<p>By checking if they have a mental illness to go with it or not and if they have any proof or evidence besides what they are saying :)</p>
<p>A good psychiatrist would look at evidence from other areas: does the person have cognitive difficulties? Are they coherent? Are they organized in their speech? Do they appear healthy if I ask them about everyday items, stories, and things that happened to them other than the story? Do they have a healthy memory (again, when asking about other than the story)? If they have a delusional mental illness, I would find it hard to have anyone believe them, even if what they are saying is true.</p>
<p>Here's DSM 5 and it's what psychiatrists use to diagnose. So they will check for symptoms of schizophrenia (disorganized speech, memory problems, etc) or any delusion-related disorders.
<a href="https://repository.poltekkes-kaltim.ac.id/657/1/Diagnostic%20and%20statistical%20manual%20of%20mental%20disorders%20_%20DSM-5%20(%20PDFDrive.com%20).pdf" rel="nofollow noreferrer">https://repository.poltekkes-kaltim.ac.id/657/1/Diagnostic%20and%20statistical%20manual%20of%20mental%20disorders%20_%20DSM-5%20(%20PDFDrive.com%20).pdf</a></p>
<p>Furthermore, many people believe, for example, that the government is conspiring against them and are pretty healthy in every other way. Those people might just believe in something improbable. It could be true (or not) because we humans can be perfectly healthy and believe things that are not true. An excellent way to ascertain the truth is to always ask for evidence or proof, which I think is standard police/justice procedure. This will differentiate people who believe something vs people who know something!</p>
<p>Here's a really nice note about the psychology of belief:
<a href="https://www.psychologytoday.com/gb/blog/finding-purpose/201810/what-actually-is-belief-and-why-is-it-so-hard-change" rel="nofollow noreferrer">https://www.psychologytoday.com/gb/blog/finding-purpose/201810/what-actually-is-belief-and-why-is-it-so-hard-change</a></p>
<p>So, in short, it is ascertained by checking that person's full mental health and if they have any real proof or evidence of the matter besides what they say. They can be mentally ill, or healthy and believing in a false story, or that everything they are saying is true and happening as they say it. It will depend on the judgment of the psychiatrists and police etc, who see them.</p>

CC BY-SA 4.0
2023-12-20T10:40:44.680Z
2023-12-20T10:40:44.680Z
researcher145212
<p>Many people suffering from persecutory delusions have very weird, clearly improbable stories about how they are being persecuted. However - correct me if I'm wrong - in many cases these stories are, at least theoretically, <em>possible</em>.</p>
<p>If, for example, someone believes they are harassed by a Satanic cabal that has hacked their computers and phones, and is exfiltrating data from said devices, makes certain they will not get a job by pulling strings from behind, sends goons to stalk them and chase them down the street while leaving little tangible evidence for its actions and this is all happening without any obvious reasons then, granted, in the vast majority of cases such a person will, indeed, be delusional.</p>
<p>Nonetheless, it is <em>possible</em> that such a person is <em>not</em> delusional and, instead, this is precisely what is happening. Add to the above story that the Government is plotting with the coven against this person and the story will <em>still</em> be possible, even if highly improbable. It might even be the case that the persecutors are subtly convincing everyone that their victim is delusional to gaslight their victim.</p>
<p>Is it a real worry that a person suspected of and treated for persecutory delusions is actually really being persecuted? Even if this is a very rare case it still seems to me that treating a person who is indeed being persecuted for persecutory delusions is one of the worst things that can be done.</p>
<p>How is it being ascertained that this situation does not happen? That a person suspected of persecutory delusions is indeed delusional and not actually persecuted?</p>

