A Conversation about “Madness, Mysticism, and the Reenchantment of Psychology”

Ron Unger January 14, 2026 2 comments

Madness, aka psychosis, is in some ways like wilderness.

A person can be lost in the wilderness, utterly bereft, suffering terribly, and desperately needing rescue. When we focus on those sorts of possibilities, it seems that wilderness is a terrible thing, and that it would make sense to stay away from it as much as possible, and to keep anyone else from going there.

But of course there are also more positive sides to wilderness, aspects of wilderness that attract many of us into it despite the dangers. And I would propose that the same is true of madness.

While professionals paint psychosis as nothing but bad, everyday speech acknowledges a more complex reality. Something may be “crazy” or “insanely” good, meaning it escapes normal limits. A “psychotic” guitar solo may be one that “blows your mind” – in a good way. Is it possible that everyday people are noticing a possibility that professionals routinely miss?

When we think of madness, or psychosis, as nothing but bad, we also slip into the opposite, which is thinking of “staying sane” or staying within our culture’s definition of sanity, as nothing but good. And yet, as my friend David Oaks likes to note, “normal people are destroying the planet.” It may be a bit “mad” to question this normality, but maybe more questioning is needed?

I would argue that psychology deadens itself when it buys into highly polarized theories of (completely bad) madness vs. (completely good) sanity and normality. Our world becomes much more interesting when we open ourselves to the possibility that there may be much of value in states outside of sanity, even if there is also danger of horrible misfortune in that same, tricky territory.

This point of view is not exactly new – for example the film “Crazywise” documents how in many indigenous cultures, when young people experienced something like what we would now call a “psychotic break,” it was seen as an indication that the person might have a calling to be a shaman. It’s not that they didn’t see the young person as needing help – they did get help and training – but they were also seen as someone who might be trained to competently explore, understand, and find useful things in the wild states of mind that go beyond “normality.”

I would argue that we become much more able to effectively help those who have gotten lost in madness when we view sanity vs. madness in a more nuanced way. Rather than proceding with certainty about the absolute superiority of our “sane” perspectives, we can engage much more productively with those who have wandered outside of sanity when we maintain openness to the possibility that they may sometimes have found something that the rest of us are missing (even when in other ways they may be badly in need of assistance.)

This is a big topic, not easily summed up in one discussion. But, in a webinar on 2/4/26, a few of us had an in depth conversation on this topic, the recording is available below!

“To live in this moment of history is to feel something slipping away. What precisely is being lost is difficult to name, though one can sense it in the loneliness that has become the defining mood of our age. Despite our technological advances and growing scientific knowledge, many of us experience a deep sense of loneliness and disconnection from each other, from nature, and from any shared sense of meaning.

“Psychology, as the field intended to help us understand the human mind, could have provided a source of resistance to this growing sense of disconnection. Instead, it has come to treat people as mere objects of analysis, divorced from the webs of relationship that compose the ecological landscapes of our lives. In doing so, psychology has overlooked what makes us human: our capacity for wonder, imagination, and connection to something larger than ourselves. Experiences that fall outside of rational explanation, such as mysticism, madness, or moments of deep communion with others, are too often pathologized or simply ignored. But what if these very experiences are what hold the most transformative potential in our time of widespread alienation and social crisis?

“In this webinar, a group of Mad Studies scholars and activists meet to discuss lived experiences related to madness, art, activism, and mysticism in relation to two 2026 conferences centered on these themes. This includes Wouter Kusters, the author of Pure Madness: A Quest for the Psychotic Experience and A Philosophy of Madness: The Experience of Psychotic Thinking (MIT Press, 2020), who is helping to organize the Too Mad to be True conference in Ghent, Belgium. Joining as representatives from the Madness, Mysticism and the Reenchantment of Psychology Conference/APA Division 24 Spring Meeting planning committee are Tim Beck, Manvi Singh, and Cris An.” (Coincidentally, these two conferences overlap in mid-May 2026.)

To view the recording, click on this link!

