Hall of mirrors

I had one of those "Am I about to be locked up" moments today. I'm sure you know the feeling.

We'd been in our psychiatry tutorial and had just seen two patients interviewed (by two of us). Both patients were suffering from psychosis and had very strange delusions, but one was in the midst of it while the other had apparently recovered from it recently. We were discussing their cases with the psychiatrist afterwards and I took the opportunity to ask him something that I've been wondering for a while. Namely, do people ever get higher order delusions, or meta-delusions?

The psychiatrist asked me what I meant, and I explained that I meant would it be possible for someone to have delusions regarding their delusions. For example, could someone falsely believe that they had recently suffered from severe delusions but were now recovered? Likewise, could someone lack insight into whether or not they have insight?

To me, this seems like a perfectly reasonable question. In many fields of study asking these sorts of meta-questions or considering things in a recursive way can be really helpful.

However, it seems that psychiatry is not one of those areas. The psychiatrist gave me a very very strange look. Perhaps he thought I was trying to be funny or was trying to play semantic games with him, but I was perfectly serious about it. I suppose it's sufficient to know that the person is simply delusional and the exact degree of reflexivity of those delusions is irrelevant - how dull.

Fortunately, before he could forcibly detain me, the fire alarm went off. I cracked the mandatory "Can anybody else hear that noise?" joke (it's funny once you've been doing psych for a while, trust me) and then we all trooped outside and the tute was over.

A narrow escape!