Most people think of the "mentally disordered" as a delusional lot, holding bizarre and irrational

ideas about themselves and the world around them. Isn't a mental disorder, after all, an
impairment or a distortion in thought or perception? This is what we tend to think, and for most
of modern psychology's history, the experts have agreed; realistic perceptions have been
considered essential to good mental health. More recently, however, research has arisen that
challenges this common-sense notion.

In 1988, psychologists Shelly Taylor and Jonathan Brown published an article making the
somewhat disturbing claim that positive self-deception is a normal and beneficial part of most
people's everyday outlook. They suggested that average people hold cognitive biases in three key
areas: a) viewing themselves in unrealistically positive terms; b) believing they have more
control over their environment than they actually do; and c) holding views about the future that
are more positive than the evidence can justify. The typical person, it seems, depends on these
happy delusions for the self-esteem needed to function through a normal day. It's when the
fantasies start to unravel that problems arise.

Consider eating disorders, for instance. It's generally been believed that an unrealistically
negative body image is an important factor in the self-abuse that characterizes anorexia and
bulimia. A 2006 study at the University of Maastricht in the Netherlands, however, came to a
very different conclusion. Here, groups of normal and eating disordered women were asked to
rate the attractiveness of their own bodies. They were then photographed from the neck down,
and panels of volunteers were brought in to view the photos and rate the women's appearances
objectively. The normal women, as it turned out, evaluated themselves much more positively
than the panels did, while the self-ratings of the eating disordered women were in close
agreement with the objective ratings. The eating disordered subjects, in other words, had a more
realistic body image than the normal women. However, it is important to note that the study was
based upon the broad concept of "attractiveness" rather than body weight specifically-while the
eating disordered women may have rated themselves poorly because they felt "fat," their weight
was a controlled variable and not the basis of the volunteers' assessments.

Studies into clinical depression have yielded similar findings, leading to the development of an
intriguing, but still controversial, concept known as depressive realism. This theory puts forward
the notion that depressed individuals actually have more realistic perceptions of their own image,
importance, and abilities than the average person. While it's still generally accepted that
depressed people can be negatively biased in their interpretation of events and information,
depressive realism suggests that they are often merely responding rationally to realities that the
average person cheerfully denies.

Lear's Fool speaks wisdom disguised as madness. Those with paranoid disorders can sometimes
possess a certain unusual insight as well. It has often been asserted that within every delusional
system, there exists a core of truth-and in their pursuit of imagined conspiracies against them,
these individuals often show an exceptionally keen eye for the real thing. People who interact
with them may be taken aback as they find themselves accused of harbouring some negative
opinion of the person which, secretly, they actually do hold. Complicating the issue, of course, is
the fact that if the supposed aversion didn't exist before, it likely does after such an unpleasant
encounter.
As one might imagine, these issues present some problems when it comes to treatment. How
does one convince a depressed person that "everything is all right" when her life really does
suck? How does one convince an obsessive-compulsive patient to stop religiously washing his
hands when the truth of what gets left behind after "normal" washing should be enough to make
any sane person cringe? These problems put therapists in the curious position of teaching
patients to develop irrational patterns of thinking-patterns that help them view the world as a
rosier place than it really is. Counterintuitive as it sounds, it's justified because what defines a
mental disorder is not unreasonable or illogical thought, but abnormal behaviour that causes
significant distress and impairs normal functioning in society. Treatment is about restoring a
person to that level of normal functioning and satisfaction, even if it means building cognitions
that aren't precisely "rational" or "realistic."

It's a disconcerting concept. It's certainly easier to think of the mentally disordered as lunatics
running about with bizarre, inexplicable beliefs than to imagine them coping with a piece of
reality that a "normal" person can't handle. The notion that we routinely hide from the truth about
ourselves and our world is not an appealing one, though it may help to explain the human
tendency to ostracize the abnormal. Perhaps the reason we are so eager to reject any departure
from this fiction we call "normality" is because we have grown dependent on our comfortable
delusions; without them, there is nothing to insulate us from the harsh cold of reality.