We Don't Know How Little We Know
What over 20 years of treating psychosis teaches me about U.S. politics today.
Posted February 20, 2026 | Reviewed by Gary Drevitch
This is a tough time for politics in America. But it’s an extremely interesting time for those of us who wrestle with the nature of reality. As a psychiatrist who has treated people with psychosis for over 20 years, I have lived in the uncomfortable space between their experience of reality and mine and I have worked to change beliefs that are some of the most resistant to change: delusions. And this is what that work has taught me about the current political moment in America.
- We have no access to objective reality.
While there most certainly is an objective reality outside the human experience, we have no access to it. Our experience of reality is informed by the way our five senses perceive the world, and how our brain processes the information.
So the best we can hope for is consensual reality, which means that our realities more or less align: We both think the sky is blue, and that what I mean by “blue” and you mean by “blue” are similar enough. But when people develop psychosis, they deviate dramatically from consensual reality into their own idiosyncratic reality. I can usually tell that their experiences, while they feel real, are not shared by a consensual reality. But sometimes I’m surprised. My Haitian patient is highly distressed while talking to me about her aunt placing a Voodoo curse on her. I think she is having a psychotic delusion, until her family joins and confirm the curse. They are sharing a consensual reality; it’s just a different one than mine.
- Our country is having a similar experience.
Lately, we are living in two completely different consensual realities. In one reality, a leftist terrorist recently attacked ICE agents with a gun, who shot him to protect themselves. In another, a non-violent protestor defended a woman attacked by ICE and was thrown to the ground and his legal and holstered gun taken off his person, after which he was assassinated by ICE agents. Both of these realities are based on the death of Alex Pretti, but the descriptions are so different that we would be forgiven for thinking they described two different events. Both groups of Americans are seeing evidence that confirms their version of their consensual reality, and it seems that nothing that the one says to the other can change their mind.
Emotionally charged learning makes ideas hard to change. When you sit through a civics lesson in class, the lecture is sent to the auditory cortex, and with little emotional engagement, it is sent to the pre-frontal cortex which processes it before sending it for storage in long-term memory . In the classroom, the stakes are low, and sometimes the information is not stored especially accurately or accessibly. When it comes time for the test, you might not remember it at all.
Contrast this with the experience of stepping on a snake. Out on a hike, there is a rustle of leaves and what looks like a stick. You step on the stick and it lunges. Your heart pounds, and adrenaline pulses through your body. In your brain, your amygdala, the brain’s fire alarm, begins firing vigorously, activating both your nervous system and the site of long-term memory storage. The events – the hike, the rustle of the leaves, the stick that was really a snake — gets seared in your memory so strongly that every rustle of leaves on a trail gets your heart pounding, sometimes for years.
This is the effect of pairing new information with heightened amygdala activation – a strong, visceral memory that is hard to forget or outreason. This is how people with psychosis often "learn" delusional thoughts. During the early period of psychosis, when strange ideas are being generated and paired with strong sensory or emotional experiences, their amygdalas are highly active, forming memories that act as thoughts that are hard to change. In the US, the emotionally charged political environment is also leading to heightened amygdala activation and strong, difficult-to-change memories and learned ideas. These memories and thoughts, in addition to being paired with strong emotional reactions, are also reinforced by the “groupthink” of our political bubbles.
- Group think is powerfully persuasive.
One of the reason that cults, conspiracy theories, and the like are so persuasive is the reiteration and amplification of powerful ideas from other members. As a group, we begin to shape a new consensual reality confirmed by other like-minded people. Over time, the ideas take shape and harden, and we are less likely to examine disconfirming viewpoints. This is known as confirmation bias . Because large news outlets and our social media feeds have for the most part chosen sides, it has become harder and harder for Americans to hear both opposing views of any politicized story, and so to some extent we all become victims of groupthink.
How do I work with patients with psychosis? How do I work with beliefs formed under fire, or confirmed by bias ? Slowly. But there are faster ways to change minds. The fastest way is to have a disconfirmatory experience. In an interview with the New York Times , Marjorie Taylor Greene described the moment she began to break from Donald Trump : At Charlie Kirk’s funeral, his widow talked about forgiving his killer as part of her Christian identity . Trump, on the other hand, said that unlike Kirk's widow, he hates his opponents. Greene took note of that, and how it strongly conflicted with her own views of Christianity. For her, that was the beginning of a change of mind.
For others, change comes after hearing a new or different message from an important person in their lives. A religious leader , a teacher, a mentor, a parent — most of us have memories of our opinions being shaped or changed by those of an important figure in our lives. This is one of the reasons that curtailing freedom of speech on college campuses, by the left or the right, is so damaging, leaving no opportunity for young people to hear alternative positions.
A final key reason that people will change their minds is through repeated cognitive dissonance . This is what I practice in therapy with patients with psychosis. Over time, if we witness our beliefs being continuously disconfirmed, we eventually change our minds. Friends have told me that the killing of Alex Pretti led some of their Republicans family members to change their minds about the administration’s approach to immigration raids and the presence of ICE in cities. Similarly, many Democratic colleagues have voiced a change in how they view the Second Amendment – from an anachronistic part of the constitution to an important mechanism for citizens to protect themselves against their government.
How NOT to change a mind
Anyone who has spent time with someone who is actively psychotic knows that simply telling them that their experience of reality is wrong will not cure their delusion. And if one is insistent that the person is wrong, the only outcome is anger and an even more entrenched position. Similarly, everyone has at some point tried to convince someone on the other side of the political spectrum that they are wrong. This does not work. Furthermore, typically these conversations, on both sides of the aisle, are condescending, and condescension only further divides us. It never changes minds. If it makes us feel better to yell into our own echo chamber, then so be it. But it is not a discourse that can make a difference.
Our country is not only divided; it lives in two different realities. To each of us, these realities feel objective. I can assure everyone that they are not. If we are to meet in the middle, we need to start with this guiding principle: We might not be right about what we think is real.
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Irene Hurford, MD, is a psychiatrist and psychoanalyst with over 20 years of experience treating psychosis with both medications and psychotherapy.
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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.