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Primary and Secondary Delusions
Schizophrenia and Psychosis

 

Primary delusions are primarily those discussed previously where the delusion forms the basis of the schizophrenic's experience.

Like any belief they are the filter through which the individual perceives his world.

These classically take the form of "delusions of identity" where the schizophrenic makes the world fit into the categories formed by his belief.

In practice these delusions can be considered to be rare and the psychiatric texts suggest that they are too readily diagnosed by inexperienced practitioners.

Secondary delusions are more common with schizophrenia and a misunderstanding of their structure can quickly lead the NLP practitioner down the wrong path and can result in an extension of the schizophrenic's world when the practitioner acts inappropriately.

Understanding the difference between the two is crucial if the session is to avoid that of the pantomime format of:

"Oh yes it is!!!!"......."Oh no it isn't!!!"......"Oh yes it is!!!!"......."Oh no it isn't!!!"

For example, a secondary delusion can be expressed by a schizophrenic claiming that other people can hear his thoughts.

An understanding of the schizophrenic process and linguistic presuppositions will enable the practitioner to spot the underlying process.

It is not uncommon for schizophrenics to experience a projection of their internal dialogue and internal auditory remembered/constructs. These clients experience these 'voices' as originating external to themselves and the brain processes them as though they are detected upon the timpanic membrane. For these people, it is not necessarily an unrealistic presupposition that other people can hear these voices and sounds as well.

For the NLPist, there is an important distinction between these voices.

Auditory sound-bytes ("Echos from the past") are often more 'free floating' and are distinctly different from voices that are expressed internal dialogue.

As a broad general-LIE-sation, that character in 'Psycho' was hearing injunctives given to him by his mother (Auditory Remembered).

That madman you see in the street shouting/having an argument with himself might be hearing and responding verbally to his [pretty damned disturbed] internal dialogue.

Thus, a secondary delusion can be seen to be more of a general verbalisation of his experience whereas the primary delusion provides the structure of his experience.

A primary delusion, like most true belief, is the filter through which he interprets and understands his reality.

Handle it wrong, and you will be in for a very long day indeed.

Secondary delusions are formed as a way of interpreting the abnormal ways the schizophrenic experiences the world and typically provide a structure by which a positive feedback loop is established, exacerbating the schizophrenic process into a total breakdown.

An example of this can be observed with beliefs of an absence of self worth.

The sufferer believes that because he is worthless, then other people believe him to be worthless too. Anyone saying anything on the contrary is told that he is only saying this to make the sufferer feel better. The sufferer's performance at work, in his marriage, in life, will drop, thus further providing negative experiences to confirm his belief.

This rapid downward spiral (slowly, then suddenly very quickly) is typical of a nervous breakdown and is contingent upon positive feedback loops and threshold patterns.

It is these strategies in the schizophrenic's model that can make the process of schizophrenia behave as though it were a biological illness, with the schizophrenic lurching through a huge variety of extreme states in a relatively short period of time.

From this list I have omitted such 'syndromes' as Capgras' syndrome and 'Folie a Deux' as these are comparatively rare and usually (especially in the case of Capgras') indicative of an underlying organic state such as a head injury or drug withdrawal/abuse.

One of the most frustrating things about the standard psychiatric texts is that their descriptions of psychiatric phenomena are only meta-descriptions.

Rarely have I found a description of what a practitioner can actually do when presented with psychiatric behaviours; ie how to stand/sit, posture, tone of voice, what to say, what to ask, what to ignore, what to interpret etc.

One of the great difficulties in presenting information like this is that the naïve practitioner reads information like that as 'technique' and goes away and practices the same 'technique' on everyone they meet. This is about useful as drugging everyone.