Delusion: Diagnostic Manual of Mental Disorders

Now that we have a far more accurate picture of Brahma Kumari history, one in which Lekhraj Kirpalani was considered to be god until at least 1955, one question that occurs in many people's minds even more is, "were Lekhraj Kirpalani and the Om Mandli women suffering from some kind of mental illness?" ... even within the limits of their own current beliefs.

The words delusion or delusional are often used merely as insults but they have a specific definition in mental illness.

This year, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by The American Psychiatric Association has changed the definition of "delusion". The new definition of delusions describes them as fixed beliefs that are unswayed by clear or reasonable contradictory evidence

Delusions, in the medical sense, are not simply a case of being mistaken. They are profound and intensely held beliefs that seem barely swayed by evidence to the contrary – even to the point of believing in the bizarre. Delusions represent problems with how an individuals believes – that is, problems with forming and changing beliefs – not a problem with what is believed.

(Simply believing something strange or unusual should not be considered a problem but having "stuck" beliefs that are completely impervious to reality suggests something is mentally awry).

The manual also allows for a categorisation of "Bizarre Delusion" because a single bizarre delusion was not sufficient to cover all cases? Bizarre delusions are defined as delusions that are "very strange and completely implausible" and "Mood-congruent Delusion", "any delusion with content consistent with either a depressive or manic state, eg ... a person in a manic state might believe she is a powerful deity".

DSM-5 also no longer separates 'delusional disorder' from 'shared delusional disorder', that is to say a 'folie à deux' (madness of two) or even 'folie à plusieurs' ("madness of many"). If criteria are met for delusional disorder then that diagnosis is made. Delusions do not need to be about external realities, they could be about oneself and one’s own experiences, requiring little or no inference. Mental health workers do not require hard evidence against the truth of a belief, even if the belief is wildly implausible. Delusions are now judged on the basis of "clear or reasonable contradictory evidence regarding its veracity".

In the DSM-IV delusions were defined as follows:

Delusion.

A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person's culture or subculture (e.g., it is not an article of religious faith). When a false belief involves a value judgment, it is regarded as a delusion only when the judgment is so extreme as to defy credibility.

In the DSM-5, the definition of delusions is:

Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence. Their content may include a variety of themes (e.g. persecutory, referential, somatic, religious, grandiose).[...] Delusions are deemed bizarre if they are clearly implausible and not understandable to same-culture peers and do not derive from ordinary life experiences. [...] The distinction between a delusion and a strongly held idea is sometimes difficult to make and depends in part on the degree of conviction with which the belief is held despite clear or reasonable contradictory evidence regarding its veracity.

Was Lekhraj Kirpalani deluded? I think the answer is "he clearly was ... very much so".

He thought he was god and allow the Om Mandli to be a circle around him. He took liberties with the young women, threw his own family to the wind, destroyed families and consumed all his wealth on his god-self folie.

Was his folie shared by those women closest to him. Again, I think the answer is "without any doubt".

This question is, did he and they get better ... or did they just encourage more people to join them?

One could say that we are all deluded to some degree or other. Both DSM definitions seem to say that any and all unusual and strongly held beliefs that defy credibility or veracity are pathologically delusional and should be treated, but there's no mention of how you determine when the line is crossed. By trying for precision, the terminology raises more questions.

I liked what a leading psychiatrist said recently on the radio about over-diagnosis, that the need to label or pathologise a person's mental state is often generated not by any problem that the person is having, but by problems others have with (or their intolerance of) that other person, or his mental state.

So their beliefs really only become an issue where there is significant potential for, or actual, harm to the person or to others, it should not just be because they're 'different' or being a nuisance or bothersome or weird.

Is having a delusion & drawing others into it harmful? Tricky. Each case would need to be treated separately.

A lot would depend on what the delusion was, how the person was before encountering and joining into any delusion, and how they were affected, what they became because of it.

Of course, the Jonestown People's Temple story shows how a strong belief that was at the time "acceptable" as judged by the immediate society grew into an admirable community, but eventually the "group think" followed the leader's growing delusions till they followed him "over the edge".