 00:08:58.070
Clinical delusion, on the other hand, tends to be a lot more organized around the individual and kind of more personal.
00:08:58.740 --> 00:09:11.370
You know, for example, uh, instead of just believing government surveillance exists, a person might believe a particular government agency has installed cameras in their home because of something unique about them.
00:09:11.809 --> 00:09:19.700
Or, like, maybe they're convinced a TV anchor is embedding messages intended specifically for them into the evening news.
00:09:20.169 --> 00:09:20.440
Okay.
00:09:20.440 --> 00:09:23.090
So that's kind of a good illustration of the difference.
00:09:23.330 --> 00:09:30.480
The broader culture can absolutely influence the content of a delusion, but the belief itself usually becomes intensely personal.
00:09:31.179 --> 00:09:34.340
And conspiracy theories aren't the only place that this gets fuzzy.
00:09:34.879 --> 00:09:46.080
There are a couple of other psychological experiences that can involve really persistent beliefs, and these come up in crime stories too One of them is something called an overvalued idea.
00:09:46.889 --> 00:09:57.269
An overvalued idea is basically a belief that becomes kind of like disproportionately important to a person, like, to the degree that it affects their identity, okay?
00:09:57.279 --> 00:10:05.200
So usually they're devoting huge amounts of time and energy to it, and the belief can become rigid enough that it's really difficult to challenge.
00:10:05.460 --> 00:10:11.889
But usually you can still trace a psychologically understandable road that led them there, you know?
00:10:12.039 --> 00:10:17.129
And a- actually I think we see overvalued ideas in action a lot in politics.
00:10:17.330 --> 00:10:20.230
And I'm not gonna, I'm not gonna make this like a political conversation.
00:10:20.230 --> 00:10:23.100
I don't particularly care what your political leanings are.
00:10:23.100 --> 00:10:29.240
But I think there are people in every party with overvalued ideas.
00:10:29.720 --> 00:10:44.450
And researchers and clinicians argue a lot about exactly where overvalued ideas end and delusions begin, which is a good reminder that psychiatric categories don't always come with perfectly clean little borders.
00:10:44.830 --> 00:10:46.809
I talk about that almost every episode.
00:10:46.820 --> 00:10:50.470
Human beings are annoyingly committed to being complicated.
00:10:51.470 --> 00:11:02.779
Now on a different note, Another thing I want to separate out here is obsession, especially because OCD can involve thoughts that feel incredibly convincing, but are those delusions?
00:11:03.649 --> 00:11:10.600
If you have like an intrusive thought, like what if I hit somebody with my car and somehow didn't notice?
00:11:10.950 --> 00:11:17.419
That thought, as ridiculous as it might sound to you, can become extremely distressing.
00:11:18.019 --> 00:11:29.029
Someone with OCD might even drive back repeatedly to check the road, you know, search local news, inspect their car, or keep asking other people for reassurance that it didn't actually happen.
00:11:29.509 --> 00:11:35.070
But most of the time, there's still some level of recognition that the fear may not be rational.
00:11:35.429 --> 00:11:40.399
The person is just kind of like tortured by the possibility that it may have happened.
00:11:41.269 --> 00:11:48.879
A delusional belief would be closer to becoming genuinely convinced that it happened despite having no evidence that it did.
00:11:49.210 --> 00:11:56.730
So you can see that there, there is a difference here, but even that distinction can get blurry because OCD also exists on a spectrum.
00:11:57.250 --> 00:12:05.820
So I guess kind of my point here is that it isn't that there's a perfect little diagnostic line dividing every category.
00:12:06.039 --> 00:12:19.470
It's really that things like intrusive thoughts, obsessions, extreme beliefs, and delusions can sound interchangeable in casual conversation when clinically they actually describe very different experiences.
00:12:19.799 --> 00:12:20.200
Okay?
00:12:20.519 --> 00:12:22.379
And then we have everyday paranoia.
00:12:23.240 --> 00:12:31.200
You know, if you're walking through a parking garage late at night and you notice somebody's following you, becoming suspicious of that person isn't pathological.