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Presentation by Ron Coleman and Paul Baker

Ron Unger October 20, 2025 2 comments

Hugh Massengil shot video of Ron Coleman and Paul Baker giving a presentation at the LILA Peer Support Club in Eugene, Oregon on November 14, 2010. This includes Ron telling his story (starting on the second video.) Ron at one point was what some might call a “sad case of chronic schizophrenia” – a man who had spent 6 of the last 10 years locked up in a hospital, very “low functioning” even when out of hospital, disheveled, typically food in his scraggly beard, cigarette burns all up his arms, a person with little to say to anyone. Later he became a powerful public speaker with an international reputation, as well as a married man with children and a farm on an island in Scotland.

First video: http://www.youtube.com/watch?v=dbiMyR5aCmY
Second Video: http://bit.ly/aGsQqR
Third video: http://bit.ly/aovwqw
Fourth video: http://bit.ly/bsNSqT
Fifth video: http://bit.ly/d1pYtV

You can also find other talks by him online, for example this collection which includes a short history of the hearing voices movement. You can also read a print version of his story, and find links to his books an articles, at this link.

Ron Unger

PS: The sad news is that Ron Coleman passed away this October 2025. For some years before he passed he suffered from dementia. But he brought creativity to the experience of having dementia as well, and he created a new identity for himself of being a demented poet, and he wrote plays, a musical, and organized the first Scottish dementia arts festival! Details at this link.

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Should Psychiatrists Help People Try to Get Off Antipsychotics?

Ron Unger August 23, 2025 3 comments

Psychiatrists are commonly expected to be persuading people to take drugs called “antipsychotics” whenever they experience psychosis, or when there is risk of psychosis returning. But people taking those drugs commonly dislike them, and there is much evidence that many people can recover without continuing to take them, and there is evidence that the drugs can cause various kinds of long term harm.

There is also evidence that the drugs create a kind of dependency, meaning people have an especially rocky time if they try to quit the drugs suddenly, and for the first year or so after quitting. This makes getting off the drugs tricky, and increases the chances people will need help to do it successfully.

So that raises the question, when might it be a wise choice, rather than a foolish or “crazy” choice, for people to try getting off antipsychotic drugs? And when should a psychiatrist be offering to help with that attempt?

These are questions and issues that were addressed by psychiatrist Helen Speyer in a recent webinar titled “Navigating Complex Choices in Antipsychotic Reduction.” The recording of that webinar is now available:

Here’s the official description for the webinar:

“Stopping or reducing antipsychotic medication raises tough ethical questions in both everyday care and research. One big issue is balancing safety with respect for the wishes of the person taking the medication.

“In clinical practice, tension arises when a service user asks to reduce or stop medication. If a doctor says no, the service user might go ahead and stop on their own, which can be more dangerous without support. But a doctor agreeing without clear evidence of safety can also carry risks. So who gets to decide what level of risk is okay—the doctor, or the service user?

“If the service user is capable of making decisions, most would agree they should have the power to decide. Ignoring that can be disrespectful, especially if we assume professionals always know best, without truly listening to lived experience. Research also runs into problems. In studies where people are meant to stick to certain treatment plans, many don’t, especially when it involves stopping medication.

“That makes it hard to tell what the results really mean. On top of that, most studies look at group averages, which may not reflect how any one person will actually respond. What works for some might harm others.

“So instead of one-size-fits-all answers, we need research and care that are flexible and focused on the individual. This includes using real-world data and creating more supportive, respectful ways for service users and professionals to make decisions together. Ways to accomplish this will be discussed in this webinar.”

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Getting Your Life Back After Being Diagnosed with Psychosis

Ron Unger May 27, 2025 2 comments

Many people who are diagnosed with psychosis are having difficulties with motivation and connection (commonly referred to as “negative symptoms”) that make them the least likely to engage in psychosocial treatments. These difficulties are unlikely to improve, and may even get worse, after treatment with psychiatric drugs. Recovery Oriented Cognitive Therapy for Psychosis was developed with the intent of reaching these people. Instead of focusing on symptoms or problems, it works by connecting with the person’s interests and supporting their aspirations, helping them to recover and gain the life they want.

In a webinar on 6/26/25 (see the recording below), we reviewed the fundamentals of recovery-oriented cognitive therapy, including the basic model and research. We discussed clinical applications, providing a taste for providers interested in trying out the treatment now. We also introduced a new book designed to help individuals with psychosis find ways to recover and live well, along with how providers can use this book in their work with such individuals. The writing process behind the book was also discussed.

