On 2/22/07, Brent Meeker <[EMAIL PROTECTED]> wrote:

Stathis Papaioannou wrote:
> > A patient says that his leg is paralysed, behaves as if his leg is
> > paralysed, but the clinical signs and investigations are not consistent
> > with a paralysed leg. The diagnosis of hysterical paralysis is made. A
> > patient claims to hear voices of people nobody else sees, responds to
> > the voices as if they are there, but the clinical signs and response to
> > antipsychotic treatment is not consistent with the auditory
> > hallucinations experienced by peopel with psychotic illness. The
> > diagnosis of hysterical hallucinations is made: that is, they aren't
> > hearing voices that aren't there, they only *think* they're hearing
> > voices that aren't there.
> How is this diagnosis made?  It sounds like an impossible distinction - a
> scientific resolution of the zombie question.

The diagnosis of "pseudohallucinations" is made if they don't have the
characteristics typical of hallucinations in schizophrenia - that is, there
are third person observable differences. Without these differences it would
be impossible to tell and, since psychiatry at least aspires to be an
empirical science, the possibility is generally ignored. However, you can
have delusions about anything, so it should be at least theoretically
possible to have a delusion that you are having a perception. Patients
frequently report delusional memories of perceptions: that is, they insist
that they had a conversation or experience that they could not even have
hallucinated, because they were under observation at the time of the alleged
incident. Suppose this process is happening "live", so that they believe
they are hearing a voice and responding as if they are hearing a voice even
though they are not even hallucinating such a thing. We might speculate that
the actual experience would surely feel different to the mere belief that
they are having the experience, but if they could notice such a difference
they would not be deluded.

Stathis Papaioannou

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