A person having delusions is literally out of touch with reality for biological reasons. This can be seen in college students who are having a “first break” episode of a thought disorder or, occasionally, in students who have abused stimulant drugs for an extended period.
College-aged students are in the middle of the period (late teens to mid-thirties) when most people with thought disorders first demonstrate the symptoms of their illness.
Some of the features of being out of touch with reality are disorganized speech, disorganized behavior, odd or eccentric behavior, inappropriate or no expression of emotion, expression of erroneous beliefs that usually involve a misinterpretation of reality, expression of bizarre thoughts that could involve visual or auditory hallucinations, withdrawal from social interactions, an inability to connect with people and an inability to track and process thoughts that are based in reality. Less severe symptoms may come across as a kind of “oddness”, with the student responding with non-sequiturs and showing extended delays before responding to questions or in conversations. While this student may elicit alarm or fear from others, they are generally not dangerous and are likely to be more frightened and overwhelmed by you than you are by them. Occasionally, a person experiencing a paranoid delusion may act violently, but this occurs in the minority of cases. If you cannot make sense of their conversation, they are in trouble.
When you encounter a student who demonstrates delusions or confusion:
- Call the GWU Counseling Center to consult first, if the situation is not an immediate crisis.
- Respond with warmth and kindness, but with firm limits.
- Remove extra stimulation from the environment (turn off the radio and step outside of a noisy classroom).
- Acknowledge your concerns and state that you can see they need help. “I don’t really understand what you’re trying to tell me, but I see that you’re upset.”
- Acknowledge their feelings or fears without supporting the misperceptions, e.g., “I understand you think someone is following you, but I don’t see anyone and I believe you’re safe.”
- Acknowledge your difficulty in understanding them and ask for clarification or restatement. “Sorry, I’m not understanding you, what I asked was…”
- Focus on the “here and now.” Tell the student the plan for getting him/her to a safe environment, and repeat the plan emphasizing the safe environment. “Ok, let’s get you over to the Gardner-Webb University Counseling Center to talk with the folks there, it’s a safe place. They’ll help you figure out what to do to be safe.”
- Speak to their healthy side, which they have. It’s OK to laugh and joke when appropriate – but not about any of their beliefs or fears.
- Be aware that the student may show no emotions or intense emotions.
- Be aware that the student may be extremely fearful to the extent of paranoia.
- Be aware that the student may not understand you or understand only parts of what is being said. Be aware that, on occasion, a student in this state may pose a danger to self or others.
- Argue or try to convince them of the irrationality of their thinking, as their brain may be literally incapable of accepting the information.
- Play along, e.g., “Oh yeah, I hear the voices (or see the devil).”
- Encourage further discussion of the delusional processes.
- Demand, command, or order.
- Expect that the student will understand you.
- Assume the student will be able to take care of him/herself when out of touch with reality.
- Allow friends to take care of the student without getting a professional opinion.
- Assume the family knows about the student’s condition.