Monday, May 7, 2012

Impaired Cognition: Does Visual Stimuli Trigger Distorted Perceptions of Reality?

I've recently (past couple of months) been in the process of considering a developing theory by Jose Caravaca.   Mr. Caravaca has been proposing what he has coined "Distortion Theory"  Basically, Mr. Caravaca has been proposing that some UFO encounters are forms of visual distortions that are triggered by an external agent.  Currently, he is homing in on the trigger be it physiological and/or neurological...and possibly other sources.  His work can be viewed at The Caravaca Files and on various postings at The UFO Iconoclasts.

With Caravaca's Distortion Theory in mind.  I have a case study to present that may have some (or not) components of the trigger mechanism.

Some two years ago, a female patient was admitted to our unit for the evaluation of agitation, maladaptive behaviors in the context of long standing dementia, probably of the Alzheimer's type.  The patient was an 87 years old female, married for 67 years (husband still living), scored 4/30 on the Mini Mental Status Exam.  Due to her anxiety and agitation we were unable to do a comprehensive Dementia Rating Scale.

I had initially interviewed the patient as she was sitting in an isolated location in the day room. (on the fringe)  My initial assessment showed that she was alert and confused being oriented to her name only.  She was not able to tell me her present location, city of location.  She was unable to state the correct date (day, month, year).

When asked where she was from, she initially stated "Buffalo", then later changed to "Brooklyn".  During this initial interview, she appeared somewhat restless and irritable.  Her mood was neutral (congruent), but with flat affect.  Initially there appeared no signs of active delusional thinking or hallucinations.

After a brief interlude, I sat down next to her (she was seated in a wheel chair) and re-introduced myself and asked the following line of questions:

"How old are you?"-18 years old

"Where do you live?"- Brooklyn

"Where is your father?"-At work with the newspapers.

"Does he work for one of the local papers?"- No, he just sells papers.

"What kind of a house do you live in?" -A beautiful house.

"What does your mother do?"- She stays at home.

"What is your father's name?"- Joseph.

"What is your mother's name?" - Pauline.

"Do you have any sisters?" - Yes, two...Dolores.

"How old is Dolores?"- 23.

"Do you have a brother?"- Yes, he is a doctor.

"What is the name of your high school?"- She names a high school located in Brooklyn.

When asking her last name, she provided her real maiden name based on her history and physical and family members.  She stated that she was not married.

"Where are we currently located?"- We are in a school.

This ended the interview for this particular evening.  Based on the above exchange, the patient obviously had placed her physical presence in a "school" and living in "Brooklyn".  For all practical purposes, she was mentally back 69 years in time.

Why did she place herself in a "school" and her age as being that of 18?  I can deduce that the hospital unit, with two hall ways and with numerous patient rooms off to the side would appear that she was in some sort of school setting.  The door ways to individual patient rooms would have appeared as entry ways to class rooms. (Our psychiatric unit does not resemble your typical hospital unit.)

Questions to ponder:  Did the fact that she believed that she was 18 years old (current thought content) trigger her perception that she was in a school setting?

Or, was it due to her visual perception that the hospital unit looked like a school, and if she was in school, then she had to be 18 years old?

Perception is how one sees, hears, tastes, touch and smells their environment...a sensory construct allowing one to interpret and interact within their version of reality.  This corresponds to the old adage that perception is reality.

Is she cognizant and conscious?  Her cognition is severely impaired secondary to the dementia.  Impaired cognition has no appreciable effect on consciousness.   That she is conscious is evident that she is alert and aware of "an" environment, and thus interacting with the environment even though her perceptions of reality did not conform to my, or the other staff member's perceptions.  Yet we, including this patient, were all interacting in the same physical environment subjected to our interpretations via sight, sound, smell and touch.

Day 2

On the following day, I re-interviewed the patient in our day room.  She appeared restless and irritable.  Periodically telling me, "I want to be left alone."  Using the same questions asked previously, she was able to relate the following:

She is 21 years old and single.  She lives in Chicago.  She does not recall her parents.  She does not know where she is locally.  She denies having any brothers or sisters.  She complains that there is too much noise in the day room. (cause of her restlessness and irritable demeanor).

I waited an hour, then took the patient to a secluded room.  I had piped in classical music at a low volume.  I had the patient facing the room's window which over looked the hospital's surrounding neighborhood and the San Diego city skyline.  With the patient seemingly calm.  I commenced with the interview.

