A delusion is broadly defined as a fixed, false idea, not shared by others, unshakable in the face of decisive evidence contradicting it.
Where do delusions come from, and what do they mean? After all, it requires a considerable amount of imaginative work to create an alternative reality, and then heroic efforts to keep that reality going in the face of others – that is, everyone else – who don’t share the same belief; who might even laugh at you, for having glass feet or a glass rear end. It’s an intriguing question.
It’s not a static situation; we’ve changed how we’ve thought about them over the centuries. In the classical world it was an imbalance of ‘humours’, later demonic possession, then organic brain disease.
A more consistent feature is how subjects cling onto their delusions, seemingly for dear life. What do delusions offer that is worth the trouble? What kind of help or protection?
Delusions are only just starting to emerge as a field of study in their own right. Accounts over the centuries offer us peepholes into this historically overlooked area of everyday human experience. They were typically written up as ‘curios’, or marvels of the mind, but there’s more to know about these individuals in context, following each path through their daily lives; along the streets they walked, coming in and out of the shadows, glimpses of real human lives, struggles and powers of imagination. Can we spot traces of the route taken, how each managed to make a living, navigate love affairs and marriages, the birth and death of children, illness, wars or political or religious disorder, their sense of the future? Will their delusions become more understandable?
Looking back across centuries of experiences, we can see a common thread; common enterprises. Certain delusions seem to function in the same way. Organising ideas emerge. One persistent theme is lives that have gone catastrophically wrong. Delusions here are helping to assimilate a dramatic fall in status and to reconcile with the wretched existence which inevitably follows. The stakes for each of them in their delusions are as high as they come:
A housewife from 1920s Paris believes her husband and children have been replaced by substitute doubles. An Englishwoman in her Sunday best says she was swapped at birth and is the rightful heir to George III. She travels to St James’s Palace to confront him with a petition and a butter knife. A man says he’s Napoleon and barks his orders – countless lives depend on compliance. ‘Madame X’ calmly explains that she won’t be needing supper because she is, regrettably, already dead. These people have never met, they are separated by hundreds of years, but they begin to talk to each other and reveal a certain solidarity. They have all experienced a reversal of fortune.
With other cases, delusions are a way of reconciling the irreconcilable. Francis Spira and James Tilly Matthews are men from very different eras. Spira is a lawyer living through the Counter-Reformation, Matthews a British diplomat and suspected double agent in revolutionary France during the Terror. Both are tormented by impossibly conflicted feelings and demands made on them. In Spira’s delusion, God resolves things once and for all: Spira is damned for all eternity. Matthews clears up the confusion which surrounds him by identifying a political conspiracy: the British government is in league with the revolutionaries. There are good players and there are bad players and Matthews’s paranoid delusion places him firmly on the side of justice.
And then we have our French glass king and his fragile posterior. The chaotic Charles VI responds so strongly to a new technology that he melts himself into it. Delusions of the body are often exquisite metaphors, witty and poetic, even when they result from grisly trauma, as with our clockmaker who survived the decapitation spree of the Terror but believes that he ‘lost his head’ under the blade of the newfangled tech of the guillotine.
And what of the people who want to know about delusions, who get obsessed with a cure? Who are they? The characters of the pioneering doctors we meet along the way are no less compelling, or confounding, than their subjects. Making his mark in the Paris medical journals in the early 1920s, for example, is Gaëtan Gatian de Clérambault. He gave his name to a delusional syndrome, otherwise known as ‘erotomania’, where a person believes that someone of high rank is in love with them (when they’re not). While his theories circulated between the most distinguished Parisian doctors, he kept a personal fetish for silk and other sensual materials completely secret, from everyone except the mannequins in his apartment. He killed himself with his First World War service pistol, staging the desperate tableau of his suicide in front of a mirror as if it were the final shot of a motion picture. The pioneers of new thinking around delusions in the nineteenth and twentieth centuries were frequently traumatised by a direct experience of war. The diagnosing doctor and the delusional patient undertake months, if not years, of conversation. They engage in a dance of sorts, and doctor and patient frequently have more in common than they might imagine.