About the Presenter:

Aaron P. Brinen, PsyD, is a clinical psychologist in private practice, who employs evidence-based treatments to help people recover from serious mental health conditions. He is also Assistant Professor of Psychiatry and Behavioral Sciences at Vanderbilt University Medical Center in Nashville, Tennessee. Dr. Brinen is a codeveloper of recovery-oriented cognitive therapy (CT-R), and has been active in adapting CT-R for different settings and training therapists from around the world.

About the book, Living Well with Psychosis: Practical Strategies for Improving Your Daily Life

While mental health is thankfully no longer a taboo topic, the experience of psychosis is still highly stigmatized. Leading psychologist Aaron P. Brinen busts myths and helps readers build the lives they want in this empowering book. An expert in recovery from serious mental illness, Dr. Brinen provides step-by-step guidance for becoming a strong self-advocate, navigating treatment options, managing symptoms that cause distress, connecting with others, and pursuing school and work goals. The brief, engaging chapters are warm and compassionate, with downloadable practical tools expressly designed to boost energy and motivation for getting out into the world. Readers can read this book cover to cover or dip into it any time they need extra support to live well and feel good.

To order the book with a 15% discount (good through 10/31/25) go to this link and in the box for “special promotional prices” enter the code “MIA2025” then click “apply.”

Living Well with Psychosis: Practical Strategies for Improving Your Daily Life (The Guilford Living Well Series)

By the way, one misconception about “negative symptoms” is that they result from something wrong with the brain, some part of a “mental illness.” A better understanding is that they result when people get confused and demoralized, due to confusing experiences and the confusing and distressing ways others often react to their experiences, and they are related to negative beliefs that can change with more encouraging experiences. This webinar and/or this book can help you help others reorient and start having those more encouraging experiences and to reengage with life.

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What Professionals Need to Learn from Those They Try to Help

Ron Unger March 21, 2025 2 comments

While mental health professionals usually want to help, good intentions are unfortunately not enough to insure that attempts to help will truly be effective, and will avoid harm.

The truth is that mental health issues can be very tricky, and attempts to help often backfire, compounding existing problems. This applies both to attempts by people to help themselves, and to attempts by professionals to help their clients.

But professionals often think too highly of their own expertise, and fail to notice when their well intended interventions are aggravating existing problems. Instead, they assume the difficulties caused by their own mistakes are just part of the client’s “mental disorder” and then often just double down on what isn’t working.

Fortunately, there are communities of people with lived experience of mental health problems who have been observing all this, and who have been developing ideas about how treatment might be provided in ways that reduce harmful interactions and harmful directions.

On Tuesday, 4/15/25, a webinar with Caroline Mazel-Carlton titled “The Hope of Harm Reduction: Exploring New Dialogue Models Developed by Non-Clinical Support Communities” explored this subject.

Event Description:

Frequently, clinical models of mental health support involve telling people their thoughts, feelings, and experiences are “wrong” or “pathological”—and then telling them what to do to “fix” it. Unfortunately, this often creates conditions for iatrogenic harm, extreme power differentials, and coercion.

So what else is out there? Join the conversation about how approaches developed in peer-run communities, mutual aid groups, drug user’s unions, and so on can be applied with integrity in a wide variety of settings (including in our own families).

In this webinar, presenter Caroline Mazel-Carlton from the Wildflower Alliance explores alternative harm reduction dialogue philosophies and how to use them in real-life, whether we are supporting someone who uses drugs, hears voices, is thinking of suicide, etc. We discuss how to avoid common dialogue pitfalls that rupture connections and cause further pain. We also talk about how to build authenticity back into conversations and let go of unhelpful agendas and jargon.

About the Presenter:

Caroline Mazel-Carlton is a psychiatric survivor and former IV drug user who has supported the development of alternative dialogue models that are now taught worldwide. She serves on the Board of Hearing Voices Network-USA and is the Director of Learning Opportunities for the Wildflower Alliance. She has contributed to multiple academic publications on the topic of suicide and one book on her experience skating on a roller derby team as #18 “Mazel Tov Cocktail.”

