On 2/22/07, Jesse Mazer <[EMAIL PROTECTED]> wrote:

> Stathis Papaioannou wrote:
> >But some patients claim to hear voices with none of the "correct"
> psychotic
> >features; similarly, they have "delusions" without the classic features
> of
> >paranoid delusions, which do not respond to antipsychotic treatment.
> But wouldn't it also be true that a person hypnotized to experience
> stimuli
> like voices would display none of the correct psychotic features, and
> would
> not respond to antipsychotics? That doesn't mean the hypnotized person is
> not having genuine qualia of voices or whatever they've been hypnotized to
> experience. Why do you think it's different with these patients?

Sorry that I can't give you a straight answer, but the truth is no-one knows
what is going on in these peoples' heads, and there is no way of being sure.
I am quite happy dealing with psychotic patients, but when someone is not
psychotic and insisting they have the symptoms of psychosis (it is in most
cases easy to tell), it generates controversy among clinicians. Logically,
it would seem that *either* you have a delusion (a fixed, false belief not
in accordance with the patient's cultural background) *or* you don't have
one. What could it mean to have the delusion that you have a delusion, or
that you have wilfully convinced yourself of a delusion?

In an inversion of the Catch-22 situation, there was the case of a patient
who became convinced that he was going mad, even though there was no
evidence to suggest that this was the case. This was therefore diagnosed as
a delusional disorder, treated with antipsychotic medication, with
resolution of the delusion. Madness gets really weird...

Stathis Papaionannou

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