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

Background

Delusions are one of the core clinical symptoms that are diagnostic of almost all psychotic disorders. The phenomenological examination of delusions has continued to be of clinical interest since the 19th century [1, 2]. This is related to the idea that delusions serve as a tool for understanding the patient’s inner world [3, 4]. Additionally, studies indicate that there is also a relationship between the content of delusions and the world the patient inhabits [5–7]. However, with the development of biological psychiatry, there appears to have been a temporary decline in the focus on delusional content [8, 9]. Today, the challenges in classifying psychotic disorders have reached an impasse, leading to discussions about the necessity of returning to the concept of psychosis as an overarching framework [10]. This overarching concept suggests that a phenomenological examination of delusions, one of the core symptoms of psychosis, could also be beneficial for understanding the etiopathogenesis of psychotic disorders. One of the most important findings supporting this phenomenon is that the content of delusions in patients with schizophrenia changes over time [5]. Delusions evolve in response to new technological developments [11, 12], political processes [13, 14], sociocultural changes [15, 16], and popular music trends [17]. The change in delusional content influenced by history, culture, and politics also raises the question of whether the difference between psychotic and non-psychotic thought is quantitative or qualitative.

Phenomenological examinations of delusions have typically revealed classifications such as persecution, grandeur, jealousy, and religious delusions, which are often used in clinical practice [5, 18]. While this classification provides some insight into delusional content, it is not sufficient to fully understand the patient’s subjective experience. However, it is known that the frequency of these basic delusion classes varies according to political, social, or cultural changes [7, 16, 19]. For example, a study conducted in Slovenia showed that the frequency of persecution delusions increased, particularly among individuals with dissenting views, following Yugoslavia’s transition from a monarchical regime to communism [19].

Politics can be defined as the sum of activities related to decision-making processes and power relations among various groups, individuals, or organizations within society [20]. However, one of the definitions that can be used to explain politics is based on Nancy Fraser’s triad. According to this, politics can be defined as a multidimensional process aimed at achieving justice through addressing economic inequalities (redistribution), recognizing identities and cultural differences (recognition), and ensuring individuals’ participation in democratic processes and equality in political representation (representation) [21]. It is likely that, as members of the society they live in, both the lives and thought content of patients with psychotic disorders are influenced by the political environment they find themselves in. This thought content may take on a delusional nature in patients who have not reached complete remission or are in an active phase of the illness.

As far as we know, there is no qualitative study specifically on delusions with political content, but a few studies can offer insights into this topic. One was conducted on Egyptian patients in 1976 [22]. The delusional content provided as examples in this study reflects the political tensions of the time, being related to the conflicts between Arabs and Israelis. In a study by Kim and colleagues in 1993, it was noted that patients’ delusions related to politics were shaped by their country and political agenda [23]. According to the data from these studies, most politically themed delusions are classified as persecution or grandiosity delusions [24]. Additionally, many politically-themed delusions also resemble conspiracy theories [25]. These conspiracies typically involve authorities such as politicians, leaders, and scientists or socially marginalized groups like Jews, Muslims, and Black people.

Turkey’s recent history is a highly complex period marked by successive major economic, political, and cultural crises, and the records of the patients included in this study were documented during these periods. Many of these patients were born, grew up, and lived during a time marked by the Cold War, with its global impacts, the right-left conflicts that engulfed the country, military coups, elections, and economic issues [26]. This study will carry out a thematic analysis of political themes in the delusions of patients with psychotic disorders in Turkey. The aim is to reveal the relationship between political events and the content of delusions, addressing a gap in the literature. While there are a limited number of studies on politically themed delusions, these studies mostly highlight persecution and grandiosity delusions (Kim et al., 1993; El Sendiony, 1976). However, the dynamics of political delusions and their relationship to historical-political events have not yet been thoroughly explored. In this context, understanding the content of politically themed delusions in the light of historical-political events in Turkey and the world can help us assess individual pathology and better understand the socio-political environment in which these individuals live.

Methods

Results

This study investigated the phenomenological architecture and sociohistorical embedding of politically themed delusions in a clinical sample of 122 inpatients diagnosed with psychotic disorders. The patients had a mean age of 36.57 years, with 68.9% identified as male and 31.1% as female. Diagnostic distribution included schizophrenia (66.4%), schizoaffective disorder (13.1%), delusional disorder (10.7%), and brief psychotic disorder (9.8%) (Table 1). The delusions were not treated as isolated cognitive anomalies, but as meaningful reorganizations of the self–world relationship, shaped by the intersection of subjective vulnerability and political-symbolic imaginaries. The eight thematic clusters that emerged from the analysis were organized into two primary categories to better illustrate the core dynamics observed: experiences of a persecutory political world, and the reorganization of the self through political narratives (Table 2).

