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How do hallucinations appear through reversing goggles?

How do hallucinations appear through reversing goggles?



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If one is experiencing elaborated visual hallucinations, what will happen when one puts on reversing goggles? Will hallucinations change their orientations as well? Links to relevant papers will be most welcome.


Karl Jaspers describes clinical reports in which patients hallucinatory perception was changed in accordance with the optical distortion. For example, a prism would double the images of devils, binoculars enlarge or decrease the image, colored glasses make it colored, etc. He refers "Seppilli, Contributo allo studio delie allucinazioni unilaterali. Riv. sper. di fren. 16, 82. 1890" and "Pick. Beitrage zur Lehre von den Halluzinationen. N. C. 11. 329. 1892" Now, the question is, has anyone done a study on that in the 20th century.


Pay Attention to Thought Patterns

Now, identify what kinds of thoughts were brought up by the situation or event that led to the problem behavior. How did you evaluate the situation or yourself in that situation? Did you engage in catastrophic or all-or-none thinking?

Think about what emotions you were having as a result of that situation. Try your best to list as many emotions as you possibly can, such as fear, sadness, anger, shame, guilt, embarrassment, or dread.

Pay attention to what you felt in your body. Try to recognize and label all the sensations that came up.

For example, did you experience shortness of breath? Muscle tension? An increased heart rate? Think about how your body reacted to the situation.

Next, list off what your thoughts, emotions and bodily sensations made you want to do. That is, did they make you want to escape the situation or do something to make those feelings stop? Did you feel a need to engage in your problem behavior?

Finally, think about the consequences of engaging in your problem behavior. Did you feel better afterward? Did you feel disappointed in yourself? Ashamed? Try to list as many consequences (both positive and negative) as you can.


The Symptoms of Drug-Induced Psychosis

Drug-induced psychosis can be caused by both the use of, and withdrawal from, a range of substances, including marijuana, alcohol, illicit and prescription stimulants (including cocaine, methamphetamine, and ADHD medications), and hallucinogens (including MDMA, LSD, and PCP). Some newer, synthetic drugs that fall under the category of “bath salts” are also known to cause psychosis. Although opioids are not typically associated with psychosis, it is possible that some users may experience psychotic symptoms.

Unfortunately, drug-induced psychosis is often spoken about primarily in the context of particularly vicious violent crimes perpetrators recount hearing voices directing them to commit heinous acts they would never normally be capable of, or holding delusional beliefs that drive them to extreme acts. While these narratives speak to the possibilities present within states of drug-induced psychosis, their extremity can make the condition feel so foreign and implausible that you may fail to appreciate the risk of experiencing anything resembling it yourself. However, drug-induced psychosis can express itself in a variety of ways, few of which involve violent tendencies. Understanding the symptoms of drug-induced psychosis is essential to recognizing these experiences for what they are and seeking treatment as soon as possible.

Specific symptoms of drug-induced psychosis include:

  • Hallucinations: Hallucinations are disturbances in perception that can cause you to hear, see, or feel things that aren’t there.
  • Delusions: Delusions are unjustified, fantastic, or bizarre beliefs, such as thinking that you are a different person, that people are out to get you, or that you can read other people’s minds.
  • Disorganized thinking and speech: Disorganized thinking and speech refer to illogical thought and nonsensical associations. This may range in severity from difficulty staying on topic during a conversation to an inability to communicate at all due incoherent and incomprehensible thinking.
  • Disorganized behavior: Disorganized behavior includes socially unacceptable and context-inappropriate behaviors, including childlike, aggressive, and exaggerated behaviors.

These phenomena may be accompanied by symptoms such as mood changes, sleep disturbances, loss of energy, poor motivation, social withdrawal, the inability to experience pleasure, and flat affect.

Hope is Just a Phone Call Away

Experiencing Mental Health Issues as a Result of Drug Use?


Overcoming Anxiety With Dehydration

Dehydration is completely preventable. Drink water more often, and you'll avoid many of the symptoms of dehydration and the subsequent anxiety. There's no harm in drinking more water if you're not sure how hydrated you are. Add a few extra glasses of water to your daily meals, and you may find that your anxiety and some of its symptoms clear up.

Yet most people that suffer from anxiety and dehydration have anxiety regardless of their hydration levels. Their water intake simply effects how severe their symptoms feel. That's why you still need to treat your anxiety separately from just increasing your intake of water.


Analog Neural Computation Using Principles of Harmonic Resonance

The very heart of Lehar’s work outlines how harmonic resonance shows up as a principle of self-organization in the mind.

Steven Lehar argued against the (at the time) prevailing neuron doctrine of neural computation which states that the contents of our experience are the result of the activity of highly discrete and individualized neurons that “encode” high-level features (such as a “grandma cell”). Importantly, Lehar points out that there is a key distinction between “rendering” an experience and merely “encoding” it. If you look for neurons that get activated if and only if a certain experience is happening you will be inadvertently mapping out how the brain encodes information rather than how it renders it. Failing to make this distinction will trap you in a worldview that is extremely hard to square with phenomenological facts. Of note is that our internal representations are flexible, a fact that the neuron doctrine finds really difficult to account for. As he puts it in “Harmonic Resonance Theory”:

There are several properties of the harmonic resonance model that are suggestive of human recognition. Unlike a rigid template, the pattern defined by a standing wave representation is elastic and adaptive. This can be seen in the manner that the spatial patterns of animal skins are defined. The parameters of the reaction-diffusion that distinguish between the spots and stripes of the tiger, zebra, leopard, and giraffe are encoded as general rules for the generation of those patterns rather than as a spatial template of any one such pattern. For example if a spot or stripe were to be fixed at one point as the pattern was emerging, the rest of the pattern would redistribute itself to adapt to that fixed feature while maintaining the general character of the encoded pattern. This invariance in the representation allows one set of parameters to generate an infinite variety of exemplars of any particular pattern type, or to adapt most flexibly to any fixed constraints or boundary conditions. (Lehar, 1999)

This flexibility of our internal representations is essential for understanding how the brain solves the “binding problem”: how is it possible that distributed neuron firings can simultaneously contribute to a unified internal representation? Indeed, Lehar takes the binding problem seriously and his solution involves resonance across spatial and temporal levels. This way, one can get representations that “lock in” low-level features to the high-level phenomenal objects that integrate them. In turn, our world-simulation works in a holistic fashion: every part of it pulls and pushes every other part of it. He explains it well in this interview:

Q: What would be the new paradigm in neuroscience?

A: The first thing that it will change is our concept of how the brain works. Right now we are in a neuro-reductionist era where people are making probes ever smaller and smaller to read into tinier and tinier parts of the brain and read the signal there and try to make some kind of sense out of it. The paradigm that they are thinking is discrete connections between individual neurons mediated by synapses. And separate individual signals going every different direction. What we see in consciousness is a much more holistic process. Something like water seeking its own level in a vessel, where the final state of the water depends on every position of every other molecule. If you change one portion, scoop out some water in one place or dump some in some other place, every single molecule in the bath quickly readjusts itself in order to seek a new level. It is a different paradigm of computation. It is what the gestaltists proposed: field theories of mind, not in the terms of fields of mental energy propagating out into the world, but fields of physical energy in the brain interacting with each other in a holistic manner the way that water seeks its own level in a vessel. (Sandu, 2016)

In Lehar’s world, the three-dimensional volumetric representations that we experience “around us” are internal representations made with a hierarchy of patterns of resonance which are mode-locked with one another. From the tiniest detail to the broadest outline, when we experience a phenomenal object as “rigid”, we are in fact experiencing a complex network of resonating patterns locked in place as a stable “solution” of a network of tuned oscillators. In other words, the binding problem is solved explicitly by hierarchical resonance at all levels. This model can explain many of the bizarre effects of psychedelics (which we’ll discuss further below) in terms of a decoupling between the resonance of the different levels! Or as Lehar would put it, “everything on LSD looks like a Fourier representation with the high-frequencies chopped off”, meaning that the fine details that would usually cancel out the broad repeating patterns of low-frequency resonance are desynchronized, and thus objects look as if they were filled with symmetrical and resonating filigree patterns!

