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Is one mental illness 'better' than another? (And, chances are, you know someone who is delusional)

If you had to have a mental illness, which one would you choose?

Would you rather be afflicted with Depression? Anxiety? Bipolar Disorder? Schizophrenia?

Most people probably choose along these lines:

People often think of mental illnesses as sitting somewhere along a spectrum from "better" to "worse". Schizophrenia, with its delusions, is knocked as being "the worst". After all, what could be worse than a complete break with reality?

Well, in reality, it's not that clear cut.

To associate delusions with Psychotic Disorders alone would be a gross mischaracterization.

All mental illnesses range from "mild" to "moderate" to "severe".

Delusions are a common link between the severest cases of each type of mental illness.

Severe cases of each type of mental illness (depression, eating disorders, PTSD, OCD, etc.) all involve some sort of "break with reality".

Think about it this way:

A delusion is an unshared, unshakable belief in something that is clearly untrue.

No argument (no matter how compelling it seems to everyone else) will convince the delusional person that their belief is untrue.

Here is an example of paranoid and persecutory delusions characteristic of schizophrenia:

A 20 year old college student living in a residence hall firmly believes that "the cafeteria food is being poisoned, there are cameras hidden in all of the light fixtures and also behind the mirrors. Every black car on the road has been sent by the CIA to follow me. They're watching me all the time. They're monitoring my every move. I don't know why - but I know with 100% certainty that it's happening".

Consider now a beloved, middle-aged, married doctor who has two young children. The doctor commits suicide during a Severe Major Depressive Episode. Before pulling the trigger, the doctor is convinced that the emotional angst experienced during the depressive episode will never go away. "It's hopeless. It's never going to get any better. I'm a burden on everyone. My children would be better off without me. I can't go on like this". The doctor's spouse, children, colleagues, patients - they all feel differently. They will be so saddened and shocked by his suicide. The doctor is suffering from "mood congruent delusional ideation" (delusional thoughts that are influenced by - and aligned with - his severely depressed mood).

Or, to give one more example, imagine someone who suffers from severe contamination OCD. She absolutely will not move from the couch. She is convinced that everything around her is contaminated. She is paralyzed by her fear of being contaminated by some lethal disease if she touches anything at all in her environment. She won't eat. She puts off going to the bathroom as long as possible lest she expose herself to dangerous germs. Her hands are excoriated from aggressive scrubbing.

You can challenge them all day long. Try as you might, the person with:

Schizophrenia will not be "logic-ed" out of thinking that they are being followed and monitored.

Major Depression will not be talked out of thinking that they are such a burden on their family that they should end their lives.

OCD will not realize that their living room is safe and they can freely interact with their environment without contracting a deadly disease.


The best answer to the question "If you had to choose a mental illness, which one would you pick"? Choose the mildest (least severe) mental illness. Better to contend with mild schizophrenia than severe depression.

Nearly 1 in 5 adults in America experience a mental illness (not necessarily a severe one).

Nearly 1 in 25 adults in America live with a serious (severe), chronic mental illness.

So, presuming you know more than 25 people, you likely know at least one person who suffers from serious psychiatric illness. And, in turn, you likely know someone who suffers from some variant of delusional thinking.

You may be wondering, "What should I say to them?".

That will be the topic of my next blog post.

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