I thought (though I could be wrong on this) that the hallucination pseudo-hallucination distinction was around whether the person lacks insight into the non-veridicality of some of their experiences (hallucination) or whether the person has insight that some of their experiences are non-veridical but insists that they are having those experiences (pseudohallucination).
Not necessarily. Simply having or lacking insight cannot, by itself, mean the difference between the existence of a phenomena which may or may not be indicitive of a particular disorder - in this case, psychosis. In that scenario, the same could be argued for any hallucination.
The DSM seems to build lack of insight into the definition of hallucinations and I have wondered at times whether a consequence of this is that hallucinations turn out to be a proper subset of delusion such that when someone meets criteria for hallucination they also meet criteria for delusion. For example, if someone hears a voice that they attribute to an external agency then they are having a hallucinatory experience and they are also having delusion with respect to its origin. But... I could well be missing something. (If hallucination is a proper subset of delusion then it would be an uninteresting empirical finding that hallucinations tended to be correlated with delusions, however. Much more interesting would be finding cases where someone was regarded as having hallucination in the absence of delusion.
This happens all the time, and depends on no small part, on the 'sophistication' of the patient, and that patient's use and adaptation of defenses.
It would be interesting to know whether these cases were really cases of pseudohallucination rather than delusion or whether they had been incorrectly regarded as non-delusional).
There has been a lot of debate around how delusions are distinct (if they are in fact) from religious beliefs and from over-valued ideas and so forth. I'm not sure that it is helpful to say that those beliefs that respond to anti-psychotics must have been biologically based whereas those beliefs that do not respond to anti-psychotics are not biologically based.
This isn't really what I intended to imply. Rather, using my example above, it would be unlikely that a pseudo-hallucination would respond to a medication (dopamine antagonist) which by definition, is not produced by a pathway malfunction in the sense that a "regular" hallucination is.
Surely our beliefs are in fact represented in our neurology and hence all beliefs are biologically based. I guess that ethical issues come up around whether it is or is not okay to attempt to treat someone for their belief especially if they are not wanting treatment for this. E.g., political dissentors in Russia were diagnosed as having 'sluggish schizophrenia' and treated on the basis of their political beliefs. The psychiatrists who treated them genuinely believed that those beliefs were signs of pathology (to be charitable to those psychiatrists).
An extreme example to be sure...and there are quite a few others. Siding with this view is basically what the scientologists and other anti-psychiatry zealots preach: that psychiatrists are tools of the government that are employed to quell social uprising against a totalitarian regime.
Jaspers attempted to distinguish between primary delusions (delusions 'proper') and secondary delusions ('delusion like ideas') as follows: Secondary delusions arise understandably from prior experiences whereas primary delusions are the result of disease process and they are ununderstandable. The trouble with this distinction is that it makes whether a person is delusional or not a matter of understandability or, in other words, a matter of how much the clinician is able to empathise with the client (hence it may well say more about the limitations of the psychiatrist than the limitations of the patient). One example of supposed ununderstandability was a case where a woman said 'there are bees buzzing around inside my skull' and pressure on her temporal lobe was found upon autopsy. It was possible that this pressure resulted in a buzzing sound. Another example was 'Dr B has turned me into a portfolio' where investigation revealed that the patient had some rare condition that Dr B was interested in and Dr B had indeed written her up as a case study.
The DSM casebook still makes similar distinctions, but instead of using the terms "understandable," uses the term "bizarre vs. non-bizarre." Unfortunately, they then go on to cite the example of a person who believes that poison gas is coming into her apartment via heating ducts through by her neighbors. Is this bizarre or not? In some ways yes, and in others, no. A horrible example that they used to try and illustrate a concept.
I'll leave it up to the readers to look up or remember how the DSM casebook classifies the above delusion.
Another distinction in the vicinity is the distinction between 'bizzarre' and 'non-bizzare' delusions where it is possible for non-bizzare delusions to be true (e.g., the FBI are following me) whereas it is impossible for bizzare delusions to be true (e.g., my body is a nuclear power plant). I won't even get started on problems in specifying the relevant notion of possibility, however (e.g., logical, metaphysical, physical, nomic).
See above! Somehow I skipped over this paragraph the first read-through.
🙂
I'm fairly confident that for every proposed distinction there would be counter-examples or cases that fell between the categories. This would be expected if it were the case that there was a continuum between ordinary beliefs and delusional beliefs with over valued ideas being somewhere between those. I've been reading Bentall at the moment where he argues against the notion that there is a hard and fast line between mentally disordered and not mentally disordered and also between kinds of mental disorder (e.g., schizophrenia and bi-polar).
I would find it much easier to argue Bentall's point, than the counterpoint...wouldn't most?
I would suppose that in this particular case (the onepresented in the start of the thread) it isn't going to make a great deal of difference to the treatment whether the persons speech is regarded as culturally appropriate or not. The context seems to place it as culturally inappropriate but more than that the greater context of the patient would seem to indicate intervention at any rate...
And that's where the rubber hits the road. These discussions are great for helping us to understand the phenomenology behind these abnormal? processes, yet at this stage, treatment remains largely the same. On a more basic level, the decision to treat at all, is ironically the harder question in some ways. That, of course, depends on a thorough history of the patient, previous level of functioning, medical conditions, and many more factors.
