To this day, many argue about how to define a delusion, though the core features have long been recognised. A delusion is a belief that is impossible, incredible or false, yet is held with a high degree of certainty, and endures despite evidence to the contrary.
For centuries, societies dismissed delusions as signifiers of ‘madness’, as something for doctors to sort out behind locked doors. But eventually, delusions became the provenance of modern psychiatry, and by the end of the 19th century, the German psychiatrist Emil Kraepelin had categorised delusions as a key symptom of what became the clinical diagnosis of Schizophrenia. In recent years, delusions have emerged as a field of study in their own right.
In her fascinating book A History of Delusions: The Glass King, a Substitute Husband and a Walking Corpse, Victoria Shepherd uncovers historical accounts of delusions from medieval times to the present day. Shepherd asks, what were the real lives and struggles behind the bizarre psychiatric case studies in the archives?
Here are 9 of the most common delusions Victoria Shepherd uncovered.
1. Delusions of grandeur
After Emperor Napoleon died in exile on the remote island of St Helena, writer Alphonse Esquiros recorded the admission of 14 ‘Emperor Napoleons’ who presented themselves at the Bicêtre Asylum in Paris in 1840, the year Napoleon’s body was returned to the city. This “Delusion of Grandeur”, featuring Napoleon in particular, continued as an intriguing phenomenon for many decades afterwards.
“That first day we found him dressed elegantly, head held high, with a proud, haughty air; his tone was that of command, and his least gestures indicated power and authority. He soon informed us that he was the Emperor of France, with millions in riches, that Louis Philippe was his chancellor, etc. Then… he pompously recited verses of his own commission, in which he allocated kingdoms, settled the affairs of Belgium and Poland, etc. During the day he smashed everything because people would not obey his every order.”
Charenton Asylum, Paris. Register of Medical Observations. Patient admitted June 10th 1831.
2. Cotard’s Syndrome – the belief that you are dead
In Paris in 1880, Jules Cotard wrote the case study of a 43-year-old woman he called Mademoiselle X. He described her condition as “le délire des negations”. He recorded how she claimed to have “no brain, no nerves, no chest, no stomach and no intestines”. The “delusions negation” wrote Cotard, “extended to the metaphysical”, as Mademoiselle X believed “she has no soul and accordingly she does not need to eat in order to live.” She is recorded as dying of starvation.
Cotard’s Syndrome is often an extension of severe depression, a person’s explanation of experiences of disassociation and detachment.
3. Francis Spira and the delusion of despair
In delusions of despair, an excessively negative sense of self can set in motion a troubling line of thought that other people may be judging you, observing you and waiting to punish you.
Francis Spira was a 15th-century Italian lawyer who believed he was damned by God – a case of delusional thinking that haunted the 16th and 17th centuries, and inspired Christopher Marlowe’s Doctor Faustus.
4. Delusions relating to trauma
A case study from 1800, recorded by the pioneering mental health physician Philippe Pinel in Paris, noted a man who believed he had lost his head on the scaffold. This was one of many accounts of how guillotine trauma created delusional responses in people during the French Revolution.
Vivid cases such as these were most likely to be recorded in psychiatric studies. However today there is a growing awareness of the “clinician’s illusion” and how mental health services see only the rare, extreme end of a continuum. Delusional thinking is actually more common than once thought, and for most people, it isn’t problematic and doesn’t always demand clinical care.
Paranoia is the most common type of delusion, and is the incorrect belief that others are observing you and may be trying to harm you. Occasionally in the archives, cases emerge that allow us to see what such a delusion might have meant on an existential level for a person suffering from it. One of these is the case of James Tilly Matthews.
Tilly Matthews was a London tea broker who was committed to Bethlem psychiatric hospital in 1797. He became convinced of an elaborate conspiracy involving the British establishment and a mind-controlling machine called the Air Loom. Tilly Matthews is considered to be the first fully documented case of paranoid schizophrenia.
6. The ‘Capgras Delusion’ or the ‘Illusion of Doubles’
In 1923 the French psychiatrist Joseph Capgras first described the delusion which later took his name. The case study concerned his patient, Madame M, who claimed that her husband and children had been substituted for doubles.
7. Grand passions
In 1921, Gaetan Gatien De Clerambault, a French psychiatrist, published a landmark paper detailing the delusion that became commonly known as ‘erotomania’. The case study featured ‘Lea Anne B’, a 53-year-old milliner who became convinced that the English King George V was in love with her.
8. Intensive care delerium
In a case from 1892, a patient at the Victorian psychiatric hospital Bethlem in London believed that people were telephoning into her ears. More recently, there have been cases of a man who experienced delusions of being dead and under attack as a consequence of being in a hospital intensive care unit.
9. Delusions of the body
Distressing concerns about the body often feature in the content of delusions. Although unusual examples, Renaissance case studies of people who believed they had frogs living in their belly or that they are made out of glass or butter can be viewed as hypochondriacal delusions.
In hypochondriacal delusions, people erroneously believe that their body is unhealthy, rotten or diseased. But there are also people who are unaware at first that they do have a physical illness and that it is a physical illness that is leading to delusions.
Our June Book of the Month
Victoria Shepherd’s A History of Delusions is History Hit’s Book of the Month in June 2022. Published by Oneworld Publications, it explores historical accounts of delusions, from King Charles VI’s belief that he was made of glass, to the scores of 19th-century women who believed that they were dead, that they were ‘walking corpses’.
Victoria Shepherd is an author, historian and radio producer. She created and produced the 10-part radio series A History of Delusions for BBC Radio 4.