“Social security is a scam”: the Ethical Dilemmas in Treating Overvalued Beliefs

Abstract

<h3>Introduction</h3> In the 19^th century, Carl Wernicke introduced the term ueberwertige idee (overvalued idea), a rigidly held belief that influences behavior and is shared by others. Delusions, on the other hand, are defined as fixed, false beliefs, not accepted by others of that culture. Through the internet and social media, information is ever more readily accessed, leading to rapid transmission of ideas, including those considered fringe or extreme. Here, we present the case of a man with major neurocognitive disorder complicated by an ueberwertige idee that undermined his care. We consider the diagnosis of delusional disorder versus an overvalued belief, and the ethical implications inherent in the distinction. <h3>Methods</h3> Case report: The patient was assessed and treated on the inpatient geriatric psychiatry unit. This case was reviewed and compared with relevant literature. <h3>Results</h3> This is a case report of an elderly homeless man with a history of major neurocognitive disorder, lower extremity deep venous thromboses, chronic venous stasis, and blindness secondary to glaucoma. He was hospitalized for treatment of cellulitis, then involuntarily transferred to the inpatient geriatric psychiatry unit for grave disability. He had a long-standing suspicion of the American social security system, believing it to be a means of covert government control. He expressed a consistent preference to live on the streets, while his health conditions required a higher level of care. Unfortunately, his fixed beliefs were a barrier to supported housing, health insurance, and disability benefits. During his prolonged psychiatric hospitalization, he did not exhibit other psychotic symptoms and he refused to take psychotropic medication. We were unable to secure a Lanterman Petris Short conservatorship for him; themes of the difference between delusion and extreme belief dominated the legal hearing. The patient was discharged to the streets, per his preference. <h3>Conclusions</h3> Distinguishing between delusions and overvalued beliefs can be a significant challenge. With the internet and the global growth of subcultures, encountering patients with extreme beliefs will become increasingly common. Examining the diagnosis and ethical considerations carefully is essential to providing the care most aligned with an individual's interests and values. <h3>Funding</h3> No funding sources to report