Check out this video and let me know what you think in the comment section!

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Understanding and Discussing “Troublesome Beliefs”

Ron Unger January 2, 2025 0 comments

When people have beliefs that no one around them understands or sees as credible, and that lead to trouble in the person’s life, psychiatrists call those beliefs “delusions.” That is a harsh word, and could be seen as excessively polarizing, which is why some prefer instead terms like “troublesome beliefs.” Whatever the word used however, it seems true that many people do start believing things that alienates them from others and disrupts their lives.

To make a finer distinction, important differences can be noted between the troublesome beliefs held by individuals that psychiatrists call “delusions” and the also troublesome beliefs held by groups of people that are referred to by terms such as “conspiracy theories” or simply “strongly held beliefs.” Both kinds of beliefs may seem weird and lacking any credible evidence by those who don’t endorse them, but the key difference is that believers in conspiracy theories are synchronizing their beliefs with other like minded people, their fellow believers, while people who believe in “delusions” are going it alone and not synchronizing with anyone.

Such distinctions are not perfect of course. Sometimes a person may convince just one other person that their “delusion” is true – then psychiatrists call it a “shared psychotic disorder” or “folie à deux” (French for “madness of two.”) And if a third person starts believing, the term is “folie à troix.” If even more people start believing, then eventually it is no longer seen as a delusion, just a conspiracy theory or whatever. And if just about everyone believes it, we might call it “consensus reality” even though it is pretty clear that not everything that most people believe is really true!

One thing that is clear is that we need better ways of understanding and of talking to people who have beliefs that we think are causing trouble.

If you are interested in learning more about how to have such understanding and such conversations, especially with people who have troublesome beliefs that are individual and unique, I encourage you to view the recording, linked to below, where an expert in therapy for psychosis discusses “Decoding Delusions: Making Sense of Different Types of Troublesome Beliefs.”

In this webinar, which was held on Thursday 2/20/25, Doug Turkington discussed all of the following:

the variety of different delusions seen in clinical practice including persecutory paranoia, grandiose, Capgras, organic and Cotard’s delusions.
the typical presentations of delusional systems/memories and substance induced delusions.
how delusions relate to strongly held beliefs which, despite minimal factual basis, spread widely on social media.
the variety of approaches for clinicians and also for family members including befriending, collaborative (peripheral) questioning, shared reality testing, asking questions about the pre-psychotic period, and generating a timeline.
schema vulnerability and goal conflict models

About the Presenter:

Dr. Doug Turkington is a Founding Fellow of the Academy of Cognitive Therapy and a Professor of Psychosocial Psychiatry at Newcastle University. He co-edited the book “Decoding Delusions: A Clinician’s Guide to Working With Delusions and Other Extreme Beliefs” and he has authored over 100 articles and more than half a dozen other books on CBT for psychosis, including notable works such as “Cognitive Therapy of Schizophrenia” and “Back to Life, Back to Normality: Cognitive Therapy, Recovery and Psychosis.” He has also provided guidance to family members interested in drawing from CBT for psychosis to improve relationships with their loved ones who are struggling – some recorded webinars are available here.

By the way, I did previously write a review of the “Decoding Delusions” book that Doug co-edited, you can find that review here.

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Can Completing a Workbook Aid Recovery from Psychosis?

Ron Unger December 14, 2024 2 comments

Biological psychiatry would have us believe that the state of mind called psychosis always results from something gone wrong with the brain, and that a drug intervention is the only way to have a substantial impact on that defect.

But the reality is much more complex. Research in past decades has shown that psychosis is often a reaction to adverse life events, to trauma, experiences of oppression, and other stressors. And if it is a reaction, then the possibility exists that people can learn to react differently, and that this difference in reaction can play a major role in overcoming the problem.

That’s why I was interested when earlier this year I heard that a colleague was co-authoring a workbook designed to help people understand their state of mind in a more psychological way and to take an active role in their recovery. I was asked to write a foreword for it (which you can read below) and the book is now published:

Here’s my foreword for the book:

Rufus May currently works as a psychologist helping people with psychosis, but when he was 18 it was he who became paranoid and was diagnosed with schizophrenia. Professionals at the time explained what they thought had gone wrong with his mind, but he noticed the way they framed things made him feel like the passive victim of an active illness, with no room for hope that his own efforts could lead to recovery.

