SLS Web Magazine

Delusions are common in many mental illnesses. It is thought that damage to the right hemisphere can actually cause our minds to produce delusions from everyday experience. The left hemisphere, it is believed by some neurologists, is the agency that reconciles new experiences with existing expectations. In other words, the left hemisphere "translates" or even "interprets" new experiences into what we already know to be true. An experience that is very bizarre makes a proper interpretation or reconciliation nearly impossible. This is when the right hemisphere gets involved. It actually revises the framework and does the work of the left hemisphere. But when the right hemisphere is damaged, the left operates unchecked, forcing new experiences into the old mold by any way possible. The damage to the right hemisphere often results in losing the emotional significance of perceptions. This is believed to be the final factor that causes delusions in the mentally ill. Healthy right and healthy left hemispheres, the way we were before illness struck.

CAPGRAS SYNDROME

In this mental disorder, the regions of the brain which govern face recognition, found in the right hemisphere, may have been cut off from limbic centers. This results in the patient still recognizing familiar faces, but not feeling the expected warmth and "sense" of familiarity. The left hemisphere may intervene, then, by sending the message that this person is an imposter or robot. In this way, Capgras syndrome is something like the opposite of the deja vu experience. In deja vu, there is a strong sense of familiarity with something or someone never encountered before. In Capgras syndrome, this sense of familiarity with someone who is well known is lost. The sense of familiarity is often connected to an emotion. This too is lost. Without emotion, nothing matters, and the bewildered left hemisphere can interpret this emotional deadness as only death itself. Emotions are, although some would deny it, part of life itself.

GOOD SENSE AND JUDGMENT

Most people, if not all, have an excess capacity to assign meanings, especially to the behavior of other people. This tendency towards searching for meaning everywhere can actually result in mistaken beliefs. Most people also, if not all, judge people and events by their effect on ourselves. We are inclined to mistake coincidences for causes and blame persons rather than circumstances when things go wrong. These ideas, however, are not etched in stone but are adaptive; it is possible to "grow out of" false suspicions and false beliefs. Delusions may just be a pathological response needed to maintain vigilance for survival and reproduction. This is sort of an evolutionary look towards delusional disorders. Judgment requires reason.

DELUSIONS AND HEREDITY

Delusions can be responses to environment, but they can also be a result of heredity. Personality types are thought to have a link to heredity; one such is the paranoid personality. These people have a hypersensitivity to betrayal and hostility. They may also believe they are being persecuted and are mistrustful. Other traits of paranoid personalities include suspicion, touchiness, argumentative, arrogant, and fearful of intimacy. They envy the powerful and disdain the weak or naive. Additionally, they are reluctant to request or provide help, and are attracted to enterprises that encourage blaming others. Consequently, these people may become delusional. With the paranoid personality being highly heritable, one can see that the delusions can be attributed to heritable factors as well. Paranoia: a result of nature or nurture?

DELUSIONS AND THE THERAPEUTIC ALLIANCE

Perhaps the main therapeutic activity is not giving advice or providing interpretations but asking questions. With delusional persons, they can be asked such questions as "What is the evidence for the conspiracy or betrayal or disease? What other explanations are possible? By offering sympathetic interest in the person´s delusions, instead of challenging it outright, the therapist seeks to establish a trust with his patient. Formal respect, courtesy, and honesty are all qualities the therapist exudes with his patient, whereas aloofness and excessive warmth are avoided. Trust is difficult to establish, yet a necessary ingredient for recovery.

PARASOMNIAS

Parasomnias are conditions in which sleep is disrupted by inappropriate activation. The areas that are disrupted are brain centers that control body movements and sometimes areas that govern various physiological and emotional functions. These disruptions can occur either in the first third of the night or the last two-thirds of the night. But they are not limited to any specific period of the night. The most common parasomnias are sleepwalking and tooth grinding. Bed-wetting is another. Some less common parasomnias are sleep behavior disorder, leg cramps, sleep terrors, nightmares, and painful erections. Sleep is not necessarily dormancy.

