By Hal Brown, MSW
The photo above is from the NOVEMBER 13, 2020 Rolling Stone article “Q Is Back, But Does QAnon Have a Future?” and seems to show "QAnon Shaman" Jacob Chansley.
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Reading “QAnon followers still think Trump will be inaugurated — on March 4. National Guard will be ready” in Salon reminded me of how many times I used the word delusional in stories I posted here. I did a web search and found quite a few. Most were about the “former guy” but one, “Some people spread lies because they're mentally ill, others spread them because they're evil” was relevant to my thoughts about the Salon article.
Psychiatric diagnosis is an evolving endeavor. For example, most well known is that In 1973, the American Psychiatric Association (APA) removed the diagnosis of “homosexuality” from the second edition of its Diagnostic and Statistical Manual (DSM). On the opposite side of the coin, child sexual abuse by parents was thought to be rare. How it sometimes led to dissociative disorder (multiple personalities) was thought to be extremely rare.* The current diagnostic criteria for delusional disorder may be another instance where experts missed the prevalence of a diagnosis. The diagnosis itself without a description that would describe QAnon believers is currently thought to be very rare. However the number of people in the QAnon group suggests that at the least the word “very” ought to be removed from the word “rare.” According to this poll an almost unbelievable 17% said they believed this statement: “A group of Satan-worshipping elites who run a child sex ring are trying to control our politics and media.”
The Wikipedia entry for delusional disorder is consistent with other descriptions. Like a number of other psychiatric disorders the list of types delusional disorder has classifications breaking it down into groups with particular symptoms and includes at the end of the list “mixed type” which is a common way disorders are sub-categorized. This is the one that needs to be studied in light of what we see with people who believe the QAnon conspiracies: “Unspecified type: delusions that cannot be clearly determined or characterized in any of the categories in the specific types.”
There is only one Wikipedia reference for unspecified type and this dates back to 2010. This is the relevant section:
This subtype applies when the dominant delusional belief cannot be clearly determined or is not described in the specific types (e.g., referential delusions without a prominent persecutory or grandiose component).
Epidemiology
General
The prevalence of delusional disorder in the United States is estimated in the DSM-IV-TR to be around 0.03% , which is considerably lower than the prevalence of schizophrenia (1%) and mood disorders (5%). Our current understanding of delusional disorder, however, is limited by scarce scientific data that mostly consist of individual case descriptions or small uncontrolled case studies, which are therefore difficult or impossible to duplicate.
The last sentence above (in bold) is the most important.
The delusions held by many Trump and many of his supporters been addressed by Bandy Lee, MD among others (see “The ‘Shared Psychosis’ of Donald Trump and His Loyalists”) but I think the QAnon group is a special category because of their outlandish, bizarre, ludicrous beliefs and those that are downright dangerous like those about pedophilia. These go far beyond believing Trump is a deity and that he really won the election.
Sometimes it is difficult to find a group of people with specific beliefs or behaviors to study. Serial killers who have been imprisoned have been studied because researchers know where to find them.
If I was beginning a PhD program in clinical psychology I might want to study these people and to try to determine if they deserved their own classification of delusional disorder. I would risk flying to Washington to attend the March 4th rally. I had my first Moderna vaccination on Feb. 17th so according to this I would have about 85% protection. It would be worth the risk to get a jump start on my dissertation.
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* I was a clinical social worker with an MSW and didn’t have to write a dissertation. Early in my practice by chance I had four clients who had multiple personality disorder (later changed to be called dissociative disorder). One had been wrongly diagnosed and treated for schizophrenia. At that time it was considered extremely rare. Only two books had been published about it. “Three Faces of Eve” was the first followed by “Sybil”. Both had movies based on them. If I’d been in a PhD program in psychology this is what I would have done my dissertation on. A few years later it became generally accepted that it was much more prevalent than previously thought with the common cause being sexual abuse by a parent in early childhood. This was the cause in every client I worked with, including the two additional clients I treated later in my career. Several psychiatrists became famous for doing research on this.