A difficult case: Diagnosis made by hallucinatory voices (1997)
researchgate.net
researchgate.net
https://www.reddit.com/r/legaladvice/comments/34m92h/update_...
So I wonder...is it possible that this person's memory (of e.g. personal health research) or consciousness was affected by the malady to the degree that she perceived her own past experiences forming into intuitions that were so foreign that she interpreted them as others' voices?
My sense of time was screwed up.
It got to the point I would often joke about being casualty challenged. (When more lucid)
Hallucinations started up from this. A constant sense of doom became the norm.
So yea, confused timeline, hallucinations and, and a sense of going to die can make some interesting and unpleasant mental games.
At some cost we could capture the CO2 that comes out of a power plant, clean it, compress it to 1500 psi or so, then inject into the ground somewhere. Engineers get bonus points when they use the CO2 to flush out extra oil, since CO2 mixes so well with oil. (Roughnecks have been pumping CO2 out of the ground in Texas and using it for oil recovery since the 1970s.)
Turns out a CO2 pipeline is more dangerous than a methane pipeline. Methane can burn, but it rises, so the danger is in a limited area. CO2 on the otherhand will sink downhill and accumulate in places and quickly suffocate people.
Terrifying, you're suddenly out of breath but don't know why, and then you die without knowing you'd be okay if you stood on a roof or tree.
Guy from gas company made it clear no one would be waking up in a matter of days
I'm not sure that I've experienced CO2 poisoning per se, but definitely higher-than-safe levels of it. We were installing new air quality sensors at an indoor farming facility when we (eventually) discovered the existing CO2 alarms were malfunctioning. The symptoms came on fast and immediately affected my ability to think. The first sensors we installed reported something like ~6000ppm, which we assumed to be a calibration error because no way people had been working at those levels. Didn't even occur to us it was accurate. A few minutes later I remember just staring at another sensor unable to decide which way to install the battery.
We didn't even realize something was wrong until I went outside for a few minutes.
EDIT: grammar
Life- or health-threatening CO2 poisoning, maybe, but low-level cognitive impairment due to elevated CO2 is extremely common in indoor environments.
Unfortunately medical literature for long term natural gas exposure is limited since people tend to explode.
Rental company kept making excuses for smell. Claimed it was not gas.
After 3 months of total health meltdown I called gas company. Their alarms went off at road. Started screaming at us to get away. Guy was amazed any of us were still alive.
As it is, me and at least one kid have permanent changes from it. She’s was gifted, now is borderline special needs.
Which is, we're really good at crafting narratives and conforming our perceptions to fit them, whether or not our brain is working right, and bystanders should probably not take the narrative at face value.
I love medical reports.
Makes me think about set and setting with psychedelics. Maybe our schizophrenics have menacing delusions because our culture is full of hostility and negativity.
There are counterexamples in our culture though. You find them in the new age, occult, and some religious communities. I think some channelers, alien contactees, prophets, etc. probably are schizophrenic but some of them relate positive experiences and messages. Maybe high functioning schizophrenia is just a very non-neurotypical edge case.
I'm not downplaying the other aspects of this case though. In this case actual novel and objectively verifiable information seems to have been learned. It's a particularly compelling one because it happened under the loose observation of medical professionals, but if you talk to people you hear less extreme anecdotal experiences like this all the time. I've heard tons of parents tell me stories about spooky parental intuition, things like "knowing" that a child is in danger and going and saving the child just in time.
I'm an open minded skeptic on this stuff. I tend toward the skeptical but don't completely dismiss it. Speaking of delusions, the idea that after methodically doing science for only ~200 years we know everything is a peculiar delusion of our culture.
Always makes me think of this:
In many tribal cultures, what western psychiatry castigates as schizophrenia, they honor as shamanism.
https://slatestarcodex.com/2020/06/01/book-review-origin-of-...
I remember reading a reddit comment and my internal voice changed to what seemed to me like a very relaxed well studied black pimp.