00:12:31.639 --> 00:12:34.639
Your, your brain is supposed to notice possible threats.
00:12:34.649 --> 00:12:35.970
That's a, that's a good thing.
00:12:36.490 --> 00:12:41.529
Even somebody who's excessively suspicious isn't automatically delusional.
00:12:42.120 --> 00:12:50.009
Where that shifts is when it comes to something called a persecutory delusion, and that takes things further.
00:12:50.419 --> 00:12:58.129
So that's where a person becomes genuinely convinced that somebody's deliberately targeting them without adequate evidence that this is actually happening.
00:12:58.259 --> 00:12:58.559
Okay?
00:12:58.559 --> 00:13:04.220
You know, maybe they think somebody's spying on them or poisoning them, following them, planning to hurt them.
00:13:04.279 --> 00:13:05.110
You get the idea.
00:13:06.029 --> 00:13:10.649
So at this point, we've mostly been sorting out different beliefs that can resemble each other.
00:13:10.899 --> 00:13:24.759
But before we move on, there's another distinction we need to make,'cause I've noticed that true crime coverage tends to sometimes mix up delusions and hallucinations, or at least it kinda makes them sound interchangeable, and they're not the same thing either.
00:13:25.139 --> 00:13:27.480
A hallucination is a perception.
00:13:27.600 --> 00:13:34.779
So that's when, like, somebody hears a voice that isn't actually being produced by another person, or maybe they see something that isn't actually there.
00:13:35.200 --> 00:13:44.379
I think the simplest way to think about it is that a hallucination is where a person has a sensory experience without an external source.
00:13:44.960 --> 00:13:48.100
A delusion, on the other hand, is a belief.
00:13:48.429 --> 00:13:59.779
So if I hear a voice say,"Your neighbor's trying to kill you," the voice is the hallucination, and then if I become convinced my neighbor is trying to kill me, that's the delusion.
00:14:00.009 --> 00:14:00.830
Make sense?
00:14:01.669 --> 00:14:06.769
And I should also clarify, those experiences can 100% happen together.
00:14:07.049 --> 00:14:14.750
Like, if you're repeatedly hearing a voice tell you that somebody's trying to hurt you, obviously that can reinforce a persecutory belief about that person.
00:14:15.190 --> 00:14:24.629
Or you might hear a voice actually telling you to do something, which is what clinicians mean by a command hallucination, if you've ever heard that term.
00:14:25.100 --> 00:14:27.320
That's still a hallucination, though.
00:14:27.419 --> 00:14:29.220
It's, it isn't a type of delusion.
00:14:30.070 --> 00:14:44.509
So now that we've separated those ideas, there's one other misconception I kinda wanna clear up before we get into different types of delusion, which is that having delusions does not automatically mean somebody has schizophrenia.
00:14:45.509 --> 00:14:54.500
Delusions can happen in schizophrenia and other psychotic disorders, but they can also happen in severe mood disorders like bipolar disorder.
00:14:55.029 --> 00:15:01.440
Drugs or medication can also trigger psychosis and delusions, and even certain neurological and medical conditions can cause it.
00:15:01.899 --> 00:15:04.789
Dementia is actually another one that might be surprising.
00:15:04.799 --> 00:15:06.399
It can involve delusional thinking, too.
00:15:07.399 --> 00:15:18.269
There's also a condition called delusional disorder, and this one's especially interesting in the context of crime, because somebody with this disorder can actually come across as pretty normal.
00:15:18.730 --> 00:15:26.690
They might work, pay their bills, have good relationships, and could probably even have, like, a totally normal and benign conversation with you.
00:15:27.100 --> 00:15:41.200
But then you happen to mention the woman who lives three streets away, and a person with delusional disorder might then calmly explain that she's in love with them, and she secretly communicates her love by changing which curtains she opens in the morning.
00:15:41.809 --> 00:15:54.759
So outside that very specific belief system, their functioning is actually relatively intact, which is kind of interesting, and that's one reason our stereotype of someone in psychosis doesn't really work.
00:15:55.149 --> 00:16:01.080
You know, people in psychosis aren't always visibly disconnected from reality every second of the day.
