Just now when reading one of my favorite series (Murder on the TranSiberian Express by Kaminsky) I was struck by what Rostnikov told Karpo. Rostnokov asks Karpo to read a book of poetry and Karpo declines saying that poetry serves no function other than delusion and fantasy. Rostnikov again asks him to read and says,'...Perhaps you have undervalued the function of delusion and fantasy..."
I have been struggling when counselling a few clients of mine who have paranoid delusions. Some are on anti psychotics, some on anti-depressants and others are not on any medication. Irrespective of the type of medication or the type of diagnosis, all clients' delusions have remained resistant to treatment.
After reading this perspective of Rostnikov, I think I should reconsider my clients paranoia from a new perspective. What are the gains my clients have with their delusions? By trying to reduce their delusions through CBT counseling, I am probably taking away something which is useful to them and so they resist the efforts I make in psychotherapy. (Also, I do understand that delusions are often resistant to treatment).
Client one: The functions of delusion for this client: he or she possibly gains some mental satisfaction, seeing him/herself as a victim who has been abused and bullied by society. His/her delusions, probably makes him/her see him/her-self as a 'good person' and makes him/her see the 'others' as bad.
Client two: The paranoid delusions of this client helps him/her to experience and express anger against people he/she has little or no interaction. This client would love to have a relationship with people, have a girl/boyfriend and so on but he/she has not succeeded due to many reasons such as his/her illness, social skill deficits, etc. He/she has this delusion that strangers are making nasty comments about him/her. It is likely that he/she has low selfesteem, loneliness and an unfulfilled need for companionship. His/her delusions of paranoia help him/her believe that others are against him, though he/she has done nothing wrong. Here again, the blame is shifted outside and there is no introspection about one's own issues.
I believe that even paranoid delusions have their uses.
An article by Margaret Wente talks about the uses of delusions of optimism in the Globe and Mail (December 3 , 2011) . I believe that even paranoid delusions have their uses. The blame is shifted outside of self and one does not have to look into self for problems to be dealt with.