From collective memory to clinical cases: analyzing political delusions in patients with psychotic disorders

TL;DR

This study explores how political themes shape delusions in patients with psychotic disorders in Turkey, showing that these delusions are culturally rooted and influenced by public political symbols.

Contribution

The study introduces a detailed thematic analysis of politically themed delusions in a Turkish clinical context, revealing structured narratives shaped by political culture.

Findings

Eight distinct political themes were identified in delusional narratives, including surveillance, grandiosity, and ethno-religious persecution.

Patients' delusions often involved blurred self-world boundaries and externalized agency, reflecting cultural and political contexts.

Context-attentive clinical approaches are recommended to improve patient engagement and safety in politically charged environments.

Abstract

Politically charged public life supplies powerful symbols that can be recruited into delusional meaning-making. This study examined how political contexts shape the content and experiential structure of delusions in patients with psychotic disorders in Turkey.

We conducted a retrospective, archive-based qualitative study of inpatient psychiatric records from a tertiary hospital spanning 1985–2024. Of 1,657 records screened by two clinicians, 122 cases with sufficiently rich, politically themed delusional content were included following consensus review. Analysis used reflexive thematic analysis in an inductive, primarily semantic mode. All narratives were analyzed in Turkish to preserve nuance. Descriptive statistics summarized sample characteristics; no inferential tests were performed.

The sample comprised 122 inpatients (mean age 36.57 years; 68.9% male). Diagnoses were schizophrenia (66.4%), schizoaffective disorder (13.1%), delusional disorder (10.7%), and brief psychotic disorder (9.8%). These themes were grouped into two main categories: experiences of a persecutory political world, and the reorganization of the self through political narratives. Eight themes captured recurring constellations of actors, plots, and experiential disruptions: (1) an intrusive state and collapse of ontological distance, with surveillance and mind–body control motifs (39.5%); (2) grandiosity as compensatory self-organization via identification with national or global leaders (13.7%); (3) persecutory threat based on ideological identity (12.1%); (4) the foreign state as enemy, extending persecution to a transnational horizon (10.5%); (5) the personalized leader’s gaze transforming symbolic authority into direct persecution (8.1%); (6) ethno-religious others as ontological contaminants (6.5%); (7) “psychotic nationalism,” merging self and nation amid catastrophic scenarios (3.2%); and (8) illegitimate pursuers, such as terrorist or nameless clandestine groups (6.5%). Across themes, patients’ narratives reflected blurred self–world boundaries, externalized agency, and the recruitment of widely circulated political symbols.

Politically themed delusions are structured, culturally anchored narratives rather than incidental noise. In the Turkish context, state institutions, charismatic leaders, foreign powers, clandestine organizations, and ethno-religious figures recurrently organize delusional meaning. Context-attentive assessment and formulation—mapping each patient’s political horizon of meaning, anticipating risk around salient public events, and integrating proportionate psychoeducation—may improve engagement and safety. Prospective, mixed-methods studies linking first-person accounts with timelines of public events are warranted to clarify temporal coupling and guide interventions.

Not applicable.