I spent many days eavesdropping on conversations from centuries past between physicians and the people describing their experience of delusions, via the case studies which resulted. The case notes are often brief sketches, with gaps and omissions, and they are inevitably coloured by the psychiatric gloss, or the religious or philosophical parameters of time they were written. Many, of course, were recorded well before the language of psychoanalysis was formulated. I’ve taken a certain licence in passing a psychological lens over the oldest stories. My hope is to try to understand a little more about the individuals who hide behind the pseudonyms that headline the landmark cases and how their delusions functioned in their lives; to flesh out the elusive characters like ‘Madame X’ who believed she had already died, and ‘Madame M’ with her stolen children and a double for a husband. What’s it like to experience an extreme delusion first-hand? What were the specific experiences their delusions answered?
We receive our subjects refracted through the mind of their doctors and chroniclers with agendas, even delusions, of their own. Occasionally, like tuning an old radio, you catch snatches of what feels like an authentic voice in the static. Then they tell us how common our troubles are and have always been.
Don’t mistake these stories for a collection of dusty curiosities from a long-lost past. Large-scale epidemiological studies in the 1980s and 1990s in the US interviewed members of the public, selected at random, to determine the prevalence of certain psychiatric conditions. This was the first time people who had not found their way to a clinical setting had been assessed. The findings surprised researchers. One such landmark study conducted in Baltimore in the US in 1991 noticed something interesting: ‘The issue is the unexpectedly high prevalence of reported hallucinations, delusions and other bizarre behaviours among individuals who do not meet the criteria for diagnosis.’1
Historically, only the most extreme and bizarre cases were recorded, because these represented the people admitted to hospital. A far larger body of the people who were experiencing delusions remained under the radar, because the majority never required treatment and were otherwise relatively high-functioning. Simply put, we are all somewhere on the delusional scale: we all have at least one fixed, false idea about ourselves which other people, who know us well, would dispute. They could offer us plenty of evidence, too. Delusions are extremely common in the general population and, presumably, always have been. A modern reading suggests that delusions have always been closely tied to a person’s sense of self, their views of the world and what is happening in it, and we should take them more seriously. The historian of madness Andrew Scull calls delusions a ‘reminder of how tenuous our common sense reality seems to be’ and this is an uncomfortable idea to sit with. Still we’re drawn to them. Why do so many of us go to the trouble of creating these curious alternative realities? Which of our own beliefs might be false? Maybe the distance between the delusional – safe on the other side of the window – and the rest of us is no wider than a pane of crown glass.
Delusions offer rare access to private motivations, into the secret minds of others. We can’t know on a day-to-day basis how other people are within themselves but when a person maps out their delusion for us we glimpse a whole world, designed entirely by them. We might be allowed inside for a tour, but only on the condition that we play by the rules as they set them out. It’s invitation only and the by-laws of the land are non-negotiable. That is where they live. On the other side of the glass.
We have to feel our way carefully around to let our eyes get accustomed to the dimly lit rooms. As we listen to each story and become accustomed to the unfamiliar backstreets, not just of the past, but of an alternative reality, we begin to make out a living, breathing person and catch intimations from them of real-world and perfectly ordinary troubles and ambitions, imaginatively packaged for us to interpret. There are ‘encoded hopes and possibilities’ here somewhere, as psychoanalyst Adam Phillips has it. The difficulty is hearing the hopes and possibilities in what sounds crazy.2
Each of the individuals featured in this book laid a whole lot on the line by challenging reality so publicly; it follows they have something they want to say, commentaries and strategies to smuggle through. People with delusions have had their quieter, more sober messages drowned out by professional arguments over how they should be classified or cured. The longer you sit and listen to their accounts (they were amazingly good company during the lockdowns while writing this book) the more reasonable, even ingenious, they seem. Can we understand?