A difficult case: Diagnosis made by hallucinatory voices (1997)

https://www.researchgate.net/publication/232271307_A_difficult_case_Diagnosis_made_by_hallucinatory_voices

by booleandilemma • 6 years ago

109 75 6 years ago

researchgate.net

carapace3• 6 years ago

Needs a "(1997)" in the title.

This sort of thing happens all the time, the unusual thing here is that someone wrote it down and got it published.

leoh• 6 years ago

Fascinating — have any references?

carapace3• 6 years ago

I don't, really, but here's another well-known anecdote:

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?

marcan_424• 6 years ago

As I was reading this I immediately went for the third explanation given, or a similar variant.

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)

caymanjim4• 6 years ago

This isn't science. "Multiplicity" isn't real. The Wikipedia article on disassociative identity disorder ("multiple personality disorder") is much more extensive, and while some psychiatrists consider that to be clinically real, the majority don't. There's no evidence of any of it being anything more than an act. It's all crackpot nonsense.

bulgagoo2• 6 years ago

calling something crackpot nonsense is unwarrantedly cruel, violates the site's guidelines, shows lack of empathy with people who might believe that and you should stop doing it. thank you

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?

marcan_424• 6 years ago

"It's all crackpot nonsense" isn't a very good argument when it comes to the human brain, now is it? That sounds like the same class of garbage argument that transphobes use to claim trans people aren't real.

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).

asveikau3• 6 years ago

I don't know too much about it. But I knew somebody who said they had it and it turned out to be a more ordinary psychosis that they eventually had treatment for. Seems to me that if you are correct that it doesn't exist, that there can still be people who genuinely believe they have it and may have another illness. Those people deserve better than to be dismissed as crackpots. Like maybe to approach it as one would schizophrenia may help.

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.

tsimionescu4• 6 years ago

while some psychiatrists consider that to be clinically real, the majority don't

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.

caymanjim4• 6 years ago

I simply don't believe this. The implication is that some external knowledgable entity communicated with the patient. There's no way to prove what really happened, and in the absence of any evidence to the contrary, the easiest explanations are that the entire anecdote is fabricated; that someone was communicating with the patient through normal means and due to illness she interpreted it as a hallucinatory voice; or that the patient had acquired information about the hospital facilities through normal means and due to illness the memories manifested as hallucinatory voices. In the absense of any evidence to the contrary, I'm going with the "100% BS" option.

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.

bulgagoo2• 6 years ago

you successfully restore your worldview and advance to the next stage. achievement unlocked. 10 points

badrabbit• 6 years ago

That's not the easiest explanation, it's just more convenient for you. Burde of proof is on the accuser, you can't prove they fabricated or hallucinated and no one can prove their experience to you. If they learned new information with no prior visits to any one capable of diagnosing them then the easiest explanation is their experience was real, especially give that this phenomena has been observed in other historical cases. Fear of the unknown is also a bias we should be aware of.

caymanjim4• 6 years ago

This is the exact opposite of how burden of proof works. An extraordinary claim is being made. The burden of proof is on the person making the extraordinary claim. The claim is not only extraordinary, but the anecdote does not include any information indicating research into the origin of the "voices". I don't have to prove anything. I'm saying I don't believe it. The full article contains zero citations, zero clinical records, zero anything. It's a story. Maybe it's entertaining, but again, it's not science or medicine.

msla• 6 years ago

Burde of proof is on the accuser, you can't prove they fabricated or hallucinated and no one can prove their experience to you.

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.

me_me_me• 6 years ago

I would be careful of playing hardcore skeptic when it comes to the brain.

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.

asveikau3• 6 years ago

or that the patient had acquired information about the hospital facilities through normal means and due to illness the memories manifested as hallucinatory voices

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.

Confusion• 6 years ago

You have obviously not actually read the article and are railing against a strawman.

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.

DagAgren2• 6 years ago

The article also mildly makes fun of the people who believe it to be a supernatural phenomenon.

DagAgren2• 6 years ago

The implication is that some external knowledgable entity communicated with the patient

The implication of the actual article, if you read it to the end, is the exact opposite.

akimball4• 6 years ago

Either it happened or it didn't. If it did, it constitutes important differential information, and publication is important. Saying that it is not medicine or science implies that medicine and science disregard facts, which is an implication I reject.

jrochkind12• 6 years ago

or that the patient had acquired information about the hospital facilities through normal means and due to illness the memories manifested as hallucinatory voices.

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.

bgroat• 6 years ago

This is my understanding.

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.

themodelplumber• 6 years ago

This reminded me of the guy who thought a third party was interfering with his life, and then realized he had CO poisoning thanks to a good person on the internet. And the third party in question was his past self.

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?

treeman793• 6 years ago

I Suffered CO2 poisoning for months. This explanation is believable.

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.

quietbritishjim• 6 years ago

FYI, and sorry for the pedantry, but it's CO (carbon monoxide) poisoning. CO2 (carbdon dioxide) poisoning is also a thing but very hard to do in a domestic scenario, and especially hard to do without noticing because you'd feel very out of breath (too much CO2 in your lungs is exactly what makes you want to take breaths in regular breathing).

arkades3• 6 years ago

I find an important take-away of that CO story was "The handwriting was nothing like mine. I pulled up my old lease and the writing on the notes is identical to the landlords'!" That suspicion went away as soon as he got his head on straight.

