The latest from Nautilus, and this weekâs Facts So Romantic. [View in browser](| [Join Nautilus]( Did a friend forward this? [Subscribe here.]( This Thursday, your free member newsletter includes one full story, by journalist and author Pagan Kennedy. After that, be sure to check out this weekâs Facts So Romantic. PSYCHOLOGY [The Happiest Man in the World]( Harryâs psychotic delusions bring him cheer. His psychiatrist embraces them. BY PAGAN KENNEDY Several years ago, a British man named Harry picked his nose. A hidden camera recorded him in this private moment, then someone uploaded the video to the internet, and soon Harryâs pratfall exploded into a worldwide meme. Millions of peopleâmost of them in the United Statesâbecame obsessed with the video. Everywhere Harry went, strangers shot significant looks at him and touched their nostrils, as if to say, âHey, youâre that nose-picking guy!â Harry loved the attentionâhe described his fame as a âsafety blanketâ and said he felt as if everyone on the street had become his friend. But there was a problem with Harryâs internet stardom: No one else could perceive it. In a parallel reality where most of us live, Harry had been diagnosed with psychotic delusions, many of them seemingly borrowed from the YouTube videos he obsessively watched. If lining a hat with tinfoil gives a person a sense of power, wonderful. Letâs do it. His family convinced him to visit a mental health clinic affiliated with the University of Birmingham. There, he enthused to his clinicianâRosa Ritunnanoâthat he was âthe happiest man in the world.â Harry told Ritunnano that he could read and control other peopleâs thoughts; he deployed his telepathy to battle the lizard-humans and the Illuminati at the center of a web of power. These enemies, for their part, surveilled him through hidden cameras and telepathic spies. As nightmarish as that all might sound, Harry relished the attention from the imaginary conspirators who monitored him. âIf I found out that they [were] not watching me and reading my mind, I would feel alone and crazy,â [he explained to Ritunnano](. Though he was engaged in an apocalyptic psi war, Harry was also a remarkably pleasant fellow who seemed to pose no threat to anyone. He did refuse his prescribed antipsychotic medications, but when Ritunnano and her colleagues asked him whether he would submit to a battery of pencil-and-paper tests, he cheerfully agreed. And so the doctors administered some whimsically named tools that are used to measure self-worth, including the Purpose in Life Test, the Life Regard Index and the Existential Meaning Scale. Harry aced them all. Photo by sondem / Shutterstock In the past decade, the Hearing Voices Movement, a federation of people who experience auditory hallucinations, has pushed the medical community to acknowledge that their symptoms can be a [meaningful]( adaptation to trauma. Ritunnano belongs to a compatible movement among caregiversâwhen she met Harry a few years ago, she had just started her Ph.D. in a field known as phenomenological psychopathology, which puts the doctorâs sense of reality on an equal footing with the patientâs. In Harry, Ritunnano saw a teacher. She thought she could âlearn something about what it means to be happyâ from him. At the same time, she struggled with her obligations as his clinician: How was she supposed to help a man like Harry? Clearly, his psychosis had cost him some heartbreaking losses. Due to Harryâs odd behavior, and concerns that his children might be at risk, he was barred from seeing them for a period. Even when he was able to see his children more regularly, Harry often spent his days glued to YouTube, addicted to videos about the flat Earth and other conspiracies, making it impossible for him to work and damaging his family life. And yet he reveled in his imaginary superpowers, which he told Ritunnano connected him to all of humanity. Now, he said, all âpeople are like a family for me.â They are always struggling to find human connection. Ritunnano isnât the only one asking such questions. Louise Ishamâa research clinical psychologist at the University of Oxfordâtold me that she first began to grapple with ethical dilemmas connected with delusions after she met a female patient who believed she worked undercover as an MI5 spy. The patientâs âmissionsâ let her imagine that she was rushing around the world to battle villains and gave her a sense that she was serving her country. So even if doctors could find a way to bring the patient back to reality, would that be the right thing to do? This question inspired Isham to scour the psychiatric literature for guidelines on how to treat patients with âgrandiose delusions.â (The term is psychology-speak for delusions involving fantastical powers or secret knowledge.) As it turned out, there were no clear guidelines. Isham realized, âthis is an area thatâs massively under-researched.