Since Lehar worked on “Harmonic Resonance Theory,” there have been many advancements in neuroscience and the field of AI. In particular, two very noteworthy connections should be highlighted. The first is the work of Selen Atasoy (who is also one of QRI’s lineages) on connectome-specific harmonic waves (2016). Atasoy, like Lehar, identified principles of harmonic resonance in physics and biology (such as Murray’s leopard spots and zebra stripes in the standing waves of vibrating sheets of steel) and decided to apply them to the brain. Unlike Lehar, Atasoy found an empirically measurable aspect of the brain amenable to this kind of modeling: the connectome. Thus, Atasoy’s work enables the study of the standing waves that Lehar hinted at qualitatively, but now in an empirical and quantitative way.

In this way, the work of Atasoy and Lehar can be thought of as complementary rather than redundant: Lehar brings the phenomenological observations and arguments whereas Atasoy comes up with the precise empirical quantitative paradigm. Along these lines, we can already see possible extensions of this work. Namely, as we find more core structural scaffolds of the nervous system, we can examine them in light of a paradigm of harmonic resonance by building high-definition structural models, empirically extracting their corresponding wave equations, and then numerically approximating the emergent resonant modes of such structures. The beauty of this paradigm is that suddenly, large amounts of self-organizing complexity can be compressed in terms of weighted sums of harmonic resonant modes. At QRI, we consider this general paradigm to be extremely promising and endorse exploring how the overlap between these two great researchers leads to novel models of neural computation.

The second development that is important to point out is how advancements in artificial neural networks seem to have brought back the neuron doctrine with a vengeance. You get the impression that feature visualization techniques (Olah et al., 2017) allow us to make sense of what each neuron in a network “does.” Recent work at OpenAI takes this further and identifies recurring principles of self-organization that emerge in artificial neural networks (i.e. circuit motifs (Olah et al., 2020)).

The key to make sense of this is to recall the distinction between encoding and rendering. In Lehar’s world, populations of neurons that implement specific kinds of pattern recognition are in fact tuned resonators. Think of these resonators as having the function of adding clamps or pinches to a vibrating Chladni plate: the actual experience being rendered is the pattern of standing waves that emerge from the pinched plate, not the pinches themselves. While there is an extremely detailed correspondence between the content of experience and these clamps, what the experience is requires the pattern of standing waves to happen. Thus, insofar as artificial neural networks do not bring about such standing waves, they will simply and forever fail to render the contents of any experience.

Naturally, this is a testable view, since we can in principle manipulate the standing wave patterns directly (with e.g. transcranial magnetic stimulation). At QRI, we expect that in the future, this distinction will be extremely important. Without it, we would be at risk of thinking that specific computations done in digital computers entail qualia even though there is in fact no “rendering of experience” going on at all in the computational system as a whole.

A final note on this discussion is that Steven Lehar also has a theory of aesthetics. Foreshadowing the Symmetry Theory of Valence, first suggested by Johnson (2016), Lehar proposes a theory of aesthetics based on principles of harmonic resonance that explains our preference for symmetrical patterns. See the excerpt below titled “A Psycho-Aesthetic Hypothesis” in Appendix A. Thus, another key parallel between Lehar’s work and our models at QRI is that we have a non-standard interpretation of neuroanatomical functional localization. In particular, we think that the impression that “pleasure is what goes on in the pleasure centers” is at least in part an artifact of our measuring tools. As Michael Johnson postulates, the reason why activating the pleasure centers feels good is because they are strategically positioned in such a way that you get large-scale (consonant) resonance across the brain. In other words, the pleasure centers are “tuning knobs” for global synchrony in the brain! Thus, they are a kind of “master clamp” for harmonic resonance in the brain. What feels good is such resonance and not the activation of the pleasure centers per se. Don’t expect to find “beauty” in a single neuron both Lehar and QRI will be quick to point out that beauty is a holistic property of a holistic system!


Cognitive Theories of Hallucinations in Children and Adolescents

Cognitive Profiles and Early-Onset Hallucinations

Studies obtaining cognitive profiles of children with hallucinations have been valuable in providing clues to underlying cognitive mechanisms. By comparing healthy adult individuals with and without AVH, Daalman et al 67 showed that individuals with AVH were more sensitive to distraction (lower performance on inhibition), had a lower verbal working memory capacity (lower digit-span backward performance), and underperformed on Wechsler Adult Intelligence Scale III subtests of vocabulary and similarities. These authors postulated that a specific alteration in the executive functioning combined with a reduced level of verbal IQ might increase the tendency to hallucinate in the auditory-verbal domain, explicable in terms of difficulties in the inhibition of irrelevant verbal information. Another study of 11–13 y.o. participants confirmed lower performance on executive functions (mental flexibility and verbal abstraction) and language (denomination of images) in hallucinators compared with healthy subjects, 68 along with impairments of fine motor skills and information processing speeds. These latter elements were additionally shown to be risk factors for psychosis. 69

ToM in Children With Hallucinations

ToM is defined here as the ability to correctly interpret another individual’s intentions or emotions. Several studies have revealed that patients with schizophrenia, 70–73 as well as nonclinical adults with schizotypal traits, exhibit impairments in ToM 74 (although, see eg, Fernyhough et al 75 ). Few studies have focused on the direct relationship between AVH and ToM. Although Abdel-Hamid and colleagues 76 demonstrated weaker ToM abilities in schizophrenia patients, they did not establish a significant association between ToM deficits and positive symptoms, such as hallucinations. Delusions may be secondary to abnormal perceptual processes 77 and aberrant attributions of salience. 78 The pathway from AVH to delusions might therefore be explained by a misinterpretation of these percepts, raising the questions of whether and how (social) cognitive processes may be involved. As Smeets et al 55 observed, the combination of hallucinations and delusions, rather than either one in isolation, may contribute to a persistence of symptoms and a deterioration in clinical outcomes. The results of Smeets and colleagues were based on data collected at 2 time points from the Early Developmental Stages of Psychopathology (EDSP) Study in a large representative general population sample of adolescents and young adults (mean ages 21.8 and 26.6 years, respectively).

In children, associations between ToM and AVH, and the role of delusion formation, have also been examined. In a prospective longitudinal birth cohort study in Great Britain (following 2232 children), it was demonstrated that 12 y.o. children with psychotic symptoms (including AVH) exhibited impaired ToM at age 5. 79 A negative appraisal of the tone of the voices heard in children was also proposed to elicit delusion formation, 52 but an absence of reasoning biases was shown able to prevent the formation of threatening appraisals about anomalous perceptions. 80 Finally, a study by Bartels-Velthuis and colleagues 81 focused on the role of ToM in the process of delusion formation in 12 and 13 y.o. preadolescents with AVH. The authors suggested that better mentalizing abilities might confer protection against delusion formation in children experiencing perceptual anomalies, an effect that was not reducible to general cognitive ability.

