August 30, 2006
Q and A #1
This first Q and A comes from a series of questions my father asked me in an exchange of emails recently. All the "answers" have been edited, rewritten and polished for clarity's sake.
Can you explain to me again the difference between a delusion and an hallucination?
Delusion: a false belief --"I am Satan and make everyone around me sicken and die." May arise because of a hallucination...or simply arise of its own accord. That's how the delusion I described below in “Hospital Stay” arose, simply from that nurse not saying Hi properly. (I wrote it down in my notebook as it was happening and the Hustler stuff started immediately after the “Hnh” don’t-bother-me greeting)
Hallucination: a false perception -- hearing voices when no one is speaking (the most common hallucination) or seeing things that aren't there. For instance, I knew that dogs and Christmas trees should not be popping up in front of me even as I swerved to avoid them. On the other hand, I was mostly curious as to why Alan Arkin and Joe Lieberman were in Nazi uniforms supervising a conveyor belt going to crematorium ovens in the wall. They also may be tactile, olfactory or gustatory. An example: After ECT for months everything smelled like burnt rubber, so I couldn't eat anything but tomatoes and apples, and pasta with tomato sauce on it, unless I took Depakote. Then there was gustatory, when water, plain old selzer water that I loved, tasted like penicillin for months.
(in a later e-mail)
Here's a better more precise definition of delusion, since while it is a 'false belief' not all 'false beliefs' are delusional: an irrational false belief held with certainty against reason and proofs to the contrary.
Hallucination is even more difficult. It is a ‘false perception’, yes, but not all false perceptions are hallucinations; they can be illusions, misperceptions, optical illusions, distortions and so forth. I suppose you could say something qualifies as an hallucination if it is a false perception, or stimulation of one of the five senses, with no known reasonable source or other explanation and presumed to be generated by the person’s own brain.
What brings so much credibility to the phenomena?
Geeze, that stumps me. I really do not know the answer. Part of it is simply the fact that certainty is part of its being a delusion or hallucination. The brain's misfiring gives you the feeling of absolute certainty that XYZ is happening, or that such and such is real. That's what L says at any rate. Dr O says that the feeling the misfiring sparks may be fear, say, and then the brain constructs a scenario around that fear to explain it, a scenario that is built from our own psyches according to our own feelings and real fears, or according to what she calls the antidote to fear, which might be power if fear makes us powerless. I think she says it is so credible because the brain is credible by definition and what it creates it believes. I’m not sure, really.
Why do you obey the command hallucinations and delusions?
It's really hard to explain, except that the feeling certain they are real is part of the whole experience. And what could happen if I didn't obey is felt certain to be somehow much worse than the consequences of doing so. I think if you weren't certain it was real, a belief would be halfway to not being a delusion anymore. However, I could give an example where rationally something I know, or am supposed to know, is true, but when push comes to shove I still behave in that situation under the very same delusion I argued was "just a delusion..." The situation I’m talking about here is the grocery store and shopping, which I find excruciating because I feel people looking at me and watching and commenting on what I buy and making me buy things I neither want nor can use. I realize this is both delusion and hallucination at this moment. But when I walk into Stop and Shop, all that knowledge falls by the wayside and I go right into protective mode, preparing for the battle to come.
So does knowledge that something is delusional really make you un-deluded? I don't know. You have to believe what you know, I suppose. And in some areas I haven't come that far. But I'm growing and changing in other areas a little every day, so all in all things are pretty balanced. BD (in case you don’t know, that’s a smiley face with glasses - me!)
Posted by pamwagg at August 30, 2006 10:09 PM
I HAVE A PATIENT THAT IS A
AND WE HAVE KIDS TOGETHERE
AND SHE NOT TAKEING ABILIFY
AT ALL SINTS WE HADE KIDS TOGETHER SHOLD I BE A FRADE
OF LIZEING HER A LOND WITH THEM WITH HER OR NOT BECOUSE SHE CHOCKED MY 2 YEAR OLD DAUGHTER ANDTHROUGH JULIE ON HER BACK ON MY CHEST AND
TWO DAY LATER JULIE HADE A SEIZURE IF I WAS NOT THERE
STOP SHE I DO NOT KNOW WAIT WOULD OF HAPPIN TO THEM
LIKE NOW I DO NOT KNOW WAIT HAPPIN TO THEM NOW SO I WOULD LIKE TO ONE WAIT YOU THINK I SHOULD DO I AM THE FATHER OF THE GIRLS I WOULD LIKE TO KNOW WAIT TO DO NOW
Posted by: GARY at March 18, 2007 01:10 AM
After posting the above I realized that it was not precisely true: A. was not ALWAYS able to recognize delusions. She was initially, and has been for the last several years, but there was a period of time immediately following her first hospitalization during which she grew worse rather than better. She believed with conviction that aliens were colonizing earth, and it was about two and one-half months before she could laugh at this notion with any real cheer. In this same period she was not certain of all hallucinations, and sometimes this worked rather in reverse: she could not believe her eyes. There was an adult-care center next to the day hospital where she stayed, and on seeing a man whom we suppose was a client she decided that he COULDN'T be for real--but next day, same time and place, he was there again and it seemed probable that he did indeed exist.