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.

retreatguru• 6 years ago

No one on this thread is talking about the simplest explanation: that unseen entities were communicating with this woman. Of course this explanation flies in the face of scientific naturalism. But it’s good to question beliefs based on new evidence. Research by Ian Stevenson and Dean Radin is compelling in pointing to a pan psychic reality.

kiliancs• 6 years ago

It being the first that comes to mind doesn't make it the simplest, because its implications must be considered as part of the explanation.

baxtr• 6 years ago

This reminds me of a quote from Mark Cuban: “Unless you have a reliable, duplicatable, scalable and consistent way to bring potential customers in, you don’t have a business. You have a hobby!”

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.

marcan_424• 6 years ago

Welcome to psychology.

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".

akimball4• 6 years ago

It actually requires more rigor. Methodological laxity is particularly deadly in such challenging domains.

dash2• 6 years ago

This sounds as if you are saying that all psychology experiments are unethical. I'm sure that's not what you meant - expand?

tsimionescu4• 6 years ago

If you were right, science would be limited to designed experiments. The scope of science is broader, and collecting information about rare cases and studying them, even when they can't be predicted ahead of time or artificially induced, is absolutely a part of science.

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.

pygy_• 6 years ago

Science is the process that makes our cultural representations of the world match the world as it can be observed and measured.

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.

jrochkind12• 6 years ago

The practice of medicine involves sharing case studies. This is a case study. It's true that medical knowledge is not produced solely through an idealized version of the scientific method.

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."

arkades3• 6 years ago

Case studies aren't science, and aren't meant to be. They're clinical medicine.

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.

jyriand• 6 years ago

Simplest explanation is usually the correct one(Occam’s razor). In this case i would agree with the second or third explanations. She probably made it up. 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. In this case the woman wanted to get free treatment from NHS. Or maybe this whole story is made up.

tsimionescu4• 6 years ago

She probably made it up. [...] In this case the woman wanted to get free treatment from NHS. Or maybe this whole story is made up.

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.

nabla9• 6 years ago

Imagine event that could happen once in a million days (once 2700 years) , once in in 10 million days (once in 27,000 years) and so on.

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.

hprotagonist• 6 years ago

But this is the first and only instance I have come across in which hallucinatory voices sought to reassure the patient of their genuine interest in her welfare, offered her a specific diagnosis (there were no clinical signs that would have alerted anyone to the tumour), directed her to the type of hospital best equipped to deal with her problem, expressed pleasure that she had at last received the treatment they desired for her, bid her farewell, and thereafter disappeared.

I love medical reports.

api• 6 years ago

It was a long time ago, but I recall reading once that in some cultures the voices and delusions of schizophrenics tend to be of a more positive nature. In our culture they tend to be almost entirely menacing, paranoid, accusatory, etc.

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:

https://xkcd.com/638/

banads• 6 years ago

It was a long time ago, but I recall reading once that in some cultures the voices and delusions of schizophrenics tend to be of a more positive nature. In our culture they tend to be almost entirely menacing, paranoid, accusatory, etc.

In many tribal cultures, what western psychiatry castigates as schizophrenia, they honor as shamanism.

nwienert• 6 years ago

Read Julian Jaynes’ book, here’s a nice recent review:

https://slatestarcodex.com/2020/06/01/book-review-origin-of-...

raducu• 6 years ago

The first couple of times I had Zolpidem at 10mg I had the sweetest audio hallucinations -- otherworldly positive familiar voices but with an added sweetness and thinness; the voices seemed to come from far, far away.

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.

Hitton• 6 years ago

There is one more alternative explanation. There are so many different people with many different delusions without any substantiation that it's statistically inevitable that in few extremely rare cases the delusion turns out to be true.

akimball4• 6 years ago

The likelihood of stopping in an infinite search space depends on the distribution of stop regions. The hypothesis makes an implicit assertion about that distribution. I'd love to see that assertion made explicit, and support provided, if you will.

scottlocklin4• 6 years ago

One of the fun (and a little scary) things about HN is seeing what google trails led people to find the articool in question. In this case, it was almost certainly dexamethasone, which was used in the treatment of this poor lady's tumor, and which was recently revealed, rather unsurprisingly, to be a marginally effective treatment for severe Covid19. I say it's a little scary because it's the sort of thing that one could probably model, and considering the payoff, I'm sure someone has at least tried. In fact, I pitched an idea to DARPA about 12 years ago...

Anyway cool story.

motoboi• 6 years ago

I could not completely understand what you said. But found it interesting anyway. Care to explain?

scoopertrooper• 6 years ago

That's a relief, I thought I was the one having a stroke for a minute there.

pavel_lishin• 6 years ago

Why is it scary? And what's the payoff?

scottlocklin4• 6 years ago

A potentially very effective propaganda tool.

bondarchuk• 6 years ago

A woman who had a brain tumour suspected she had a brain tumour and sought diagnosis for it. Sure, the thought was of an unconventional nature, but it was still a thought she was having, despite her feeling that it was foreign in a way. Atavism of the bicameral mind?

filoeleven• 6 years ago

This reminds me of Philip K. Dick’s experience, somewhat detailed in VALIS, of receiving information via a pink laser aimed at his forehead. One of the things he learned was that his son had a tumor that needed to be removed immediately.

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.

Trasmatta• 6 years ago

Small correction, it was a hernia, not a tumor.

A difficult case: Diagnosis made by hallucinatory voices (1997)

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