Functional Brain Imaging of Early-Onset Hallucinations

Progress in brain-imaging technology has paved the way for the noninvasive exploration of the neural structures involved in hallucinations 82 during development. Two main categories of brain-imaging studies are conceptually available on the problem of early-onset hallucinations. Initially, studies compared hallucinators with non-hallucinators. These “trait studies” investigated the neural bases of the susceptibility to hallucinate, because no information on the child/adolescent experience during scanning was available. Comparing 11–13 y.o. preadolescents with psychotic-like experiences with matched healthy controls, an initial set of experiments showed functional changes encompassing the error-related processing network, 83 the perspective-taking network, 84 and the status of intrinsic functional connectivity within the inhibitory control network, 85 in line with behavioral findings previously mentioned (see “ToM in Children With Hallucinations” section). Such differences measured in the blood-oxygen-level-dependent (BOLD) signal—during cognitive tasks and at rest—were shown to be associated with gray matter 83, 86 and event-related potentials changes 87 in at-risk or first-episode adolescents compared with controls, supporting a hypothesis of distributed neural impairments associated with the psychosis phenotype in general.

The second category of experiments is “state studies,” ie, studies conducted during the occurrence of hallucinations. 88 State studies allow researchers to directly measure brain activations associated with symptom emergence. A recent multimodal magnetic resonance imaging (MRI) experiment conducted on 20 11–16 y.o. adolescents with brief psychotic episodes and suffering from auditory, visual, and multisensory hallucinations confirmed an increase in the BOLD signal within modality-dependent association sensory cortices during hallucinatory experiences. 89 Notably, recruitment of primary sensory cortices was not systematic and was observed, when present, to be associated with increased, vivid hallucinatory experiences. By exploring the neurodynamic patterns of the default-mode network (DMN) and associative sensory cortices during hallucinations, these authors showed spatial and temporal instabilities of the DMN that correlated with severity of hallucinations and persisted during symptom-free periods, 89 suggesting an intrinsic instability of the DMN in this population compatible with the phenomenological properties of these experiences, specifically their intermittent nature.

Neuromodulation and Early-Onset Hallucinations

In neuroscience, transcranial magnetic stimulation (TMS) has been used as a complementary technique to brain imaging in cognitive mapping. This method has been especially useful for exploring the neural bases of self-other distinctions. For example, sense of agency and the severity of hallucinations was shown to be functionally dissociable in a functional MRI (fMRI)-guided TMS case report that specifically explored these functions in an 11 y.o. child with COS. 90 Few studies have examined the neurocognitive bases of early-onset hallucinations, indicating that replications in larger samples of children or adolescents are required.

TMS was also proposed as a second-line therapeutic strategy for refractory AVH occurring in children and adolescents. By focally modulating neural excitability, these methods allow for a dimensional and noninvasive add-on therapy for hallucinations. In adults, repetitive TMS (rTMS) centered on the left temporal-parietal junction has been shown to be effective in reducing the severity of AVH. A recent meta-analysis confirmed a 0.42 effect size for rTMS in this indication, which constitutes a moderate but significant effect when compared with placebo. 91 rTMS has shown good tolerance in pediatric populations, 92 as was shown by recent preliminary data on the effectiveness of rTMS in relieving early-onset hallucinations. Decreased symptom severity and improved global functioning were shown immediately after treatment and at subsequent reassessment 1 month later in a cohort of 10 adolescents. 93 Although these results appear encouraging, replication in larger groups, looking at long-term effects, and according to evidence-based standards (ie, randomized control trial designs) is now required.


Delusion

This entry focuses on the phenomenon of clinical delusions. Although the nature of delusions is controversial, as we shall see, delusions are often characterised as strange beliefs that appear in the context of mental distress. Indeed, clinical delusions are a symptom of psychiatric disorders such as dementia and schizophrenia, and they also characterize delusional disorders. The following case descriptions include one instance of erotomania, the delusion that one is loved by someone else, often of higher status, and one instance of Cotard delusion, the delusion that one is dead or disembodied.

She realized he was empty without her and was pursuing her, but enemies were preventing them from uniting. The enemies included a number of people: people in her family, her classmates, neighbours and many other persons who were plotting to keep them apart. She knew that her conclusions were accurate because he would send messages to her proving his love. These messages would often present themselves as the license plates on cars of a certain state, the color purple and other indications that she received from the environment that proved to her that he loved her. (Jordan et al. 2006, p. 787)

She repeatedly stated that she was dead and was adamant that she had died two weeks prior to the assessment (i.e. around the time of her admission on 19/11/2004). She was extremely distressed and tearful as she related these beliefs, and was very anxious to learn whether or not the hospital she was in, was &lsquoheaven&rsquo. When asked how she thought she had died, LU replied &lsquoI don&rsquot know how. Now I know that I had a flu and came here on 19th November. Maybe I died of the flu.&rsquo Interestingly, LU also reported that she felt &lsquoa bit strange towards my boyfriend. I cannot kiss him, it feels strange&mdashalthough I know that he loves me.&rsquo (McKay and Cipolotti 2007, p. 353)

The category of delusions is not homogeneous, and we find that different delusions have different features. Some delusions have implausible content (as we saw in the case of Cotard). Other so-called bizarre delusions include mirrored self misidentification (the delusion that the person in the mirror is not one&rsquos reflection but a stranger), and the Capgras delusion (the delusion that the spouse or a relative has been replaced by an impostor). The content of other delusions can be plausible and even true (as in erotomania). One can have the delusion that one is an uncomprehended genius, that one&rsquos spouse is unfaithful, or that one&rsquos neighbor is a terrorist, and these may be true beliefs. What makes all the above examples instances of delusions is that they are rigid to some extent, that is, they are not easily given up in the face of challenges and they tend to resist counterevidence. Moreover, delusions are reported sincerely and with conviction, although the behavior of people with delusions is not always perfectly consistent with the content of their delusions and their conviction in the delusional content can fluctuate. Another common feature is that, for people experiencing delusions, the delusion is often source of distress, and it is found to compromise good functioning. For instance, people who have delusions of persecution and believe that they are followed by malevolent others live in a state of great anxiety and can give up their jobs, stop communicating with their families, and move cities as a result.

The following first-personal account of delusions illustrates the pervasive effects of delusions on people&rsquos lives:

I increasingly heard voices (which I&rsquod always called &ldquoloud thoughts&rdquo or &ldquoimpulses with words&rdquo) commanding me to take destructive action. I concluded that other people were putting these &ldquoloud thoughts&rdquo in my head and controlling my behavior in an effort to ruin my life. I smelled blood and decaying matter where no blood or decaying matter could be found (for example, in the classrooms at school). I had difficulty concentrating, I fantasized excessively, and I had trouble sleeping and eating. (Bockes 1985, p. 488)

This entry only starts to address some of the philosophical debates centered on delusions. Section 1 provides an overview of the philosophical significance of delusions. Section 2 introduces the issues surrounding the controversial definition of delusions, and some of the common distinctions between types of delusions are explained. Section 3 discusses the most prominent theoretical approaches to the nature and formation of delusions and the conceptual questions emerging from such approaches are highlighted. Section 4 reviews three of the most discussed themes in the philosophical literature on delusions: whether delusions are irrational whether they are beliefs and to what extent they overlap with cases of self-deception. The examination of the issues above often culminates in the attempt to understand how delusions differ from other pathological and non-pathological beliefs.