She was able to relay that she 21 years of age living in Brooklyn.  Her parents are Pauline and Joseph and both are doing well.  Her father sells newspapers.  She has hopes of attending college.  She has brothers and sisters but she cannot recall their names.  She is able to make out houses and buildings while looking out the room's window.  She specifically narrows in on an airplane making its' approach to the airport.  When I point out that the city skyline is that of San Diego, she states, "It can't be...its too far west."

Two hours later, after patient had finished with her dinner, I again re-introduced myself and took her back to  the same room mentioned above.  I re-asked the same questions.

She is 18 years old and single.  She has a sister named Deloris.  Her parents are Joe and Pauline.  She likes to read, swim and ski.  She may have gone to Japan on a ski trip.

Day 3

The patient is alert and oriented to her name only.  She appears less anxious and less restless.  She is able to smile at me, but generally she is apathetic, flat affect.  Spontaneity varies to my questions with some noted pausing and word searching.  I duplicated the setting of yesterday for today's interview session.  And again, asked the same formatted questions.

She is 22 years old.  She is able to tell me her full name (gives maiden name for her last).  She is single and going to college in Brooklyn.  Her parents are Pauline and Joe.  Her father sells newspapers.  She has a dog named "Ginger".  When asked what kind of do is Ginger, she replies that she is a "Mutt."

During the last two days, the patient never made reference to being in a school.  Recall that I had taken her to a secluded room away from the milieu that was increasing her restlessness and agitation.  The only visual trigger was during the Day 2 interview when she mentioned that the sight of the city skyline could not have been that of San Diego because it was too far west. (Her mental location was Brooklyn)  Prior to this statement, she had already told me that she was 21 years of age living in Brooklyn, so the proposed visual trigger had nothing to do with setting her mental time frame.  Day 3 interview had no visual trigger components.

What I was able to "loosely" conclude was that in the "busy" setting of the day room and the unit's appearance, she visually interpreted the unit to be that of a school with numerous classrooms off to the side. This had no effect on her perception of age (18-24 years of age).

In the secluded setting, away from the day room stimuli, her thought content was basically the same regarding her self-perceived age, location, and family dynamics.  There was no evidence that she thought she was in a "school" setting due to the lack of a visual source or cue.

Granted, I'm dealing with an individual who has a neurological disorder that has basically destroyed her short term memory leaving only her long term memory intact.  Yet her ability to access long term memory information is limited to only those memories of when she was 18 to 24 years old.

How does all of the above information pertain to Mr. Caravaca's Distortion Theory and the search for an external source enhancing UFO sightings, close encounters, and possibly the abduction phenomena?  Components of stress can alter our perceptions of reality.  In the above case study, under certain circumstances/conditions, visual interpretation of the surrounding environment can be altered causing the distortion of reality.


  1. Hi, Tim;

    This is a really interesting article, and once I get a bit of free time, I intend to check out "The Caravaca Files", as well as the postings at "The UFO Iconoclasts". Until that time, I'd like to ask the following:

    (1) I'm sure I'm missing something, but what's the difference between "visual distortions that are triggered by an external agent", and any type of induced hallucination, such as that caused by drugs, an allergic reaction, extreme stress, or trauma (although allergic reaction, extreme stress, or trauma might not meet the standards required of an external agent)?

    (2) What does a score of 4/30 on the Mini Mental Status Exam indicate about your patient (keep in mind, I've never even heard about the exam)?

    (3) What does "flat affect" refer to, and what does it indicate?

    (4) Do the answers she gave to you throughout the second interview represent accurate "memories" from when she was 18-years-old? What about subsequent interviews (obviously, contrary answers such as those concerning her brothers and sisters indicate that one of the answers was wrong. I'm just wondering which one it was)? Contrary by absence I can understand, so her observation that she has no brothers or sisters doesn't disturb me much more than simply forgetting particular facts. It would disturb me, however, if your patient was creating a memory instead of merely forgetting one.

    (5) Have you seen this type of apparent "triggering" in other patients? If so, do your patients have anything in common (aside from the hospital unit)?

    (6) Has Mr. Caravaca published any parts of his theory or discussed it in any way with his peers in the mental health industry or care facilities? Have you come across any critical (or pro) assessments?

    In a weird bit of synchronicity, I was reading some commentaries on a recent article in Skeptic magazine (see, one which concerned the changes the author experienced upon seeing a UFO. Specifically, he stated that the UFO "was other-worldly and made an impact on my life. That is what happens, when you see a real UFO, your perceptions of the universe change forever." What sort of trigger would Caravaca propose for something like this? I ask, because this seems to suggest a depth of perception similar to a religious impulse, like a conversion experience.

