I was referring to my own clinical observation treating psychiatric
patients. Patients with schizophrenia undoubtedly have perceptions in the
absence of stimuli: they have certain stereotypical features which make them
instantly recognisable, get better with antipsychotics and fMRI studies show
that the appropriate part of the temporal cortex is active during
hallucinations (although this is a research rather than a clinical tool).
But some patients claim to hear voices with none of the "correct" psychotic
features; similarly, they have "delusions" without the classic features of
paranoid delusions, which do not respond to antipsychotic treatment. These
patients are sometimes persecuted by the system, accused of malingering
(usually not to their face), but although some are just making it up there
are those who are absolutely consistent over time and whose life is affected
as much by the symptoms as people with "real" psychosis. It's very difficult
to even conceptualise this state where someone is not deliberately lying
about experiencing a psychosis but does not have the well-recognised
features of psychosis: it's like having the delusion that you have a
delusion, or hallucinating that you're hallucinating. Long term follow-up of
these patients show that some of them do eventually develop "real"
psychosis, and others end up doing as poorly in terms of relationships,
employment, suicide etc. as patients with schizophrenia.
Stathis Papaioannou
On 2/22/07, Jesse Mazer <lasermazer.domain.name.hidden> wrote:
>
> Stathis Papaioannou wrote:
> >
> >On 2/21/07, Jesse Mazer <lasermazer.domain.name.hidden> wrote:
> >
> >
> > >
> > > Stathis Papaioannou wrote:
> > > >
> > > >
> > > >It is a complicated issue. Patients with psychotic illnesses can
> > > sometimes
> > > >reflect on a past episode and see that they were unwell then even
> >though
> > > >they insisted they were not at the time. They then might say
> something
> > > >like,
> > > >"I don't know I'm unwell when I'm unwell, but when I'm well I know
> I'm
> > > >well". OK, but then how do you know that you're not unwell now? How
> do
> >I
> > > >know I'm not unwell now? We rely on other people telling us (although
> >of
> > > >course we won't believe them if we lack insight into our own
> illness),
> > > but
> > > >in the example of fading qualia we would (a) not notice that the
> qualia
> > > >were
> > > >fading, a kind of delusion or anosognosia, and (b) no-one else would
> > > notice
> > > >either, because by whatever mechanism the external appearance of
> > > conscious
> > > >behaviour would be kept up. So how do I know I'm not that special
> kind
> >of
> > > >zombie or partial zombie now? I feel absolutely sure that I am not
> but
> > > then
> > > >I would think that, wouldn't I? The fact is, it happens all the time,
> >to
> > > at
> > > >least 1% of the population.
> > > >
> > > >Stathis Papaioannou
> > >
> > > But are you claiming that psychotic patients not only are mistaken
> about
> > > what's going on in the external world, but are mistaken about the
> actual
> > > qualia they experience? i.e. if a psychotic says he's hearing voices
> and
> > > thinks they are martians sending him messages via microwaves, not only
> >is
> > > he
> > > mistaken that the voices come from martians as opposed to being
> > > hallucinations, but he's mistaken that he's having the subjective
> > > experience
> > > of hearing voices in the first place? I've never heard of a condition
> >like
> > > that...your example of recognizing one was unwell in the past is more
> >like
> > > recognizing the things one was hearing and seeing were hallucinatory
> > > rather
> > > than accurate perceptions of the external world, not recognizing that
> >one
> > > was not hearing and seeing anything at all, even hallucinations.
> > >
> > > Jesse
> >
> >
> >A patient says that his leg is paralysed, behaves as if his leg is
> >paralysed, but the clinical signs and investigations are not consistent
> >with
> >a paralysed leg. The diagnosis of hysterical paralysis is made. A patient
> >claims to hear voices of people nobody else sees, responds to the voices
> as
> >if they are there, but the clinical signs and response to antipsychotic
> >treatment is not consistent with the auditory hallucinations experienced
> by
> >peopel with psychotic illness. The diagnosis of hysterical hallucinations
> >is
> >made: that is, they aren't hearing voices that aren't there, they only
> >*think* they're hearing voices that aren't there.
>
> But where did you get the idea that hysterics are thought to be incorrect
> about their own qualia? Is this something you've read in an authoritative
> source, or your own inference, or something else? I had always understood
> hysterical illnesses to be something like auto-hypnosis, and if you put
> someone under hypnosis and tell them that they are hearing voices or that
> a
> limb is paralyzed, even after they are taken out of hypnosis they will
> report that they were really hearing the voices and really feeling nothing
> in the limb (it is even sometimes possible to use hypnosis as an
> alternative
> to anaesthesia during surgery--certainly the people who do this don't
> later
> claim that they really were in excruciating pain but were just temporarily
> deluded into acting as if they weren't!) Also, some early attempts to scan
> the brains of people under hypnosis seem consistent with the idea that
> there
> brain is responding as if they really were experiencing whatever they were
> hypnotized to experience--in the experiment I read about, when given the
> "Stroop task" where subjects have to identify the colors of words even
> when
> the words themselves stand for different colors (like the word 'red' with
> the letters in blue), if the subjects were hypnotized to see the words as
> gibberish, then there was decreased activity in the part of the brain that
> deals with conflict resolution and they were able to complete the task
> significantly faster (see
> http://www.bioedonline.org/news/news.cfm?art=1865
> for some more details). It would be interesting to do a similar experiment
> where a patient was hypnotized into feeling blind or paralyzed, and then
> expose them to visual or tactile stimuli--I would predict that activity in
> the corresponding sensory areas of the brain would be at least suppressed,
> even if not necessarily quite as low as in a person who had actually been
> blinded or paralyzed.
>
> Jesse
>
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Received on Wed Feb 21 2007 - 20:38:45 PST