“Yes, I am the queen of England, but you can call me Elizabeth,” the middle-aged woman said to me, offering her hand.
We were standing by a row of washing machines in the homeless shelter. Odors from a nearby restroom were strong.
I was 21 years old. I had joined the staff at the shelter a few months earlier.
Unsure what to say, I shook her hand and said, “Good evening, Elizabeth.”
As soon as I could break away, I ran to my supervisor in a panic.
The conversation went something like this:
Me: “We have a woman who thinks she is Queen Elizabeth!!!!”
Supervisor: “Uh huh. Her real name is Susan.”
Me: “What are we going to do?!?!!?!?!?”
Supervisor: “What do you mean?”
Me: “She thinks she is Queen of England!!! What if she changes her delusion to think she is Jack the Ripper?!?!?!!?”
Supervisor: “She won’t. That isn’t how this works.”
My supervisor spent the next half hour calming me down and explaining how delusions work.
As I was leaving her office, my supervisor called my name. I turned around and she said, “Ask Susan to make you a cup of tea. Believe it or not, she makes one hell of a cup of tea!”
The first time you encounter someone with delusions, it is very unsettling.
We have all seen Hollywood portrayals of mental illness where someone grabs a chainsaw and attacks an entire state.
Those movies are bullsh*t.
The vast majority of delusions are not dangerous…. Even if they are very bizarre.
There are TWO exceptions. I’ll cover the first today and the second next week. Before I do that, I want to say that again, so it doesn’t get lost in the exceptions:
THE VAST MAJORITY OF DELUSIONS ARE NOT DANGEROUS… EVEN IF THEY ARE VERY BIZARRE.
According to the research, there are two types of delusions that are more worrisome: command hallucinations and persecutory delusions.
Today let’s talk about command hallucinations.
Command hallucinations are voices telling the person to do something violent.
“The voices told me to hurt that man.”
People comply with the command hallucination 39-89% of the time (depending on which study you look at… source below)
According to the literature, command hallucinations are more dangerous when paired with a related delusion. For example, “The voices told me to hurt that man because he is a KGB spy out to destroy America.”
If someone at your organization has a violent command hallucination, call the police immediately.
I am a huge advocate of calling the police as little as possible. This is not the time to avoid calling, though. The individual is at a greater risk of harming themselves or others and needs immediate help.
Next week: The other type of delusion that is dangerous.
Want to learn more about interacting with individuals suffering from extreme mental illness? See below!
Have a great week!
(Source: Hersh & Borum, Command Hallucinations, Compliance and Risk Assessment, J. Am. Acad. Psychiatry Law, Vol. 26, No. 3, 1998.)