The phrase alternative facts has recently built the news in a political context, but psychiatrists like me are already intimately acquainted with the concept indeed, we hear various different forms of alternate reality carried almost every day.
All of us need to parse perceived from actual reality every day, in nearly every aspect of our lives. So how can we sort out claims and notions that strike most people as odd, unfounded, fantastical or just plain delusional?
Untruths arent always lies
First, we need to make a distinction often emphasized by ethicists and philosophers: that between a lie and a misrepresentation. Thus, someone who deliberately misrepresents what he or she knows to be true is lying typically, to procure some personal advantage. In contrast, someone who voices a mistaken assert without any intent to deceive is not lying. That person may simply be unaware of the facts, or may refuse to believe the best available evidence. Rather than lying, hes stating a falsehood.
Some people who voice falsities appear incapable of distinguishing real from unreal, or truth from fiction, yet are sincerely convinced their worldview is absolutely correct. And this is our entree into the psychiatric literature.
In clinical psychiatry, we insure patients with a broad spectrum of notions that many people would find eccentric, exaggerated or blatantly at odds with reality. The clinicians undertaking is, first, to listen empathically and try to understand these notions from the patients point of view, carefully taking into account the persons cultural, ethnic and religious background.
Sometimes, clinicians can be wildly mistaken in their first impressions. A colleague of mine once described a severely agitated patient who was hospitalized because he insisted he was being stalked and harassed by the FBI. A few days into his hospitalization, FBI agents showed up on the unit to arrest the patient. As the old joke goes, simply because youre paranoid doesnt mean they arent when you are!
When what you believe is wrong
We can think of distortions of reality as falling along a continuum, ranging from mild to severe, based on how rigidly the faith is hold and how impervious it is to factual info. On the milder aim, we have what psychiatrists call over-valued notions. These are very strongly held convictions that are at odds with what most people in the persons culture believe, but which are not bizarre, incomprehensible or patently impossible. A passionately held faith that vaccinations cause autism might qualify as an over-valued notion: its not scientifically correct, but its not utterly beyond the realm of possibility.
On the severe end of the continuum are hallucinations. These are strongly held, entirely inflexible notions that are not altered at all by factual info, and which are clearly false or impossible. Importantly, hallucinations are not explained by the persons culture, religious beliefs or ethnicity. A patient who inflexibly believes that Vladimir Putin has personally implanted an electrode in his brain in order to control his thoughts would qualify as delusional. When the patient conveys this belief, he or she is not lying or trying to deceive the listener. It is a sincerely held faith, but still a falsehood.
Falsehoods of various kinds can be was put forward by people with different neuropsychiatric ailments, but also by those who are perfectly normal. Within the range of normal misrepresentation are so-called false memories, which many of us experience quite often. For example, you are absolutely certain you sent that check to the power company, but in fact, you never did.
As social scientist Julia Shaw find, false memories have the same properties as any other memories, and are indistinguishable from memories of events that actually happened. So when you insist to your spouse, Of course I paid that electric bill! youre not lying you are merely misled by your own brain.
A much more serious type of false memory involves a process called confabulation: the spontaneous production of false memories, often of a very detailed nature. Some confabulated memories are mundane; others, quite bizarre. For example, the person or persons may insist and sincerely believe that he had eggs Benedict at the Ritz for breakfast, even though this clearly wasnt the case. Or, the person or persons may insist she was abducted by terrorists and present a reasonably elaborated account of the( fictional) ordeal. Confabulation is usually seen in the context of severe brain damage, such as may follow a stroke or the rupture of a blood vessel in the brain.
Lying as a default
Finally, there is falsification that many people would call pathological lying, and which goes by the extravagant scientific name of pseudologia fantastica( PF ). Writing in the Psychiatric Annals, Drs. Rama Rao Gogeneni and Thomas Newmark list the following features of PF 😛 TAGEND A marked tendency to lie, often as a defensive attempt to avoid consequences. The person may experience a high from this imaginative story-telling. The lies are quite dazzling or fantastical, though they may contain truthful components. Often, the lies may capture considerable public attention. The lies tend to present the person or persons in a positive lighting, and may be an expression of an underlying character trait, such as pathological narcissism. However, the lies in PF usually go beyond the more believable stories of persons with narcissistic traits.