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.