Psychotherapy expert: Delusions of grandeur

By DR. MIKE GROPPER
September 13, 2009 12:30

 
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Dr. Mike is a licensed clinical social worker (USA and Israel) in private practice in Ra'anana and Jerusalem. He is also founder and director of SmokeQuitters. He recently wrote a column called "Psych-Talk with Dr. Mike" in which the feedback from readers was excellent. He has decided to shift gears and invite readers to submit their questions concerning a wide range of topics: child development, adult problems, addictions, ADHD, adjustment problems, crises and transitions, trauma, phobia, mental disorders such as anxiety, depression, and bi-polar.



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He also welcomes questions concerning your marital or couple relationship, family issues, parenting, problems at work, self-confidence, shyness and much more.



To arrange a consultation (Israel and international), call or e-mail Dr. Gropper at (972) 9 774-1913 or at drmikegropper@gmail.com



"I take pleasure having the opportunity to answer your questions in what I hope will be an informative and exciting weekly column in the Jerusalem Post-online edition. Look forward to hearing from you soon."



Send your questions for Dr. Mike and please leave your comments on the Q&A below.



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    This column is intended solely to educate and is not a substitute for personal diagnosis or treatment. If you have a difficult problem, please seek advice from your own doctor or mental-health professional.



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    Vol XXIX



    Q: If a loved one is suffering from 'delusions of grandeur' and has done and continues to do things which might put them (and/or others) in harm's way indirectly or unintentionally, how can they be legally treated when they don't agree to get help? How does the family get some remedial help?



    A: Delusions of grandeur are firmly-held ideas that a one is famous or an important person; for example, believing that one is Moses, Jesus, Napoleon, or Superman.



    This grandiose belief system is often accompanied with the conviction that the individual can "fly" or "see through walls" or "levitate". Delusions are a core symptom of people suffering from schizophrenia, a psychotic disorder that affects one per cent of the population, and characterized by severe distortions of reality such as experiencing auditory or visual hallucinations, disturbances of thought and language, and withdrawal from social contact.. In fact, delusions are present in 90% of the cases of people with schizophrenia.



    I am reminded of the 2001 film K-PAX, starring Kevin Spacey, based on the 1995 novel by Dr. Gene Brewer. After a mugging incident at New York's Grand Central Station, Prot (Kevin Spacey), a man who claims to be an alien from the planet K-PAX, is turned over to a public mental hospital and the care of Dr. Mark Powell (Jeff Bridges). When medication fails to alter Prot's insistence that he is visiting from another world on a fact-finding mission, Powell gets more involved with his patient, who seems to have a calming effect on the other residents of his ward. At first convinced that Prot is a delusional who can be treated, Powell begins to wonder if his bizarre patient's story is true, particularly after the hospital's doctors find that Prot possesses the baffling ability to see ultraviolet light. As the date grows nearer when Prot claims he must leave Earth (a "class BA-III planet"), Prot begins to compromise the safety of the other patients by giving them the false hope that they can come with him to his planet. This is classical example of a person with delusions of grandeur.





    You asked what can be done to get this person help, even against their will. For starters, I would suggest trying to bring the individual to a psychiatrist to have him or her evaluated.



    Sometimes, a schizophrenic individual who appears uncooperative can be convinced to go to see a professional for an evaluation. If a family member cannot influence cooperative behavior, ask yourself, who - a friend, a relative, a rabbi - may be able to get the individual to go to be seen. It's important to utilize whatever resources your can muster up.



    Another option would be to pay for a psychiatrist to come to the home to evaluate this person. It is possible that this could lead to an accurate diagnosis; let's say, in this case, schizophrenia, with appropriate anti-psychotic medication prescribed. As a last resort, Israel has a system of forced evaluation. Each region of the country has a regional psychiatrist. You can get the name of this person by calling up your health care organization or the city's information telephone number and ask for the telephone number and name of this individual. If the person you describe is really endangering him/her self and/or others, the regional psychiatrist can order a psychiatric evaluation and if need be have this individual committed against his/her will. Two psychiatric nurses, usually big and trained for this type of intervention, come to the home to escort, by force, if need be, the individual to a psychiatric hospital for either evaluation and/or commitment. These laws have been outlined under "The Law for the Protection of Patients' Rights" (1995), depicting emergency care in a life-threatening situations.



    The prognosis for people suffering from schizophrenia is very good today with the advent of major advances in diagnosis, medication, and rehabilitation. Most schizophrenic individuals, while once spending much of their lives in psychiatric hospitals, today live in the community. Medications have been developed that help to keep psychotic symptoms under control and in remission.



    Good luck.



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