Imagine the following: You’re a psychiatrist. A man comes to see you who believes his every movement, action, and word are being recorded by Chinese spies. They aim to kidnap and/or assassinate him. Two questions:
1) Does the specific content of what he believes automatically tell you he’s delusional?
2) Assuming he is delusional, does the specific content of what he believes tell you anything about the nature or origin of his disease or how to treat him?
For most of the 20th century, psychopathology has answered “No” to both these questions. According to Karl Jaspers, a German psychiatrist turned philosopher, the content of a belief, no matter how bizarre, could not be used as a criterion for diagnosing delusion. After all, how could a psychiatrist, sitting in his cozy leather armchair, definitively verify the truth or falsity of a given idea? (What if the man really *was* being followed by the CIA?) Jaspers also argued, in his 1913 book General Psychopathology, that the content of a delusion was a superficial phenomenon, easily altered by circumstance and culture, and was therefore largely unimportant compared with the underlying biological mechanism driving the patient’s disease.
Finally, Jaspers held that it was impossible for an outsider to comprehend the reasons behind a bizarre belief. True, you might pin the broad shape of your patient’s nutty notion to the fact that he’d spent three years in China working as a teacher, or to a childhood obsession with spy movies. But could you ever really trace the peculiar trivialities he tells himself each day—the fact that not just his cellphone conversations but his dreams are somehow tapped, or that a Chinese agent is the one who hands him a receipt at the place he goes to buy his shoes— to a useful understanding of the origin or nature of his psychosis? Nope, Jaspers said. Not a chance. Better to set aside the content of a delusion and focus on its form instead: How certain is a patient that his delusions are true? How does she react when confronted with a countervailing fact? It is these more objective factors that will really enable you to comprehend a delusional state.
While Jaspers’ ideas remain hugely influential, however (one 2003 survey found that 20% of mental health practitioners thought attending to the content of delusions would harm their practice), psychiatry has recently begun to take a greater interest in the specific details of delusional narratives. In particular, a small sub-field of research has arisen dedicated to examining the content of psychotic delusions centered on modern technology.
The Influencing Machine
The relationship between delusional beliefs and technological devices often takes the form of a condition psychiatrists call alien control, in which self-generated impulses are mistakenly attributed to an external source. “Technical alien control,” a version of this in which the external force in question is mechanical, was observed as early as 1810, with the first recorded case of a schizophrenic patient who believed himself to be under the influence of a malevolent machine. The victim was one James Tilly Matthews, a 19th century tea-broker who envisioned a gigantic “air loom” full of strange levers, batteries, and keys, floating high in the air above. A band of underground revolutionaries controlled the machine using magnetic forces, and used it to manipulate Matthews’ thoughts and ideas—or so he believed until the day he died.
Almost two hundred years later, a group of psychologists headed by Vaughan Bell (who blogs at the always intriguing Mind Hacks) examined a series of cases in which a delusional patient’s beliefs were closely connected to 21st-century technology. They documented, for example, a woman who believed “beams of light” were entering her house to observe her activities, and that these beams were controlled through the Internet. Another case involved implanted microchips, again connected to the Internet, that the patient believed controlled not only herself, but her household appliances. Perhaps the oddest and most poignant technology-related delusion, held by a young paranoid schizophrenic, was that everything she saw, heard, and did was being “filmed” via a chip in her brain and transmitted to the Internet in order to control her behavior; she believed, in other words, that she herself had been turned into a webcam.
You can read the full paper here and Vaughan’s summary here; focusing on the content of these particular beliefs, the researchers argued, is valuable because it provides insight into how delusions are formed and how to treat them. For instance, the fact that Internet searches make it easy to form highly tangential connections might promote the development of extreme delusional beliefs. One patient typed in the name of a chemical ingredient she’d seen on a box of breath mints, then used a series of numbers from a page describing scientific studies of the chemical as a new search term. Finding herself next at a page about Aramaic numerology, the woman decided that what she’d found was secret data about a Middle Eastern terrorist network, and subsequently came to believe she was being spied on by it.