I've had audio hallucinations before when I was a teenager and had a high fever and I could hear bell-like noises from a wall and what I can only describe as female angels singing -- the hallucinations had a very positive mental impact and in the morning I felt much better physically.
Anyway -- all these audio hallucinations have been very positive, I don't want to think how bad any negative voices can be.
The human mind is such a fascinating thing.
When you have hundreds of millions of people, these events happen several times per day.
The patient had tumor in her head causing voices. The voices made right call. Voices are not random. They come from the same brain that is worried about being crazy or sick.
Similar to this event, doctors didn’t believe him (there were no signs of a tumor, so they had no reason to) but had a scan done anyway to make him go away, and his son had a tumor exactly as described.
Anyway cool story.
I just want to clarify that I did not find this ResearchGate article by googling for dexamethasone. I hadn't heard of that until now! I found a link to this article on the front page of a certain news site, and thought the fine people of HN would enjoy it.
Thank you very kindly for the corrective post!
This example (which OP helpfully told me I was mistaken about) would have been one of a sort of "forced hand" as in stage magic. I doubt as anyone could have foreseen that specific paper being googled up, but one can easily foresee things relating to that drug being more exposed in a group like ours than they were ... 4 years ago or something. Add a lot of little things up like that, and you can really push things in a desired direction in a group of people. Enough groups of people, and you are influencing an entire society in pretty radical ways. Lots of modern propaganda works this way in large and small ways. If you've been alive for a while, you'll see that we've had some pretty significant changes for the last couple of decades.
My "contribution" would have been providing a model to test scenarios. They actually funded a considerably less speculative project than mine: more or less Poisson regression applied to this problem.
This sort of thing happens all the time, the unusual thing here is that someone wrote it down and got it published.
> On one occasion, Dick was startled by a separate recurrence of the pink beam. It imparted the information to him that his infant son was ill. The Dicks rushed the child to the hospital, where his suspicion was confirmed by professional diagnosis.
https://en.wikipedia.org/wiki/Philip_K._Dick#Paranormal_expe...
FWIW, I once attended a thing that was sponsored by invisible purple telepathic space dolphins, so... yeah. Just a group hallucination?
I think it’s very similar in science. It’s difficult to argue that this is science because it seems impossible to design a repeatable experiment which yields the same outcome every time.
Turns out, it's unethical to design "repeatable experiments" when it comes to the human existence, which is why we have to make do with less rigorous forms of science. That doesn't mean it isn't science, it just means it's harder to draw solid conclusions than "just run a repeatable experiment".
By the logic you stated, seismology or volcanology would not be real sciences either, as earthquakes and volcanic erruptions can't be repeated with the same outcome each time.
Now, the article does seem to light on clinical details, and has a few personal flourishes that detract a lot from its use as a basis for a future study of similar cases, so I don't disagree that it's not really a scientific article, but the reasons are more nuanced. Well-written case studies are absolutely a valid scientific tool. This one reads more like an anecdote than a case study, though.
Provided the author is otherwise trusted, even anecdotes add to the scientific corpus. "Hey, I saw this" is IMO valid science, even if a more thorough examination would have been better.
What would a medical practicioner be expected to take from this case study? I don't think it's that "psychic phenomena are real", really. In addition to just an entertaining story , perhaps "don't be so quick to dismiss what apparently mentally ill people are saying, pay attention to them and respect them as people."
They (not necessarily all applying to this one) illustrate that: (A) This fucking cool thing happened. (B) This weird presentation (or lab finding, or imaging) turned out to be, we're pretty sure, X. (C) This weird presentation or case was successfully concluded with treatment X, with the caveat that, you know, we can't prove it was the treatment that did it.
When other docs are searching for "wtf is this weird presentation?", finding a case that shares other clinicians' reasoning and a possible diagnosis for that weird presentation is super helpful. Some things are too rare for your immediate colleagues to have much insight.
Case studies are professionals kibbitzing with one another, not science. They may give rise to science, as when an unconventional but logically sound therapy appears to have worked and prompts someone to test it in a proper trial.
