When we consider what it means to have a thought disorder, we are usually talking about someone’s impaired reality-testing. Sometimes, our senses seem to deceive us: we see or hear something others do not and cannot. Probably most people have experiences that fall into such a category, but it stands out for them as an exception, and they are able to label that experience as “other than normal” for them. Many have spiritual encounters as well, but are able to distinguish those from their typical life. Where we can find ourselves in trouble is when we are unable to distinguish between these atypical sights and sounds from what are typical. The line is blurred or non-existent between “reality” in a concrete sense and “un-reality.” In 2001, Russell Crowe starred as John Forbes Nash, Jr., a mathematical genius and schizophrenic, in “A Beautiful Mind.” This story depicts the challenges Nash faced trying to sort out in his world what was “real” and what was something that was constructed, possibly by his unconscious mind.

Another symptom of a thought disorder is a persistent belief that will not give way despite overwhelming evidence to the contrary. These are called delusions, which may take many forms: grandiose, romantic, jealous, persecutory, or somatic. For example, a grandiose delusion may lead someone to an over-inflated sense of worth or power or knowledge – feeling one is a super-star. A romantic or erotomanic delusion convinces someone that another person is in love with him or her. Often, this other person is important or famous. A jealousy-based delusion causes someone to believe with certainty that their partner is unfaithful. Persecutory delusions leave people convinced either they or someone they love are being mistreated, spied on, or that others are planning to harm them. People with somatic delusions believe something is medically wrong with them, despite evidence to the contrary.

Often, many other psychological symptoms of distress co-exist with thought disorders such as impaired mood, anxiety, phobias, dissociation (feeling disconnected from one’s self or the world), interpersonal challenges, and aggression or hostility. Unlike many psychological challenges, when we have thought disorders, we may not be motivated at all to seek treatment. We may not trust others to help us. We may not believe that anything is wrong with us. It may require some significant event or set of events to convince us that we are not as we should be. Often others who love us may intervene and even use legal means if we resist getting treatment.

Thankfully, because thought disorders have been the focus of much research, a great deal of help is available. Prior to psychotherapy being useful, medications are usually required initially to bring most of the more flagrant symptoms under control. But then what? Often, this person without the symptoms has a tenuous sense of what the world is truly like. They may feel incredibly vulnerable or afraid or untrusting. Group therapy may also serve as a helpful adjunct to treatment because it helps this person normalize life: “I am not the only one struggling with this.” That alone can provide amazing relief.

If you suspect something may be awry with your thoughts or those of someone you love, please don’t hesitate to talk with someone about this. Usually this can be quite reassuring!