Fortunately, Rufus later met others who were more encouraging, and he found ways to regain control of his life and to move toward a meaningful future.

People shouldn’t have to be lucky, however, to hear about active approaches to recovery from psychosis: such ideas should be available to everyone! This workbook is a great step in that direction.

I first met one of the authors, Jessica Murakami-Brundage, when she was an intern assisting me in facilitating a hearing voices group. I’ve taught a multitude of students, but Jessica stands out as someone who was subsequently inspired to learn and work with leaders in the field and who is now, with this publication coauthored by her own former student Laura Dewhirst, stepping into leadership herself.

When a path is well laid out, it seems simple and easy to follow. So it is with the exercises in this workbook. But those familiar with the variety of often conflicting therapy approaches for psychosis will recognize that impressive work was done to boil down the wisdom of those various modalities into this very user-friendly format.

Better yet, the authors have done so in a way that is not superficial. They offer creative approaches even for some of the deeper and trickier issues, such as exercises exploring the possible meaning behind what a voice is saying and guidance in how to respond to a voice in a way that balances assertiveness with compassion toward both the voice hearer and the voice.

Still though you may be asking, how much can a workbook do to help someone escape from something as daunting as psychosis?

One way of understanding psychosis is as something that results when our minds experiment with seeing things differently, and then get lost somewhere, or tangled up. Once this occurs, it’s easy for us to lose confidence in ourselves. How can we possibly use that same mind to get us out of a trap that it has created?

We might recall though the wise saying that “if you are going through hell, keep going!” Our minds may have gotten into a confused or hellish place, but stopping mental experimentation can be an unhelpful solution, sort of like stopping in hell. A better approach might be to recognize that while we’ve wandered into making sense of things in a way that doesn’t work very well, we can keep experimenting with other ways of making sense till we find something that works better.

That’s what this workbook is about: experimenting with possibly better ways of making sense. The authors provide some ways of understanding psychotic experiences, but they also acknowledge that the perspectives they offer are not the only possibilities. That’s important since there are many unresolved questions not only about psychosis but also about the nature of reality itself. What people need is not a one-size-fits-all view but help in finding a perspective that fits them personally and facilitates forming good relationships with others and creating a meaningful life.

Another barrier to recovery can be the exaggerated negative views of people with psychosis held by many professionals and members of the public. Such “stigma” can then be internalized by the person with psychosis, causing huge problems. Oryx Cohen has stated that after he first became psychotic, the way psychosis and its implications were explained to him made him feel he was being kicked out of the human race! Fortunately, he later found better ways to understand what was happening, and he now helps others recover through his work as chief executive officer of the National Empowerment Center. Escaping from stigma is not easy and some have reported it can be more difficult than dealing with psychosis itself, but the exercises in this workbook on resisting stigma and discrimination can help people begin to break free.

The journey of a thousand miles truly does begin with a single step. I’m hoping that many of you reading this workbook will find that it facilitates some very significant early steps in your journey toward recovery and toward fashioning the life you want.

Compared to some of the (relatively few) other workbooks or general self-help books devoted to psychosis, this book is notable for drawing on a number of different therapy approaches, including cognitive behavioral therapy for psychosis (CBTp), Acceptance and Commitment Therapy (ACT), Dialectical Behavioral Therapy (DBT) and Compassion Focused Therapy (CFT).

If you like the idea of self-help books though, here’s a few others you might also want to check out:

Think You’re Crazy? Think Again

Relating to Voices using Compassion Focused Therapy: A Self-help Companion

The Dialectical Behavior Therapy Skills Workbook for Psychosis: Manage Your Emotions, Reduce Symptoms, and Get Back to Your Life

Overcoming Paranoid and Suspicious Thoughts, 2nd Edition: A Self-Help Guide Using Cognitive Behavioural Techniques

Overcoming Distressing Voices

Our minds are tricky, and the world is confusing, and it can be difficult trying to figure everything out. Well, we never figure everything out, but with some help, we can often get to a place where it doesn’t seem quite so hard.