Also, since the content of some beliefs about technology can be easily refuted by physical demonstration (someone who believes photos and video of himself appear on the Internet can be shown that searching his name brings up no such information), cognitive behavioral therapy may be a viable treatment option for patients with technological delusions.
A Novel Fantasy
A 2010 re-examination of technical alien control by German psychiatrists Dusan Hirjak and Thomas Fuchs goes even further. Their provocative paper in a recent issue of Psychopathology asserts that delusions involving modern technology are absolutely natural, because they serve as a concrete means of expressing certain peculiar kinds of experiences common to many schizophrenics. The idea of being controlled by technology, they say, is a kind of metaphor for—or mirror version of—what it’s like to be schizophrenic.
For example, sitting alone in a room with an Internet-enabled computer makes it possible for a single individual to connect, in seconds, to a vast universe of information and people, making the user the center of every conceivable experience and relationship. At the same time, the reality of that universe is unreliable, and in any case is limited to the small, flickering square of the computer screen (this is also true of televisions, radios, and virtual reality consoles).
These features, Hirjak and Fuchs, mirror two classic schizophrenic experiences: One, that of extreme “self-centrality,” or the feeling that every event and action in the world is related to you. Two, that of a “subjectified perception of the world,” or the feeling that everything you see and hear is experienced only by you and no one else. One patient’s technological delusion encapsulated both these phenomena. He held a powerful belief that he, like Truman Burbank in The Truman Show, was the sole real person in an artificial, hallucinatory environment that only he perceived. How had this come to be? Why, Marilyn Manson and the famous Chilean filmmaker Alejandro Jodorowsky deemed the man such an important figure that they had placed a virus on his computer and were using to broadcast an illusory world they had created just for him.
Another characteristic modern technology shares with the schizophrenic experience, the authors point out, is its ability to produce palpable effects from hidden sources: “Contemporary technical devices such as the computer, radio, television, cellular phone, internet and others...are able to accomplish tasks impossible for human beings. Many people do not even understand how these machines function.” How does the disembodied voice on the other end of a telephone travel to your ear? Are the vivid images on a television screen really contained within it? Similarly, a schizophrenic may experience powerful emotions, impulses, and sensations that are very real, but obscure in origin. Why, they may wonder, do I hear these voices? Where is this fear coming from?
Given this parallel, it is not hard to understand why a delusion may arise that attributes inexplicable schizophrenic experiences to (equally inexplicable, but objectively real) technological sources. Hirjak and Fuchs describe a patient who believed her hallucinations were coming from machines within her body:
When asked about the sexual imagery, she commented that she could see porn movies and pictures in her eyes as if she were watching them on television. She described the belief that she had a small white disc implanted behind her left ear which was actually a microphone. Two other microphones had been implanted into her body, one in her larynx and the other in her uvula. These devices were especially active during the night and it was through these that she was able to hear ‘voices’. The patient described experiencing auditory hallucinations stemming from the white disc in her ear and the 2 microphones in her body.
This tendency to use concrete terms to describe abstract experiences is common among schizophrenics, who often trace their feelings or sensations to a specific physical location, either inside or outside their bodies. How different is this, ask Hirjak and Fuchs, from the way in which computers have given all of us a mechanistic explanation for abstract mental processes? (How many times have you heard someone describe the brain as a computer?)
The twin conclusions the authors come to in their paper are both elegant and somehow disquieting. First, they say, delusions involving technology just make sense in the schizophrenic mind. Interacting with technology is in some ways so similar to experiencing certain disordered mental states that believing one is being controlled by a machine is an effective way of anchoring what would otherwise be even more strange and confusing sensations.
Second, and stranger: Living in a world full of technological innovations, argue Hirjak and Fuchs, has altered human experience in such a way that, to some extent, it more closely resembles “the schizophrenic way of being in the world.” In other words, our gadget-filled 21st-century lives give us more of an insight than we could ever have imagined into the everyday delusions of the seriously mentally ill. I’ll admit: it’s a far-fetched notion, more poetic than scientific. But in that poetry may be a powerful way of thinking about modern times—which often feel as if they have a hint of madness.