You have to believe in something. “Lewis Wolpert argues that beliefs may
come from our genes and we have a
fundamental need to tell ourselves
stories to make sense of life.” If causal thinking is preordained biologically, it is no surprise that irrational beliefs hold such sway, and Skeptics will always face such an uphill battle. Certainly, while beliefs differ tremendously, it is quintessentially human to explain things, make sense of them and believe in our explanations. Telegraph
In my psychiatric practice and teaching about psychosis, I’ve reached similar conclusions to Wolpert. It’s never easy, and a source of endless debate, to figure out which psychiatric symptoms (especially in the severe illnesses we call psychotic) are the so-called “primary” manifestations of a disease process’s alteration in brain function, and which are “secondary” — attempts of the mind at restituton in the face of the dysfunction. I firmly stand on one side of the deep controversy in psychiatry surrounding delusional beliefs — with the assertion that they are not primary psychotic symptoms. Instead, they are the attempts at restitution — a bewildered mind finding a way to “believe in something” in the face of the dysfunction of the machinery for making sense of things. For example, if you’re overcome by terrifying paranoid feelings of danger, it’s much more powerfully tempting and comforting to have an explanation (no matter how outlandish and no matter to what extent it sacrifices consistency with reality or consensus) than to have no explanation at all for how you are feeling. So you’ll come to believe, for example, that those people lurking on the corner across the street are CIA agents who have you under surveillance — and that that’s why you are feeling these frightening bewildering feelings of being in danger.
Figuring out whether delusions are primary symptoms of the alteration in brain function in the illnesses in which they occur has important clinical consequences in how we treat these disorders. I contend that treatments of psychosis, especially the powerful and effective antipsychotic medications we have at our disposal, never change delusional thinking, because once formed beliefs are very compelling and we abandon them only with great difficulty and at great cost even if the occasion for them has passed. Perhaps this “conservation of belief”, as I call it, speaks to Wolpert’s assertion of a biological determinism driving it. In any case, the implication is that we should stop throwing medications at a patient expressing fixed delusional beliefs if that’s his or her only “symptom”; instead, a focus on slower, cognitive measures for belief-changing is called for.
There is precedent for this distinction between primary symptoms and compensatory beliefs from other areas of psychiatry where it is more generally accepted. Panic disorder is a crippling condition with explosive spontaneous outbursts of severe anxiety. Along with it, patients often develop agoraphobia, the fear of going out, because they become convinced that certain places or activities away from the security of their home and family will bring on the panic attacks. Even when these patients have become completely free of panic attacks with the use of the appropriate medications, the agoraphobic avoidance persists as a fixed belief. The patient cannot be convinced that, because their susceptibility to panic attacks is stabilized, they no longer have to avoid the feared exposure. No medication can correct this, but rather only a variety of cognitive therapy approaches.
Well, enough of getting technical on you…