The word "alternative reality" has recently become news in the political background, but psychiatrists like me are already very familiar with this concept-in fact, we can hear various forms of alternative reality expressions almost every day.
All of us need to analyze what we perceive from reality every day, almost in every aspect of our lives. So, how can we sort out the opinions and beliefs that most people find strange, unfounded, illusory or simply delusional? "
Lies are not always lies. First of all, we need to distinguish what ethicists and philosophers often emphasize: the difference between lies and lies. Therefore, a person who deliberately distorts the facts he or she knows is lying-usually for personal gain. On the contrary, a person who makes false statements without any cheating intention is not lying. This person may not know the facts at all, or may refuse to believe the best evidence available. He is not lying, but lying. Some people who tell lies seem to be unable to distinguish between truth and illusion, or between truth and fiction, but they sincerely believe that their world outlook is absolutely correct. This is the center of our entry into psychiatric literature.
In clinical psychiatry, we see that patients have all kinds of ideas, and many people think these ideas are eccentric, exaggerated or openly contrary to reality. The job of clinicians is to listen first, and try to understand these beliefs from the patient's point of view in an empathetic way, and carefully consider the patient's cultural, ethnic and religious background.
Sometimes the clinician's first impression may be all wet. A colleague of mine once described a very excited patient who was hospitalized because he insisted that he was being followed and harassed by the FBI. Within a few days of his hospitalization, FBI agents appeared in the ward and arrested him. As the old joke goes, just because you are paranoid doesn't mean they don't pursue you! "When you think it is wrong, we can think that the distortion of reality decreases along a continuum, from slight to serious, based on how beliefs are adhered to and how they are not affected by factual information. On the milder side, we have what psychiatrists call overvalued ideas. These are very firm beliefs, which are contrary to the cultural beliefs of most people, but they are not bizarre, incomprehensible or obviously impossible. A view full of * * * that vaccination will lead to autism may be regarded as an overrated idea: scientifically incorrect, but not completely impossible.
At the very end of this continuum is an illusion. These are powerful and totally inflexible beliefs, which will not be changed at all because of factual information. They are obviously wrong or impossible. It is important that delusion cannot be explained by people's culture, religious belief or race. A patient can't help but believe that Vladimir Putin has implanted an electrode in his brain to control his thoughts, which will be considered as delusion. When the patient expresses this belief, he or she is not lying or trying to deceive the audience. This is a sincere belief, but it is still a fallacy.
All kinds of fallacies and heresies can be expressed by people suffering from various neuropsychiatric diseases, and also by completely "normal" people. Within the scope of normal fallacies, it is the so-called false memory that many of us often experience. For example, you are absolutely sure that you sent a check to the power company, but in fact, you have never done so. As social scientist Julia Shaw observed,
False memory "My memory, like other memories, is no different from what actually happened." So when you insist on saying to your spouse, "Of course I paid the electricity bill!" "You didn't lie-you were just cheated by your own brain.
More serious false memories include a process called dialogue: the spontaneous generation of false memories, usually of a very detailed nature. Some fictional memories are ordinary, while others are quite weird. For example, this person may insist-and sincerely believe-that he ate Benedict's eggs for breakfast in hotel ritz, although this is obviously not the case. Or, this person may insist that she was kidnapped by * * * and give a fairly detailed description of the (fictional) encounter. Conversation usually occurs in the case of severe brain injury, such as stroke or cerebral vascular rupture.
Lying is the default. Finally, many people will call it the falsification of pathological lying, and this falsification is named as the luxury scientific name of pseudologia fantastica (PF). Dr Rama Rao Gogeneni and Thomas Newmark listed the following characteristics of PF in the Yearbook of Psychiatry:
Is an obvious tendency to lie, usually as a defensive measure to avoid consequences. This person may experience a kind of "excitement" from this imaginative story. Although these lies may contain true elements, they are also quite dazzling or full of fantasy. Lies often attract great public attention. Lies tend to present people with a positive side, which may be a manifestation of potential personality's characteristics, such as morbid narcissism. However, narcissistic lies usually surpass the more "credible" stories of people with narcissistic characteristics. "Although the exact cause of PF is still unknown, some data show that there is an insulating sheath called myelin sheath around the abnormal white matter of the brain-nerve fiber bundle. On the other hand, psychoanalyst Helene Deutsch believes that PF originates from psychological factors, such as the need to enhance self-esteem, gain admiration from others, or portray yourself as a hero or a victim.
Who cares about the facts? Of course, all these assumptions are about what constitutes "reality" and "fact", and most people are interested in determining the truth. However, under the background of "post-truth era", this assumption seems to be increasingly questioned. Charles Lewis, the founder of the Public Trust Center, described our times as "ups and downs, everything is wrong and nothing is true." What is more worrying is that the public seems to have a soft spot for lies. As writer Adam Kirsch said recently, "More and more people seem to want to be cheated." Kirsch thinks this lie is very tempting: "It allows the liar to cooperate with his audience and change the nature of reality itself in a way that seems almost incredible."
When this magical reality changes, it is difficult to reverse it politically or scientifically. As the writer jonathan swift said, "Lies will fly away and the truth will stumble to catch up."
Psychiatrists cannot comment on the mental health of public figures that they have not personally evaluated, nor can they comment on the nature of lies that our political leaders sometimes tell. In fact, the Golden Water Law forbids us to do so. However, psychiatrists are keenly aware that human beings need to avoid or distort unpleasant facts. Many people may nod and agree with an observation made by psychoanalyst carl jung: "People can't stand too much reality."
Professor of psychiatry and lecturer in bioethics and humanities at Suni Northern Medical University Ronald W. Pais, Clinical Professor of Psychiatry at Tufts University School of Medicine.
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