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I had a severe case of nihilistic delusions eight years ago. For me, it felt as if my body was transparent and people could walk by or through me without seeing me. I couldn't maintain a conversation -not because I didn't hear it, but because I thought I didn't exist so they wouldn't receive my reply. I hallucinated and thought I was in the past. I wasn't sure what physical objects were real, or if I was real. It felt like a complete break with reality. The only reason I didn't commit suicide was because I felt I was dead already.

My body wasn't participating in life. I lost over 30 pounds in two months. I was able to talk and dress myself, but that was the extent of it. I had never heard of anyone experiencing these symptoms with depression until now. I have now been stable for six years. But for health workers and concerned family and friends: pay attention to those around you who are depressed with nihilistic tendencies. Avoid normal day-to-day conversations it makes it worse/doesn't help. Stay by their side don't leave them alone. Be careful with touching sometimes it helped anchor me, sometimes it scared me.

When you have these traits in your head, your world turns upside down. It took years of therapy to reverse my head mantras, but it's possible to be "normal again" if the person stays with it, and their brain doesn't relapse. Medication was a life-saver for me. Remember that logic is flipped and you lose a grasp on reality. What seems logical to you, isn't to me, so try to understand. It's a very scary time and you often feel alone which makes matters worse. Like I said, I've never met anyone who experienced nihilistic delusions. I thought I was the only one. It's a hard concept to grasp because it's the antithesis of the will to live, but if you find a person experiencing these signs: hold on to them. You are their link to reality. burcinc April 19, 2014

@discographer-- No, nihilistic delusions or Cotard's Syndrome is rare, very rare. It affects men and women equally but age increases the risk of developing it. discographer April 18, 2014

@SteamLouis-- I'm no expert on this subject but I don't think that this condition is rare or common.

As far as I know, it results from a brain dysfunction and this can happen even without injury. The dysfunction causes the person to disassociate with themselves, meaning that they can't recognize themselves and their appearance. Because of this disassociation, the person develops the feeling that this body is not theirs, their body is deteriorating or they don't exist. So nihilistic delusion is scientifically explainable.

I think that there are also psychological causes of the disorder though. I think that a fear of death also plays a role. For example, there was someone who developed nihilistic delusions after a severe traffic accident. He almost died and after survival, that fear of death seems to have triggered his delusions. SteamLouis April 18, 2014

This is the first time that I'm hearing about nihilistic delusion. Is nihilistic delusion rare in comparison to other types of delusions?

I often hear about people with mental health disorders who believe that their dead relatives are alive. Others think that they are a different person and start to act that way. But I have never heard of anyone thinking that they are dead or that they do not exist. It's a very odd and interesting notion.

In cases where the condition is not due to brain injury, do past grievances and traumas explain them fully? Do we have any experts here who can shed more light on this condition? Pippinwhite April 7, 2014

I suppose nihilistic delusions are the opposite of Truman Syndrome, where someone feels his every move is being watched by everyone -- probably on TV.

This must be an absolutely miserable way to exist -- I certainly wouldn't call it "living," per se. There's no quality of life, in any case.

Barring a mental illness like schizophrenia, I have to wonder if some sufferers are victims of abuse, where just not being there was the preferable option, and that became the way the person functioned -- he or she simply wasn't there.

The article does not address how common this disorder is. I'd be interested in finding out.


Ever Wonder What a Visual or Auditory Hallucination Was Like?

It&rsquos one thing to be told that schizophrenia often involves a person who hears or sees things that aren&rsquot there. It&rsquos another to &lsquoexperience&rsquo it yourself, via Second Life. (Although I&rsquom not sure I&rsquod call it &lsquoexperiencing&rsquo something by watching it on a screen, but I digress.) But a press release that came across our desk the other day did make it seem like this has some potential to help people with understanding a component of schizophrenia.

A University of California-Davis professor of psychiatry has helped develop an Internet-based virtual reality (VR) environment that simulates the hallucinations of people with schizophrenia. The vast majority of individuals who have toured the environment self-reported that it improved their understanding of the auditory and visual hallucinations experienced by people with schizophrenia.

&ldquoUsing traditional educational methods, instructors have difficulty teaching about the internal phenomena of mental illnesses, such as hallucinations,&rdquo said Peter Yellowlees, professor of psychiatry and director of Academic Information Systems at UC Davis Health System.

Developed by Yellowlees and colleagues in the UC Davis Department of Psychiatry and Behavioral Science, the virtual reality system is being used as a teaching tool at the UC Davis School of Medicine. Yellowlees and his team created the virtual environment to replicate the experiences and world of a schizophrenia patient to provide medical students with a better understanding of this mental illness.

Schizophrenia is a severe mental illness that affects 1 percent of the population. Most people with schizophrenia experience auditory hallucinations, particularly hearing voices, and about one-fourth of those with the disorder experience visual hallucinations.

The researchers took photographs of an inpatient ward and hospital furnishings at UC Davis Medical Center to create their virtual setting. The team constructed simulations of auditory and visual hallucinations based on recorded audio samples and digital images described in interviews with schizophrenia patients. The researchers inserted the hallucinations as individual objects that would appear automatically throughout the ward, triggered by the presence of an avatar, an electronic image represented and manipulated by a computer user.

The hallucinations in the virtual environment included:

  • Multiple voices, occasionally overlapping, criticizing the user
  • A poster that would change its text to obscenities
  • A newspaper in which the word &ldquodeath&rdquo would stand out in a headline
  • A floor that would fall away, leaving the user walking on stepping stones above a bank of clouds
  • Books on bookshelves with titles related to fascism
  • A television that would play a political speech, but then criticize the user and encourage suicide
  • A gun that would appear under a cone of light and pulse, with associated voices telling the user to take the gun and commit suicide
  • A mirror in which a person&rsquos reflection would appear to die, becoming gaunt with bleeding eyes

Over a two-month period, the virtual psychosis environment was toured 836 times and received 579 valid survey responses. Large majorities of the responders said the tour improved their understanding of auditory hallucinations (76 percent), visual hallucinations (69 percent) and schizophrenia (73 percent). Eighty-two percent said they would recommend the tour to others.

One user said, &ldquoThat tour was amazing. I didn&rsquot think it would affect me, but about halfway through, I wanted to shout, &lsquoStop it!&rsquo&rdquo

Another user said, &ldquoMy first husband was schizophrenic. I have experienced visual hallucinations and they are disturbing enough.&rdquo

Yelllowlees and his colleagues acknowledged some important limitations of their pilot project, including their survey population not being a representative sample of the general population. Also, because users did not take a pre-test, the researchers cannot prove that participants improved their knowledge. Lastly, because the virtual environment focuses only on hallucinations, it may give inappropriate weight to these symptoms, rather than a fuller view including other symptoms such as delusions, and disordered speech and behavior.

However, despite those limitations, Yellowlees and his team believe their approach is promising. They plan to perform a more formal evaluation of its effectiveness in teaching students about psychotic experiences as compared to traditional teaching approaches. In addition, they intend to use the virtual environment to teach caregivers attending an early intervention program for patients experiencing a first episode of psychosis.


The consequences of complexity

Spend time talking to people in detail about their voices - the ways in which they are experienced, made sense of, and coped with - and the heterogeneity of auditory hallucinations is unmistakable.

Yet it is still commonly assumed that hearing voices is always a symptom of severe mental illness, and that the voices heard by people with a diagnosis of schizophrenia are loud, commanding, and dangerous. That wasn’t the case for our participants, though it must be recognised that people who are experiencing acute difficulties with managing their voices may be less likely to participate in research.