Discussion

This study set out to illuminate how political contexts inflect the content of delusions in psychotic disorders by undertaking a reflexive thematic analysis of archived inpatient records spanning 1985–2020 in Turkey. Rather than treating delusions as isolated cognitive anomalies, we examined them as meaning-bearing narratives situated within specific social and historical environments, a stance that accords with a view of the mind as shaped by social relations—echoing Marx’s sixth thesis on Feuerbach that human essence is constituted in, and through, the ensemble of social relations [29]. Taken together, our findings underscore that politically themed delusions are not random; they coalesce around culturally resonant actors, institutions, and events, and they reorganize personal experience in ways that are legible against the background of Turkey’s political history and its global entanglements [5].

A concise summary of the principal findings is warranted before interpretation. Across the corpus, patients recurrently articulated experiences of invasive or persecutory intrusion by state institutions; conflated their personal significance with national or global leadership; understood themselves as targeted because of ideological identity; located threat in foreign state actors; attributed direct agency to named political leaders; recast ethno-religious others as ontological contaminants; fused self-integrity with national integrity; and construed pursuit by non-state, clandestine organizations. These configurations were not uniformly distributed by time or biography; rather, they often echoed moments of political upheaval, regime change, geopolitical tension, and highly mediatized events, producing an overall picture in which political symbols and figures are recruited as building blocks for delusional systems precisely because they are already overrepresented in public discourse and collective memory [19].

The sociohistorical embedding of delusional content is particularly salient in the Turkish context. Turkey’s second half of the twentieth century and the early twenty-first century were punctuated by coups, states of emergency, ideological polarization, and shifting alignments with global powers, and against this background many patients narrated the state—police, military, intelligence services—as omnipresent, invasive, and punitive [30–32]. The long shadow of the 1960, 1971, and 1980 coups, and the attempted coup of 2016, left behind a repertoire of widely shared expectations about surveillance, arrest, and repression; these expectations did not create psychosis, but they furnished a ready-made vocabulary of threat that could be taken up in delusional meaning-making [32]. Our material also registered the enduring salience of the right–left divide that structured social and campus life in the 1960–1970 s, including fears of politically motivated violence and conspiracies attributed to “the other side,” with several patients articulating the conviction that they were singled out for their ideological commitments in ways that mirror how identity positions were historically encoded as public risks rather than merely private stances [32].

The transnational dimension of threat likewise emerged with force. As a NATO country situated at the intersection of Europe and the Middle East, and as a society steeped in Cold War legacies of espionage and proxy conflict, Turkey’s public imagination has long circulated images of foreign interference and technological reach, and it is therefore notable that patients frequently invoked the United States, Russia, Saudi Arabia, and other foreign powers as persecutors, sometimes linked to satellites, clandestine agents, or religious authority. The presence of global political figures—appearing not as abstractions but as direct actors in patients’ lives—speaks to the power of mediatized leadership as a symbolic resource, and highly visible moments such as diplomatic visits or widely covered scandals can amplify the recognizability of certain names and endow them with narrative utility in delusional systems [23]. In parallel, we observed a recurrent fusion of self and nation, wherein national disintegration or foreign invasion is experienced as an attack on bodily integrity and where bombs under cities or threats to factories become analogues for internal rupture; clinically, such fusions suggest that political news and anniversaries of historical events may function as triggers or organizers of distress in vulnerable patients [19].

The appearance of clandestine, non-state persecutors—such as “counter-guerrilla,” ISIS, or unnamed “organizations”—further reflects a broader social vocabulary of hidden networks and deep structures, recapitulating enduring narratives in public life about invisible hands and shadow governance [25]. For many patients, these culturally available narratives provide an account of why things happen and of who, precisely, is responsible, transforming diffuse anxiety into systematized explanation and thereby conferring an uneasy sense of order on otherwise overwhelming experience [25]. Importantly, politically themed delusions are not synonymous with political interest or activism: many patients reporting surveillance or persecution had no documented histories of political engagement, and political content should therefore not be read as evidence of political action but, rather, as an index of how widely available symbolic resources are pressed into service to make sense of distressing phenomena [22, 23].

