Hypothetical Q's about psychotic beliefs and antipsychotics

[Mister Agenda]

From what I've learnt, psychosis is a false perception of reality, which is categorized into 2 kinds: hallucinations and delusions.

Be careful to distinguish between ordinary false beliefs and delusions that warrant a psychiatric diagnosis. They are quite distinct. It's possible that no one is entirely free of delusion if any belief unfounded in reality is considered a delusion. It would be fair to say the distinction is between false belief due to misapprehension and false belief due to mental illness.

1) I believe that antipsychotics are usually prescribed when a person has a paranoid belief. However, I think that psychiatrists rarely bother to check whether the paranoid belief is true or not. They just assume that the paranoid belief is false because they deem it implausible.

I don't think psychiatrists just assume a belief is untrue because it is implausible.Paranoid personality disorder is associated with generalized deep suspicion of others and paranoid schizophrenia involves hallucinations. In either case the problematic behavior would have to persist over months before a reputable psychiatrist or psychologist would render the diagnosis.

Consider person A who thinks his wife is spying on him. If he is right about his wife spying on him, then his belief that his wife is spying on him is not psychotic. In fact, if his wife was really spying on him and he believed that she wasn't, then that would be a psychotic belief, for it would be false. So why don't psychiatrists spend more time verifying the falsity of a particular paranoid belief before labeling it a "delusion".

You're equating being wrong with being delusional. Whether the person is delusional in the psychiatric sense depends on the basis of the belief, even if it is true. Even if your wife is spying on you, it is a delusion to believe she is if your belief is rooted in a mental disorder rather than evidence. Whether your wife is spying on you or not, what makes your beliefs about it delusional is why you believe it, not whether it's true.

2) Suppose person B believes that his wife isn't spying on him when in fact she is. B is psychotic because he has a false belief about his wife. Would he respond to antipsychotics? This is an example of a psychotic (false) belief that isn't paranoid.

Anti-psychotics have no effect on beliefs held for reasons other than particular types of brain malfunction. If person B believes his wife is not spying on him despite finding hidden recording devices around the house and receipts in her name for them, then you might have the beginnings of a justified suspicion that person B may be delusional...but trusting your wife so much that you can't believe it is not in itself a delusion.

3) For another psychotic belief that isn't paranoid, consider a physics student who believes that the sun actually rises in the west and that it is an optical illusion that it rises in the east. Would he respond to antipsychotics? Or more importantly, should society prescribe him antipsychotics or try to engage him in an intellectual debate? For all we know, he may be the next Einstein!

If the belief is rooted in particular brain dysfunction, the student might respond to antipsychotics. 'Society' should not prescribe him antipsychotics without a proper diagnosis and an indication that the belief interferes significantly with the student's life to the point that prescribing medication with potentially dangerous or even fatal side effects is warranted. There's nothing wrong with engaging someone in intellectual debate if they're willing, you could say that cognitive therapy is a form of this.

4) Finally, and relevant to this forum, should religious people be prescribed antipsychotics? Have any religious people become atheists as a result of antipsychotic treatment? I ask because we know that religious belief is one delusion that does not respond well to reason or argument by itself.

A belief not being rationally justified is not the same thing as it being delusional in the psychiatric sense. I think Dawkins was rather reckless in titling his book on the topic. Religious ideation is associated with some forms of schizophrenia, and can be 'dialed back' under the influence of antipsychotics. Ordinary religious belief held because it's what you were raised to believe would not respond to antipsychotics, and in my opinion it would be very immoral to prescribe them for that purpose.

Not responding well to reason or argument is a common trait in humans, it's a feature, not a bug; despite the problems sometimes caused by it. A significant portion of our social cohesion depends on that trait. Anything that would put a person at the 'right' level to 'respond well' to reason or argument would likely be able to put someone all the way to 'gullible' with a slightly higher dosage. Being resistant to reason and argument may cause us to not be swayed when we should be, but it also helps us avoid being taken advantage of, which is more likely in many cases to result in immediate harm. We're complicated creatures, even our faults often have some value.