is a psychologist whose research focuses on belief, delusion and identity. The young woman sitting in front of me is sure she is dead. It – her dying – happened two weeks ago, she says.
Now she simply doesn’t exist. I check the scrawl of referral notes, which don’t say anything about this. There isn’t much time; I’m supposed to administer her a battery of cognitive tests, dictate a brief report, and move on to my next patient.
I want to reassure her, but her eyes dart about my office – small, over-lit and cluttered with stacked folders and a tangle of dusty cables. I’ve spent my professional life trying to make sense of cases like these: delusions. Part of the challenge is how to draw the line between who a person is and what has gone wrong with them.
In the clinic this is often straightforward, and as a clinician or theorist trying to understand such cases there is at least a measure of certainty, and the possibility of detachment. But these questions are increasingly contested in cultural spaces – and sometimes they must be confronted not just at work, but at home. Many of the most fascinating clinical examples of delusion concern personal identity and bodily integrity.
Some patients look in the mirror and see a stranger; others believe their loved ones have been replaced by physically identical impostors. In one strange case, published in 2018, a man presented to an Australian emergency department convinced that his penis had been stolen and substituted with someone else’s. Are delusions merely the dysfunctional products of a broken brain?
Or might they in some cases be functional – purposive constructions that protect the self? Sigmund Freud famously described a delusion as a kind of psychic bandage, and many others have followed suit. Psychoanalytically inclined theorists have construed the conviction that you are dead as a paradoxical defence against death: if you are already dead, you have nothing to fear from dying.
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