Please do comment if you have any thoughts about this post!

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Working Effectively with the Intersection of Psychosis and Spirituality

Ron Unger September 7, 2024 0 comments

Psychosis can seem to involve the loss of access to any kind of spiritual reassurance, while at other times it may appear as a preoccupation with spiritual themes, or taking what seem to be extreme or bizarre spiritual perspectives. In response professionals frequently ignore the spiritual dimension and frame everything as a struggle with an illness, but that approach can create barriers to forming a common understanding and to accessing and supporting opportunities for development along what might be seen as a spiritual dimension.

What might work better? How can professionals bring an awareness of this spiritual dimension and a willingness to talk about and work with it into treatment, without making mistakes such as romanticizing psychotic experiences, promoting specific beliefs or dogmas, or causing other kinds of harm? In the talk below, I explore possible answers to those tricky questions.

Spirituality is a route to recovery frequently cited by service users, yet usually marginalized within treatment. When professionals are instead willing to engage with people’s deepest concerns in an open minded way, balance may become more possible and new opportunities for recovery may emerge.

If you want to get deeper into this topic, I offer a 6 hour online course on Spiritual Issues within Treatment for Psychosis and Bipolar. You also might want to check out a list of resources for exploring more about that topic, at this link.

Also, note that the talk above was given for the Early Psychosis Virtual Summit put on by the Tennessee Association of Mental Health Organizations (TAMHO). You can access the recordings for other talks given at that event at https://www.youtube.com/playlist?list=PLWThhKstuRWB8po1n74vIad7tXeMxcK2n

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Why Suppressing Psychosis Often Backfires – And What Works Better!

Ron Unger March 21, 2024 2 comments

Are psychotic experiences something that should simply be suppressed? These experiences cause so many problems, it may seem that the answer should always be yes!

But there’s a paradox when we try hard to get rid of psychotic experiences. Our efforts to do so can quickly make the problem worse!

At its simplest level, we see the basis for this when we try too hard to get rid of a thought. For example if you focus too much on not thinking about elephants, they will be on your mind all day. If you focus on not having the thought that you might have germs on your hand, you might spend all day washing your hands to make sure there is no basis for the thought.

And if you are very sure you shouldn’t be having a thought, it might start to seem that the thought is coming from somewhere else, like a brain implant or a demon or telepathy from someone you don’t like. Now the battle is really on! But the prognosis for winning this battle is not good. Efforts to get rid of what now seem like voices etc. just make them seem more important and more compelling. Things can rapidly spin out of control, and go to some really dark places, which often just convinces everyone involved that doubling down on attempts at suppression is the way to go!

Fortunately, there is a better way. Paradoxically, it involves accepting even the “crazy” thoughts or voices that seemed to be causing so much trouble, but in away that avoids making too much of them.

Our brains are weird, our minds are weird, and that’s OK. We can learn to help people not make too much of the weirdness, and to identify what helps them move on and make a life they value, and to connect with the people and activities they love.

Finding the common humanity within the sometimes freaky experiences that get called psychosis is a key part of the CBT for psychosis approach called “normalizing.” It can help a lot in getting people to change their relationship with tricky experiences, rather than seeing those experiences as pathology that requires suppression and elimination.

If you would like a better idea of what normalizing is, check out this video:

For those who want to learn more about how CBT and a few other therapy options can be helpful for psychosis, or what gets called that, there is a series of 5 seminars that I am offering over the next few months. Attending one or more of these seminars could be a very affordable way to grow your competence in a psychological approach for psychosis – and you can save by accessing Early Bird pricing that only lasts through 4/5/24!

Each seminar will be 4 hours long, and will provide time for questions, discussion, and practice. Continuing education credits will be available for most US professionals. Each seminar will be recorded, and those who register will have access to the recording. CE credit however will only be available to those who attend the seminar live (on Zoom, or in person in Eugene OR) for the entire seminar.