â She told me, âthere is a genuine problem that Iâve witnessed in clinical services, where you can see the harm thatâs coming from a patientâs grandiose delusions, but thereâs also a clear benefit to the belief, and there is a real lack of empirical literature that tells us what to do about that.â Patients with âsuperpowersâ might decide to fly off the top of a building or to baptize strangersâand often they may be so busy with their imaginary role that they lose their real-life jobs and become socially isolated. And yet, âgiven the benefits that people can getâ from their delusions, Isham said, âyou have to be really careful not to go in and make things worse.â In order to learn more about this condition, Isham and her colleagues identified patients with grandiose delusions and polled them about their experiences as messiahs, secret agents, and conspiracy-investigators. You might think people described as âgrandioseâ would dream themselves into the billionaire class and indulge selfish desiresâif you have godlike superpowers then why not sail an imaginary yacht to Macau and win every hand of blackjack? But Isham and her coauthors [found]( that most of the patients had created a fantasy world where they performed selfless acts, even miracles, to help others. About 70 percent of these patients reported that their âspecial powersâ helped them to make other people happy and to protect others from harm. Perhaps the inner life of these patients tells us something more universal about the search for meaning: For most of us, self-worth depends on being useful to others. And we, like Harry, are always struggling to find human connectionâbut he and others with psychosis might get that need met more easily by communicating telepathically with fictional strangers than in person with family or friends. As Isham said, âThis is a very misunderstood group of people.â Photo by Maciej Bledowski / Shutterstock Caroline Mazel-Carlton would agree with that. She told me that she heard her first disembodied voice after being abused by a daycare worker. The womanâwho had hit young Caroline and scalded her with chemical cleanersâwas chatting with another adult, and said, âItâs such a nice day. Not a cloud in the sky.â Thatâs when the voice in young Carolineâs head spoke up: âSheâs lying. I hate her.â Mazel-Carlton told me that the voiceâshe would later name it âFrankââdidnât frighten her at first. If anything, he seemed to be coming to her defense. But later, voices turned into a swarm of tormentors. As a teenager and young woman, Mazel-Carlton bounced from mental hospitals to jail cells, where doctors numbed her with pills. In her late 20s, Mazel-Carlton detoxed from psych meds and learned how to tame and soothe even the most frightening voices in her head, including âFrank.â If Frank orders her to throw a chair across the room, for instance, she can âsatisfyâ him, by simply touching the chair or turning it over. Like an improv actor, she jumps into their stories with them. Nowadays, Mazel-Carlton uses her lived experience to guide other peopleâsheâs the director of training for the Wildflower Alliance in Western Massachusetts. A support network thatâs aligned with the Hearing Voices Movement, the Wildflower Alliance brings together a community of peers to cope with voices, visions, and other âextreme states.â Years ago, when Mazel-Carlton was on the other side of the consulting table, the doctors would ask her whether she was hearing voices, yes or no? And the conversation would usually end thereâwith a diagnosis and a prescription for meds. But now, as a caregiver, she explores her clientsâ hallucinations with probing questions that her own doctors never bothered to ask: âDo you want to share what your voices say? How do they make you feel? Do your voices remind you of anyone youâve known in the past?â Mazel-Carlton said that âas mental health professionals, weâre not really doing our job if weâre not looking for meaning,â and she emphasized that caregivers should recognize that psychosis can be a survival tool. As an example of that, she told me about a man sheâd met in a locked psychiatric ward who announced that he was the president of the United States. The patient âhad been through horrific institutional trauma. He was once stripped naked and handcuffed to a sink by police,â she said. And now the psychiatrists on the ward wanted to drug the âpresidentâ back into painful reality. They identified patients with experiences as secret agents and conspiracy-investigators. Mazel-Carlton had a different idea. She invited the patient to walk the halls of the locked ward with her, and then she asked him, âHow does it feel to be the president of the United States?