Do Psychotic Delusions Have Meaning?

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Do psychotic symptoms like hallucinations have meaning, or are they just the products of a broken brain that misfires neurons? For years, psychiatrists and psychologists have struggled with this issue, at times attempting to decode patients’ delusions and at other times using medicine, like antipsychotic drugs, to dismiss them.

Now, patients with psychiatric and neurological conditions are finding a middle ground for themselves, studying their own symptoms and identifying the meaning behind them, while simultaneously addressing the problems posed by the disconnection between their own sensed experiences and those of others around them.

In a recent New York Times feature, reporter Benedict Carey wrote about the case of Milt Greek, a computer programmer in Athens, Ohio, who manages a successful work and family life, despite living with schizophrenia and having a long history of delusions about meeting God and Jesus.

Carey described Greek’s reaction to his mother’s death several years ago:

It was Mother’s Day 2006, not long after his mother’s funeral, and he headed back home knowing that he needed help. A change in the medication for his schizophrenia, for sure. A change in focus, too; time with his family, to forget himself.

And, oh yes, he had to act on an urge expressed in his psychotic delusions: to save the world.

So after cleaning the yard around his house — a big job, a gift to his wife — in the coming days he sat down and wrote a letter to the editor of the local newspaper, supporting a noise-pollution ordinance.

It was a small act, but important: Greek has learned to live with his diagnosis by understanding and heeding its urges.

“I have such anxiety if I’m not organizing or doing some good work. I don’t feel right,” Greek told the Times. “That’s what the psychosis has given me, and I consider it to be a gift.”

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Carey’s story describes how people with schizophrenia are starting to come together and share their stories of living with the disorder. They are helped not by viewing their delusions as mere neural nonsense or symptoms of disease, but by working with them and modulating them — sometimes with medications, sometimes with social support and therapy, often with both — into the impetus for living a good life.

In doing so, they are part of a larger trend in mental health care: combining traditional medical treatment with support from other people with similar experience, guided by the principle that recovery requires living a meaningful life.

These ideas perhaps first entered the mainstream via 12-step programs for addiction, which have long believed that people with addictions could often offer the best help for each other. The 12-step model generated widespread acceptance of the importance of social support in overcoming addiction, and now research shows that some form of social support for recovery — whether it be from 12-step programs, religious organizations, family, friends or other groups — is often critical.

The 12 steps of Alcoholics Anonymous are also themselves essentially a guide to a meaningful life, encouraging a focus on humility, service to others, and making amends for wrongdoing. People with addictions have also long incorporated the pursuit of purposeful living into their ideas about how to get better.

However, the same notion has also long been used to support a moralistic view of mental illness and addiction. And consequently, it has also often fed opposition to medical treatments like anti-addiction medications or even professional therapy. A similar problem occurred in earlier self-organization attempts by the mentally ill, which tended to oppose psychiatry itself while trying to help people recover.

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Today’s recovery movement — as Carey’s Timesseries and earlier coverage has shown — is much broader. These days, people with mental illnesses incorporate medication, therapy, social support and other tactics as needed, not seeing them as mutually exclusive but as options that can be right at one time and not needed at another.

This “mad pride” or “neurodiversity” movement characterizes mental differences not only as illness, but also as a potential gift — albeit one that has dangers — defining conditions like addictions, bipolar disorder, schizophrenia and autism as sources of potential talent, productivity, human connection and wisdom.

While that may sound paradoxical — and while falling prey to delusions or other symptoms, rather than appraising them appropriately, can be problematic — the strictly medical model has downsides, too. By dismissing those who have mental differences as simply mentally diseased, we exclude them and deny them meaningful participation in life.

That means we do not benefit from the insights that their unique perspective can bring or from the volunteer work they are deterred from doing or from other contributions to the arts and business world they could make.

Happily, finding meaning in life is linked to health, longevity and productivity for all people — and helping those with mental differences can help everyone.  Not all delusions or mental symptoms have a deeper meaning, but being open to harnessing and using such hallucinations in some cases may help the rest of us see further too.

As Greek told Carey, “When I began to see the delusions in the context of things that were happening in my real life, they finally made some sense. … And understanding the story of my psychosis helped me see what I needed to stay well.”

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Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland’s Facebook page and on Twitter at @TIMEHealthland.

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