Ideas of reference and delusions of reference

Ideas of reference and delusions of reference involve people having a belief or perception that irrelevant, unrelated or innocuous phenomena in the world refer to them directly or have special personal significance: 'the notion that everything one perceives in the world relates to one's own destiny'.^[1]

In psychiatry, delusions of reference form part of the diagnostic criteria for psychotic illnesses such as schizophrenia,^[2] delusional disorder, or bipolar disorder during the elevated stages of mania. To a lesser extent, it can be a hallmark of paranoid personality disorder. Such symptoms can also be caused by intoxication, especially with hallucinogens or stimulants like methamphetamine.

1 Freudian views
2 Anti-psychiatry
3 Delusions of reference
4 Examples
5 Literary analogues
6 See also
7 References

Freudian views

Sigmund Freud considered that ideas of reference illuminated the concept of the superego: 'Delusions of being watched present this power in a regressive form, thus revealing its genesis...voices, as well as the undefined multitude, are brought into the foreground again by the [paranoid] disease, and so the evolution of conscience is reproduced regressively'.^[3]

In his wake, Otto Fenichel concluded that 'the projection of the superego is most clearly seen in ideas of reference and of being influenced....Delusions of this kind merely bring to the patient from the outside what his self-observing and self-critical conscience actually tells him'.^[4]

Lacan similarly saw ideas of reference as linked to 'the unbalancing of the relation to the capital Other and the radical anomaly that it involves, qualified, improperly, but not without some approximation to the truth, in old clinical medecine, as partial delusion'^[5] - the 'big other, that is, the other of language, the Names-of-the-Father, signifiers or words',^[6]in short, the realm of the superego.

Anti-psychiatry

Main article: Anti-psychiatry

For the antipsychiatrists, validation rather than clinical condemnation of ideas of reference frequently took place, on the grounds for example that 'the patient's ideas of reference and influence and delusions of persecution were merely descriptions of her parents' behavior toward her'.^[7] Whilst accepting that 'there is certainly confusion between persecutory fantasies and persecutory realities', figures like David Cooper considered that 'ideas of connection with apparently remote people, or ideas of being influenced by others equally remote, are in fact stating their experience' of social influence - albeit in a distorted form by 'including in their network of influence institutions as absurd as Scotland Yard, the Queen of England, the President of the United States, or the B. B. C.'^[8]

R. D. Laing took a similar view of the person who was 'saying that his brains have been taken from him, that his actions are controlled from outer space, etc. Such delusions are partially achieved derealization-realizations '.^[9]

Laing also considered of the way 'in typical paranoid ideas of reference, the person feels that the murmurings and mutterings he hears as he walks past a street crowd are about him. In a bar, a burst of laughter behind his back is at some joke cracked about him' that deeper acquaintance with the patient reveals in fact that 'what tortures him is not so much his delusions of reference, but his harrowing suspicion that he is of no importance to anyone, that no one is referring to him at all'.^[10]

Delusions of reference

'Ideas of reference must be distinguished from delusions of reference, which may be similar in content but are held with greater conviction'.^[11] With the former, but not the latter, the person holding them may have 'the feeling that strangers are talking about him/her, but if challenged, acknowledges that the people may be talking about something else'.^[12]

At the same time, there may be 'transitions...to delusions' from ideas of reference: whereas 'abortive ideas of reference, in the beginning of their development or, in Schizotypal personalities, continuously, may remain subject to the patient's criticism...under adverse circumstances, by minimal economic shifts, however, reality testing may be lost and daydreams of this kind turn into delusions'.^[13]

It has been noted that the character 'rigidly controlled by his superego...readily forms sensitive ideas of reference. A key experience may occur in his life circumstances and quite suddenly these ideas become structured as delusions of reference'.^[14] Within the 'focus of paranoia...that man crossing his legs, that woman wearing that blouse - it can't just be accidental. It has a particular meaning, is intended to convey something'.^[15]

Examples

Persons with ideas of reference may experience:

Believing that 'somehow everyone on a passing city bus is talking about them, yet they may be able to acknowledge this is unlikely'.^[16]
A feeling that people on television or radio are talking about or talking directly to them
Believing that headlines or stories in newspapers are written especially for them
Believing that events (even world events) have been deliberately contrived for them, or have special personal significance for them
Seeing objects or events as being set up deliberately to convey a special or particular meaning to themselves
Thinking 'that the slightest careless movement on the part of another person had great personal meaning...increased significance'.^[17]

Literary analogues

In Mrs Dalloway, as a plane flew over a shell-shocked soldier, '"So, thought Septimus, they are signalling to me...smoke words"'.^[18]

The author, Virginia Woolf, recorded in a memoir how she herself 'had lain in bed...thinking that the birds were singing Greek choruses and that King Edward was using the foulest possible language among Ozzie Dickinson's azaleas'^[19]

In Margaret Mahy's Memory, the confused adolescent hero decides 'to abandon himself to the magic of chance. From now on his signposts would be words overheard accidentally, graffiti, advertisements, street names...the clues the city offered him'.^[20]

The Naval Intelligence hero of Treason's Harbour reflects ruefully that 'after a while an intelligence-agent tended to see spies everywhere, rather as certain lunatics saw references to themselves in every newspaper'.^[21]

In Vladimir Nabokov's short story, "Signs and Symbols, initially published in 1948, the parents of a suicidal youth suffering from a variation of this disease, "Referential Mania", decide to remove him from a hospital in order to keep a more watchful eye. ^[22]

References

^ Lawrence M. Porter, Women's Vision in Western Literature (2005) p. 117
^ Andreasen, Nancy C. (1984). "Scale for the assessment of positive symptoms"; The Movement Disorder Society.
^ Sigmund Freud, On Metapsychology (PFL 11) p. 90
^ Otto Fenichel, The Psychoanalytic Theory of Neurosis (London 1946) p. 430-1
^ Jacques Lacan, Ecrits: A Selection (London 1996) p. 214
^ Philip Hill, Lacan for Beginners (London 1997) p. 160
^ Thomas J. Scheff, Being Mentally Ill (1999) p. 180
^ David Cooper, The Death of the Family (Penguin 1974) p. 14 and p. 82
^ R. D. Laing, Self and Others (Penguin 1969) p. 39
^ Laing, p. 136
^ P. B. Sutker/H. E. Adams, Comprehensive Handbook of Psychopathology (2001) p. 540
^ Sutker/Adams, p. 540
^ Fenichel, p. 444
^ A. C. P. Sims, Symptoms in the Mind (2003) p. 129
^ Iain McGilchrist, The Master and His Emissary (London 2010) p. 399
^ V. M. Durand/D. H. Barlow, Essentials of Abnormal Psychology (2005)p. 442
^ Eric Berne, A Layman's Guide to Psychiatry and Psychoanalysis (Penguin 1976) p. 205
^ Quoted in Porter, Women's Vision p. 117
^ Quoted in Hermione Lee, Virginia Woolf (London 1996) p. 195
^ Margaret Mahy, Memory (London 1987) p. 23
^ Patrick O'Brian, Treason's Harbour (London 2007) p. 19
^ http://www.angelynngrant.com/nabokov.html