BLOG

Share 0
Like 0
Dysfunctional Unshared Beliefs

Dysfunctional Unshared Beliefs

A recently published article revises the clinical impact of terms like 'delusions' and 'hallucinations' on the therapeutic relationships and searches for alternatives.
http://www.jemh.ca/issues/v8/documents/JEMH_Vol8_Insight_TowardsaMoreEgalitarianApproachtoCommunicatingPsychopathology.pdf
A recently published article http://www.jemh.ca/issues/v8/documents/JEMH_Vol8_Insight_TowardsaMoreEgalitarianApproachtoCommunicatingPsychopathology.pdf discusses potential creation of a barrier to communication with patients as a result of using these terms. This posts attempts to eolaborate on the nature of therapeutic communications.


The field of mental health professional is full of terms that can be used legitimately by the mental health professionals, which subsequently diminishes the potential to revise them . These terms though accurate and highly descriptive to the symptoms that some service user experience. Yet, many service-users may find them incongruent with the notion of an egalitarian relationship between mental health professionals and service-users. These terms when used may offer lots of debate among service-users as well as philosophers. The terms 'delusion', 'over-valued idea', and 'hallucination' do not address only symptoms. They may have the potential to put the interviewer in the position of the 'Truth' knowing judge. It could be awkward for the psychiatrist to label the patient's beliefs as 'false' or 'over-valued' and communicate this back, as such. An expected reaction from the patient is 'the doctor does not believe me'. The term 'dysfunction' can be used to encompass combined psychopathology concepts and value concepts such as 'harm'.

 

 The term delusion commonly identified as false, unshakeable belief that is out of keeping with the patient’s social and cultural background i. This term has the risk of creating a temporary crack in the mutual sense of equality between the therapist and the service-user. This may be due to the labelling of certain dysfunctional belief as unreal by one side. It has the potential for a subtle change in the relationship to the psychiatrist placing himself/herself in the omniscient position and it contrasts with the essence of medical practice where practitioners assume the truth in what the patients say as in the rest of subjective symptoms as headache for example. The subsequent sequel of this is other labels such as 'bizarre delusions' or 'systematised delusions', further add to the deviation of the role of the psychiatrist from a professional therapist to an investigator in the domain of 'Truth' and architecture of 'Truth'. Furthermore, it's quite strenuous to the relationship when the psychiatrist – based on skeptic enquiry – starts explaining such symptoms.

 

 For example, if a patient believes that Martians have abducted him, implanted a device in his brain and sent him back to earth, and the psychiatrist communicated that this is 'delusional'. It could be argued by the patient that the doctor who had not seen a Martian or a brain device before, labelled the whole story as 'delusion' with no intention to check on the existence of Martians or the device. In other words, the healer became the arbiter of truth, where both lack evidence for or against the whole thing; one member in the relationship stepped into power on basis of subjective view of plausibility.

 

 It might be more in-tune with the therapeutic relationship to use more egalitarian terminology. I propose the use of the term 'dysfunctional unshared belief' which is not in-line with a single psychopathological symptom. It rather covers a range of symptoms as 'delusions' and 'over-valued ideas'. The term 'dysfunctional belief' may help create a collaborative relationship by looking at the patient's symptoms from a utilitarian point of view taking into consideration the outcome of such 'beliefs'. This may make the description fall short of describing 'delusions' that people may find meaningful or fulfilling, that do not cause harm to the person or others, and in this case, probably such person would not require the attention of mental health professionals.

 

 Mental health professionals are usually encountered by people who suffer to various degrees or make others suffer, and not because of various degrees of conviction. The primary role of the therapist is to be defined as some one who tries to alleviate the sufferings of others rather than correcting their beliefs. Communicating with patients in terms of how functional is their belief rather than it's truth may prove to be more egalitarian and clinically tuned. This may provide some middle ground in communication, without having to put an effort on defining the differences between what is 'true' and what is 'real'.

 

 This concept may be also applied to describe experiences commonly labelled as 'hallucination' which is defined as 'perception without an object ' and 'illusion'. A more egalitarian term could be 'dysfunctional auditory perception' or 'dysfunctional visual perception' depending on the perceptual modality of perceptual deception. The proposed terms may fall short of describing symptoms such as Charles-Bonnet syndrome as it usually does not have negative consequences.

 

 The concept can be extended to cover other terms such as 'autistic thinking'ii, 'apathy', 'blunting of affect', 'poor grooming' other terms can be applied to communicate these terms with service-users with minimal deviation from the therapeutic relationship.

 

 The proposed terms are not intended for use as a replacement to well carved descriptive psychopathological terms. Terms like 'delusion' or 'hallucination' are of value in teaching psychopathology. However in practice, meaningful egalitarian communication may require some skill in selecting suitable terms that is more than simplifying jargon. They also carry the burden of having to add to the psychiatric terminology with subsequent effort in learning them. However, this has been the case from 'hysteria' to 'medically unexplained symptoms'.

 

 The author does not expect that such proposal would be an easy answer to difficulties in communication during practice. Rather, the author hopes it may open a discussion on the most effective and appropriate terms that can be used while communicating with patients. Also, it might be more in-line with an egalitarian approach to seek to the opinion of service-users and professional bodies that represent the opinions of service-users. Despite the limitations of such proposal with regards to completeness, it's hoped that the introduction of any term may help to add to the main purpose of any classification or labelling that is accurate communication on equal basis.

 

Biblography

01. Sidhom, E. (2013) Towards a More Egalitarian Approach to Communicating Psychopathology, JEMH · 2013· 8 | 1 © 2013 Journal of Ethics in Mental Health (ISSN:
1916-2405)

iFish's clinical psychopathology. p.39

iiFish's clinical psychopathology.p.33

Share 0
Like 0