In psychiatry, what does double-bookkeeping mean?

Question

TL;DR What does double bookkeeping mean? +1 for sharing stories about your Tappy

Tappy (Talbott) has always been a tad odd, but who'd blame him, right? The guy took a whole bunch of tropane delieriants, then locked everyone out of his apartment, flipping out for reasons unknown, then in all the chaos, seriously cut an artery on the side of his head.

Now, Tappy tells me that one term he picked up from his $350/hr psychiatrist is the concept of "doublebookkeeping" ... My impression is that it has to do with

From wiki:

Double Bookkeeping. The tendency, among those who experience delusions, to perceive reality and the delusions as both being real, while remaining unbothered by the discrepancy or inconsistencies between the two.

Isn't this description the same as the concept of reality testing? You may have weird things go on all around you, but it's not so much as "aliens are inserting thoughts into my mind as it is just merely a more open-minded approach to one's phenomenology: "It would appear as though..." "aliens are doing this to me

So, within the context of psychistry, mental-health, or psychology, how might one interpret the term doublebookkeeping?

1. Does it relate, if even only thematically, to the actual accounting concept of of double-entry bookkeeping?

2. My alternative interpretation is that it means "take the raw crazy inside your head" ("insanity"), run it through a cultural appropriateness filter, process, shake, dress it up for mainstream consumption, and then release: hello outsanity.

3. Or, do you reckon Tappy lied to me just to sound cool?

Answer 1

Within Psychiatry and psychology, Double Bookkeeping, also known as Double Entry Bookkeeping is not quite the same as double entry bookkeeping within accountancy. Within Psychiatry and Psychology, it refers to the tendency, among those who experience delusions, to perceive both the reality and the delusions as being real. There are discrepancies or inconsistencies between the two within psychiatry which the affected person may not be bothered about, whereas within accountancy, the two entries made in different parts of accounts records are there to reconcile the records and ensure there are no discrepancies or inconsistencies.

Example Accountancy Double Bookkeeping

The main accounts ledger may have a record of a transaction paying $100.00 towards a dept to Debt and Renters Ltd.

Meanwhile another entry will be made in the debts record for Debt and Renters Ltd. stating that on the same date in the main ledger, \$100.00 has been taken off the debt, with the running balance remaining being $100.00 less than previous.

All records reconcile, showing no discrepancies or inconsistencies.

In psychiatry and psychology

Swiss psychiatrist and eugenicist, Eugen Bleuler in Dementia Praecox or the Group of Schizophrenias (his 1911 seminal study, translated from German into English in 1950 by Joseph Zinkin) said on pages 56:

It is especially important to know that these patients carry on a kind of “double-entry bookkeeping” in many of their relationships. They know the real state of affairs as well as the falsified one and will answer according to the circumstances with one kind or the other type of orientation—or both together. This last is especially frequent in mis(-)recognizing people: the physician “is now here as Dr. N.,” at other times he becomes the former lover.

With this, "Dr. N." is both a former lover and their physician whilst in reality, Dr. N. was never their lover. Without the ability to carry out reality checking efficiently, they can refer to either or both as being true.

In accounts ledgers terms there are two entries in the person's main record within the mind recording the facts concerning Dr. N. without a strong second record to refer to regarding the person's past lovers.

Jeneen Interlandi, wrote in The New York Times Magazine (2012)

While we waited for the doctor to evaluate him, my father did what mental health professionals refer to as double-bookkeeping. He remembered most of what transpired earlier in the day but still believed he was in the hospital to have his pacemaker checked.

References

Bleuler, E. (1950). Dementia praecox or the group of schizophrenias. Oxford, England: International Universities Press.

Interlandi, J. (2012). When My Crazy Father Actually Lost His Mind - New York Times Magazine
Accessible from: http://www.nytimes.com/2012/06/24/magazine/when-my-crazy-father-actually-lost-his-mind.html

See also

Bortolotti, L., & Broome, M. R. (2012). Affective dimensions of the phenomenon of double bookkeeping in delusions. Emotion Review, 4(2), 187-191.
DOI: 10.1177/1754073911430115

and

Carruthers, B. G., & Espeland, W. N. (1991). Accounting for rationality: Double-entry bookkeeping and the rhetoric of economic rationality. American journal of sociology, 97(1), 31-69.
DOI: 10.1057/9780230304253_12

Answer 2

I think "double bookkeeping" here refers to the practice of some unethical accountants of keeping two sets of accounting books - one with the "real" numbers for day-to-day use and one with the "show" numbers that are available for auditors, attorneys, etc. to view.

Thus, a patient who is engaged in "double bookkeeping" could be, in essence, keeping two sets of "books" in their minds, with those "books" being world-views or understandings of reality. One book might compartmentalize the "delusional" ideas (with the rational ideas stored in the other book), or delusional ideas might be apportioned among the books in such a way that each book is internally consistent (e.g. Book 1 says space aliens ate my brain, but there are no Crab People, while Book 2 says that there are Crab People who are controlling the House of Representatives and who are holding my brain hostage on Saturn but that my brain was not, in fact, eaten, and Crab People come from Memphis, not space).