On Delusion Formation

Controversy surrounds the birth of delusions. Most theorists agree on the first step, that delusions arise in the context of a delusional mood, an emotionally aroused state that makes the person hyperalert to threat.1 After that, some assume perception goes awry-something misheard or misperceived giving rise to increasing emotional upheaval and misinterpretation. Others believe that cognitive processes are dismpted first, setting in motion various interpersonal behaviours that reinforce originally tenuous mistaken beliefs.2,3 The nature of the original stimulus that sets the misperceptions or misconstruals going lias not been given much attention. It has been seen as unimportant. In this Perspective, make the assumption that the original stimulus has to be one that inherently lends itself to numerous possible interpretations. In the case example, it is the colour red. Psychiatrists are not present when a delusion is first bom, thus we have to reconstruct the series of events that lead to delusion as best we can, working backwards, relying on what patients choose to tell us. The example that use as illustration is loosely based on my experience with a former patient, now deceased. Identifying information lias been changed. The purpose of this communication is to identify the stages of delusion formation: the emotional matrix, the provocative stimulus, the perception, the interpretation, the reinforcement, and the full-blown delusion.On her first visit, a patient said to me: You can't wear red. If you wear red, won't come back. She was 45, lived alone, and had been diagnosed with schizophrenia at age 28. She was firmly against taking medication because, she said, she needed to have her wits about her: they were trying to force her into sexual relations. They whispered orders of this nature outside her window and left various related ciphers and signs around her bedroom. The identity of the they was unclear to me, but was associated in a peripheral way with a boyfriend of long ago. Based on her earlier excellence in academic work, this patient had received tenure in the Department of History at a local college, which meant a regular income. However, she was not allowed to teach because of the disruptions she caused among staff and students whenever she came on campus. As a result, she worked on her own research from home, and published in scholarly journals; her academic area was the mythology of ancient Egypt.I asked her to elaborate on her aversion to red. Because of the nature of her delusion, suspected that red clothes were associated in her mind with red-light districts and that, by wearing red, was crossing over to the theys who plotted to turn her into a sexual degenerate. mentioned this to her. She responded, I don't want to talk about it; thus the subject was closed. One day, inadvertently wore a red blouse and she walked out of the office. never saw her again, although we stayed in touch for many years over email because she repeatedly asked for help to find new psychiatrists. She needed a psychiatrist to sign her forms so that she could continue receiving her university pension. Very recently, heard that she had died, which made me think again about the colour red as a trigger, a delusional stimulus.Red as the TriggerAs the patient was either offended or frightened or angered by the colour red, was it possible that, in her 20s, when emotionally upset as a result, perhaps, of a relationship gone wrong, the sight of the colour red had jump-started her delusion? Red is fertile ground for the growing of a delusion. It is generally acknowledged to be a stimulating colour, heightening any underlying aroused state. Kurt Goldstein noticed nearly 75 years ago that patients prone to psychosis were especially sensitive to the effects in their surroundings of stimulating colours, such as red.4Is there something about red that is inherently stimulating? In about 10% of primate species, females call attention to their fertile periods by bright red sexual swellings around their buttocks and vulva. …

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