MOTOR PARASOMNIAS

These parasomnias result from the effects of sleep on the brain´s motor control system. To fall asleep we must usually change our posture and muscle tone by lying down and relaxing our muscles. This deactivates the centers in the brainstem that preserve the waking state, and sleep soon follows. Body movements are possible even in very deep sleep, because nerve circuits using dopamine (a brain chemical) never become completely dormant. Motor parasomnias, then, or more simply body activity, can occur even in REM sleep. Life is activity.

SLEEPWALKING

Sleepwalking is a common motor disorder of NREM sleep. The movements of sleepwalkers can range anywhere from manipulation of sheets and nightclothes to travels out of the bedroom or the house. This form of nighttime activity is common among the young. They usually do not recall their activity the next morning. They are able to return to their beds and rarely harm themselves or others, but there are a few cases of assault and even homicide committed by sleepwalkers. Courts typically grant immunity to the perpetrators in these cases. Sleepwalking is serious business.

REM SLEEP DISORDERS

In REM sleep the amygdala and other brain regions that mediate anxiety and fear are strongly activated. But the prefrontal cortex, a region which normally moderates the expression of these emotions, is inactive. As a result, anxiety is the emotion most often associated with dreams. These dreams are what we call nightmares. Children are especially susceptible because they have so much REM sleep. In 50% of children at the ages of 3 to 6 nightmares are common. REM sleep may also produce sleep paralysis, the suppression of muscle movements for a few minutes after awakening from a dream. In this frightening state, the higher brain is awake, but the spinal cord is still asleep. Sleep paralysis corrects itself, however.

RELAPSE AND EXPRESSED EMOTION

When one member of a family is a psychiatric patient, the other family members may be classified as high in expressed emotion (EE) if they show signs of hostility, speak critically of the patient, or have a high emotional overinvolvement. When this expressed emotion is at a high level, the outcome is poor for those with schizophrenia. Patients hospitalized for mood and eating disorders also have a poor outcome. Relapse rates reflected the correlation between high expressed emotion and relapse. 65% of schizophrenic patients relapsed when the EE was high, whereas only 35% relapsed when the EE was low. For mood disorders, the rates were 70% and 30% respectively. Expressed emotion has become unacceptable.

LITHIUM PREVENTS SUICIDE

A recent Italian study compares suicidal acts in 284 patients with bipolar disorder. Before taking lithium, the rate of suicide attempts was 2.2% per year over eight years. During an average of six years on lithium, however, the rate was 0.4% per year--nearly six times lower. Lithium is known to stabilize mood as well as reduce aggression and impulsiveness. Suicide occurs mostly during depressions. Lithium is still a valuable aid for the mentally ill.

DISSOCIATION AND SEXUAL ABUSE

Dissociation is the division of consciousness into mutually uncommunicative states. This can be a result of childhood trauma, specifically sexual abuse. 1,200 people from the general population were chosen and asked about childhood physical and sexual abuse. They answered a 15-item questionnaire on dissociative symptoms. The symptoms include feeling that the world, self or others are unreal, having no idea how you arrived where you are, a feeling of standing next to oneself or being two different people, reliving past events, not remembering whether you did something or just thought about doing it. The incidence of these symptoms was highest among those who had psychiatric disorders as well as sexual abuse. Sexual abuse alone, however, did not necessarily produce high levels of dissociation. Dissociative states of mind, bizarre as they are, are under study.

CULTURE AND EATING DISORDERS

Anorexia is often considered a disorder that plagues mostly white, affluent, Western women as a result of social pressure to be slender. But at the Caribbean island of Curacao where overweight is socially acceptable, there is also high rate of anorexia. The rate for anorexia was practically the same for this culture as in American culture. The authors conclude that cultural demands for dieting are not a requirement for the development of anorexia. Culture is not as influential as one may believe.

PLACEBOS AND RELAPSE IN DEPRESSION

Nearly two thirds of depressed patients will improve when given an antidepressant. Yet so will about one third of those given a sugar pill instead. Whether or not a depressed patient relapses is what distinguishes between a true drug effect and a placebo response. In a recent study, nearly 400 depressed patients took Prozac for three months. Those who improved were then divided into four groups. One was switched to a sugar pill right away, the second after three months, the third after nine months. The fourth group stayed on the Prozac. The patients most likely to relapse after three months and after nine months were those whose symptoms improved very quickly--in the first two weeks. The authors call those on the sugar pill "placebo responders." The placebo effect is fascinating to all.