Sovereign Citizens: A Psychiatric Edge Case

Between clear cut cases of delusion and ordinary beliefs lies an interesting no man's land. It's difficult (arguably impossible: 1, 2) to clearly define a delusion, so the border between ideas that are and are not of psychiatric concern is uneasily guarded. One strand of this pragmatic policing involves considerations about how widely shared a candidate belief is. If lots of people believe something - even if that something is manifestly false or at odds with other culturally mainstream ideas - it is less likely to be judged a delusion.

This issue comes up infrequently in regular mental health work. Most clinically significant ideas are personal and are causing people terror. An individual who believes they are being injected with AIDS every night is almost certainly not in possession of a shared belief. Such a belief is first personal, not belonging to a broader cultural web.  But in forensic psychiatry, where people often endorse unusual beliefs that get them into trouble, determining whether a belief represents a delusion can sometimes be more complex. It also has significant ethical and legal implications. Reasonably widespread but relatively obscure belief systems can fall into the psychopathological no man's land.

One distinctively North American example is the Sovereign Citizen movement, brought to my attention by a forensic clinical supervisor who has evaluated some adherents for their competency to stand trial. This is a terrain in which Sovereign Citizens are assessed with some frequency, as their beliefs bring them into direct conflict with the US legal system. There is no single coherent belief system (check out this link to the Southern Poverty Law Center,and the papers linked below for more information), but adherents believe a diverse mix of things about their relationship to the state. Broadly - as implied by the name - Sovereign Citizens take themselves to be technically legally independent of the government. For at least one strand of believers this is because they think that they were put up as collateral for US government debt when the dollar came off the gold standard in the 1930s. By cashing themselves in against this in some way Sovereign Citizens seem to hold that they can opt out of the country's laws.

As a result these individuals are not very cooperative participants in legal interactions. They present police with fake government documents to evade basic traffic regulations. They commit violent crimes but refuse to enter pleas. Their lack of cooperation sometimes extends to levels of disruption that require their ejection from court. It may be that their anti-government beliefs elevate the risk that they will break the law. They are frequently violent, and are regarded as a domestic terrorist threat in the US. For the seriously interested, there is a Reddit thread devoted to collecting (and mocking) their antics. 

But what do mental health professionals make of these individuals? They certainly have idiosyncratic and over-valued ideas. Their behavior is sometimes described as "bizarre." When they put forward their ideas they talk in a strange pseudo-legal language that sounds idiosyncratic and grandiose, resembling what Silvano Arieti called "talking on stilts." But the limited available literature suggests a wariness to include them under the umbrella of the mentally disordered. Sovereign Citizens share their beliefs with other people; they are typically able (if not always willing) to converse with professionals, and they don't necessarily meet other criteria for mental health problems. A good case series can be found in this article by a US psychiatrist, and their spread into Canada is evidenced in this article by two University of Toronto psychologists. The case of Sovereign Citizens provides a fascinating example of a distinctively American extreme belief system somewhere between the religious and the legal. It also speaks against the worry that the country's mental health care is nothing more than a way of regulating political and social deviance. 

The Pool of Explanations

I'm loathe to return to this subject. Sensible Twitter voices have lamented the repetitive diagnosis debate, and it fuels ugly disagreement. But it is an issue I care about, and one that really matters, so here goes.

A couple of years ago I wrote a post in response to DCP guidelines on psychologists' language in mental health. This week a sharper, wittier writer has made similar points. It brings up all the same arguments, which have played out on Twitter in a remarkably similar way. 

For the avoidance of bad feeling, I would like to address this post directly to people who would normally disagree with me. I want to make a short, good faith argument and try to persuade you of the merits of what I said then. But I want to do it in a way that brings you with me. I plead for your good humour and open mindedness. Despite the siloing that happens in social networks, virtually everyone who engages in this debate is on the same page in one major respect. Everyone wants better mental health care. 

Why does such a goal lead to concern about the DCP guidelines? It has to do with the pool of explanations. The pool of explanations is the set of viable theories a person has available to them to make sense of their psychological suffering.

The great liberating component of opposition to diagnosis has been in the push to a wider range of explanations for people to use in making sense of their experiences. We want to move beyond limiting and dominant accounts like simplistic versions of the chemical imbalance theory, or over attachment to DSM categories. However, the mind is so mysterious that very a relatively small proportion of historical theories (see e.g. the "schizophrenogenic mother") can really be conclusively junked. For the time bring,  more is better. Frameworks that emphasize the importance of trauma, of relational and interactional factors, and of intrapsychic processes have pulled back successive layers of mire from our vision of the field, and have liberated many people. Frameworks that talk in terms of illness and diagnosis continue have real meaning for others. This isn't controversial.

Until a new epoch of more comprehensive mental health theory, it is absolutely incumbent on us to continue to grow the pool of explanations rather than shrink it. Shrinking the pool pushes people out. Enlarging it means more imagination, more discovery, and more choice. This is not a call for a slide into relativism. We need a range of ways of getting at the single inarticulate truth. We need a cacophony of voices in order to approach understanding.

The DCP language guidelines were not an expansionist project. They sought to shrink the pool of available explanations. This was for noble reasons, but with unintended effects. They alienated people who do relate to diagnostic/illness language, and they policed the language of professionals who already prize reflectiveness and theoretical pluralism. As someone who works with the confounding complexity of mental health every day I value explanatory pluralism. You can refine language to avoid harm, but you cannot make reality more tractable by dispensing with whole swathes of lived experience. This is not an ill tempered intellectual game we are playing. It is real people and their real sense of self. It matters.