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Many people suffering from persecutory delusions have very weird, clearly improbable stories about how they are being persecuted. However - correct me if I'm wrong - in many cases these stories are, at least theoretically, possible.

If, for example, someone believes they are harassed by a Satanic cabal that has hacked their computers and phones, and is exfiltrating data from said devices, makes certain they will not get a job by pulling strings from behind, sends goons to stalk them and chase them down the street while leaving little tangible evidence for its actions and this is all happening without any obvious reasons then, granted, in the vast majority of cases such a person will, indeed, be delusional.

Nonetheless, it is possible that such a person is not delusional and, instead, this is precisely what is happening. Add to the above story that the Government is plotting with the coven against this person and the story will still be possible, even if highly improbable. It might even be the case that the persecutors are subtly convincing everyone that their victim is delusional to gaslight their victim.

Is it a real worry that a person suspected of and treated for persecutory delusions is actually really being persecuted? Even if this is a very rare case it still seems to me that treating a person who is indeed being persecuted for persecutory delusions is one of the worst things that can be done.

How is it being ascertained that this situation does not happen? That a person suspected of persecutory delusions is indeed delusional and not actually persecuted?

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    $\begingroup$ I think you're not appreciating the level of "possible" that is typical of these delusions. It's also "possible" for monkeys on a typewriter to produce the works of Shakespeare, but it isn't really fruitful to wait for that to happen. $\endgroup$
    – Bryan Krause ♦
    Commented Dec 29, 2021 at 22:15
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    $\begingroup$ Whilst I appreciate the analogue, I feel it's only right to point out that we have a fair amount of evidence that monkeys did in fact evolve and write the works of Shakespeare. Then, the question is asking about evidentiary standards, not probability and geological time. $\endgroup$
    – Jiminy Cricket.
    Commented Dec 29, 2021 at 22:31
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    $\begingroup$ @ARogueAnt. I assure you, a physician with a probable diagnosis is not going to wait for all the alternative potential causes for that diagnosis to evolve in order to exclude them before sticking with the diagnosis they've come to. If that were the policy we'd never diagnose anything and there would be no sense in medicine at all. $\endgroup$
    – Bryan Krause ♦
    Commented Dec 29, 2021 at 22:43
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    $\begingroup$ I agree with the last comment from @BryanKrause but nevertheless, the OP has raised an interesting and, to a certain degree, valid argument which would ethically need to be borne in mind. Look at the situation with the Rohingya Muslim persecutions in Myanmar which officials there deny exists. One point I would need to add however, is that the hypothesis is not strictly proven yet. "However - correct me if I'm wrong - in many cases these stories are, at least theoretically, possible." needs some research citations to prove or deny this claim. $\endgroup$
    – Chris Rogers
    Commented Dec 30, 2021 at 7:05
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    $\begingroup$ It's worth noting that in addition to false-negatives, the profession has been subject to false-positives potentially more often, such as the satanic panic and a variety of other false accusations. $\endgroup$
    – Arnon Weinberg ♦
    Commented Dec 30, 2021 at 7:28

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By checking if they have a mental illness to go with it or not and if they have any proof or evidence besides what they are saying :)

A good psychiatrist would look at evidence from other areas: does the person have cognitive difficulties? Are they coherent? Are they organized in their speech? Do they appear healthy if I ask them about everyday items, stories, and things that happened to them other than the story? Do they have a healthy memory (again, when asking about other than the story)? If they have a delusional mental illness, I would find it hard to have anyone believe them, even if what they are saying is true.

Here's DSM 5 and it's what psychiatrists use to diagnose. So they will check for symptoms of schizophrenia (disorganized speech, memory problems, etc) or any delusion-related disorders. https://repository.poltekkes-kaltim.ac.id/657/1/Diagnostic%20and%20statistical%20manual%20of%20mental%20disorders%20_%20DSM-5%20(%20PDFDrive.com%20).pdf

Furthermore, many people believe, for example, that the government is conspiring against them and are pretty healthy in every other way. Those people might just believe in something improbable. It could be true (or not) because we humans can be perfectly healthy and believe things that are not true. An excellent way to ascertain the truth is to always ask for evidence or proof, which I think is standard police/justice procedure. This will differentiate people who believe something vs people who know something!

Here's a really nice note about the psychology of belief: https://www.psychologytoday.com/gb/blog/finding-purpose/201810/what-actually-is-belief-and-why-is-it-so-hard-change

So, in short, it is ascertained by checking that person's full mental health and if they have any real proof or evidence of the matter besides what they say. They can be mentally ill, or healthy and believing in a false story, or that everything they are saying is true and happening as they say it. It will depend on the judgment of the psychiatrists and police etc, who see them.

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