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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)

#51

Post by arkades »

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.

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.

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

#52

Post by arkades »

caymanjim wrote: post #14
_8j50 wrote: post #9

Earlier quoted context omitted.

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 historic…

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 clinic…

> his is the exact opposite of how burden of proof works. An extraordinary claim is being made.

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."

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

#53

Post by arkades »

themodelplumber wrote: post #7

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…

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.

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

#54

Post by walleeee »

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).

> very hard to do in a domestic scenario, and especially hard to do without noticing

Life- or health-threatening CO2 poisoning, maybe, but low-level cognitive impairment due to elevated CO2 is extremely common in indoor environments.

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

#55

Post by pavel_lishin »

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…

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

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

#56

Post by filoeleven »

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.

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

#57

Post by scottlocklin »

pavel_lishin wrote: post #55
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…

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

A potentially very effective propaganda tool.

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

#58

Post by api »

hprotagonist wrote: post #35

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 des…

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/

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

#59

Post by polytely »

scottlocklin wrote: post #57
pavel_lishin wrote: post #55

Earlier quoted context omitted.

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

A potentially very effective propaganda tool.

You mean like planting an article into the results for a certain search query, then manufacturing a (news)event that causes someone to want to research that particular subject?

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

#60

Post by Trasmatta »

filoeleven wrote: post #56

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 e…

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