One myth that has grown around movies like "Harvey" and "One Flew Over the Cuckoo's Nest" is that delusional people who used to end up in mental institutions or who now talk to themselves in the street are as happy as everyone else. They're not. They're disturbed.

 

The Stanton Peele Addiction Website, October 25, 2010. This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

The Delusion That Delusional People Are Happy

News item: Randy Quaid and his wife applied for refugee status in Canada, claiming they were "fleeing Hollywood killers."

I'm a lawyer as well as a psychologist, but I didn't go to law school until my late forties, after being a psychologist for several decades, when I attended Rutgers at night. I only took one daytime course while I was there - mental health law. Not only were the day students much younger than I was - so was the instructor (a Harvard grad)!

By that time, I had had considerable clinical and forensic experience. I found that I was in a different world from everyone else in the class - including the instructor. For example, after dealing with the issue of therapist liability, the students arrived at the consensus that it was better not to keep case notes, which they felt might incriminate the therapist.

I listened silently, then looked for the instructor to offer her opinion. When she didn't, I spoke up: "Not having case notes, in itself, may comprise malpractice. The best defense against malpractice is to produce contemporaneous notes showing you displayed concern and took appropriate steps in response to worrisome clinical issues (such as suicide potential, child abuse, etc.)."

I just couldn't let that delusion stand without comment! No one said anything. (Oh, I got a B- in the course.)

But the most pervasive delusion displayed by the "kids" in the class was that mentally ill people were perfectly happy in their own worlds. I call this the "Harvey" (Jimmy Stewart is happy with his giant imaginary rabbit friend) or "One Flew Over the Cuckoo's Nest" (a highly sane Jack Nicholson is entrapped in a mental institution) movie-world delusion.

Now don't misquote me - I don't think people should be involuntarily treated for mental illnesses - unless (another mental health law concept) they are a threat to themselves or others. Occasionally people were placed in institutions where they didn't belong, but not since deinstitutionalization. And people walking alone in the street, talking to themselves, are not happy, or simply different in some neutral way from you or me. The mentally ill people I have met are, as a rule, deeply unhappy. Hence the word, "disturbed."

(And people don't show up at my residential addiction treatment center living contented lives, either.)

In fact, I suspect that Randy Quaid and his wife have become delusional (if this is true) in response to intolerable stress and negative life outcomes. But being delusional doesn't mean that they think that things are going well in their lives - which they have embodied in the delusion that people in Hollywood want to kill them rather than the rich, or famous, or notorious stars in the news who are likely to draw more real-world attention.

The Quaids' predicament is not a laughing matter (a typical response on cable news). It's sad. I feel sorry for them and the trouble they have encountered.

(I wonder if my mental health law classmates and instructor would feel the Quaids are fine?)