By Barbara Pierce
“Howard Hughes was my father. I’m sure of that,” said Alan, with certainty. The attractive 46-year-old man had come to the mental health clinic where I worked because he was concerned about shakiness in his hands.
On his first visit, we talked about his shakiness for only a few minutes when he dropped the bomb—stating that Howard Hughes was his father and Katherine Hepburn his mother.
I knew I had to stay cool, not let my face show the thoughts running through my head.
I dealt with disturbed people all the time — depressed, ready to end their life, or psychotic — out of contact with reality. But this was a new one for me.
Alan was handsome and neatly dressed. His demeanor was normal. He didn’t appear depressed or anxious or have any unusual behaviors. That is until he started talking.
That explained why he’d lost his job; why he had no friends. He was quite psychotic, readily talking about his delusions.
A delusional disorder is a type of serious mental illness in which a person cannot tell what is real from what is imagined. A belief that is not based in reality and is not changed or modified when the person is presented with contradictory evidence.
People with delusional disorder experience non-bizarre delusions, which involve situations that could occur in real life, such as being followed, poisoned, deceived, conspired against, or loved from a distance.
These delusions usually involve the misinterpretation of perceptions or experiences. In reality, however, the situations are not true at all or highly unlikely.
They often can continue to socialize and function normally, apart from their delusion, and don’t behave in an odd or bizarre manner. This is unlike people with other psychotic disorders. In some cases, however, people with delusional disorder might become so preoccupied with their delusions that their lives are disrupted.
That was Alan — his life was disrupted. No job, no friends.
His mother had died, leaving him her condo and money. He used the money to follow his delusion: to the Library of Congress in Washington D.C., seeking records that would prove his parentage; to Alaska, where he’d been born, to Katherine Hepburn’s apartment in Manhattan.
I remember another client with delusional disorder, Linda. Like Alan, Linda was an attractive, well-groomed, normal looking woman in her mid-40s. She was likeable, without friends or family. She came to our clinic because she’d quit her job and felt something must be wrong with her.
She quit her job in a pediatrician’s office as she believed the doctor was purposefully hurting his young patients. As I worked with Linda and she went through job after job, it became clear she had a persecutory delusional disorder.
In little signs, she saw evidence of other people’s wrongdoing, plotting against her, planning to harm her or others. After a few weeks, she quit or was fired, from job after job.
Our psychiatrist prescribed several different antipsychotic medications. All gave her unpleasant side effects, so she refused medication.
My goal was to help her understand why talking about what she thought she was observing didn’t work for her. I stressed that she should just ignore the plots and schemes. I’d learned that pointing out to her how improbable her beliefs were did not decrease her belief in them. This plan didn’t work.
Like with Alan, what I did didn’t work either, and had serious consequences.
He also refused medication. As he came in to see me, week after week, I gently worked to dissuade him from his delusions. He trusted me, agreed with me, and came to the decision that Howard Hughes could not be his father.
Very bad on my part. The day after he came to that conclusion, I got an urgent call from his brother: “Alan wants to kill himself and he has a gun.” I sent the police to take his gun; he came to see me to talk about why he wanted to end his life.
We continued to work together, getting his life back together. He reverted to his delusions; this time, I didn’t challenge them.
As with many other psychotic disorders, the exact cause of delusional disorder is not yet known, according to the Cleveland Clinic online.
Researchers are looking at several factors.
There might be a genetic factor involved. Or, brain abnormalities might be the cause. People who tend to be isolated socially appear to be more vulnerable to developing delusional disorder.
Treatment includes medication and therapy. Therapy provides a safe environment for patients to discuss their symptoms while encouraging healthier and more functional behaviors.
There’s no known way to prevent delusional disorder. Diagnosis and treatment can decrease the disruption to the person’s life, family and friendships.
When properly treated, many people with this disorder find relief from their symptoms. Some recover completely; others experience episodes of delusional beliefs with periods of remission.