If you click through to the actual PDF, it's not a medical paper. It's a collection of anecdotes without evidence, of lower quality than the light medical anecdotes in Discover magazine. This is neither science nor medicine.
Person suffering hallucinations is concerned they have a brain tumor, experiences said concern in the form of hallucination, turns out to have brain tumor, isn't an extraordinary claim. Person with symptom X consistent with disease Z worries they might have disease Z, expressed through symptom X, and finds out they have disease Z is ... not extraordinary at all. It's the particulars that make it an interesting anecdote, but the overall phenomenon isn't. Imagine we changed it just slightly:
Patient with spastic paralysis of their lower limbs thinks they have a brain tumor. Attributes that thought to themselves. Calls the nearest big medical center - because that's what people worried about cancer do - and gets seen by onco. Onco finds a brain tumor. Unsurprising, because central neuro symptoms.
The story changes only insofar as "symptom was a cognitive effect that made it an interesting anecdote."
No, burden of proof is on the person making the interesting claim. If I claim that I went to Mars, and you claim I'm lying, the burden is on me to prove I went to Mars, because humans lying is boring, and humans going to Mars is interesting.
This is what people are trying to get at with the "extraordinary claims require extraordinary evidence" copypasta: It's so easy for humans to make shit up that the evidence is on the person who told the story, especially if it's an interesting story you want to believe.
> Fear of the unknown is also a bias we should be aware of.
Bulverism is saying "Of course you believe/don't believe that because of some trait you have!" It's irrelevant, in that it doesn't disprove the belief. It doesn't matter if they believe something because it's blue on Tuesday and today is Odin's favorite month. If it's true, it's true, and if it's false, you only find out if it's false by examining the belief and its logical consequences, not the traits of the person who proposed it, positive or negative.
You can heal someone by giving them sugar pills, that makes no sense (said a straw-man i just built) - yet placebo effect is a reality. As a matter of fact placebo take place even if you tell patient that they are given a sugar pill that has no effect on them (though effect is lower).
We are not master of our brain.
There are a lot of things happening inside that we are not aware of or only vaguely. Like split brain patients show symptoms of possibly two entities with separate choices on given questions.
Also consider tuplas, which are created entities that are separate from yourself living gin your brain. Those I believe were first described by Buddhist monks.
And the whole multiple personality disorder. I remember reading article about a person that was blind when one personality was in charge. Theirs pupils would not respond to light like a blind persons.
Sure there is no definitive answer here, but saying everything is fake and you need hard evidence is not getting us any closer to the truth.
A variant of this appears in the abstract: that some speculated she was somehow unconsciously aware of the tumor or "not feeling right" and that perhaps she had internalized more knowledge of the locations of hospitals than she was aware, so this surfaced as the hallucinations telling her to go to the place she knew (without knowing) could fix it.
The third of your ‘easiest explanations’ is pretty much the third explanation offered in the article. The article is an object level description of what happened, with little to no speculation, apart from three tentative explanations, and does not endorse any remarkable claims about how the world operates.
You have invented that ‘implication’; nothing in the article even hints at that being the obvious implication and it’s entirely unclear what you “don’t believe” to people that have actually read the full article.
The implication of the actual article, if you read it to the end, is the exact opposite.
The paper suggests this as one possibility too.
What I take from this is simply that we shouldn't be so dismissive of what "crazy" people are telling us, but should pay attention to it. Regardless of what caused it (assuming the story is true and not simply fabricated), this was a case that paying attention to what the 'crazy' person was saying, instead of just dismissing it as crazy, resulted in a succesful medical outcome.
It's also what I argued in a thread about Mr. Robot (a show where the protagonist perceives an individual who doesn't exist) sometime back.
Someone was asking how Elliot could be on a computer while Mr. Robot is scanning a bookshelf. My proposal was that Elliot memorized the bookshelf as he walked past it.
Per the article, that is a pretty unlikely explanation, given the vacation and her entitlement to free treatment regardless or the psychiatric eval.
