What Psychiatric Condition Might Explain This?

In My Humble Opinion
1

Ten years ago my closest friend suffered extreme personal stress and over the course of a month came to believe I was conspiring against him (in a seemingly unimportant professional matter). It was entirely untrue, could largely be disproven by email records, and would not have been advantageous to me.

During a meeting at my house he seemed genuinely delusional, stormed out, and said maybe we could talk again in six months. Trying to help him caused a lot of problems for me. After 4 months he wrote saying he’d forgotten why we were fighting, but by then I felt seriously wronged and it seemed he was just magnanimously forgiving me. That seemed bad for his sanity and unjust for me, so I largely dropped him from my life.

Also I was very hesitant to renew our friendship when it seemed like I would be, on some level, talking down to him, instead of having a friendship of equals. But I missed the guy — the way he had been.

Most of our conversations were by email due to my friend’s hearing problems.

After four years I heard a lecture about how to talk to addicts to convince them to get counseling. It made the point that even if it seemed impossible for an inexperienced friend to break through to a person in denial, that often it could be done — because the person might already be substantially aware that they had a problem and be looking for a way out. I figured there was a good chance my friend realized he had had a “breakdown” and had treated me very badly — but was embarrassed to acknowledge it.

I decided to combine a feel-good “you’re important to me, and have done wonderful things for me” spin with an exacting e-mail analysis. I formatted it as a Powerpoint (since heavy conversation was a problem with his hearing, and I wanted the message to seem more important than an email). The email evidence pretty much refuted 80% of his claims against me.

What I got back was an absolutely perfect “Gish Gallop”. He had come up with five or six new accusations, each of which was more absurd than those of his earlier story. Example: “You told me I was over-reacting, which was very offensive to me.” The situation: when I said he was over-reacting I was almost literally stunned. In the course of 20 minutes he had revealed a non-existent plot, had made statements that seemed insane, and announced he was breaking off contact with me. (Insane type statement: “You made that pamphlet green after we agreed it should show Hope. Orange shows hope, not green!) It wasn’t said dismissively; I could barely say anything.

I am unfamiliar with modern mental health terminology, but right after the falling out I thought of him as having had a 'delusional episode". However I couldn’t get him to abandon his “paranoid” beliefs. As years went by I was struck by how much his beliefs were like a “conspiracy theorist”, such as a “9-11 Truther”, and seemed immune to what most people would consider logic and evidence.

During the Trump/Pandemic years there was much discussion on the boards about how to deal with friends and relatives who had bought into dangerous scams and preposterous conspiracy theories. There’s information on-line about the best ways of coping with those situations, but my friend doesn’t seem to be a classical conspiracy theorist. And while it would be foolish to take my one-sided story here as gospel, can anyone with substantial mental health knowledge make a best guess diagnosis?

(The “extreme personal stress” my friend was under: Potential blindness (on top of hearing issues), and an adult child seriously ill in the hospital with only one antibiotic left to try.)

2

It sounds like paranoia to me, which can be part of many conditions or a thing on its own. You put “paranoid” in quotes, but I’m not sure why.

3

Because I have no idea if “paranoia” is a valid modern diagnosis, and how clinical paranoia might differ from the popular concept of paranoia (which is all I’m familiar with). Hence the quote marks.

4

How did all those stressful issues from ten years ago turn out? Is he still under a lot of personal stress, or have those issues mostly resolved themselves? He is still behaving irrationally, if I understand your narrative, is that correct?

You have described someone who is having a long-term, possibly severe break with reality. I’m not at all clear what you are going to do with a diagnosis from strangers on the internet. It seems to me that the only thing you can do to help him is to steer him towards professional help. Trying to talk him out of whatever is going on with him is, forgive me, ludicrous.

5

He didn’t go blind. His daughter didn’t die, but has had an life filled with illness and misfortune. My wife sees his wife regularly (5 or 6 times a year). He’s retired and seems to have a functioning life, but I can’t know that for sure.

I do wonder if his delusions regarding me could be a sealed off area in his brain, created during crisis, and not having much effect on the rest of his thinking. Maybe people can believe bizarre theories about, say, Covid vaccines, but be otherwise “normal”?

6

If he’s having delusions about you, it’s not about you.

7

While I don’t have “substantial mental health knowledge,” I’ll suggest that forgiveness can breed resentment.

8

I’m not a medical professional; nor even a college graduate. That said, my late first wife did form some baseless delusions about me during the last few years of her life, that were attributable to Alzheimer’s-related dementia.

OP, are you in a position to know (or learn) if his brain has been examined for any sort of neurological deterioration?

9

In his state, this kind of approach is probably not going to be very productive. It’s too much based on logical analysis. He’s not going to be receptive to that. And the truth is, he’s likely not going to be receptive to having his position contradicted no matter what you do. If you want to continue your relationship with him, you’ll likely have to find a way to just move on from whatever happened in the past rather than trying to confront those episodes and get them clarified and resolved. He thinks he’s right and that’s pretty much where he’s going to stay.

A way to understand it is to think about how you accept things when you’re in a dream. You often accept totally illogical situations without any critical thought, like a sheep is your office mate at work. In your dream it seems real and factual. If someone in your dream said that there wasn’t a sheep in your office or that the sheep was really a person, you would likely argue with them that your office mate was really a sheep and had always been a sheep. A person going through a psychotic episode isn’t necessarily dreaming, but their ability to critically analyze reality is impaired in a similar manner. If you have a relationship with a person in that state, you will need to be able to go along with the ride and try to gently nudge them away excessively delusional thoughts. Trying to confront these thoughts head on likely won’t be productive and may make the person even more delusional.

