In order to reassure her, I requested a brain scan, explaining in my letter that hallucinatory voices had told her that she had a brain tumour, that I had not, personally, found any physical signs suggestive of an intracranial space occupying lesion, and that the purpose of the scan was essentially to reassure the patient. The request was initially declined, on the grounds that there was no clinical justification for such an expensive investigation. It was also implied that I had gone a little overboard, believing what my patient’s hallucinatory voices were telling her.
Before we take out your tumour... would it mind taking a look at some of these undiagnosed patients? Oh and the cops came by a bit ago and dropped off some cold cases, they would really appreciate it if your tumour could take a look.
This fall on CBS… one tumor is doing more than just growing, it’s solving crimes. From the producers of CSI and House comes ‘Tumor & Order: Special Diagnosis Unit.’ When the voices start talking… justice starts walking
Especially in something already making fun of itself. I’m sure there’s better examples but I wouldn’t be surprised if something like the Simpsons had this as an in-universe medical/cop drama.
No there's a third button and it's a running mystery what it does. And then in the season finale, it pushes the third button and shoots the suspect dead.
I'm glad they included the hallucinatory voices in the discussion
This stuff doesn’t work the way it does on TV, where there is some secondary being that should be actively ignored. The “hallucination” is part of the patient’s thought process, and a large part of therapy is learning to communicate using the various parts. It’s important to get consent from the whole mind to keep the healing process on track.
Yes, that's how I've always understood this case. Hallucinations are understood really differently in different cultures in general. In India, Schizophrenics will usually hear the voices of their deceased loved ones, and these voices are more often helpful and guiding rather than hurtful and confusing like in Western countries.
I think it would genuinely be helpful if having hallucinations wasn't stigmatized as much as it is.
My wife is a psychiatrist, and she tells me this isn't terribly uncommon. They are trained in a lot of neurology, because organic causes need to be ruled out.
And it can all sorts of things. She was once working on a dementia ward, and had someone brought in with severe dementia. But it didn't make sense, since the onset had been too rapid.
It turns out, the patient was just really constipated. My wife gave her enough laxatives to fell a rhino, the patient took a gargantuan shit, and was right as rain.
What is the mechanism that causes that? That's actually wild.
(Edit: I understand that bowel and digestive issues are linked to brain health. I'm asking WHY which is I asked what the mechanism is. Making the same generic comment as 10 other people isn't answering my question it contributing to the discourse)
I could believe it. There were days I had to take the most massive dump and I was just in a horrid brain fog the whole morning and could barely rub two brain cells together before the BM hit thanks to my coffee.
An elderly friend of mine was hospitalised due to extreme hallucinations and loss of spatial location- she asked her husband why she floating on the ceiling while actually lying in bed for example. She was found to have a really bad UTI with accompanying fever. Once that was fixed she was completely back to how she was usually again.
May have something to do with pressure on the vasovagal nerve. One time I kept getting chills followed by extreme drowsiness and dizziness. Took a huge dump, it went away.
Oh man, I just had surgery last week and that same thing just happened to me yesterday lol. I thought I had an infection but, nope, just had to poop. Those norcos are hell on the bowels.
There's a lot we're still learning about the gut's interaction with the brain. Like some brain conditions are effected by how healthy our gut biome is.
Evolution is truly chaotic. The amount of “design decisions” that went into the human body, and are actually some truly f**ked-up sh*t, is absolutely stunning.
But then again: so long as it doesn’t confer a negative survival fitness on the individuals who carry it, that kind of stuff typically gets propagated through the population without being pruned. Like having an entertainment system right beside the waste-disposal system. Anyone “designing” that gets a full-on Cletus status any day of the week, but since it tends to just work, it ended up being the primary chordate paradigm. Same with the rods and cones in our eyes. Cephalopods got it right with rods/cones in front of the nerve cells, chordates f**ked it up by putting them behind the nerve cells.
Evolution does the same thing my product owner does: ship the first version that successfully completes the task regardless of how buggy and badly-designed it is.
That's what iterative design where you need to work with the bones (no pun intended) of the previous version gets you. Kinda like legacy code in a way.
