Having practiced psychiatric clinical care for more than 30 years, the psychotic symptom I am most familiar with is delusion of victimization. Because this symptom is not only seen in traditional psychiatric disorders – schizophrenia or paranoid psychosis, but also in depressive episodes or mixed episodes of mood disorders, especially bipolar disorders, I have always been very curious and wanted to find out the pathopsychological mechanism behind this symptom. Whenever I have encountered a patient with delusions of victimization in recent years, I have delved into the psychological background of the formation of the patient’s delusions of victimization. According to the definition of psychopathology, the delusion of victimization in psychiatric patients refers to the patient’s conviction that he or she is being persecuted or murdered by others without sufficient factual basis, and the conviction that it will lead to certain consequences that will jeopardize him or her, such as damage to interests and reputation, or even the death of his or her family or even his or her life. A few decades ago, once a patient was found to have a clear delusion of being victimized, most doctors would “logically” diagnose the patient as suffering from schizophrenia or paranoid psychosis (here “paranoia” refers to the psychiatric concept of paranoia, see my article “Psychiatrists Speak Out” on my public website. (The term “paranoia” in this context refers to the psychiatric concept of paranoia, see my article “Psychiatrists Explain the Words: Paranoia, Paranoia, and Stubbornness”), because according to the diagnostic concepts of the time, it was almost universally accepted that delusions of grandiosity must necessarily be a form of schizophrenia or paranoid psychosis. Even to this day, this notion has considerable influence among psychiatrists worldwide. However, in recent years, as I have gained a deeper understanding of and thought about psychotic symptoms in patients with mental disorders, I have found that delusions of victimization are not diagnostically specific, but are merely an important marker indicating that the patient’s illness has reached a psychotic (精神病的)severity. Based on my observation of and communication with many patients, I believe that there are two basic forms of delusions of victimization, as distinguished from the pathopsychological background and developmental process. One is the belief that he or she has, in the past, inadvertently done something wrong, said something wrong, offended someone or some people, causing these people to have a grudge against him or her, and that he or she will retaliate and persecute him or her because of grudges, even after the passage of time. Such patients believe that the cause of their persecution is their own unintentional mistakes that hurt their present-day persecutors, i.e., they believe that they were at fault in the first place, and that they were punished by persecution in the second place, which is indeed the cause of the incident, only that the severity of the persecution they are currently suffering is far more serious than the punishment that should have been accepted for the mistakes that they made in the first place. Therefore, such patients, while regretting the mistakes they made due to their own carelessness, are also disgusted, fearful or angry at being “punished” to such a serious extent, and hope to avoid the unacceptable consequences by all means. Secondly, the patient believes that he or she is wise, talented, or rich, and that he or she has attracted the “envy, jealousy, and hatred” of many people. Patients will also believe that these people may be both “alone”, because “a mountain can not be two tigers” and kill; or because of the so-called “the class results of the second student is most looking forward to the first classmate to transfer to school “and the implementation of” forced “persecution means of nature, so that they know difficult to retreat or flee; may also be too much because of their own cynicism, resulting in these jealous people to join forces to persecute them, or by one of them to take the lead in the organization or “buy” Some coercive personnel, “cooperation” or “joint” persecution. If we look at the identity and background of the persecutors from the outside world, patients with the first form of delusion generally believe that the persecutors are ordinary, mostly “common people”, and do not have the deep social background or official status that only powerful people have. The identity of the persecutor identified by patients with the second form of delusional thinking tends to be more special, for example, the patient will firmly believe that the persecutor has a powerful backer, a deep social background or even “all-knowing”, and is powerful, and believes that the act of persecution against him or her may be directly directed by the official authorities and assisted by the official forces. Some patients even believe that a high-ranking official or a prominent and powerful person is directly manipulating and directing the persecution of the patient. Regardless of the above forms of delusion of victimization, if the patients are asked why the persecutors have failed to succeed in their schemes so far, some of them will say that they may be secretly protected by the forces on the opposite side of the persecutors. Sometimes the patients also believe that there seems to be an uneasy relationship between the forces of persecution and protection, so that the more intense the persecution, the better the protection seems to be. The two forces seem to “tussle” around each other for some elusive purpose. Moreover, some