A chapter on ‘Delusions as Shared: folies à deux and the Madness of Crowds’. In it she highlights the puzzle that begins to emerge when shared beliefs can also qualify as delusional.
After all, it is ‘the solipsistic and idiosyncratically “private” nature of some states’ (Radden, 2011, p. 78) that many of us, including writers of traditional psychiatric texts, take to be pathognomonic of delusions, and yet these same psychiatric texts also include categories for shared delusions. The Diagnostic and Statistical Manual of Mental Disorders, 4th edn., Text Revision (DSM-IV-TR), the most widely used diagnostic classification scheme for mental health research today, requires of a delusion that, ‘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)’ (p. 765). And yet, the DSM-IV-TR also includes ‘Shared psychotic disorder’, to be diagnosed when a delusion of similar content develops in an individual who is in a close relationship with another person who already has the delusion. Likewise, the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), the other widely used system for diagnosing mental disorders, includes ‘Induced delusional disorder’, to be diagnosed when two people share the same delusion and support each other in the belief. In each case, there needs to be a limited degree of sharing, however. So, while I agree with Jennifer Radden that there is much to be learned about the factors that promote delusions by also considering the factors that promote ‘folie à plusieurs’, or a madness of crowds, I will restrict my own comments to the variants of ‘folie à deux’ that dominate the clinical literature, including the cases of ‘folie à trois’ and ‘folie à famille’ (madness of three, or within a family). This is because my primary aim in this paper is to consider the puzzle of folie à deux by adopting a cognitive neuropsychiatric approach to retrospectively analyse published cases.
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