The seminars are:

Date: 3/29/24 – Essential Elements of CBT for Psychosis: Engagement Style, Normalizing, & Developing a Formulation

Date: 5/10/24 – Paranoia and Troublesome Beliefs: A CBT Approach

Date: 6/21/24 – Voices, Visions, and Other Altered Perceptions: Changing Outcomes with CBT

Date: 7/19/24 – Trauma, Dissociation, and Psychosis: CBT and Other Approaches to Understanding and Recovery

Date: 8/16/24 – Addressing Cultural and Spiritual Issues Within Treatment for Psychosis

The most affordable option is to register for all 5 seminars as a bundle (only 59.99 per seminar if you register by 4/5/24) but you can also register for seminars individually.

For more information and to access options for registration, go to this link.

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Decoding “Delusions” – A Review of a New Book on Working with Extreme Beliefs

Ron Unger February 17, 2024 1 comment

When people report the extreme beliefs that are often labeled “delusions,” it can be difficult to know how to make sense of what is going on and what might be helpful. That’s why I took the time to review a new book on the subject, “Decoding Delusions: A Clinician’s Guide to Working with Delusions and Other Extreme Beliefs,” edited by Kate V. Hardy and Douglas Turkington.

What follows is a draft version of the review, but if you are one of the first 50 people to click on this link, you can see the final version that is now published online in the journal ‘Psychosis.”

Delusions are commonly understood within a medical model, but this book challenges that, starting with the title! That is, the assertion that delusions might be “decoded” implies that with some effort we might come to understand them, a notion that is in sharp contrast to the prevailing belief that delusions are just the meaningless product of a brain that has become ill.

We tend to call a person’s beliefs “delusions” when we can’t come up with a better understanding of why the person believes them. This can provide some relief for us: if the strange belief is simply caused by an illness, then we don’t have to wonder any more about any meaning we might be missing or how the belief might be an understandable result of the person’s life experience. Unfortunately, while this may make us feel better, it risks trapping the person with the strange belief in a lifetime of confusion and disconnection, where people around them give up trying to understand them and where they also come to believe that it is pointless to try to understand themselves.

In contrast, “Decoding Delusions” offers multiple perspectives on both the possible sources and meaning of these beliefs and on how to help people understand themselves and how to experiment with shifting views in ways that can reduce distress.

The chapters of this edited collection offer varying points of view, including views drawn from lived experience, from contrasting theoretical perspectives, and from people working in different settings and with different cultural groups. And to facilitate working with those different cultural groups, it includes guidance in thinking about extreme beliefs through a cultural lens.

One angle well covered in this volume is the possibility of delusions having their source in traumatic experience. The impact of understanding them this way can be profound, as evidenced by this exchange reported in one of the chapters:

“’I am going to tell you that there is absolutely nothing wrong with you.” Quite taken aback, I said, “But I’ve been told I have schizophrenia; I have been told that I will never recover.” He said, “I know what you have been told, but I am telling you there is nothing wrong with you whatsoever. This is normal, it’s not illness. In the context of your life, this is normal.’”

Of course, letting someone know that their way of thinking may be an understandable reaction to their life events is just a beginning; the bigger challenge is to help them modify those reactions and to find a new perspective on the world. This opens the door not only to reducing distress but also creates opportunities for people to recover and to regain control of their life. Here, the book also has a lot to offer: it describes many cognitive behavioral approaches to change but also other promising approaches drawn from sources such as psychodynamic and compassion focused therapy.

Human beliefs come in many forms and varieties, including those which are called delusions. The book explores ways of understanding and working with many forms of delusional thinking, including persecutory paranoia, delusional jealousy, erotomania, Capgras syndrome, and delusions of thought possession, and it compares beliefs that qualify as delusions held by individuals with the often equally wild conspiracy theories that are of increasing popularity within many subcultures.

As a bonus, the book includes links to a series of video examples illustrating effective therapy approaches for people who seem to have delusions (along with a couple of illustrations of approaches that are likely to be ineffective or to backfire.) People with delusions often seem stuck in unhelpful beliefs, but the mental health field has also been stuck in unhelpful beliefs about such delusions. The contributors to this book deserve credit for guiding us into taking a fresh look at the evidence and considering more helpful perspectives.

One other resource of note on alternative ways of understanding and working with “delusions” is this video presentation by Rufus May – a psychologist who was once hospitalized due to his own extremely paranoid beliefs!