Hallucinations
Hallucinations moved away from understanding the semantic
content towards differential classification from veridical perception, illusion
and hallucination
Hallucinations/ illusions surveys of population in 19th
century showed common in healthy population.
Definitions of pseudohallucinations unstable; vary from
false perceptions with insight to false perceptions with limited
"vivacity" or less convincing than veridical perception or in
internal space.
Importance of Scottish philosophers of common sense on
faculty psychology i.e. separate functions/ faculties
contrast with associationist models where simpler mental
phenomena are building blocks of more complex phenomena and are interconnected
Thought disorder
Thought disorder originally not separated from language
problems like expressive and receptive aphasia. Associated with dementia
praecox as an important symptom. As it is dependent on theories of thinking it
will be harder to find direct biological correlates
Delusions
Delusion regarded as hallmark of insanity . Often combined
with delirium only separation that of Presence of fever.
18-19th C Aetiology involved somatic events of various types
Locke made parallel of arguing right from a wrong premise,
he also had continuity psychosis description that erroneous thoughts/ beliefs
also occur in general population
Often thought to be secondary to an internal event
Associationist thinking, defect of reason/judgement
Also separating into delusions caused by hallucinations and
other delusions
Pinel only had 4 categories, delirium included
hallucinations and delusions
Delusions thought often due to eg hallucinations or internal
sensation, importance of affective response
Disorder of intellect of reasoning and judgment due to
organic brain disease e.g. Pinel thought attention
Delusions may be graded in severity
Often seen in context eg Falret who also thought lack of
insight important
Early 19th C delusion and delirium thought to be same
construct
Delirium split into with fever and without - the latter was
insanity.
Early 19th C French psychiatry identified delusional
disorder as separate, had continuity ideas of delusions; thought could be
caused by emotional excitation
German 19thc insanity is chronic delire without fever but
also partway between physical disease and mental illness as possible
unidentified somatic disease
Griesinger unitary psychosis - melancholia to mania to
dementia
Delusions are secondary eg to hallucinations or strong
emotions; incorrigibility, contrary to previous ideas, different from normal
strong beliefs, due to brain disease
English speaking 19th c Haslam impossibility of infallible
definition of madness; all mental faculties involved eg judgment and memory
Mania at the time includes insanity not just elated moo
Pritchard - partial insanity with some insight
Bucknill and Tuke - delusion in English errors without being
corrected by reason
Mid 19th C French.
I use delirium a lot but often means delire
Cotard linked motor activity, thinking and mental content
Mid 19th C British
Hughlings Jackson includes positive and negative but in
terms of evolution and dissolution of functions and not as we think of it
He thought delusions were the expression of healthy tissue
released by abolition of function in diseased tissue
Late 19th to 20th C French psychiatry Magnan Serieux similar
to Jaspers incubation, crystallisation, and 2 further stages
Targrowla and like Levy-Bruhl like Jaspers of intrusion of
sudden complete judgment
Chaslin like Cotard and earlier regarded delusions and
hallucinations as similar,
Delusions could occur in absence of defect of reasoning but
also with defect
German 19thc insanity is chronic delire without fever but
also partway between physical disease and mental illness as possible
unidentified somatic disease
Griesinger unitary psychosis - melancholia to mania to
dementia
Delusions are secondary eg to hallucinations or strong
emotions; incorrigibility, contrary to previous ideas, different from normal
strong beliefs, due to brain disease
English speaking 19th c Haslam impossibility of infallible
definition of madness; all mental faculties involved eg judgment and memory
Mania at the time includes insanity not just elated moo
Pritchard - partial insanity with some insight
Bucknill and Tuke - delusion in English errors without being
corrected by reason
Mid 19th C French.
People use delirium a lot but in French often means delire
Cotard linked motor activity, thinking and mental content
Mid 19th C British
Hughlings Jackson includes positive and negative but in
terms of evolution and dissolution of functions and not as we think of it
He thought delusions were the expression of healthy tissue
released by abolition of function in diseased tissue
Late 19th to 20th C French psychiatry Magnan Serieux similar
to Jaspers incubation, crystallisation, and 2 further stages
Targrowla and like Levy-Bruhl like Jaspers of intrusion of
sudden complete judgment
Chaslin like Cotard and earlier regarded delusions and
hallucinations as similar,
Delusions could occur in absence of defect of reasoning but
also with defect
Delusions concept based on outdated concepts eg of
epistemology
Eg based on concept of wrong belief that may or may have
volitional content
Berrios states Jaspers actually regards delusions as having
the form of beliefs but the content is morbid and false
Berrios states delusions do not meet Price criteria for
beliefs
He states Bayesian models may not apply to delusions or
normal beliefs
Delusions not real beliefs as not statements about the world
(calls them empty speech acts) but Berrios ignored that they tell you something
about the patient and their world
Talks about delusions being “enveloped” in “psychosocial
noise”
Primary vs secondary delusions plus theories of
psychological and biological causation
Even if can’t currently comprehend delusions on future may
be able to
Up until early 19th C delusions considered sign of madness
and little interest in their content
By 1850 interest in their form Then interest in the their
content 1850s onward - hermeneutic rules driving content not succeeded
Pre delusional state PDS of moods, thought, connotation
(consciousness) and motor action - existed before Jaspers including Hesnard in?France
Links between madness and dreaming again.
Ball & Ritti late 19th c linked sudden delusional
formation with VEGETATIVE symptoms p116
Many before Jaspers had primary and secondary delusions
including in France / Germany
De Clerembeault early 20th C thought delusions and
hallucinations secondary to coenesthopathies - internal anamolous experiences
Pre Delusional State (PDS()
in relation to primary delusions what hallucinations or moods are to
secondary delusions
PDS primordial soup out of which hallucinations/ delusions
formed depending on coding rules
PDS not always observed by clinicians as occurred before
contact as may function ok
Berrios says cognitive functioning during PDS impaired and
delusion formation may not therefore provide adaptive / teleological /
epistemological function
PDS descriptions important form various authors
Conrad Endogenous depression caused by SCZ but never other
way round
Blondel and Llopis important ideas
In Continent PDS are disorders of consciousness - Continent
disorders of consciousness is not just attention problems, disorientation and
confusion but also dysphoria, irritability, subtle loss of grasp, situational
disorientation and hypereasthetic states
Others also focussed on perplexity
Unclear if delusions different in SCZ from mania or organic
disorders
May be mistaken believing same structure as normal beliefs
Dimensional measurements of aspects of delusions not v
helpful and dimensional model does not clarify well from Normal beliefs
according to experienced clinicians “figment of the researcher’s imagination”
p. 125
Also wrong to have continuum between over-valued ideas,
delusions and obsessions
20Th C saw sub typing of delusions eg jealousy as of
separate diseases
19th C delusions “intimately linked to the notion of
insanity itself” p. 126 and before 1800 both organic delirium and insanity depended
on delusions, illusions and hallucinations (which were not considered as
separate phenomena)