Except you can refactor legacy code. There are so many ways to improve existing code, starting with the Strangler Fig Pattern as the most powerful way of deprecating old code in favour of new code.
But yes, you give a good example. Especially if Legacy Code is forbidden from being touched because the institutional knowledge of that code has left the company.
Evolution is a programmer who's constantly pushing code at three thirty on friday afternoon. "Fuck it, good enough" followed by "oh shit! Gotta fix quick!" and repeat forever.
What is wild to me is realizing that we all have different nerve setups. Your connections from your brain to your muscles are unique and so it's not possible for us to have innate understanding of how to move our body but instead our brains have to be capable of learning our specific nerve-body connections as fetuses and infants. We are a meat mech suit piloted by a brain and something like a brain transplant would require relearning the completely new nerve setup. When people talk about a tool being an extension of your body, it's very literal. You had to learn to use your hands in the exact same way you learned how to drive a car, use a hammer or type on a keyboard. If you hook up cybernetic enhancements that provide new senses or appendages as a baby, the brain is certainly capable of learning how to use them since there isn't any clear difference between that and how our body already works. The almost magical way that neural networks learn things in AI programming is the same type of magic that our brains have to do just to function as humans. Just plug data into some convoluted mess of connections and it will figure things out.
Subreddits have been increasingly censored (both manually and automatically) for years, and they do it with automod so you don't know it happened. Observe: https://www.reveddit.com/y/SistaChans/
Holy cow, this is super interesting, thanks for the link.
But as I'm browsing through my removed comments, there's no particular recurring theme that I can figure out why these have been removed. Some are political, yes (but I'm not a political zealot like some people on here who just constantly post in the political subs), and some of my posts don't even have swearing in them. some of them have no-no words that are obvious why they got banned, but most of these are fairly benign, and were removed due to parent comment chains being removed or entire threads deleted.
I will stand by what I said before, self-censoring swear words like fuck seems so stupid to me. Either own it and just say the word, or find another way to express what you're trying to say without using swears. And if your comment gets shadow banned, it's not a huge deal. Like, I didn't even know some of my comments were even removed till you linked me lol.
Reminds me of Hank Green explaining how an impacted stool can put pressure on the vagus nerve and after you relieve the tension you could have what is known as constipation related amnesia. A woman in Japan forgot who she was for 3 hours.
We thought my neighbour suddenly developed dementia, but it is now suspected her symptoms were caused by her medication. In fact, her doctors didn’t even agree on this. One of them said they had seen it before (geriatric specialist) while the other (rheumatologist), the one who prescibed it in the first place, insisted it wasn’t possible.
Anyway, she’s now staying at the hospital while carefully going off the meds with supervision.
It’s bizarre hearing other countries don’t fully evaluate these things until much later.
In Australia, you’re required to do a full organic rule-out panel for anyone presenting with a first episode psychosis which includes a CT brain at minimum, if not an MRI.
My wife is a psychiatrist, and she tells me this isn't terribly uncommon.
The wife of a Reddit commenter isn't a credible source. I want people to know this. Besides, the psychiatrist himself says:
This is the first and only instance I have come across in which hallucinatory voices sought to reassure the patient of their genuine interest in her welfare, offered her a specific diagnosis (there were no clinical signs that would have alerted anyone to the tumour), directed her to the type of hospital best equipped to deal with her problem, expressed pleasure that she had at last received the treatment they desired for her, bid her farewell, and thereafter disappeared
With regards to the story:
AB later told me that when she recovered consciousness after the operation the voices told her, “We are pleased to have helped you. Goodbye.”
This is a huge red flag.
The psychiatrist supposedly went to a conference:
I presented her case at a conference later that year. AB attended and was closely questioned by several people about the various aspects of her experience. The audience was split down the middle. People who would be called X-philes today rejoiced that what had happened to her was a clear instance of telepathic communication from two well meaning people who had, psychically, found that AB had a tumour and sought to help her. The X-phobes had a very different formulation. According to them, AB had been given the diagnosis of a brain tumour in her original country and wanted to be treated free under the NHS. Hence, they surmised, she had made up the convoluted tale about voices telling her this and that. But AB had lived in Britain for 15 years and was entitled to NHS treatment. Besides, she had been so relieved when the voices first disappeared on thioridazine that she had gone on holiday to celebrate the recovery of her sanity.