Our study drew on a wide range of expertise – including in philosophy, psychology, medical humanities and the history of psychiatry, as well as personal experience – to investigate the phenomenon of hearing voices. This shows the value of a range of methods and approaches in illuminating this fascinating aspect of human experience.

A greater understanding of the complexity and variety of that experience is crucial. Our research also has implications for the therapeutic management of distressing voices and for the design of future studies of voice-hearing.


Cognitive Theories of Hallucinations in Children and Adolescents

Cognitive Profiles and Early-Onset Hallucinations

Studies obtaining cognitive profiles of children with hallucinations have been valuable in providing clues to underlying cognitive mechanisms. By comparing healthy adult individuals with and without AVH, Daalman et al 67 showed that individuals with AVH were more sensitive to distraction (lower performance on inhibition), had a lower verbal working memory capacity (lower digit-span backward performance), and underperformed on Wechsler Adult Intelligence Scale III subtests of vocabulary and similarities. These authors postulated that a specific alteration in the executive functioning combined with a reduced level of verbal IQ might increase the tendency to hallucinate in the auditory-verbal domain, explicable in terms of difficulties in the inhibition of irrelevant verbal information. Another study of 11–13 y.o. participants confirmed lower performance on executive functions (mental flexibility and verbal abstraction) and language (denomination of images) in hallucinators compared with healthy subjects, 68 along with impairments of fine motor skills and information processing speeds. These latter elements were additionally shown to be risk factors for psychosis. 69

ToM in Children With Hallucinations

ToM is defined here as the ability to correctly interpret another individual’s intentions or emotions. Several studies have revealed that patients with schizophrenia, 70–73 as well as nonclinical adults with schizotypal traits, exhibit impairments in ToM 74 (although, see eg, Fernyhough et al 75 ). Few studies have focused on the direct relationship between AVH and ToM. Although Abdel-Hamid and colleagues 76 demonstrated weaker ToM abilities in schizophrenia patients, they did not establish a significant association between ToM deficits and positive symptoms, such as hallucinations. Delusions may be secondary to abnormal perceptual processes 77 and aberrant attributions of salience. 78 The pathway from AVH to delusions might therefore be explained by a misinterpretation of these percepts, raising the questions of whether and how (social) cognitive processes may be involved. As Smeets et al 55 observed, the combination of hallucinations and delusions, rather than either one in isolation, may contribute to a persistence of symptoms and a deterioration in clinical outcomes. The results of Smeets and colleagues were based on data collected at 2 time points from the Early Developmental Stages of Psychopathology (EDSP) Study in a large representative general population sample of adolescents and young adults (mean ages 21.8 and 26.6 years, respectively).

In children, associations between ToM and AVH, and the role of delusion formation, have also been examined. In a prospective longitudinal birth cohort study in Great Britain (following 2232 children), it was demonstrated that 12 y.o. children with psychotic symptoms (including AVH) exhibited impaired ToM at age 5. 79 A negative appraisal of the tone of the voices heard in children was also proposed to elicit delusion formation, 52 but an absence of reasoning biases was shown able to prevent the formation of threatening appraisals about anomalous perceptions. 80 Finally, a study by Bartels-Velthuis and colleagues 81 focused on the role of ToM in the process of delusion formation in 12 and 13 y.o. preadolescents with AVH. The authors suggested that better mentalizing abilities might confer protection against delusion formation in children experiencing perceptual anomalies, an effect that was not reducible to general cognitive ability.

Functional Brain Imaging of Early-Onset Hallucinations

Progress in brain-imaging technology has paved the way for the noninvasive exploration of the neural structures involved in hallucinations 82 during development. Two main categories of brain-imaging studies are conceptually available on the problem of early-onset hallucinations. Initially, studies compared hallucinators with non-hallucinators. These “trait studies” investigated the neural bases of the susceptibility to hallucinate, because no information on the child/adolescent experience during scanning was available. Comparing 11–13 y.o. preadolescents with psychotic-like experiences with matched healthy controls, an initial set of experiments showed functional changes encompassing the error-related processing network, 83 the perspective-taking network, 84 and the status of intrinsic functional connectivity within the inhibitory control network, 85 in line with behavioral findings previously mentioned (see “ToM in Children With Hallucinations” section). Such differences measured in the blood-oxygen-level-dependent (BOLD) signal—during cognitive tasks and at rest—were shown to be associated with gray matter 83, 86 and event-related potentials changes 87 in at-risk or first-episode adolescents compared with controls, supporting a hypothesis of distributed neural impairments associated with the psychosis phenotype in general.

The second category of experiments is “state studies,” ie, studies conducted during the occurrence of hallucinations. 88 State studies allow researchers to directly measure brain activations associated with symptom emergence. A recent multimodal magnetic resonance imaging (MRI) experiment conducted on 20 11–16 y.o. adolescents with brief psychotic episodes and suffering from auditory, visual, and multisensory hallucinations confirmed an increase in the BOLD signal within modality-dependent association sensory cortices during hallucinatory experiences. 89 Notably, recruitment of primary sensory cortices was not systematic and was observed, when present, to be associated with increased, vivid hallucinatory experiences. By exploring the neurodynamic patterns of the default-mode network (DMN) and associative sensory cortices during hallucinations, these authors showed spatial and temporal instabilities of the DMN that correlated with severity of hallucinations and persisted during symptom-free periods, 89 suggesting an intrinsic instability of the DMN in this population compatible with the phenomenological properties of these experiences, specifically their intermittent nature.

Neuromodulation and Early-Onset Hallucinations

In neuroscience, transcranial magnetic stimulation (TMS) has been used as a complementary technique to brain imaging in cognitive mapping. This method has been especially useful for exploring the neural bases of self-other distinctions. For example, sense of agency and the severity of hallucinations was shown to be functionally dissociable in a functional MRI (fMRI)-guided TMS case report that specifically explored these functions in an 11 y.o. child with COS. 90 Few studies have examined the neurocognitive bases of early-onset hallucinations, indicating that replications in larger samples of children or adolescents are required.

TMS was also proposed as a second-line therapeutic strategy for refractory AVH occurring in children and adolescents. By focally modulating neural excitability, these methods allow for a dimensional and noninvasive add-on therapy for hallucinations. In adults, repetitive TMS (rTMS) centered on the left temporal-parietal junction has been shown to be effective in reducing the severity of AVH. A recent meta-analysis confirmed a 0.42 effect size for rTMS in this indication, which constitutes a moderate but significant effect when compared with placebo. 91 rTMS has shown good tolerance in pediatric populations, 92 as was shown by recent preliminary data on the effectiveness of rTMS in relieving early-onset hallucinations. Decreased symptom severity and improved global functioning were shown immediately after treatment and at subsequent reassessment 1 month later in a cohort of 10 adolescents. 93 Although these results appear encouraging, replication in larger groups, looking at long-term effects, and according to evidence-based standards (ie, randomized control trial designs) is now required.


Delusion

This entry focuses on the phenomenon of clinical delusions. Although the nature of delusions is controversial, as we shall see, delusions are often characterised as strange beliefs that appear in the context of mental distress. Indeed, clinical delusions are a symptom of psychiatric disorders such as dementia and schizophrenia, and they also characterize delusional disorders. The following case descriptions include one instance of erotomania, the delusion that one is loved by someone else, often of higher status, and one instance of Cotard delusion, the delusion that one is dead or disembodied.