00:16:01.269 --> 00:16:01.769
Okay?
00:16:02.240 --> 00:16:07.399
So now we know what a delusion is, and we've separated it from a few things that can look similar.
00:16:07.759 --> 00:16:13.100
Let's talk about what delusions actually look like because there isn't just one type of delusion.
00:16:13.870 --> 00:16:20.720
Clinicians say there are actually several recurring types, and you'll probably recognize some of them if you listen to a lot of true crime.
00:16:21.269 --> 00:16:27.529
So I'm gonna run through them pretty quickly, starting with probably the one we hear about most often, and that's persecutory delusions.
00:16:28.250 --> 00:16:32.629
As I mentioned earlier, these are the belief that somebody is after you.
00:16:32.789 --> 00:16:33.169
Okay?
00:16:33.169 --> 00:16:40.659
Maybe you're convinced a neighbor is poisoning your food, the government is watching you, your coworkers are conspiring to get you fired, whatever.
00:16:40.659 --> 00:16:42.509
You know, somebody's planning to kill you.
00:16:42.720 --> 00:16:56.902
Then related to that but slightly different are what we call referential delusions This is when normal things happening around you seem to contain some kind of special message or meaning specifically for you.
00:16:57.412 --> 00:17:00.991
So, you know, the radio host is secretly talking about you.
00:17:01.491 --> 00:17:05.592
Two strangers laughing across a restaurant are actually discussing you.
00:17:06.352 --> 00:17:11.311
Maybe the billboard you passed this morning was placed there because somebody wanted you to see it.
00:17:11.892 --> 00:17:29.082
So this is basically the idea that kind of other people or other scenarios that you encounter in your everyday life that are actually not relevant to you at all, you kind of internalize as being about you or for you.
00:17:30.082 --> 00:17:37.362
Then we have grandiose delusions, which involve exceptional status, power, identity, or ability.
00:17:37.932 --> 00:17:52.491
Somebody might think that they are, like, a prophet or an intelligence operative, maybe the inventor of some revolutionary technology, or they, they think that they possess abilities that nobody else has.
00:17:53.491 --> 00:17:56.801
There are also somatic delusions, which revolve around the body.
00:17:57.082 --> 00:18:11.031
Somebody might become convinced that they're infested with parasites, that one of their internal organs is missing, or that their body's decaying, or maybe some, you know, impossible physical process is happening inside them that they can't control.
00:18:11.442 --> 00:18:15.332
That might sound familiar if you caught an earlier episode of mine.
00:18:15.961 --> 00:18:24.352
Jealous delusions Generally involve absolute conviction that a romantic partner is being unfaithful despite inadequate evidence to the contrary.
00:18:24.842 --> 00:18:30.761
And then there are erotomanic delusions, where somebody believes another person is in love with them.
00:18:31.402 --> 00:18:36.541
Sometimes they've barely met that person, and sometimes they've never even met them at all.
00:18:37.201 --> 00:18:42.662
So those categories, all those categories I just listed, give us the vocabulary.
00:18:43.261 --> 00:18:49.872
The more interesting question for this show is what happens when somebody starts making decisions based on one of those beliefs?
00:18:50.592 --> 00:18:56.152
Erotomania gives us a particularly clear example because we see it sometimes in stalking cases.
00:18:56.622 --> 00:19:05.321
In a Montana case from the 1990s, there was a man named James Cooney, and psychiatric experts testified that he had erotomanic-type delusional disorder.
00:19:05.741 --> 00:19:15.602
According to reports, he had persistently pursued a woman for years despite protective orders, previous legal invention, and her very clear attempts to avoid him.
00:19:16.432 --> 00:19:26.672
But Cooney believed she was in love with him, and once that belief is fixed, every attempt she makes to reject him requires some kind of alternative explanation.
00:19:27.092 --> 00:19:31.561
You know, if she says she wants no contact, maybe she's being pressured by her family.
00:19:32.071 --> 00:19:35.551
If she gets a restraining order, maybe somebody else convinced her to do it.
00:19:36.132 --> 00:19:40.672
And if she avoids him, maybe she's just scared of the intensity of her own feelings.