  2. The comments I made there also apply here: This type of perception is also typical when you see “angels”. Unfortunately, the “fact” that someone saw an “angel” doesn’t cause that change of perception; what causes it is that someone saw what he THOUGHT was an angel. The experience of witnessing a UFO — in and of itself — is no different than that of witnessing a balloon caught in the breeze. The only difference is whether or not the observer believes he was looking at the transcendent yet oppressive vision of a craft capable of embodying the impossible, or merely a “puffed-out” bit of rubber trapped within the layered channels of air pressure and temperature. Being a witness to anything is a perception-based affair, and if you ignore the psychological underpinnings that are associated with it, you are essentially ignoring the greater part of the phenomenon. A “real UFO” isn’t necessary; you need more data to substantiate what may very well be your mistaken belief that you saw a “real UFO,” — and the number of witnesses is irrelevant. It’s easier to incite a riot within a peaceful crowd of “observers” when their numbers climb. It’s also easier to establish within a group an incorrect assumption, which is why the Supreme Court finds it problematic when various witnesses to an incident are allowed to discuss and compare their assessments with each other before identifying a guilty party. An accounting of an event that has been reached as the result of group consensus and dynamics is just as often error-prone as it is accurate, although admittedly, both terms are “relative” within the structures of the group itself. The point is, when trying to determine the truth inherent to any perception-based phenomenon, all bets are off. If you want to establish truth, you need something more than a couple of guys (or 50) willing to say, “I saw it; as a result, my perception of the universe has changed forever.”

    I suspect Caravaca doesn't include mass sightings in his theory, but is there anything to suggest what kind of triggering mechanism might result in a perception as strong as a conversion experience?

    This is a really fascinating subject, so thanks for putting it out there for us. Have you spoken at all to Caravaca, and if so, has he noted any points in his presentation that he's stuck on for the moment? Thanks again, Tim -- I'm going to bed now (so I can get up again at 2 am), so take your time with these questions. I suspect this whole idea is well worth understanding, given that 99.9% of UFOlogy is pretty much a perception-based phenomenon. Your overall assessment of this theory seems to be that you're still on the fence about it. If that's not particularly accurate, please let me know.

  3. James, thanks for the comments. You caught me at my worst habit: not defining key terms in my article and will attempt to clarify in future articles.

    1) I believe that Mr. Caravaca is working on defining what the trigger mechanism consist of. It's still a work in progress. I posted a comment on his blog and he has replied that the distortion may be psychological or neurological...I tend to think both. The external agent could be as you wrote in your comment. Rich Reynolds (UFO Iconoclasts) thinks that it could also be what one eats or reads prior to the sighting. But yes, drugs (legal and illegal), alcohol, environmental factors (I'm working on a post that explains that angle).

    2) Basically, the Mini Mental Exam is used to to a quick assessment of a patient that reveals Cognition status, thought process and content, Mood and Affect, and other deficits. Its based on a series of questions in which points are given for the correct answers. 30 points is the max, obviously my patient scored a 4 which indicated that she was severely impaired at the given point in time.

    3) Affect basically is how animated with your speech pattern and tone and pitch: neutral, euphoric, flat tends to indicated apathy, non-interest. Generally goes hand in hand with your mood. In a medical setting Parkinson or stroke patients tend to exhibit flat affect yet may not indicate their mood.

    4) Her answers showed a certain degree of consistency versus total accuracy. It also depended on her mood and behaviors (restlessness, irritability, and agitation) Yet, after conferring with her family members and her chart history, she was fairly accurate with where she grew up, her parents and her sister's name and age (5 years older). These memories were not made up but came and went with each interview session.

    5) Yes I have come across similar situations and have written notes on each case with the possibility of publishing in a peer review journal in the future. There appears to be a common denominator of visual perceptions as far as where the are physically located and who I am (I may be a brother, husband, etc in their world view). It's still a work in progress.

    6) Mr. Caravaca has only provided data via his blog. I'm not aware that he has published anything formal. As of right now, I'm riding the fence, but his theory has merits and should be given consideration.

    I'm looking at putting together a Cognitive Stress Model and correlating it to some of the "close encounter" that we read about. I'll be posting about that thought in later post.

  4. Tim...

    Very interesting your article, I appreciate your words to my theory.



  5. Mr. Caravaca, glad that you found the post of interest. Whether or not the topic shows any correlation to your theory remains to be seen at this point in time.

    I'm looking forward to your on going work regarding your theory.