She realized he was empty without her and was pursuing her, but enemies were preventing them from uniting. The enemies included a number of people: people in her family, her classmates, neighbours and many other persons who were plotting to keep them apart. She knew that her conclusions were accurate because he would send messages to her proving his love. These messages would often present themselves as the license plates on cars of a certain state, the color purple and other indications that she received from the environment that proved to her that he loved her. (Jordan et al. 2006, p. 787)

She repeatedly stated that she was dead and was adamant that she had died two weeks prior to the assessment (i.e. around the time of her admission on 19/11/2004). She was extremely distressed and tearful as she related these beliefs, and was very anxious to learn whether or not the hospital she was in, was &lsquoheaven&rsquo. When asked how she thought she had died, LU replied &lsquoI don&rsquot know how. Now I know that I had a flu and came here on 19th November. Maybe I died of the flu.&rsquo Interestingly, LU also reported that she felt &lsquoa bit strange towards my boyfriend. I cannot kiss him, it feels strange&mdashalthough I know that he loves me.&rsquo (McKay and Cipolotti 2007, p. 353)

The category of delusions is not homogeneous, and we find that different delusions have different features. Some delusions have implausible content (as we saw in the case of Cotard). Other so-called bizarre delusions include mirrored self misidentification (the delusion that the person in the mirror is not one&rsquos reflection but a stranger), and the Capgras delusion (the delusion that the spouse or a relative has been replaced by an impostor). The content of other delusions can be plausible and even true (as in erotomania). One can have the delusion that one is an uncomprehended genius, that one&rsquos spouse is unfaithful, or that one&rsquos neighbor is a terrorist, and these may be true beliefs. What makes all the above examples instances of delusions is that they are rigid to some extent, that is, they are not easily given up in the face of challenges and they tend to resist counterevidence. Moreover, delusions are reported sincerely and with conviction, although the behavior of people with delusions is not always perfectly consistent with the content of their delusions and their conviction in the delusional content can fluctuate. Another common feature is that, for people experiencing delusions, the delusion is often source of distress, and it is found to compromise good functioning. For instance, people who have delusions of persecution and believe that they are followed by malevolent others live in a state of great anxiety and can give up their jobs, stop communicating with their families, and move cities as a result.

The following first-personal account of delusions illustrates the pervasive effects of delusions on people&rsquos lives:

I increasingly heard voices (which I&rsquod always called &ldquoloud thoughts&rdquo or &ldquoimpulses with words&rdquo) commanding me to take destructive action. I concluded that other people were putting these &ldquoloud thoughts&rdquo in my head and controlling my behavior in an effort to ruin my life. I smelled blood and decaying matter where no blood or decaying matter could be found (for example, in the classrooms at school). I had difficulty concentrating, I fantasized excessively, and I had trouble sleeping and eating. (Bockes 1985, p. 488)

This entry only starts to address some of the philosophical debates centered on delusions. Section 1 provides an overview of the philosophical significance of delusions. Section 2 introduces the issues surrounding the controversial definition of delusions, and some of the common distinctions between types of delusions are explained. Section 3 discusses the most prominent theoretical approaches to the nature and formation of delusions and the conceptual questions emerging from such approaches are highlighted. Section 4 reviews three of the most discussed themes in the philosophical literature on delusions: whether delusions are irrational whether they are beliefs and to what extent they overlap with cases of self-deception. The examination of the issues above often culminates in the attempt to understand how delusions differ from other pathological and non-pathological beliefs.


Overcoming Anxiety With Dehydration

Dehydration is completely preventable. Drink water more often, and you'll avoid many of the symptoms of dehydration and the subsequent anxiety. There's no harm in drinking more water if you're not sure how hydrated you are. Add a few extra glasses of water to your daily meals, and you may find that your anxiety and some of its symptoms clear up.

Yet most people that suffer from anxiety and dehydration have anxiety regardless of their hydration levels. Their water intake simply effects how severe their symptoms feel. That's why you still need to treat your anxiety separately from just increasing your intake of water.


Analog Neural Computation Using Principles of Harmonic Resonance

The very heart of Lehar’s work outlines how harmonic resonance shows up as a principle of self-organization in the mind.

Steven Lehar argued against the (at the time) prevailing neuron doctrine of neural computation which states that the contents of our experience are the result of the activity of highly discrete and individualized neurons that “encode” high-level features (such as a “grandma cell”). Importantly, Lehar points out that there is a key distinction between “rendering” an experience and merely “encoding” it. If you look for neurons that get activated if and only if a certain experience is happening you will be inadvertently mapping out how the brain encodes information rather than how it renders it. Failing to make this distinction will trap you in a worldview that is extremely hard to square with phenomenological facts. Of note is that our internal representations are flexible, a fact that the neuron doctrine finds really difficult to account for. As he puts it in “Harmonic Resonance Theory”:

There are several properties of the harmonic resonance model that are suggestive of human recognition. Unlike a rigid template, the pattern defined by a standing wave representation is elastic and adaptive. This can be seen in the manner that the spatial patterns of animal skins are defined. The parameters of the reaction-diffusion that distinguish between the spots and stripes of the tiger, zebra, leopard, and giraffe are encoded as general rules for the generation of those patterns rather than as a spatial template of any one such pattern. For example if a spot or stripe were to be fixed at one point as the pattern was emerging, the rest of the pattern would redistribute itself to adapt to that fixed feature while maintaining the general character of the encoded pattern. This invariance in the representation allows one set of parameters to generate an infinite variety of exemplars of any particular pattern type, or to adapt most flexibly to any fixed constraints or boundary conditions. (Lehar, 1999)

This flexibility of our internal representations is essential for understanding how the brain solves the “binding problem”: how is it possible that distributed neuron firings can simultaneously contribute to a unified internal representation? Indeed, Lehar takes the binding problem seriously and his solution involves resonance across spatial and temporal levels. This way, one can get representations that “lock in” low-level features to the high-level phenomenal objects that integrate them. In turn, our world-simulation works in a holistic fashion: every part of it pulls and pushes every other part of it. He explains it well in this interview:

Q: What would be the new paradigm in neuroscience?

A: The first thing that it will change is our concept of how the brain works. Right now we are in a neuro-reductionist era where people are making probes ever smaller and smaller to read into tinier and tinier parts of the brain and read the signal there and try to make some kind of sense out of it. The paradigm that they are thinking is discrete connections between individual neurons mediated by synapses. And separate individual signals going every different direction. What we see in consciousness is a much more holistic process. Something like water seeking its own level in a vessel, where the final state of the water depends on every position of every other molecule. If you change one portion, scoop out some water in one place or dump some in some other place, every single molecule in the bath quickly readjusts itself in order to seek a new level. It is a different paradigm of computation. It is what the gestaltists proposed: field theories of mind, not in the terms of fields of mental energy propagating out into the world, but fields of physical energy in the brain interacting with each other in a holistic manner the way that water seeks its own level in a vessel. (Sandu, 2016)

In Lehar’s world, the three-dimensional volumetric representations that we experience “around us” are internal representations made with a hierarchy of patterns of resonance which are mode-locked with one another. From the tiniest detail to the broadest outline, when we experience a phenomenal object as “rigid”, we are in fact experiencing a complex network of resonating patterns locked in place as a stable “solution” of a network of tuned oscillators. In other words, the binding problem is solved explicitly by hierarchical resonance at all levels. This model can explain many of the bizarre effects of psychedelics (which we’ll discuss further below) in terms of a decoupling between the resonance of the different levels! Or as Lehar would put it, “everything on LSD looks like a Fourier representation with the high-frequencies chopped off”, meaning that the fine details that would usually cancel out the broad repeating patterns of low-frequency resonance are desynchronized, and thus objects look as if they were filled with symmetrical and resonating filigree patterns!