00:19:41.662 --> 00:19:50.061
The evidence of rejection doesn't necessarily weaken the delusion because the delusion finds a way to reinterpret the rejection.
00:19:50.721 --> 00:19:55.781
That's what I mean when I say some delusional behavior has an internal logic.
00:19:56.311 --> 00:20:07.541
You know, another good example is, like, if you believe there's a fire in your house, running outside makes perfect sense, but your behavior is irrational to everybody else around you because there isn't actually a fire.
00:20:07.971 --> 00:20:12.551
And that same basic idea can become extremely important in criminal cases.
00:20:13.061 --> 00:20:22.592
We've already covered Richard Chase on this show, so I'm not gonna turn this into, like, an extension of that episode, but he's a really useful example because his psychosis was extensively documented.
00:20:23.071 --> 00:20:29.791
If you remember, if you listened to the episode, Chase had severe somatic and persecutory beliefs involving his body and his blood.
00:20:30.011 --> 00:20:37.561
He believed something was catastrophically wrong with him, and over time, those beliefs became connected to his consumption of blood.
00:20:38.061 --> 00:20:42.491
That tells us something important about why his behavior was so bizarre.
00:20:42.781 --> 00:20:47.311
He wasn't operating from a sound understanding of what was happening inside his body.
00:20:47.422 --> 00:20:53.821
He was responding to a physical crisis that, from his perspective, was completely real.
00:20:54.821 --> 00:21:12.195
There's also an Illinois case involving a man named Branden Napolitan, and I think that one highlights this same principle maybe even more directly According to the forensic evaluation discussed in his case, Napolitan believed another man intended to kill him.
00:21:12.536 --> 00:21:16.645
He was also hearing voices telling him to stab that person.
00:21:17.105 --> 00:21:22.855
So in that case, you have two separate psychotic symptoms happening at the same time.
00:21:23.425 --> 00:21:30.406
The voices were hallucinations His belief that the other man intended to kill him was a persecutory delusion.
00:21:31.406 --> 00:21:45.936
The evaluator concluded that Napolitan understood, like generally speaking, that stabbing somebody was illegal, but experienced the situation through a psychotic belief that he was defending himself from imminent threat, right?
00:21:45.936 --> 00:21:57.247
So basically,, for Napolitan, what was happening was real, and so his response, in his mind, was entirely appropriate given the circumstances.
00:21:57.946 --> 00:22:05.416
And so I think it's helpful for us to talk through these cases because they show us how a delusion can influence behavior.
00:22:05.826 --> 00:22:09.426
But they also lead us into a much bigger question.
00:22:10.076 --> 00:22:12.676
How much does any of this actually have to do with violence?
00:22:13.067 --> 00:22:16.366
The research doesn't give us a satisfying one-word answer.
00:22:16.757 --> 00:22:28.457
Most people with schizophrenia or other psychotic disorders aren't violent, and actually, people with serious mental illness are also disproportionately more likely to become victims of violence themselves.
00:22:29.136 --> 00:22:36.957
Big picture, though, psychotic disorders have been associated with an increased risk of violence compared to people who don't have them.
00:22:37.426 --> 00:22:50.047
And I think kind of the easiest way to make sense of these two competing facts coexisting is to stop treating the presence of psychosis as the whole explanation and look at the circumstances surrounding violence instead.
00:22:50.896 --> 00:23:07.146
Okay, so a large review published in twenty twenty-five looked across longitudinal studies involving more than two hundred thousand people with psychotic disorders, and that means these were long-term studies following the same people over a period of time.
00:23:07.616 --> 00:23:14.237
And what they found is that some of the stronger predictors of violence weren't unusual psychiatric symptoms at all.
00:23:14.656 --> 00:23:20.817
Previous criminal behavior, substance misuse, and treatment-related factors all mattered more.
00:23:21.606 --> 00:23:24.967
And older research actually yielded similar results.
00:23:25.076 --> 00:23:53.681
The relationship between psychosis and violence becomes substantially stronger when substance misuse is also present, and studies repeatedly identify things like previous violence, hostility, intoxication, poor impulse control, and treatment disruption as relevant pieces of the risk picture So if I hear that somebody in a criminal case was delusional, the first thing I wanna know is what the delusion actually involved, right?
