Paranoia, schizophrenia, and shaking delusions

It can't all be about Covid-19.

The marvelous thing about being mentally ill is that you're oblivious to the news that affects everyone else. The thoughts and pictures in your head that have always been the enemy continue to be the enemy. So if you suffer from ideas of reference, if you believe that when you bring your phone to therapy that your neighbor will be able to listen in, well, you take the battery out of the phone. Merely turning it off isn't enough.

Is it even worth it to relieve people of their delusions? Won't they be replaced with others?

Not always.

This is such a lovely case that I can't help but share it. Details are changed to protect the identity of the patient.

The story:

He comes to me originally to diagnose what is wrong with him. He has noticed that he may have high functioning autism. He gets most of his news on YouTube.  A brilliant man, but entirely unable to function socially, the diagnosis makes sense. His psychiatrist treats him for bi-polar disorder, has not caught onto what we used to call Asperger's.

I don't even have to test him, can confirm from his oral history that he's not able to absorb social cues, that he can't put together the meaning of silence, when it is full of anger or merely just silence. To him it is angry. He thinks in pictures. He is always, always in need of direction, has no idea what to do, when. Misinterpretations abound, dominate.

Upon further examination, it is quite obvious that he has severe paranoia, and maybe that is the primary diagnosis. Maybe is is bi-polar, but maybe, more likely, a simple paranoid disorder. He doesn't hear voices or see things that aren't there. Nobody is telling him to do anything. He infers it all. (These are called ideas of reference). They, J. Q. Public, are out to make him miserable. The average man on the street wants to harass him. Even people in my waiting room-- when they gesture, it is about him.

You see, there is so much more that telling some people, It's not about you. Most of us get that. Some of us don't.

How to treat it? Not easy, especially if the patient is not taking the meds prescribed by the doctor for crippling anxiety. They make him feel stoned, tired, and dead. He'd prefer his anxiety, his sleeplessness any day.  And anyway. He sleeps.

We went with breathing, centering him on that. Nothing else exists, only the breath. Watch that, not your thoughts. Do not give them power. Do not show them you care. Be the Buddha, stronger, implacable. Indestructible. Above them.

Especially hard for someone like him, but doable. And if he can do it, we all can.

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