Since Lehar worked on “Harmonic Resonance Theory,” there have been many advancements in neuroscience and the field of AI. In particular, two very noteworthy connections should be highlighted. The first is the work of Selen Atasoy (who is also one of QRI’s lineages) on connectome-specific harmonic waves (2016). Atasoy, like Lehar, identified principles of harmonic resonance in physics and biology (such as Murray’s leopard spots and zebra stripes in the standing waves of vibrating sheets of steel) and decided to apply them to the brain. Unlike Lehar, Atasoy found an empirically measurable aspect of the brain amenable to this kind of modeling: the connectome. Thus, Atasoy’s work enables the study of the standing waves that Lehar hinted at qualitatively, but now in an empirical and quantitative way.

In this way, the work of Atasoy and Lehar can be thought of as complementary rather than redundant: Lehar brings the phenomenological observations and arguments whereas Atasoy comes up with the precise empirical quantitative paradigm. Along these lines, we can already see possible extensions of this work. Namely, as we find more core structural scaffolds of the nervous system, we can examine them in light of a paradigm of harmonic resonance by building high-definition structural models, empirically extracting their corresponding wave equations, and then numerically approximating the emergent resonant modes of such structures. The beauty of this paradigm is that suddenly, large amounts of self-organizing complexity can be compressed in terms of weighted sums of harmonic resonant modes. At QRI, we consider this general paradigm to be extremely promising and endorse exploring how the overlap between these two great researchers leads to novel models of neural computation.

The second development that is important to point out is how advancements in artificial neural networks seem to have brought back the neuron doctrine with a vengeance. You get the impression that feature visualization techniques (Olah et al., 2017) allow us to make sense of what each neuron in a network “does.” Recent work at OpenAI takes this further and identifies recurring principles of self-organization that emerge in artificial neural networks (i.e. circuit motifs (Olah et al., 2020)).

The key to make sense of this is to recall the distinction between encoding and rendering. In Lehar’s world, populations of neurons that implement specific kinds of pattern recognition are in fact tuned resonators. Think of these resonators as having the function of adding clamps or pinches to a vibrating Chladni plate: the actual experience being rendered is the pattern of standing waves that emerge from the pinched plate, not the pinches themselves. While there is an extremely detailed correspondence between the content of experience and these clamps, what the experience is requires the pattern of standing waves to happen. Thus, insofar as artificial neural networks do not bring about such standing waves, they will simply and forever fail to render the contents of any experience.

Naturally, this is a testable view, since we can in principle manipulate the standing wave patterns directly (with e.g. transcranial magnetic stimulation). At QRI, we expect that in the future, this distinction will be extremely important. Without it, we would be at risk of thinking that specific computations done in digital computers entail qualia even though there is in fact no “rendering of experience” going on at all in the computational system as a whole.

A final note on this discussion is that Steven Lehar also has a theory of aesthetics. Foreshadowing the Symmetry Theory of Valence, first suggested by Johnson (2016), Lehar proposes a theory of aesthetics based on principles of harmonic resonance that explains our preference for symmetrical patterns. See the excerpt below titled “A Psycho-Aesthetic Hypothesis” in Appendix A. Thus, another key parallel between Lehar’s work and our models at QRI is that we have a non-standard interpretation of neuroanatomical functional localization. In particular, we think that the impression that “pleasure is what goes on in the pleasure centers” is at least in part an artifact of our measuring tools. As Michael Johnson postulates, the reason why activating the pleasure centers feels good is because they are strategically positioned in such a way that you get large-scale (consonant) resonance across the brain. In other words, the pleasure centers are “tuning knobs” for global synchrony in the brain! Thus, they are a kind of “master clamp” for harmonic resonance in the brain. What feels good is such resonance and not the activation of the pleasure centers per se. Don’t expect to find “beauty” in a single neuron both Lehar and QRI will be quick to point out that beauty is a holistic property of a holistic system!


The Symptoms of Drug-Induced Psychosis

Drug-induced psychosis can be caused by both the use of, and withdrawal from, a range of substances, including marijuana, alcohol, illicit and prescription stimulants (including cocaine, methamphetamine, and ADHD medications), and hallucinogens (including MDMA, LSD, and PCP). Some newer, synthetic drugs that fall under the category of “bath salts” are also known to cause psychosis. Although opioids are not typically associated with psychosis, it is possible that some users may experience psychotic symptoms.

Unfortunately, drug-induced psychosis is often spoken about primarily in the context of particularly vicious violent crimes perpetrators recount hearing voices directing them to commit heinous acts they would never normally be capable of, or holding delusional beliefs that drive them to extreme acts. While these narratives speak to the possibilities present within states of drug-induced psychosis, their extremity can make the condition feel so foreign and implausible that you may fail to appreciate the risk of experiencing anything resembling it yourself. However, drug-induced psychosis can express itself in a variety of ways, few of which involve violent tendencies. Understanding the symptoms of drug-induced psychosis is essential to recognizing these experiences for what they are and seeking treatment as soon as possible.

Specific symptoms of drug-induced psychosis include:

  • Hallucinations: Hallucinations are disturbances in perception that can cause you to hear, see, or feel things that aren’t there.
  • Delusions: Delusions are unjustified, fantastic, or bizarre beliefs, such as thinking that you are a different person, that people are out to get you, or that you can read other people’s minds.
  • Disorganized thinking and speech: Disorganized thinking and speech refer to illogical thought and nonsensical associations. This may range in severity from difficulty staying on topic during a conversation to an inability to communicate at all due incoherent and incomprehensible thinking.
  • Disorganized behavior: Disorganized behavior includes socially unacceptable and context-inappropriate behaviors, including childlike, aggressive, and exaggerated behaviors.

These phenomena may be accompanied by symptoms such as mood changes, sleep disturbances, loss of energy, poor motivation, social withdrawal, the inability to experience pleasure, and flat affect.

Hope is Just a Phone Call Away

Experiencing Mental Health Issues as a Result of Drug Use?


The consequences of complexity

Spend time talking to people in detail about their voices - the ways in which they are experienced, made sense of, and coped with - and the heterogeneity of auditory hallucinations is unmistakable.

Yet it is still commonly assumed that hearing voices is always a symptom of severe mental illness, and that the voices heard by people with a diagnosis of schizophrenia are loud, commanding, and dangerous. That wasn’t the case for our participants, though it must be recognised that people who are experiencing acute difficulties with managing their voices may be less likely to participate in research.

Our study drew on a wide range of expertise – including in philosophy, psychology, medical humanities and the history of psychiatry, as well as personal experience – to investigate the phenomenon of hearing voices. This shows the value of a range of methods and approaches in illuminating this fascinating aspect of human experience.

A greater understanding of the complexity and variety of that experience is crucial. Our research also has implications for the therapeutic management of distressing voices and for the design of future studies of voice-hearing.


Pay Attention to Thought Patterns

Now, identify what kinds of thoughts were brought up by the situation or event that led to the problem behavior. How did you evaluate the situation or yourself in that situation? Did you engage in catastrophic or all-or-none thinking?

Think about what emotions you were having as a result of that situation. Try your best to list as many emotions as you possibly can, such as fear, sadness, anger, shame, guilt, embarrassment, or dread.

Pay attention to what you felt in your body. Try to recognize and label all the sensations that came up.

For example, did you experience shortness of breath? Muscle tension? An increased heart rate? Think about how your body reacted to the situation.