00:23:53.691 --> 00:23:57.030
Were they convinced somebody was threatening them, for example?
00:23:57.820 --> 00:24:13.080
Then I want the broader context,'cause substance use, acute agitation, hallucinations, previous violence, and whether somebody was receiving treatment may tell us way more about risk than the word delusional all by itself does.
00:24:14.030 --> 00:24:21.721
There's also evidence that the content of the belief can matter, and this is where persecutory delusions become especially interesting.
00:24:22.471 --> 00:24:37.161
There was, um, this group of researchers analyzing data from the MacArthur Violence Risk Assessment Study, and they followed psychiatric hospital patients after they were discharged and looked at the relationship between delusions and later violence.
00:24:37.550 --> 00:24:41.641
What they found was actually a little more complicated than I expected.
00:24:42.188 --> 00:24:52.621
If researchers looked at somebody's delusions at one point in time and tried to use them to predict whether that person was going to become violent over the next several weeks, it actually didn't work very well.
00:24:53.020 --> 00:24:59.560
So just knowing that somebody was experiencing delusions wasn't enough to tell you what they were gonna do next, basically.
00:25:00.040 --> 00:25:08.280
But when researchers looked at what was happening around the same time as an act of violence, some specific delusions showed up more often.
00:25:08.451 --> 00:25:17.830
In particular, beliefs that somebody was following them, spying on them, plotting against them, or somehow controlling them were associated with serious violence.
00:25:18.320 --> 00:25:21.560
And even then, the belief itself wasn't the whole story.
00:25:22.080 --> 00:25:32.280
Those threat-related delusions were also strongly associated with anger, and once researchers accounted for the anger, much of the relationship between delusions and violence weakened.
00:25:32.721 --> 00:25:49.080
So the pattern isn't so much this person has delusions, therefore they're more likely to become violent, and it's more like certain delusions can create a very immediate sense of threat, and when that threat also produces intense anger, the risk level can change.
00:25:50.080 --> 00:25:56.691
So someone believes they're under threat, and that belief produces fear, anger, or some combination of the two.
00:25:57.290 --> 00:26:09.931
Then that person's history, substance use, impulse control, treatment status, access to the supposed persecutor, and whatever else is happening in the moment determine what they actually do.
00:26:10.790 --> 00:26:19.010
And when you think about it from inside the person's experience, the pathway isn't as mysterious as, you know, it might have appeared to us on the outside.
00:26:19.891 --> 00:26:29.224
And what I mean is if I sincerely believe you're planning to kill me, my nervous system is responding to a threat, whether that threat exists in an objective reality or not.
00:26:29.851 --> 00:26:30.421
You know?
00:26:30.711 --> 00:26:33.800
Maybe I hide from you or stop leaving the house.
00:26:34.060 --> 00:26:36.260
Maybe I repeatedly call the police.
00:26:36.461 --> 00:26:41.921
I might even confront you because m- maybe I'm frightened and really desperate to make the threat stop.
00:26:42.451 --> 00:26:51.060
In a much smaller number of cases, especially when other risk factors are present, somebody may decide that they need to attack first.
00:26:52.060 --> 00:26:58.401
The important thing here is that the delusion isn't creating some generic appetite for violence, okay?
00:26:58.641 --> 00:27:07.881
In those particular cases, it's creating a perceived reality in which violence may feel defensive or necessary to the person experiencing it.
00:27:08.760 --> 00:27:18.941
And researchers have actually spent years debating this idea, specifically whether certain threat-related psychotic experiences are especially important when assessing violence risk.
00:27:19.441 --> 00:27:22.451
The research hasn't been perfectly consistent.
00:27:22.931 --> 00:27:44.881
Some studies have found meaningful associations with violence while others haven't, which is another reason it makes very little sense to hear something like persecutory delusion and automatically translate that into,"This person is dangerous." Timing, emotion, and the rest of the person's circumstances matter way too much for us to jump to that conclusion.
