By Mark E. Smith
Among the most difficult clinical mental conditions to diagnose is delusional disorder. The reason why it’s so difficult to clinically diagnosis is because it doesn’t manifest itself as other conditions do. There are no hallucinations, you don’t hear voices, and you remain content, sensible, and logical. The question, then is, where is the disorder?
This is the tricky part. Clinically speaking, extreme forms of jealousy or grandiose thoughts are emblematic of delusional disorder. However, it still becomes tough to diagnose, doesn’t it? Most of us have felt unfounded jealousy in our lives at some point if we’re honest, and grandiose thoughts often fuel success. In this way, it’s only to the very extremes that this state of mind becomes diagnosable.
I might be among the few who are diagnosable. See, I believe that I control my own joy, which goes against the way we culturally define what creates joy. We typically base joy on external forces bringing “good” into our lives. We logically don’t feel joy during adversity. Yet, in my possible delusional disorder, I often find joy even during the toughest times of my life.
Among the gravest moments I’ve experienced was awaking with a tracheotomy, on a ventilator, unable to speak, due to respiratory failure following a surgery. To make all worse, my cerebral palsy doesn’t allow me to physically write. I was suddenly locked inside my body with virtually no ability to communicate.
As the days passed, I found the circumstance both horrifying and hilarious. On the one hand, I couldn’t communicate beyond gestures, which is a disturbing reality. You feel as though you’ve lost everything. On the other hand, seeing my family try to read my lips with little avail was a funny sight to witness. As a result, I mouthed the most obnoxious phrases, and amused myself to no end as they tried to figure out what I said. My sister was the most fun to toy with. She shares my sense of humor and joy, and she laughed hysterically at not being able to understand me and I laughed at her for not knowing the ridiculous words I was secretly uttering. It was the two of us in my hospital room, laughing hysterically during a very serious health crisis. But, there we were, finding joy.
After a week or so, it was time to learn to speak with my trach. There’s a small cap that goes on and it allows vocalization. As the speech therapist explained to my family and me, it takes days or weeks to master speaking with a trach, that I couldn’t expect to speak right away.
With the cap in place, surrounded by family, nurses, and the speech therapist, I had an audience. I took a deep breath and uttered the first words that came to heart: Hello, I’m Johnny Cash. The words came out deep and clear.
It was the way Johnny Cash began every concert and nothing seemed more fitting or joyful for me to say in the moment, per my possibly delusional mind.
Everyone expressed a combination of tears and laughter. I didn’t plan on speaking those words as my first, but the silliness and joy just came out.
I’ve found myself in such situations throughout my life, and as those around me will tell you, joy remains. I’ve had my frustrated times and dark days, of course. But, in general I live with a sense of joy, one that nothing can take from me. You can take my voice, but not my joy!
I suppose we could debate whether I have diagnosable delusional disorder. What I know I have is a specific perspective toward our emotions. We have two choices in the face of any adversity: we can allow it to pull us down or we can choose not to allow it to steal our joy. I strive to default to joy.
I say that if being joyful even during the tough stuff is delusional disorder, we should all be fortunate to have such a condition.