Next, list off what your thoughts, emotions and bodily sensations made you want to do. That is, did they make you want to escape the situation or do something to make those feelings stop? Did you feel a need to engage in your problem behavior?

Finally, think about the consequences of engaging in your problem behavior. Did you feel better afterward? Did you feel disappointed in yourself? Ashamed? Try to list as many consequences (both positive and negative) as you can.


Ever Wonder What a Visual or Auditory Hallucination Was Like?

It&rsquos one thing to be told that schizophrenia often involves a person who hears or sees things that aren&rsquot there. It&rsquos another to &lsquoexperience&rsquo it yourself, via Second Life. (Although I&rsquom not sure I&rsquod call it &lsquoexperiencing&rsquo something by watching it on a screen, but I digress.) But a press release that came across our desk the other day did make it seem like this has some potential to help people with understanding a component of schizophrenia.

A University of California-Davis professor of psychiatry has helped develop an Internet-based virtual reality (VR) environment that simulates the hallucinations of people with schizophrenia. The vast majority of individuals who have toured the environment self-reported that it improved their understanding of the auditory and visual hallucinations experienced by people with schizophrenia.

&ldquoUsing traditional educational methods, instructors have difficulty teaching about the internal phenomena of mental illnesses, such as hallucinations,&rdquo said Peter Yellowlees, professor of psychiatry and director of Academic Information Systems at UC Davis Health System.

Developed by Yellowlees and colleagues in the UC Davis Department of Psychiatry and Behavioral Science, the virtual reality system is being used as a teaching tool at the UC Davis School of Medicine. Yellowlees and his team created the virtual environment to replicate the experiences and world of a schizophrenia patient to provide medical students with a better understanding of this mental illness.

Schizophrenia is a severe mental illness that affects 1 percent of the population. Most people with schizophrenia experience auditory hallucinations, particularly hearing voices, and about one-fourth of those with the disorder experience visual hallucinations.

The researchers took photographs of an inpatient ward and hospital furnishings at UC Davis Medical Center to create their virtual setting. The team constructed simulations of auditory and visual hallucinations based on recorded audio samples and digital images described in interviews with schizophrenia patients. The researchers inserted the hallucinations as individual objects that would appear automatically throughout the ward, triggered by the presence of an avatar, an electronic image represented and manipulated by a computer user.

The hallucinations in the virtual environment included:

  • Multiple voices, occasionally overlapping, criticizing the user
  • A poster that would change its text to obscenities
  • A newspaper in which the word &ldquodeath&rdquo would stand out in a headline
  • A floor that would fall away, leaving the user walking on stepping stones above a bank of clouds
  • Books on bookshelves with titles related to fascism
  • A television that would play a political speech, but then criticize the user and encourage suicide
  • A gun that would appear under a cone of light and pulse, with associated voices telling the user to take the gun and commit suicide
  • A mirror in which a person&rsquos reflection would appear to die, becoming gaunt with bleeding eyes

Over a two-month period, the virtual psychosis environment was toured 836 times and received 579 valid survey responses. Large majorities of the responders said the tour improved their understanding of auditory hallucinations (76 percent), visual hallucinations (69 percent) and schizophrenia (73 percent). Eighty-two percent said they would recommend the tour to others.

One user said, &ldquoThat tour was amazing. I didn&rsquot think it would affect me, but about halfway through, I wanted to shout, &lsquoStop it!&rsquo&rdquo

Another user said, &ldquoMy first husband was schizophrenic. I have experienced visual hallucinations and they are disturbing enough.&rdquo

Yelllowlees and his colleagues acknowledged some important limitations of their pilot project, including their survey population not being a representative sample of the general population. Also, because users did not take a pre-test, the researchers cannot prove that participants improved their knowledge. Lastly, because the virtual environment focuses only on hallucinations, it may give inappropriate weight to these symptoms, rather than a fuller view including other symptoms such as delusions, and disordered speech and behavior.

However, despite those limitations, Yellowlees and his team believe their approach is promising. They plan to perform a more formal evaluation of its effectiveness in teaching students about psychotic experiences as compared to traditional teaching approaches. In addition, they intend to use the virtual environment to teach caregivers attending an early intervention program for patients experiencing a first episode of psychosis.


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I had a severe case of nihilistic delusions eight years ago. For me, it felt as if my body was transparent and people could walk by or through me without seeing me. I couldn't maintain a conversation -not because I didn't hear it, but because I thought I didn't exist so they wouldn't receive my reply. I hallucinated and thought I was in the past. I wasn't sure what physical objects were real, or if I was real. It felt like a complete break with reality. The only reason I didn't commit suicide was because I felt I was dead already.

My body wasn't participating in life. I lost over 30 pounds in two months. I was able to talk and dress myself, but that was the extent of it. I had never heard of anyone experiencing these symptoms with depression until now. I have now been stable for six years. But for health workers and concerned family and friends: pay attention to those around you who are depressed with nihilistic tendencies. Avoid normal day-to-day conversations it makes it worse/doesn't help. Stay by their side don't leave them alone. Be careful with touching sometimes it helped anchor me, sometimes it scared me.

When you have these traits in your head, your world turns upside down. It took years of therapy to reverse my head mantras, but it's possible to be "normal again" if the person stays with it, and their brain doesn't relapse. Medication was a life-saver for me. Remember that logic is flipped and you lose a grasp on reality. What seems logical to you, isn't to me, so try to understand. It's a very scary time and you often feel alone which makes matters worse. Like I said, I've never met anyone who experienced nihilistic delusions. I thought I was the only one. It's a hard concept to grasp because it's the antithesis of the will to live, but if you find a person experiencing these signs: hold on to them. You are their link to reality. burcinc April 19, 2014

@discographer-- No, nihilistic delusions or Cotard's Syndrome is rare, very rare. It affects men and women equally but age increases the risk of developing it. discographer April 18, 2014

@SteamLouis-- I'm no expert on this subject but I don't think that this condition is rare or common.

As far as I know, it results from a brain dysfunction and this can happen even without injury. The dysfunction causes the person to disassociate with themselves, meaning that they can't recognize themselves and their appearance. Because of this disassociation, the person develops the feeling that this body is not theirs, their body is deteriorating or they don't exist. So nihilistic delusion is scientifically explainable.

I think that there are also psychological causes of the disorder though. I think that a fear of death also plays a role. For example, there was someone who developed nihilistic delusions after a severe traffic accident. He almost died and after survival, that fear of death seems to have triggered his delusions. SteamLouis April 18, 2014

This is the first time that I'm hearing about nihilistic delusion. Is nihilistic delusion rare in comparison to other types of delusions?

I often hear about people with mental health disorders who believe that their dead relatives are alive. Others think that they are a different person and start to act that way. But I have never heard of anyone thinking that they are dead or that they do not exist. It's a very odd and interesting notion.

In cases where the condition is not due to brain injury, do past grievances and traumas explain them fully? Do we have any experts here who can shed more light on this condition? Pippinwhite April 7, 2014

I suppose nihilistic delusions are the opposite of Truman Syndrome, where someone feels his every move is being watched by everyone -- probably on TV.

This must be an absolutely miserable way to exist -- I certainly wouldn't call it "living," per se. There's no quality of life, in any case.

Barring a mental illness like schizophrenia, I have to wonder if some sufferers are victims of abuse, where just not being there was the preferable option, and that became the way the person functioned -- he or she simply wasn't there.

The article does not address how common this disorder is. I'd be interested in finding out.