Grandiosity warrants particular nuance within this matrix. Identification with national leaders or founding figures—most prominently Mustafa Kemal Atatürk—should not be reduced to inflated self-regard; in our records such identifications frequently contained ambivalence (duty, burden, fear of failure) and unfolded as attempts to restore coherence and agency amid disorganization, especially in social worlds where leadership figures are narratively cast as saviors, reformers, or embodiments of national destiny [33]. Psychoanalytic and social-cognitive accounts suggest that such identifications can serve as a defense against feelings of powerlessness, allowing individuals to integrate culturally admired images of authority into a threatened sense of self. The blurring of self–other boundaries in psychosis may further facilitate this process of absorbing public symbols into one’s personal identity [34, 35]. Seen in this light, grandiosity is culturally mediated and, at times, defensive, and an appreciation of its local symbolic scaffolding has implications for engagement, formulation, and risk assessment.

Several plausible pathways link political contexts to the architecture of delusional systems without implying that politics “causes” psychosis. First, political life offers narrative affordances—characters (leaders, agencies), structures (conspiracies, elections, coups), and plots (betrayal, rescue)—that can organize otherwise chaotic experience; when personal meaning is at risk of fragmenting, narratives with clear antagonists and grand stakes may be preferentially recruited [25]. Second, repression and states of emergency cultivate surveillance expectations that, once sedimented in collective memory, can be generalized in personal life and render everyday ambiguity legible as monitoring. Third, conspiracist ideation in public discourse supplies ready-made explanatory frameworks—hidden causes, deep states—that are portable into private experience and, once adopted, can tighten and self-seal, especially where trust is already depleted. Fourth, mediatized leaders and spectacular events multiply salience and familiarity, and familiar names are therefore more likely to be recruited under stress into personal narratives. Fifth, political identities that are publicly consequential—subject to sanction or pride—are more easily experienced as essential properties of the self, and when threat is generalized, identity can feel like a target painted on one’s being. Finally, grandiose identifications can function as compensatory reorganizations when control is diminished, drawing on culturally available images of decisive capacity, while boundary blurring promotes external attribution of agency in ways that make political symbols feel personally addressed [34, 35].

Our findings sit comfortably within a comparative literature that has repeatedly observed tracking between delusional content and socio-political climates. Studies from diverse settings have noted that persecution and grandiosity dominate politically themed delusions and that salient national conflicts—from the Cold War to regime changes—are mirrored in patients’ narratives as those conflicts permeate public consciousness [19, 22, 23]. The present material contributes by specifying how these broad tendencies took shape in Turkey: the repetition of state-centered persecution under the shadow of coups; the salience of founding or charismatic leaders as figures of identification; the appearance of foreign power as persecutor within a NATO-borderlands imagination; and the adoption of clandestine, non-state enemies in line with locally circulating ideas about deep structures. These convergences and divergences suggest that politically themed delusions are at once translatable across contexts (sharing structural features) and irreducibly local (surfacing particular symbols and actors), a conclusion that dovetails with prior work showing that delusional content changes with technological developments, political processes, and sociocultural shifts [5, 11, 13–17, 19].

A theoretical question that arises from these observations concerns whether the gulf between psychotic and non-psychotic political thinking is primarily quantitative rather than qualitative. We caution against overstatement, yet two considerations are notable: in periods of heightened political anxiety, general discourse becomes saturated with motifs—surveillance, betrayal, foreign manipulation—that also commonly populate delusional systems, and the very public figures and institutions that dominate everyday conversation appear within delusional content as well. The difference, then, may lie less in the raw materials than in rigidity, incorrigibility, and personal centrality; put differently, politically themed delusions may extend and intensify shared narrative resources rather than inventing entirely new ones, a view consistent with the claim that delusions are shaped by the social relations and symbolic economies in which minds are embedded [29].

When translated into clinical practice, this contextual frame yields concrete principles that can orient everyday assessment and intervention. Assessment should be deliberately context-sensitive; routine history taking ought to map each patient’s “political horizon of meaning,” identifying which institutions, events, and identities are salient and tracing how these attach to perceived threat or to a sense of “mission,” while acknowledging the historical roots of mistrust without endorsing delusional claims. Risk formulation is strengthened by attention to temporal coupling: where the self is fused with the nation or direct agency is ascribed to powerful leaders, news cycles and anniversaries of historical events may constitute “risk windows,” enabling teams to calibrate monitoring and support accordingly. The therapeutic alliance is consolidated by a stance that is alert to political history and present realities yet remains anchored in proportionality, corroboration, and personal centrality, thereby avoiding the epistemic invalidation that can follow from dismissing political content as mere noise. Psychoeducation and cognitive work can create space for alternative readings of ambiguous cues and for jointly weighing the costs of global, self-referential interpretations; at the same time, cultural formulation and documentation should record not only symptom form but also the cultural specificity of content—named institutions and leaders—and its personal significance, thus strengthening continuity of care and reducing the risk of misinterpretation by new providers. Finally, in contexts where surveillance and repression have in fact occurred, ethical care requires proportionate verification rather than reflexive dismissal of reported threats, keeping in view the rare but meaningful possibility of a non-delusional kernel.

