Categorising Thought

The schizophrenic ceases to be schizophrenic when he meets someone by whom he feels understood - Jung

Earlier this year King’s College London hosted a conference entitled “Revelatory Experiences: perspectives from neuroscience, psychiatry, and the humanities”.

Drawing from a diverse range of disciplines, the speakers addressed questions such as how we can talk about religious experience in a secular setting, how fMRI and other monitors of brain activity can be useful to monitor or define alleged mystical and religious experience, and whether hypnosis and suggestion can be used to recreate similar conditions that can be measured in clinical trials.

Among the speakers was Philippa Garety, a Professor of Clinical Psychology, who also has extensive experience as a therapist, specializing in Cognitive Behavioural Therapy. Philippa spoke about research work carried out by herself and by her colleague Emmanuelle Peters on the relationship between psychosis and religious belief. She also tied this in with her own experiences practicing as a Cognitive Behavioural Therapist.

Philippa explained how in researching their paper Measuring Delusional Ideation, her team surveyed over four hundred healthy individuals, along with thirty three individuals who had been clinically classified as deluded and were living as inpatients.

The survey consisted of questions that asked whether the subject had had thoughts that could be interpreted as delusional. These included questions like: ‘Do you ever feel as if there is a conspiracy against you?’, ‘Do you ever feel as if people seem to drop hints about you or say things with a double meaning?’, and ‘Do you ever feel as if people are reading your mind?’.

If a person answered a question positively, they were then asked to score their reaction to that on three different scales. The first scale measured how distressing this thought was. Secondly, they scored how often this thought preoccupied them. And finally, they scored how true they believed the thought to be. The combined results of these answers allowed the researchers to scale participants and analyse the statistics.

Unsurprisingly, the results showed that overall the ‘deluded’ group scored much higher than the ‘healthy’ group. However, what was surprising was the considerable overlap in how many people of both groups asserted that they had experienced these thoughts (on average the ‘healthy’ group said Yes to six of the thoughts, while the ‘deluded’ group said Yes to eleven). Philippa suggested that this shows that thoughts that are normally thought of as delusional were in fact quite common. 

One major difference between how the ‘healthy’ and ‘deluded’ groups scored was that the ‘deluded’ group scored the thoughts significantly higher on the scales. In this light, it is not the thought itself that is inherently problematic, but how the person reacts to the thought. The paper concluded that ‘whether or not one becomes overtly deluded is determined not just by the content of mental events but also by the extent to which they are believed, how much they interfere with one’s life, and their emotional impact… taken together, these findings imply that the divisions between normal and delusional thinking, or between delusions and other types of pathological thinking, may be rather blurred’. 

Most interestingly, Philippa also drew attention to the fact that the results also showed that a significant portion (11%) of the ‘healthy’ group, overall scored higher than the ‘deluded’ inpatients. Further research by this team (Delusional Ideation in Religious and Psychotic Populations) suggested that certain groups of religious people (Hare Krishnas were one group surveyed) had a higher number of ‘delusional thoughts’ than control groups (made up of Christians, and non-religious). 
However, they scored significantly lower than the control group in terms of how these thoughts distressed them. Again, Philippa suggested that this meant that it is not the thought itself that is inherently delusional, but how we react to them.
Anyone familiar with mindfulness meditation or CBT will know that this 'thinking about how we think' is a major part of the underlying theory. Philippa went on, moving away from the statistics to talk more about practical examples from her CBT cases. Philippa believes that many people can be helped using a CBT model by simply working on redefining how they think about what they are thinking about or what they are doing. 
Ultimately, what both the research and her lived experience show is that there are very blurry lines between what is considered normal and abnormal, and often the key to helping people progress through difficulty is to explore both how they as an individual (and we as a society) delineate these borders through language and behaviour.