Posted by: Cynthia at September 1, 2006 08:30 AM
I have often turned over in my mind the question that you present: if a person realizes that she is deluded, is she still genuinely delusional?
The saving grace in my daughter's battle with schizoaffective disorder is that she has recognized that she was ill from the onset of her illness. At the age of 15 she diagnosed herself, quite correctly, and packed her bags for her first hospital stay before her father and I knew what was happening. She had to persuade her dismissive psychiatrist to admit her: surely, he said, she was not truly psychotic; surely she did not truly need the hospital. But she gamely insisted that she was, and did, and she was right.
When her illness is exacerbated my daughter will ENTERTAIN delusions and be unable to STOP entertaining them, but she recognizes them for what they are nonetheless. Thus it is that she always has a foot firmly in reality, even when things are at their worst.
I look forward to each of your posts; none disappoint.
Posted by: Cynthia at August 31, 2006 11:29 PM
You wrote: "So does knowledge that something is delusional really make you un-deluded?"
Only if your knowledge is based on some kind of awakening, otherwise the delusion remains intact, or so I've found. I had an awakening after my last psychotic break in 2002, but I can't explain to you how the awakening was generated. Was it due to the break? Was it due to the meds I started taking? Or maybe a combination? I remember being afraid to challenge the delusion but even the voices wanted me to at that point. That might be key, that the voices themselves must want to end the delusion. But then the voices are supposedly auditory hallucinations. I will never believe this. It's like saying thoughts are all imaginary. The voices are real and separate from ourselves at the same time. My therapist helped me with this, telling me that the voices were not part of my essential self. She stressed that they were much sicker than I was and that I became sicker when I believed the negative things they were saying to me.
So she encouraged me to fight back by taking care of myself. This meant I saw the voices as "other" and began to pray for them to be healed. If they could be healed, then so could I. This method, along with taking the meds, has really helped me to get better and I still do pray for them. They are no longer my tormentors and deceivers. They switched from "You are evil" to "We are evil" and now even to "We love you". My family are also Unitarians. My parents are athiests and my brother is agnostic. Before I became psychotic I was leaning towards Buddhism but now I don't know what I am. All I know is that now I do believe in a Higher Power. An authority above the voices. It took me a while to believe it. For too long I thought the voices were the authority, but they are not. Know that they lie and try to objectify them. I think it's a mistake for the psychiatric community to say that the voices come from our subconscious and are part of us. Yes, I believe biochemistry does play a part in the illness, but it is not even close to the whole story. There is a spiritual dimension to this disease that often goes unaccounted for and because it is spiritual it can sound delusional, but then that is like saying all people who believe in God (the unseen) are delusional. Just because you can't see spirit doesn't necessarily mean it doesn't exist. You have not mentionned whether you believe in God but I think it is worth contemplating.
Posted by: Kate K. at August 31, 2006 12:04 PM
I am impressed by the coherent and understandable manner with which you defined both a delusion and a hallucination. The definitions are especially valuable because they come from someone who has actually experienced these symptoms of schizophrenia. Even though the many psychiatrists who have attempted to explain these phenomena to you are knowledgeable and well intentioned, they have not experienced either of the two. You have done so many times, and your explanation of your perceptions makes it easy to understand the difficulty you face in denying their reality, even though it flies in the face of rational thought. You are striving, learning and growing, however, with the help of L and Dr.O, to finally deny their existence. When you reach your goal, I dearly hope that you will finally be free, once and for all.
With encouagement and admiration,T3
Posted by: Paula Kirkpatrick at August 30, 2006 11:19 PM
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