Methodologically, employing reflexive thematic analysis on archived clinical narratives affords the capacity to detect patterns spanning a long time frame and to demonstrate how political symbols recur and are reconfigured; the archive also supplies a diversity of voices and contexts that would be difficult to assemble prospectively. Nonetheless, several limitations must be acknowledged candidly. First, our reliance on clinician-authored records means the data are inherently filtered through the clinician’s perspective, which may have shaped how patients’ experiences were documented. Second, over such a long and politically charged period, we cannot rule out the possibility that clinicians may have omitted or softened certain politically sensitive details from the record, representing a potential bias. Third, a key limitation is the absence of a systematic temporal analysis mapping changes in theme frequency to specific political events. Such an analysis was beyond the scope of this qualitative study due to inconsistencies in archival data quality over four decades, but it remains a crucial area for future investigation. Shifts in diagnostic systems and recording practices over the study period may also have influenced what was written, while translation from Turkish to English—undertaken by bilingual team members with secondary review—inevitably entailed choices that shade meaning. Limitations beyond the archival constraints must be acknowledged candidly. The sample is drawn from a single tertiary center in Turkey, which limits generalizability across regions and health systems, and we did not attempt fine-grained time-locking of delusional content to specific political events, an analysis that would require prospectively dated narratives and linkage to external timelines. We also lacked a comparison group of inpatients with non-political delusions that could sharpen claims about distinctiveness, and we did not capture media consumption or personal political engagement, variables that might moderate how symbols are selected and organized. Finally, while we reported theme frequencies to enhance transparency, our aim was interpretive adequacy rather than prevalence estimation, and the numbers should be read accordingly.

Future research can extend these insights through mixed designs that combine prospective, time-stamped qualitative interviews with ecological data on news cycles and social media attention, thereby enabling analysis of how public events are appropriated into personal narratives in near-real time. Cross-national comparisons anchored in matched historical periods would allow stronger inferences about the cultural specificity of symbol repertoires, while within-country, multi-site studies could examine regional differences in the salience of particular institutions or leaders and the uptake of foreign versus domestic persecutors. Clinically, intervention trials might test whether context-attentive psychoeducation and cognitive strategies reduce distress or rigidity without dismissing political meaning. Furthermore, training curricula for psychiatry residents could incorporate modules on interpreting delusional content in its sociohistorical context, with attention to ethical pitfalls such as re-traumatization through invalidation. Public mental health communication during crises should also be scrutinized for unintended amplification of persecutory narratives and recalibrated toward transparency and reduced ambiguity.

Conclusions

In conclusion, politically themed delusions in psychotic disorders are not noise at the margins of psychopathology; they are structured narratives that draw on the most available and affectively charged materials in public life. In the Turkish context examined here, state institutions, charismatic leaders, foreign powers, clandestine organizations, and ethno-religious others served as recurrent anchors for meaning, and these anchors were not arbitrarily chosen but reflected decades of political experience, memory, and media representation. Recognizing this does not collapse the distinction between psychotic and non-psychotic thought; rather, it equips clinicians with a better map—one that shows where patients are drawing their symbols from, why these symbols feel inevitable, and how therapeutic work might proceed without either pathologizing politics or ignoring symptom form.

Author contributions

ASB conducted the literature review, led data collection, performed coding, contributed to study design, and drafted the manuscript. HG contributed to study design, performed coding and data analysis, and led translation. SÇ contributed to data collection and translation. SC contributed to study design and provided supervision during manuscript preparation. All authors read and approved the final manuscript.

Funding

This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability

The datasets analyzed comprise de-identified excerpts from confidential hospital records and are not publicly available due to legal/ethical restrictions and risk of re-identification. De-identified analytic are available from the corresponding author on reasonable request and subject to institutional and ethics approvals.

Declarations