patients’ delusions of victimization shift in form and content between the two, i.e., at one time, the patient may be convinced that he or she has offended a “villain” through an unintentional mistake of a long time ago and is being retaliated against by him or her, while at another time he or she may believe that he or she is persecuted by people with a special background because he or she is talented in a certain aspect and has incurred cynical resentment. At other times, the patient may think that because he or she is talented in a certain area, he or she has attracted hatred and is persecuted by some people with special backgrounds. Sometimes it is difficult for the patient to distinguish which of these forms of persecution he is suffering from. It is because the patient’s delusion of victimization has such a complex alternation, transformation, intertwining, entanglement, some patients may feel that they may be inadvertently caught up in the ulterior motives of the person who made a “game”, he or she has become a bargaining chip or pawn in the fight between the two sides. Some patients may think that such an intricate situation may mean that it is a “bureau” deliberately designed by a person in a high position of authority or an institution or organization residing in a high position above the temple, in order to test their intelligence, ability, “emotional quotient” and other comprehensive qualities, and that it is a “God will send a great man to do a great thing”. “God will send a great task to the people also” before the “bitter mind”, “labor”, “hungry body skin” type of exercise and temptation. Exercise and temptation. There are even patients who constantly form the judgment that the top-level authority is “playing a big chess game” in the conversion and change of these two types of delusions, and believe that they are “fortunate” to be involved in this game because of their special background or accidental reasons. Some patients are happy to be in such a risky situation, willing to do their part to win the game, and even want to somehow show their goodwill to the higher-ups who have included them in the game, to express their willingness to say “how nice it would be if you understood me”. However, for the vast majority of patients in the first form of delusional victimization, they are more often than not in a quagmire of pain. Most of the patients have tried to struggle in the early stage, for example, some of them will seek help from their family members, society or the police. However, as the patients fail to get the response they expect, they may suspect that the persons concerned have also been bribed or coerced by the persecutors and have become accomplices, or they may feel that they may have “deserved it” and that no one is willing to help them relieve their predicament, thus falling into a state of disappointment or despair. As a result, they may fall into a state of disappointment or despair. Of course, there are also some patients who have the idea of “one person doing the job for one person”, so as to prevent their family members from worrying about them, so they deliberately conceal their persecution and suffering from their family members, or even reject some of their family members’ suggestions on how to resolve their “predicament” for fear that their family members may be implicated by them. Some of them may carry knives with them for self-defense, while others may fight like animals in a trap, launching vengeful attacks on their suspected persecutors, resulting in tragedies. Of course, the second form of delusion of victimization as the main thinking disorder of the patient is not always intoxicated, there are many times will be due to the feeling that they do puppets, pawns or manipulated to play the role of the pain, some patients may also want to break through such a mystery and desperate to make dangerous moves, such as kidnapping, coercion he identified as the “informant Some patients may also want to break such a mystery and take dangerous actions, such as kidnapping or coercing the person he identifies as “in the know” to “show the cards” and ask the other party to “reveal” the mystery for him. A significant proportion of patients with delusions of victimization do not take action to alert or complain to state agencies such as public prosecutors and law enforcement agencies. Most of them think that the public prosecutors and law enforcement agencies are not impartial, unreliable, and will not solve the problem for them, and even think that these agencies may have become accomplices of the persecutors. I have asked patients who think this way why they make such presumptions or judgments, and they often reveal their distrust of these institutions in a more subtle way. Most of these patients explain that these judicial institutions also do not help patients who are the weaker sex, but rather aid and abet the persecutors. Further delving into the reasons for their distrust of the outside world reveals that these patients generally suffer from both a poor sense of security and a weak sense of rules. In terms of poor sense of security, it is both the source factor of the delusion of victimization and the reason for the distrust of state apparatus such as public prosecutors and lawyers and even of justice. Most of these patients have accepted and adhered to the credo of “only three words for a man, not a whole heart” since childhood, and generally do not trust others, especially “outsiders” who are not related by blood, and it is difficult to establish sufficiently close and trusting interpersonal relationships with others. In the intricate process of