CC BY-SA 4.0
2021-12-29T19:44:47.847Z
(This question is inspired by *Rosemary's Baby* :)
gaazkam
CC BY-SA 4.0
2021-12-29T22:15:33.407Z
I think you're not appreciating the level of "possible" that is typical of these delusions. It's also "possible" for monkeys on a typewriter to produce the works of Shakespeare, but it isn't really fruitful to wait for that to happen.
Bryan Krause
CC BY-SA 4.0
2021-12-29T22:31:00.000Z
Whilst I appreciate the analogue, I feel it's only right to point out that we have a fair amount of evidence that monkeys did in fact evolve and write the works of Shakespeare. Then, the question is asking about evidentiary standards, not probability and geological time.
Jiminy Cricket.
CC BY-SA 4.0
2021-12-29T22:43:18.837Z
@ARogueAnt. I assure you, a physician with a probable diagnosis is not going to wait for all the alternative potential causes for that diagnosis to evolve in order to exclude them before sticking with the diagnosis they've come to. If that were the policy we'd never diagnose anything and there would be no sense in medicine at all.
Bryan Krause
CC BY-SA 4.0
2021-12-30T07:05:29.013Z
I agree with the last comment from @BryanKrause but nevertheless, the OP has raised an interesting and, to a certain degree, valid argument which would ethically need to be borne in mind. Look at the situation with the Rohingya Muslim persecutions in Myanmar which officials there deny exists. One point I would need to add however, is that the hypothesis is not strictly proven yet. *"However - correct me if I'm wrong - in many cases these stories are, at least theoretically, possible."* needs some research citations to prove or deny this claim.
Chris Rogers
CC BY-SA 4.0
2021-12-30T07:25:29.693Z
Bearing in mind my added point at the end of my previous comment, we do work differently to some SE sites, where we have a strict policy that all questions should [show evidence of prior research](https://psychology.meta.stackexchange.com/q/993). Please [edit] your question to show what you know about the usual stories which end up with the story maker being treated for *persecutory delusions* or even *paranoid delusions*. What have you read to find this out?
Chris Rogers
CC BY-SA 4.0
2021-12-30T07:28:55.650Z
It's worth noting that in addition to false-negatives, the profession has been subject to false-positives potentially more often, such as the [satanic panic](https://en.wikipedia.org/wiki/Satanic_panic) and a variety of other [false accusations](https://en.wikipedia.org/wiki/False_accusation#Types).
Arnon Weinberg
CC BY-SA 4.0
2021-12-30T07:30:20.503Z
Very true @ArnonWeinberg
Chris Rogers
CC BY-SA 4.0
2022-06-08T19:41:54.477Z
This is a great question. For example, if a patient claims that they are on a government "watch list", is it normal for the clinician to attempt to investigate potential watch lists and whether or not the patient is actually on them, or do they pretty much automatically consider such a claim to be delusional?
Robert Columbia
<abnormal-psychology><psychiatry><diagnosis><ethics>
How is it ascertained that people treated for persecutory delusions are not indeed being persecuted?
gaazkam
# How is it ascertained that people treated for persecutory delusions are not indeed being persecuted?

(Asked by: username_0 on 2021-12-29)

Many people suffering from persecutory delusions have very weird, clearly improbable stories about how they are being persecuted. However - correct me if I'm wrong - in many cases these stories are, at least theoretically, *possible*.

If, for example, someone believes they are harassed by a Satanic cabal that has hacked their computers and phones, and is exfiltrating data from said devices, makes certain they will not get a job by pulling strings from behind, sends goons to stalk them and chase them down the street while leaving little tangible evidence for its actions and this is all happening without any obvious reasons then, granted, in the vast majority of cases such a person will, indeed, be delusional.

Nonetheless, it is *possible* that such a person is *not* delusional and, instead, this is precisely what is happening. Add to the above story that the Government is plotting with the coven against this person and the story will *still* be possible, even if highly improbable. It might even be the case that the persecutors are subtly convincing everyone that their victim is delusional to gaslight their victim.

Is it a real worry that a person suspected of and treated for persecutory delusions is actually really being persecuted? Even if this is a very rare case it still seems to me that treating a person who is indeed being persecuted for persecutory delusions is one of the worst things that can be done.

How is it being ascertained that this situation does not happen? That a person suspected of persecutory delusions is indeed delusional and not actually persecuted?

