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

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

#41

Post by jrochkind1 »

baxtr wrote: post #12

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.

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."

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

#42

Post by akimball »

marcan_42 wrote: post #22
baxtr wrote: post #12

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.

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".

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

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

#43

Post by scottlocklin »

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.

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

#44

Post by bgroat »

caymanjim wrote: post #5

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…

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.

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

#45

Post by PaulHoule »

quietbritishjim wrote: post #32
treeman79 wrote: post #20

Earlier quoted context omitted.

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.

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).

I attended a seminar on geoengineering and carbon capture and storage this semester.

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.

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

#46

Post by StavrosK »

PaulHoule wrote: post #45
quietbritishjim wrote: post #32

Earlier quoted context omitted.

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).

I attended a seminar on geoengineering and carbon capture and storage this semester. 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…

I remember reading about the sudden death of a few hundred people in a coastal village way back when, and it looked like the lake belched a CO2 pocket and suffocated everyone.

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.

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

#47

Post by bondarchuk »

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?

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

#48

Post by thanatropism »

asveikau wrote: post #19
caymanjim wrote: post #6

Earlier quoted context omitted.

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.

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…

Up to the mid-70s psychoanalysis was one of the core clinical practices in American psychiatry (the evidence is the shift between the DSM-II in 1974 and the DSM-III in 1980), and what psychoanalysis means by "schizophrenia" is something entirely different from what the modern approach means.

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.

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

#49

Post by bradstewart »

quietbritishjim wrote: post #32
treeman79 wrote: post #20

Earlier quoted context omitted.

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.

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).

Definitely hard to do at home, but it's not all that easy to notice in certain settings. For instance, indoor and greenhouse agriculture where pumping CO2 into the room is routinely done.

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

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

#50

Post by motoboi »

scottlocklin wrote: post #43

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 c…

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