Jan. 29, 2017. Psychopathology Colloquium 2016/2017, Presenter: Seiichi Sugawara "The Boundary between Thought and Delusion (Based on The Premise That Everyone Is Delusive)"
A Patient with depression may insist that “I have depression and I cannot work so I am not worth living.” If we generalize this insistence, we come to a eugenics-like proposition that “a man who cannot work is not worth living”. However, the patient is talking only about himself and this fact is the reason why this insistence is pathological and symptomatic.
As you can see by just thinking about this example, when you try to distinguish between thought and delusion, if you do not take the part that the patient is talking about oneself into consideration, an idea which should originally be taken as a delusion can be mistaken as a (non-pathological) thought.
The traditional theory of delusion, having paranoia and schizophrenia in mind, regarded a statement that talks about oneself as a typical example of a delusion. This applies regardless of whether it is the phenomenological theory of “reference upon one’s own self” or the psychoanalytic paranoia theory by Freud.
In recent years, the idea of considering delusion as “objectively wrong belief” is the mainstream and the statement which we can verify its truth, such as “It is said that so-and-so is dead, but he actually is alive”, is taken as a typical example of delusions. Clinically, however, such delusions rarely exist.
In recent years, Spitzer, a representative of a theory of delusion as such, insisted that statements about disturbance of the self, delusions of reference and delusions of mood disorders are correct statements of their experience and should not be regarded as delusions.
Such theory, not taking the part that the patient is talking about oneself into consideration, do not take some kinds of statements as delusions from the outset. This could lead to excluding certain patients from the psychiatric field.
Contrary to this, in accordance with Lacan / Miller / Matsumoto's insistence that “everyone is delusive”, any statement would not be discarded as “non-delusional” from the outset, but would be considered from the viewpoint such as “what kind of delusion it would be”.
When symptoms of mood disorders or acute drug intoxication overlap, even patients with common thoughts can perceive themselves as special and make themselves the subjects or executors of their thoughts. Considering this fact and the fact that paranoiac or schizophrenic delusions are related to themselves, I would conclude as follows. Statements with contents that perceive themselves as special cannot be taken as “thoughts rather than delusions.”