**Tags:** abnormal-psychology, psychiatry, diagnosis, ethics

> **Comments:**
> **username_0**: (This question is inspired by *Rosemary's Baby* :)  
> **username_1**: I think you're not appreciating the level of "possible" that is typical of these delusions. It's also "possible" for monkeys on a typewriter to produce the works of Shakespeare, but it isn't really fruitful to wait for that to happen.  
> **username_2**: Whilst I appreciate the analogue, I feel it's only right to point out that we have a fair amount of evidence that monkeys did in fact evolve and write the works of Shakespeare. Then, the question is asking about evidentiary standards, not probability and geological time.  
> **username_1**: @ARogueAnt. I assure you, a physician with a probable diagnosis is not going to wait for all the alternative potential causes for that diagnosis to evolve in order to exclude them before sticking with the diagnosis they've come to. If that were the policy we'd never diagnose anything and there would be no sense in medicine at all.  
> **username_3**: I agree with the last comment from @BryanKrause but nevertheless, the OP has raised an interesting and, to a certain degree, valid argument which would ethically need to be borne in mind. Look at the situation with the Rohingya Muslim persecutions in Myanmar which officials there deny exists. One point I would need to add however, is that the hypothesis is not strictly proven yet. *"However - correct me if I'm wrong - in many cases these stories are, at least theoretically, possible."* needs some research citations to prove or deny this claim.  
> **username_3**: Bearing in mind my added point at the end of my previous comment, we do work differently to some SE sites, where we have a strict policy that all questions should [show evidence of prior research](https://psychology.meta.stackexchange.com/q/993). Please [edit] your question to show what you know about the usual stories which end up with the story maker being treated for *persecutory delusions* or even *paranoid delusions*. What have you read to find this out?  
> **username_4**: It's worth noting that in addition to false-negatives, the profession has been subject to false-positives potentially more often, such as the [satanic panic](https://en.wikipedia.org/wiki/Satanic_panic) and a variety of other [false accusations](https://en.wikipedia.org/wiki/False_accusation#Types).  
> **username_3**: Very true @ArnonWeinberg  
> **username_5**: This is a great question. For example, if a patient claims that they are on a government "watch list", is it normal for the clinician to attempt to investigate potential watch lists and whether or not the patient is actually on them, or do they pretty much automatically consider such a claim to be delusional?  

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## 1 answers

### Answer by username_6 on 2023-12-20. Score: 1

By checking if they have a mental illness to go with it or not and if they have any proof or evidence besides what they are saying :)

A good psychiatrist would look at evidence from other areas: does the person have cognitive difficulties? Are they coherent? Are they organized in their speech? Do they appear healthy if I ask them about everyday items, stories, and things that happened to them other than the story? Do they have a healthy memory (again, when asking about other than the story)? If they have a delusional mental illness, I would find it hard to have anyone believe them, even if what they are saying is true.

Here's DSM 5 and it's what psychiatrists use to diagnose. So they will check for symptoms of schizophrenia (disorganized speech, memory problems, etc) or any delusion-related disorders.
<https://repository.poltekkes-kaltim.ac.id/657/1/Diagnostic%20and%20statistical%20manual%20of%20mental%20disorders%20_%20DSM-5%20(%20PDFDrive.com%20).pdf>

Furthermore, many people believe, for example, that the government is conspiring against them and are pretty healthy in every other way. Those people might just believe in something improbable. It could be true (or not) because we humans can be perfectly healthy and believe things that are not true. An excellent way to ascertain the truth is to always ask for evidence or proof, which I think is standard police/justice procedure. This will differentiate people who believe something vs people who know something!

Here's a really nice note about the psychology of belief:
<https://www.psychologytoday.com/gb/blog/finding-purpose/201810/what-actually-is-belief-and-why-is-it-so-hard-change>

So, in short, it is ascertained by checking that person's full mental health and if they have any real proof or evidence of the matter besides what they say. They can be mentally ill, or healthy and believing in a false story, or that everything they are saying is true and happening as they say it. It will depend on the judgment of the psychiatrists and police etc, who see them.


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