interpersonal interactions in modern society, such patients, in the absence of a sufficiently strong, powerful and extensive social support system, can hardly enjoy smooth sailing in the competition for survival, and will certainly experience frustration, disappointment and loneliness when they encounter setbacks. In this way, the patient may gradually begin to doubt whether the attitudes and behaviors of the people around him are friendly enough, or whether someone is deliberately making things difficult for him or even secretly causing his current state of frustration. On the basis of such suspicion, the patient may gradually “go crazy”, looking for some plausible “clues”, and eventually convinced that others are not kind to them, but have other plans or harbor evil intentions, forming a typical delusion of victimization. In most of the patients with delusions of victimization, the weak sense of rules also constitutes the psychological basis for the formation of their delusions. After they develop delusions of victimization, they often do not actively “protect” themselves or “safeguard” their interests and safety through normal legal channels. Most of their distrust of law and justice stems from their own experiences of unpunished violations, and is generalized to all aspects of society without restriction. For example, if patients are asked why they are able to tolerate such wrongdoing by these persecutors with impunity? Many patients will explain that they have done some “bad things” in the past that violated the rules and even the law, and that they have escaped punishment and have never even been found out. They think that the persecution carried out against them by these persecutors is either too hidden and difficult to be detected, or that the law-enforcement officers have turned a blind eye to it, or they even think that the law-enforcement officers are in cahoots with the persecutors or that they are in cahoots with the persecutors. In particular, those who have reported their persecution to the law enforcement authorities in one way or another, such as by calling the police, but have not received any appropriate concern or response, are very likely to believe that the law enforcement officers and the persecutors are in cahoots with each other, or that they are all in cahoots with the persecutors in the first place. Other patients explained that the reason why they could not receive justice was that some of the “bad things” they had done in the past had gradually become known and spread, and that they had “lost their virtue,” which led to their “loss of help,” and they had “lost the way to help. The loss of moral integrity”, and then ” the loss of help”, so caused by the current situation of “walls fall down and people push” such a predicament. There are other patients who explain that they have had “unrighteous acts”, and today they have to suffer not only from the helplessness of “many unrighteous acts will lead to their own death”, but also from the retaliatory punishment of “treating others the same way as they do “The patient’s reasoning and judgment are in fact the same as the patient’s. These reasoning and judgments of the patients actually reflect the patients’ weak sense of rules at the cognitive level. Through the above understanding and analysis about the process of the emergence and development of the delusion of being victimized, we should realize that the delusion of being victimized has a very important significance or harm to the patients themselves, to their families, and to the whole society. As far as the patients are concerned, they are suffering from all kinds of pains, including the persecution of their lives, which may be taken at any time, as well as the pains and tensions related to the corresponding vigilance, alertness, and precautionary behavioral responses, which are obviously “like years”, It is obvious that “the days are like years” and “the pain is unbearable”, and they live a life of fear like birds of a feather, with no quality at all, and they may end their lives by committing suicide, or they may take drastic actions to endanger others. For the patient’s family members, on the one hand, they may agree with the patient’s worries to a certain extent and share the patient’s pain, but more often than not, it is the interpersonal conflicts among family members caused by the patient’s delusion, such as some people advocating to accommodate the patient’s delusion, and some people advocating to go to the hospital for medical treatment, and so on. At the same time, almost all family members and even close friends may be involved in the pain and conflict of trying to persuade the patient to correct his or her “mediocre” delusions. Moreover, family members also have to guard against legal disputes in the event of acute conflicts between the patient and others due to the delusion, and need to do a lot of explaining and counseling to the other party. For the social environment, patients with delusions of victimization also constitute an unstable factor in the society: they may not only cause tragedies by carrying out fierce “counterattacks” and retaliation against their persecutors under the domination of their delusions of victimization, but also commit suicidal behaviors due to the inability to withstand the mental pain, or even develop into extended suicides, which will also stage a human tragedy. The same human tragedy will be staged. It is precisely because delusions of victimization pose such a serious danger to patients that identifying, detecting and dealing with delusions of victimization has always been one of the key points in the work of psychiatrists.