â She wondered if he regretted becoming the most powerful person in the world. Wasnât he overwhelmed by his responsibilities? He told her, no, he loved being president. âHe shared with me that he was reflecting on who his cabinet members would be, and he asked me if I wanted to serve on the cabinet,â she said. âHe wanted Beyoncé to serve in another position in the cabinet, and that gave him so much joy.â For Mazel-Carlton, the patientâs fantasy seemed an act of heroismâheâd recaptured his own human dignity and found a reason to keep on living. Mazel-Carlton believes that the last thing you should do is to tell someone that their voices and visions arenât real. âIf I were to do that, Iâd sever my connection with them,â she said. âIf I donât validate their own fears and concerns, why would they turn to me as a source of support?â And so, like an improv actor, she jumps into their stories with them. This allows her to help the patient change a potentially dangerous narrative to one thatâs benign. âIf the CIA is asking them to monitor their neighborhood and theyâre ending up in peopleâs yards or looking in mailboxes, thatâs when I ask them to imagine other ways to complete their mission. Like, could you get to know your neighbors?â And if Jesus or Allah feels the need to cut out their own eyes as a sacrifice, then Mazel-Carlton suggests other ways of performing the holy ritual. She might encourage the client to make a drawing of the sacrifice, or to say a prayer. âAnything that gives someone the sense of power and wonât hurt them is great,â she says. âIf lining a hat with tinfoil gives a person a sense of power, wonderful. Letâs do it. Buying a cell phone jammer for the room? Great. Letâs do it. Because when we can give a little bit of power, then we can often have the conversation about the deeper seed of truth and meaning.â She acknowledges that her methods are out of sync with mainstream psychiatry. She and others in the Hearing Voices Movement are âthrowing ourselves bodily at the Overton Window,â she said, meaning that they want to expand the spectrum of acceptable treatments for people who struggle with mental-health problems. Photo by ver0nicka / Shutterstock This seemingly radical approach has its [critics](. Ian Gold, a professor of philosophy and psychiatry at McGill University, told me that clinicians may need to make judgment calls on behalf of patients who are suffering. âThereâs a spectrum of patients,â he pointed out. âSomebody might say, âIâm happy and I have this delusion.â But really theyâve got an illness that is not severe.â He noted that if a patient is struggling with depression or feels tormented by their voices, then the clinician may need to treat the underlying pathology that causes their pain. Ritunnano made much the same point. She told me, âItâs not about the actual belief, itâs about the individual and their social context.â If a patient with severe bipolar disorder suddenly becomes terrified of black cats, that might be âa harbinger of serious decline, and they will need intense support to avoid hospital admission.â On the other hand, she said, when a patient with a long-time delusion that heâs being tormented by aliens suddenly stops talking about spaceships, that may be a sign that he has slid into depression and needs medication for thatârather than for his delusion. Still, many clinicians are now embracing methods that empower patients to live with their voices and visions if they so choose, including a form of cognitive-behavioral therapy in which patients learn to cope with hallucinations. In [one recent paper](, for instance, researchers pointed out that clinical guidelines from countries around the world suggest that people with psychosis should have a say in their own therapyâeven if that involves refusing to take medications. And that brings us back to Ritunnanoâs question: What can we learn from Harryâs happiness? She told me that working with Harry challenged her to think differently as a clinician. âWith Harry, it was mostly about being able to sit with the uncertainty,â she said. âWhile our job as clinicians is often focused on treating âsymptomsâ and managing risk, Harryâs case reminded me that we are also always confronted with the existential struggles that accompany health and illness alike. What do you do when eliminating âillnessâ also means eliminating meaningfulness?â Harry had no complaints, and there were no immediate concerns about harm coming to him or others. So, as long as his joy lasted, Ritunnanoâs job was to believe in it, rather than treating it as a symptom to be snuffed out. Harry had discovered that his best life could be in his fantasies. As he once told Ritunnano, âI feel like Jesus. Of course Iâm not [Jesus.] But why not believe?â Lead image: fran_kie / Shutterstock More from Nautilus: ⢠[Who speaks for the whales?](
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