00:27:45.881 --> 00:28:07.612
And then there's one final piece of this that I think matters specifically because we're talking about true crime, And that's the sample of people we're exposed to in the first place So true crime gives us a very distorted view of psychosis because we're usually starting with cases where something really terrible has already happened.
00:28:08.152 --> 00:28:08.602
Right?
00:28:08.612 --> 00:28:18.832
It's like nobody ever makes an eight-part documentary about the man who became convinced his neighbors were spying on him, got terrified, withdrew from everybody, eventually received treatment, and never physically harmed anyone.
00:28:19.432 --> 00:28:22.932
There's no homicide investigation in that story.
00:28:23.201 --> 00:28:24.731
There isn't a dramatic trial.
00:28:24.951 --> 00:28:26.731
You've probably never heard about him.
00:28:27.162 --> 00:28:31.721
Instead, we meet psychosis through people like Richard Chase.
00:28:32.041 --> 00:28:35.301
We encounter erotomania through stalking cases.
00:28:35.632 --> 00:28:40.432
We learn about persecutory beliefs because someone attacked the person they believed was after them.
00:28:41.332 --> 00:28:51.781
So we're learning about an entire category of mental health experiences through a very tiny and unusually violent subset of people who have them.
00:28:52.781 --> 00:29:04.001
Even research on first-episode psychosis, which real quick, that's what we often consider to be a period of elevated risk because people might be, you know, acutely unwell and not yet receiving effective treatment.
00:29:04.721 --> 00:29:12.842
Research on first-episode psychosis starts from the recognition that most people experiencing psychosis do not commit serious violence.
00:29:13.251 --> 00:29:19.172
And I think that's probably the biggest change in how I think about the word delusional when it shows up in a crime story.
00:29:19.551 --> 00:29:24.281
If somebody tells me an offender was delusional, I don't really feel like I've learned very much yet.
00:29:24.672 --> 00:29:30.590
I wanna know what they actually believed and whether there's good evidence that they genuinely held that belief.
00:29:31.010 --> 00:29:36.111
Then I wanna understand whether it had any meaningful connection to the behavior we're trying to explain.
00:29:36.751 --> 00:29:38.922
Sometimes it absolutely does.
00:29:39.442 --> 00:29:44.851
Someone who genuinely believes another person is trying to murder them may experience an attack as self-defense.
00:29:45.351 --> 00:29:59.134
Similarly, an erotomanic belief may help explain why repeated rejection doesn't actually stop a stalking campaign another case, somebody may happen to experience delusions that have virtually nothing to do with the crime they've committed.
00:29:59.714 --> 00:30:04.595
That's why I think the word gets used too casually in true crime.
00:30:04.964 --> 00:30:09.924
It sounds explanatory when often it's really just the beginning of the explanation.
00:30:10.394 --> 00:30:17.414
Bizarre behavior isn't automatically evidence of psychosis, and irrational behavior isn't necessarily delusional.
00:30:17.845 --> 00:30:23.654
People can also commit horrific crimes while having a perfectly intact understanding of reality.
00:30:24.545 --> 00:30:34.994
So the next time somebody in a documentary says an offender became increasingly delusional, I'd pay attention to what comes after that sentence.
00:30:35.394 --> 00:30:40.515
What did the person actually believe, and did that belief genuinely help drive what happened?
00:30:41.045 --> 00:30:48.954
Because once you know what a delusion actually is, I think it becomes much harder to accept the word itself as an explanation for their behavior.
00:30:49.444 --> 00:30:52.085
And I'm curious whether it changes anything for you too.
00:30:52.545 --> 00:31:03.144
You know, if you know somebody genuinely believed they were reacting to a reality that doesn't exist, does that change how you understand their behavior, even when it doesn't change how you feel about what they did?
00:31:04.144 --> 00:31:05.744
Something to think about this week.
00:31:06.605 --> 00:31:12.255
Anyway, thanks for hanging for the side notes, and I will see you guys next week with another full-length episode.
00:31:12.775 --> 00:31:16.835
Don't forget to leave a review or follow the show if you're enjoying the podcast.