The more likely explanations are either that the story is made up by the doctor, in whole or in part; or the 3rd explanation of the article, that prior knowledge for the woman, along with the tumor itself and different kinds of unpleasant sensations, led to the psychiatric symptoms focusing on the idea of a brain tumor.
EDIT:
> Similar thing is going on with resignation syndrome in Sweden, where refugee children are pretending to be be in coma/sleeping because this prevents Sweden to send them out of the country.
Reading a bit about this, it seems that the Swedish health authorities who actually investigated these children believe that this is a real condition (whether a novel condition or some form of psychosis or depression), so I'm not sure why you are so confident in asserting that it is an obvious ploy.
One possible take on it is that the tumour made her plural/multiple. Then her new members wondered where they came from and came up with the tumour explanation, researched treatment, and communicated it back to her main self.
Read this if you haven't heard about plurality: https://en.m.wikipedia.org/wiki/Multiplicity_(psychology)
are you unacquainted with the concept of expressing your disagreement without pretending you're better than someone else? if you do that it'll make your point stronger, and should come across as less insecure , less compensating, and less triggered.
you can be right from your point of view and so can someone else, and that's okay. no need to try to trash someone else in the process is there?
You can call it whatever you want, but DID is indeed recognized in the DSM-5 and fits the OP story, and the disorder vs neurodiversity argument is largely tangential to the question of whether the condition exists at all, which it clearly does.
"Science" in general has a terrible track record when it comes to the human brain, because we still have no idea how most of it works and you can't exactly attach a JTAG debugger to someone's head. So saying psychological conditions "aren't science" is unscientific, because a proper scientist in the field would accept the limitations of the field, and be open to consistent phenomena (which telepathy isn't with the hard sciences, but multiplicity is).
I'm not sure that it fits the OP story, though, at least at is told. As far as I understand, DID would be recognizable to others, it would not be purely perceived as a hallucination by the patient. Even if she were not aware of this, her husband or others around her would have reported behavioral changes, presumably.
Otherwise, I tend to agree with what you are saying.
From there I may say that a more accepted diagnosis like "schizophrenia" still has imprecision and wiggle room, owing in part to the fact that we don't fully understand mental illness.
This was a wildly serious problem. Psychoanalysis was really only practiced at scale in the US and Argentina, so people made up theories of why New Yorkers were more psychotic than Londoners (this is somewhere in "Listening to Prozac").
I think what has happened in the mental health field (and I've been a psychiatric patient-consumer for 15 years) is that the DSM movement has finally fixed definitions in place. But defining something doesn't mean it exists (except as a cluster of symptoms that front-line clinicians treat out of "data science" type knowledge). It's possible that the only clear-cut differential diagnostic is the one made by Kraepelin in the 1890s between what's now called bipolar and "precocious dementia" (more or less schizophrenia, but who knows what schizophrenia IS rather than IS NOT). And even this is challenged in the literature. How could it not -- looking at an episode and not doing the elegant analyses made possible to Kraepelin from working in a psych ward full of unmedicated bipolars -- how could you distinguish manic and schizophrenic hallucinations?
My doctors have kept me reading the academic journal literature over the years (abeit literature about bipolar, not dissociative disorders); but by the same token I figure it's difficult to place someone's multiple-personality story in any one of the available boxes (dissociative disorders, together with amnesias and fugues; schizophrenia; malingering). What the bleep do we know.
I have one thing I would like to highlight:
> people made up theories of why New Yorkers were more psychotic than Londoners (this is somewhere in "Listening to Prozac").
Maybe I need to read your source for more context. But I could see this being a very alluring theory in prior decades, before New York and urban areas in general started seeing massive crime drops, gentrification, etc. In the 70s and 80s many talked about New York as an ugly place, somewhere to escape from. It's pretty different now.
Then I wonder about some other uniquely American problems, like the extent of our gun violence, or poor health care. And I wonder what people may say about mental illness rates compared to other developed counties. (Surely someone has looked.)
Given its inclusion in the DSM-5, I would venture to say that the opposite is true - that the majority (or at least, the majority of the more prominent psychiatrists) do believe it is a real condition.