3) Delusions & Anosognosia

Delusions & Anosognosia

I have been doing more research into delusions. I want to know exactly what they are and how they come to be. They are a big part of my son's life. To be honest I guess they are to some degree a part of all of our lives. We don't always see what other's see in the same situation. It seems to go hand and hand with lack of insight and anosognosia. Is my son being delusional or in denial? From what I can see he's not in denial because I can see how much he truly believes what he is telling me. From day to day his ability to see and rationalize what he has previously done or said changes. He can say or do something one day and two days later when we speak about it he believes the altered reality that he is telling me. For example: One day after I made the mistake of giving him two St John's Wort (Wikipedia: a herbal medicine for treating depression. I actually got it for myself to help with my insomnia and anxiety), he became very relaxed. Too relaxed. Within 20 minutes I was hearing what I will call psychosis talk. He was telling me how he was creating people in his head and giving them souls, laughing a lot over the mental pictures that he was creating and talking about being a poltergeist. St John's Wort is now in my purse (along with all the other things I want kept safely out of his reach and still take to bed with me). I learned my lesson there. Well two days later when I brought up this incident he tells me this is not what he was saying. He was just creating people in his head. Nothing else. He's altered his reality, I'm the one being delusional.

So I'm back on the internet researching exactly what a delusion is. I found one site that helped me to understand it somewhat. If you Google 'Bayes for Schizophrenics reasoning in delusional', you should be able to find it. They explain three common types of delusions. Capgras, Fregoli and Cotard. I won't define them here as they don't really apply. Anosognosia is a type of delusion. Delusions seem to fall under two main categories. Polythematic (multiple unconnected odd ideas) and monothematic (usually only has one odd idea). People with these types of delusions usually have damage to the right frontal lobe of the brain. I'm paraphrasing all this so please go to the site and read the whole article. Anosognosia occurs during right-sided brain injury but not left-sided brain injury. They first discovered/noticed anosognosia from a neurology viewpoint. People with strokes who's arm became paralyzed could not recognize or believe that their arm was paralyzed.  Physically it is obvious to everyone else but the patient has no insight into their inability to use their arm. In order to explain what is happening they come up with excuses and confabulations (memory disturbance, defined as the production of fabricated, distorted or misinterpreted memories about oneself or the world, without the conscious intention to deceive) that to them are perfectly rational. Ramachandran who is a neuroscientist, 'suggested that the left brain is an "apologist", trying to justify existing theories, and the right brain is a "revolutionary" which changes existing theories when conditions warrant. If the right brain is damaged, patients are unable to change their beliefs. This helps to explain anosognosia from a neurology viewpoint but doesn't really help me figure out what is going on with my son because even though his spiritual belief system doesn't change he is able to change his reality based on his belief system. Maybe it does help explain...  If the right side of his brain is damaged and he is unable to change his believes with respect to how he sees himself (insight) then the left side of his brain will justify these believes or theories. Information overload? and this only covers half of the article.

One line in this article that stands out for me is: "Assume that reality is such that my mental states are justified", a sort of Super Mind Projection Fallacy. A Super what? I think they go on to explain this very well. Typical schizophrenic delusions are delusions of grandeur and delusions of persecution. Delusions of grandeur are the belief that one is extremely important. One factor could be an elevated mood. "Wow, I feel like I'm really awesome. In what case would I be justified in thinking so highly of myself? Only if I were __________" Same with delusions of persecution. "In what case would I be justified in feelings this anxious? Only if people were constantly watching me and plotting to kill me. Who could do that? Based on the mental state these theories would seem logical.

The article then talks about RDPC. The right dorsolateral prefrontal cortex, an area of the brain strongly associated with delusions. For me I just note that this is again in the right side of my son's brain. Coltheart who is a cognitive scientist, refers to it as a "belief evaluation" center. The articles states that this theory doesn't explain why patients are still able to update about other situations. Coltheart speculates that maybe the belief evaluation system is weakened but not totally broken, and can deal  with anything except the ceaseless stream of contradictory endogenous (caused by factors inside) information.  For delusional patients with damage to their RDPC, what's important for them to believe something is if the explanation is adequate.  This being referred to as the Super Base Rate Fallacy. The best I can explain this Super what?.. is that they come up with a theory on what is happening based on some evidence but without taking into consideration if it was possible in the past or even if it is possible based on current evidence.  Again the line "Assume that reality is such that my mental states are justified" .

A footnote to this article that I found enlightening states that the RDPC also shows up in dream research. Usually it shuts down during dreaming which is why we don't notice how improbable our dreams are when we are having them. However it can get switched on during lucid dreaming explaining why lucid dreamers can reason normally while dreaming. I can apply this to my own dreaming. Until recently I could not control the improbability of what was going on in them but I have noticed a change in that most of the time I can now think "This doesn't make sense. I can do this or fix what is happening." If my son's RDPC (believe evaluation) center is not functioning as it should then what would be improbable to me would be possible to him.

Another website to look at is www.treatmentadvocacycenter.og/problem/anosognosia/2178
Anosognosia is a condition in which a subset of persons with schizophrenia (and bipolar disorder with psychotic features) are unable (not just unwilling) to understand they are sick because of damage to the parts of the brain which we use to think about ourselves. It is also referred to as a lack of insight or lack of awareness. Denial is a thought mechanism we all use to not pay attention to something we would prefer not to be true. The difference between anosognosia and denial can therefore be summarized as follows: A woman with schizophrenia sits daily in Lafayette Park, across from the White House, believing she is married to the President and waiting for him to call her to come over. She believes he has to wait to acknowledge her because of the interference of Israeli secret agents. She is very patient and, at night, sleeps on the streets, where she is regularly abused. When offered medication, she adamantly refuses it, saying there is nothing wrong with her. This is anosognosia. Another woman, trained as a mental health professional, briefly examines some scientific data and concludes it is wrong because it conflicts with her deeply held social belief system. This is denial.

Sorry if it has given you a headache to read this. Gave myself one writing it. Unfortunately all this information doesn't help me to deal with my son's obvious delusions regarding a job and his dad letting him move back home or his grandiose delusion regarding how powerful he is. It's difficult to watch him struggle with this and put so much effort and time into thinking about it. It does however help me to have a better understanding of why they are happening. I've tried being logical and pointing out what to me is obvious but he doesn't see it. I can except that based on what I just wrote.

On a humorous note my son said something to me along the lines of "I'm beginning to see why people would think that all this power might cause insanity." I replied "How about I switch that around and say that only insane people would want all that power." He laughed and said "Good point."  

Mom
BarbieBF

© July 2013

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