Restoring Shattered Lives:
Psychotic Delusions as Meaningful

By William A. MacGillivray, PhD, ABPP
President, Division of Psychoanalysis

Benedict Carey four-part series, "Lives Restored: Managing Severe Mental Illness" in the New York Times concluded last week with "Finding Purpose After Living With Delusion," profiling Milton Greek, a man who has been diagnosed with schizophrenia for many years. The theme of the story is that Mr. Greek has been able to maintain a productive life while still under the grip of profound delusions. Although he has relied upon medications and psychotherapy for help, he has also been able to use his delusions in productive ways. The takeaway message from the article is that delusions have meaning and individuals who are able to work on understanding and channeling their delusional themes into productive effort may actually experience more meaning and satisfaction in their lives.

While this message may not strike members of our Division as particularly novel, it is certainly one that has been increasingly obscured by the medicalization of emotional difficulties to the point that meaning itself is seen as pointless and only an array of pharmacological elixirs are needed to suppress or eliminate delusional thinking. I am reminded of a PBS special on the life of John Nash, which like the movie of his life, consistently trumpeted medication as the only solution to his difficulties. In this program, whenever significant events in his life were described there was a cutaway to an image of the brain, as if that was sufficient explanation for his troubles. The viewer had to wait until the end of the special to learn Nash's view of what cured him: the consistent love from others (something those viewing the movie never learned).

Carey's article, as well as the three preceding articles in the series, is a welcome antidote to the repeated mantra of "brain disease" and "chemical imbalance" to define mental illness. The fact that meaning is the primary casualty of emotional disorder and the restoration of meaning is the primary task of recovery needs to be continually emphasized. The fact that this message is being told by those struggling with mental illness is also important. Milton Greek and the others featured in this series (including Marsha Linehan), along with John Nash and Elyn Saks, and others are helping to provide a counternarrative that may rescue the care of mental illness from the "back wards" treatments offered by Big Pharma.