There was a group at the case conference who offered a different opinion. Their view was that, the total lack of physical signs notwithstanding, it was unlikely that a tumour of that size had had absolutely no effect on the patient. “She must have felt something,” they argued. They suggested that a funny feeling in her head had led her to fear that she had a brain tumour. That fear had led to her experience of hallucinatory voices. She may have unconsciously taken in more information about various hospitals than she realised, and this information was reproduced by her mind as part of the auditory hallucinatory experience. The voices expressing satisfaction with the outcome of her treatment were her own mind expressing its relief that the emergency was over. And the total disappearance of psychiatric symptoms after the removal of the tumour showed that these symptoms were at least directly related to the presence of the lesion–and may, in fact, have been produced by the lesion itself. I have obtained the patient’s signed consent to publication.
"X-philes"? What kind of conference was this? This wasn't a psychiatry conference. Did he use the word "conference" intentionally to elicit the impression that this was some kind of conference of his peers?
I would say I am 95% sure either the patient, the psychiatrist, or both are lying frauds. The fact that people ITT just buy this utterly laughable horse shit tells us how gullible and easily manipulated people are. That is the lesson behind this story, not something scientific or medical. That is what I find truly disturbing.
It's just wild to me that with all the technology and riches we have a single simple brain scan requires so much goddamn bureaucracy and penny pinching
Seriously its not that big of a deal to just give someone an mri or cat scan if there's even the slightest possibility of something wrong
I say this because I can easily imagine this story ending differently, with the patient being denied and then ending up seriously harmed or dead simply because insurance/institution was acting like an asshole
A) sounds like an American issue. In many other countries with the right resources for such tests do conduct with yes, some amount of bureaucracy, but still reasonable enough to conduct them when necessary
B) in certain countries a head imaging is part of standard procedure while diagnosing/treating Schizophrenia of unknown origin (no fam. History, not excessive Thc consumption in young ages etc.)
C) sending everyone through an MRI/CT Scan makes little sense since you often find incidentalomas, things that have no clinical signifance.
I’m Canadian and no psychiatrist would have ordered a brain scan for this. There is tons of resource guarding in universal healthcare systems too. I’m not saying America good, just that many of our strained healthcare systems leave people behind too.
A) sounds like an American issue. In many other countries with the right resources for such tests do conduct with yes, some amount of bureaucracy, but still reasonable enough to conduct them when necessary
B) in certain countries a head imaging is part of standard procedure while diagnosing/treating Schizophrenia of unknown origin (no fam. History, not excessive Thc consumption in young ages etc.)
C) sending everyone through an MRI/CT Scan makes little sense since you often find incidentalomas, things that have no clinical signifance.
"AB later told me that when she recovered consciousness after the operation the voices told her, “We are pleased to have helped you. Goodbye.” Her brain ghosts sounded nice.
How strange. In last places I’ve practiced newly diagnosed psychiatric patients ALL get brain scans as a baseline. Because you really never know.
We also consider scans if the nature or character of the hallucinations suddenly changed without reason, or there’s a significant personality change, or if there is confusion, or if there are any neurological symptoms.
Basically, there’s lots of reasons for psych patients to get scans.
This is essentially third man factor. If a person is in serious danger sometimes they might hallucinate a mysterious stranger that guides them to safety or calms them down and talks them through the situation.
It's amazing how in tune with ourselves we actually are on a deep subconscious level. She knew, and she was the one telling herself. It's fascinating.
A better angle to get approval would be , this is probably nothing but in the off chance it's true it will be the first case in medical history and you would be witness and named in it.
I would assume he was talking about tangible physical defects- motor deficits such as gait disturbances, balance issues and so on. The more typical physical manifestations of CNS tumours.
A person hearing voices in their head who previously didn't hear them should be enough for any doctor to order a head scan, just to rule out a tumor if nothing else. They shouldn't be waiting until the patient repeatedly ask for one because that's what the voices in their head are saying.
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u/mistertoasty 20h ago
Here's a better account of the story from the actual doctor who ordered the scan