For example, imagine you’re walking down the street and the person looks at a building and says “See that window with the open blinds? There’s a government agent in there watching me.” If you try to refute it directly with something like “There’s no government agents. You’re just imagining it”, the person may become more firm in their belief. But if instead you said “It’s such a nice day. I bet that’s a person just enjoying the view.”, it’s a way of sidestepping the delusion and nudging them to a more reasonable explanation.

10

I’d guess that only his wife — and maybe his children — would be privy to that. I’m not close enough to his wife to ask, and I doubt my wife would discuss it with his wife.

Years later I did chat with his former business partner (we are very friendly, but very different), and gave her a two sentence summary of the estrangement. She said that at about that same time my friend was going through an awkward retirement.

They had sold the business (successful marketing firm) to a couple of young ambitious guys, and my friend planned to hang around to help the new owners thru the transition period. It turned out the new owners didn’t want his help so he left several months earlier than he intended. I imagine that would be traumatic.

11

Well, I’m not a psychiatrist but I always scored pretty high on the psychiatry section of my Family Medicine boards. I’d be concerned about schizophrenia as his actions as described seems to include the reality distortion symptoms of hallucinations and delusions, as well as disorganized thoughts and behavior.

However, it’d take a full time mental health practitioner to evaluate him and come up with a more specific diagnosis.

12

My wife has, on several occasions, violently split with friends of hers, blaming them of ill-treatment over grievances that I would consider fairly trivial. Do I consider her delusional or mentally ill? No. She’s not perfect, but who is?

I guarantee you that she would not react well to a PowerPoint that said “let’s be friends again because I didn’t do anything wrong and I can prove it”.

13

Well. My Mom has (diagnosed) Borderline Personality Disorder as well as suspected (by my psychologist husband) delusional disorder. The kind of paranoia you describe is reminiscent of my mother. She believed that everyone in our family was conspiring against her and would get hung up on ridiculous details years later.

For example, when my uncle died several years ago, my mother was en-route to my grandmother’s house on a train. They found out a few hours before she arrived. When my mother arrived at the station, once they were in the car, my grandmother and my Aunt gently broke the news. My Mom seemed sad, but okay at the time.

But… Before long she developed a series of deeply paranoid beliefs about this event. For one thing, she was furious that nobody called her while she was alone on the train and that nobody broke the news immediately upon hearing it. She began interrogating me about when I found out he was dead and exactly what I did afterward (she determined me innocent.) She interrogated me about what all my other relatives did to figure out what was at the root of this vast conspiracy to hide my uncle’s death from her (again… She didn’t know about this for a few hours.) She described my grandmother and aunt as having “ambushed” her to break the news against her will. In her mind this was just more evidence that everyone in the family is horrible to her.

And she never let it go. She was still brooding over it the last time I was speaking with her. Fifteen years later.

This stuff was typical for her. Delusional disorder is a form of psychosis where people believe things that are technically plausible but unlikely to be true. So instead of seeing angels and demons, you obsess about your spouse cheating on you, for example.

That’s kind of the vibe I’m getting from your story. I am not a mental health expert, just a person with a lot of mental illness in my family (my dead uncle was schizoaffective and had full blown hallucinations… I do not see that in your friend.)

14

@filmore, @Qadgop_the_Mercotan, @Spice_Weasel: Thank you all for your considered responses.

The matter has been running through my mind recently — 10th anniversary and all. I’m not sure what actions I might take, if any, but was interested in some knowledgeable outside info. Again, thanks.

15

In your case, I believe you.

But there are two kinds of paranoia:

Paranoia that originates in someones mind for reasons ranging from an overactive imagination to mental illness.

The second form of paranoia does not originate in someones mind, but is placed there by an external human source. This is commonly refered to as gaslighting.

I wonder how a mental health professional can distinguish between the two.

16

Further, these two variants are virtually identical to a lay person.

Only a mental health professional can identify the just barely noticeable differences between the two variants based on their expertise when applying the diagnostic criteria before they make a diagnosis of paranoid schizophrenia, or any variant thereof.

17

Yes.

No offense intended to Ball_Houthan, but when I was reading your OP and got to your letter to him my immediate thought was “Ohhh, that’s not going to go over well” Confirmation bias is a hell of a difficult obstacle to overcome, and in particular if this person is imagining that you are against him, trying to correct his version of things is just going to be seen as further proof that you are trying to hide your true intentions and he was right about you.

I think this case is very different from that of a drug addict. The addict generally has incontrovertable proof that their life is spiraling out of control, even if they don’t want to admit it to themselves or others. Given how the letter he wrote to you was described I didn’t sound like he had changed his mind at all. He still thought that you did all of these horrible things to him but he was willing to be the better man and overlook them for the sake of the friendship. He was probably hoping that your response would be to admit what you did and ask for forgiveness.

Unfortunately I honestly don’t see a whole lot of hope for this friendship going forward. At best you could try to just pretend it never happened, but it will keep festering there and at some point blow up again. If he is to be convinced that you aren’t out to get him it won’t be by you since he views you as biased. If you really want to stay involved your best hope is probably to go to his wife saying that you are concerned about him and are wondering what it looks like from her perspective. The danger is that if he finds out about it there is a good chance that he will see is as your conspiring with her behind his back which could even further damage your relationship and worse result in his starting to suspect her.

Sorry that your going through this.