Opinion ID: 793602
Heading Depth: 3
Heading Rank: 1

Heading: Overview of Delusional Disorder with Grandiose Themes

Text: 215 Although the definition of delusion and the propriety of encompassing religious beliefs within that definition are both somewhat unsettled, there is ample support in the psychiatric literature for the notion that some extreme beliefs like the deific decree to kill are delusional and grandiose. At the time of Lundgren's trial, the term delusion was defined in the Diagnostic and Statistical Manual of Mental Disorders (rev.3d ed. 1987) (DSM-III-R), the psychiatric profession's diagnostic Bible, Morris & Haroun, supra, at 1023 (quoting various sources), as: 216 A false personal belief based on incorrect inference about external reality and firmly sustained in spite of what almost everyone else believes and in spite of what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person's culture or subculture (i.e., it is not an article of religious faith). 217 DSM-III-R at 395. 3 The DSM sets out various subtypes of delusional disorder. One such subtype is grandiose delusion, defined as [a] delusion whose content involves an exaggerated sense of one's importance, power, knowledge, or identity. It may have a religious, somatic, or other theme. Id. at 396. The psychiatrist's Bible further notes that people with grandiose delusions can become leaders of religious cults. Id. at 200. These definitions, both published by the American Psychiatric Association (APA), explicitly, though inartfully, embrace the notion that some religious beliefs are delusional. As two recent commentators have noted, the DSM distinguishes between `authentic' religious beliefs that are characterized as normal and `nonauthentic' religious beliefs that may be characterized as abnormal, that is, psychopathological. Morris & Haroun, supra, at 1037. 218 A chief criticism leveled at the DSM's definition of delusion is its usage of the phrase false belief, which generates the obvious problem scientifically and legally of divining true from false religious beliefs. See Manfried Spitzer, On Defining Delusions, 31 Comprehensive Psychiatry 377, 378 (1990) (stating that the question of truth or falsity is inapplicable to religious beliefs). Responding to this dilemma, some scholars have proposed excluding all religious beliefs from constituting delusions, while others like Freud have characterized all religious belief as delusional. Id. at 379. In an article published the year of Lundgren's trial, Dr. Manfried Spitzer dismissed both of these views as `quick and cheap' solutions and clinically unjustified, opting instead for the APA's general view that some, not all, religious beliefs are delusional. Id. Dr. Spitzer differed with the APA's DSM in defining delusion so as to accommodate more clearly the problem of religious delusions as statements about external reality which are uttered like statements about a mental state, i.e., with subjective certainty and incorrigible by others. Id. at 391. 219 Regardless of the definition of delusion, many, if not the vast majority of, mental health professionals agree with the APA and Dr. Spitzer that some purportedly religious beliefs and experiences should be considered delusional. The New Harvard Guide to Psychiatry, published over two years before Lundgren's trial, describes both grandiose and religious delusions under the general heading Schizophrenic Disorders. Ming T. Tsuang, Stephen V. Faraone & Max Day, Schizophrenic Disorders, in The New Harvard Guide to Psychiatry 267-68 (Armand M. Nicholi, Jr., ed., 1988). According to the text, a patient claiming to be king of the universe because of his special relationship with God suffers from a grandiose delusion. Id. at 267. The text describes religious delusions in even greater depth: Religious delusions are false beliefs that involve religious or spiritual themes. The delusional status of a religious belief may be obvious, as in the case of a patient who collected a roomful of grapefruits because she believed they contained the essence of God. More than with other delusions, however, the delusional status of religious beliefs may be difficult to establish. A religious belief is not delusional if consistent with the patient's cultural context. For example, many Jehovah's Witnesses believe in the imminent end of the world. Such a belief would not be delusional if expressed by a member of that sect, but it might be delusional if expressed by a nonreligious person ... A delusional religious belief is likely to lead to functional impairment. 220 Id. at 267-68 (emphasis in original). 221 Following the DSM's lead, a recent psychiatry textbook illustrates a grandiose type delusional disorder with a religious example: 222 A 51-year-old man was arrested for disturbing the peace. Police had been called to a local park to stop him from carving his initials and those of a recently formed religious cult into various trees surrounding a pond in the park. When confronted, he had scornfully argued that having been chosen to begin a new townwide religious revival, it was necessary for him to publicize his intent in a permanent fashion. The police were unsuccessful in preventing the man from cutting another tree and arrested him. Psychiatric examination was ordered at the state hospital, and the patient was observed there for several weeks. He denied any emotional difficulty and had never received psychiatric treatment. There was no history of euphoria or mood swings. The patient was angry about being hospitalized and only gradually permitted the doctor to interview him. In a few days, however, he was busy preaching to his fellow patients and letting them know that he had been given a special mandate from God to bring in new converts through his ability to heal. Eventually, his preoccupation with special powers diminished, and no other evidence of psychopathology was observed. The patient was discharged, having received no medication at all. Two months later he was arrested at a local theater, this time for disrupting the showing of a film that depicted subjects he believed to be satanic. 223 Benjamin James Sadock & Virginia Alcott Sadock, Kaplan & Sadock's Synopsis of Psychiatry 517 (9th ed.2003). 224 Other sources similarly posit the existence of religious delusions. See Joseph Westermeyer, Some Cross-Cultural Aspects of Delusions, in Delusional Beliefs 216-17 (Thomas F. Oltmanns et al. eds., 1988) (describing study of patients with religious delusions); Robert L. Spitzer, Michael B. First, Kenneth S. Kendler & Dan J. Stein, The Reliability of Three Definitions of Bizarre Delusions, 150 Am. J. Psychiatry 880, 881 (1993) (discussing delusions with religious themes). 225 Perhaps the most clinically effective method for distinguishing authentic religious experience from insanity was uncovered in a study of how mental health professionals make such diagnoses. See Susan Sanderson, Brian Vandenberg & Paul Paese, Authentic Religious Experience or Insanity?, 55 J. Clinical Psychol. 607 (1999) (hereinafter Sanderson Study). The Sanderson Study asked sixty-seven mental health professionals to rate eighteen different religious beliefs as authentic religious experiences or as delusions with religious content. Id. at 609-10. The studied religious beliefs ranged from following a biblical passage to cut off the hand that has sinned by cutting out the habit of shopping to hearing the voice of God telling a person to sacrifice his child. Id. Of the eighteen scenarios, the mental professionals considered the deific decree to sacrifice a child to be the least religiously authentic and the most delusional. Id. at 611. The authors offered this summary of their conclusions: 226 The essential determining factor in the ratings was ... the degree to which religious experience deviated from conventional religious beliefs and practices. The more unconventional the experience, the less religiously authentic and less mentally healthy it was deemed to be. 227 The importance of deviation from cultural convention is underscored by the fact that the two experiences rated least authentic and mentally healthy were also the two that involved the most severe physical consequences: complying with a request from God to sacrifice one's child, and following a literal interpretation of the biblical scripture to cut off one's hand ... These results suggest that participants were doing something similar to what DSM-IV prescribes, using (implicit) cultural norms as the basis for evaluating religious experience and mental health. Id. at 614. 4