
A difficult case: Diagnosis made by hallucinatory voices (1997) - booleandilemma
https://www.researchgate.net/publication/232271307_A_difficult_case_Diagnosis_made_by_hallucinatory_voices
======
themodelplumber
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_...](https://www.reddit.com/r/legaladvice/comments/34m92h/update_ma_postit_notes_left_in_apartment/)

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?

~~~
treeman79
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
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).

~~~
PaulHoule
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.

~~~
StavrosK
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.

~~~
treeman79
Is scary. Kids were super hard to wake up though this. Like 2 hours to get
them alert on bad days.

Guy from gas company made it clear no one would be waking up in a matter of
days

------
hprotagonist
_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
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/](https://xkcd.com/638/)

~~~
banads
>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.

------
nabla9
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.

------
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.

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

------
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.

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

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

------
Hitton
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.

~~~
akimball
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.

------
carapace
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
Fascinating — have any references?

~~~
carapace
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...](https://en.wikipedia.org/wiki/Philip_K._Dick#Paranormal_experiences)

FWIW, I once attended a thing that was sponsored by invisible purple
telepathic space dolphins, so... yeah. Just a group hallucination?

------
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?

------
baxtr
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_42
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".

~~~
dash2
This sounds as if you are saying that all psychology experiments are
unethical. I'm sure that's not what you meant - expand?

------
caymanjim
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.

~~~
badrabbit
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.

~~~
caymanjim
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.

~~~
arkades
> 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."

------
jyriand
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.

~~~
tsimionescu
> 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.

------
marcan_42
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)](https://en.m.wikipedia.org/wiki/Multiplicity_\(psychology\))

~~~
caymanjim
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.

~~~
asveikau
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.

~~~
thanatropism
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.

~~~
asveikau
This is a good comment, thanks.

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.)

