Wednesday, June 28, 2017

Observing the "Hard Problem" of Consciousness in a Clinical Setting

Most have heard of the concept of the "hard problem" of consciousness.  David Chalmers describes it as the understanding of qualia.   What is the description of the color of red, or describe the scent of a rose.  Such is the difficult concept of defining consciousness which is still allusive to this day.

A recent read of Robert Burton's article in Nautilus, "When Neurology Becomes Theology," reminded me that I've been exposed to the "hard problem" numerous times in the clinical setting.

A patient presents with a paranoid ideation that her ex-boyfriend is a member of a Mexican drug cartel and she sees black helicopters surveying her outside her hospital window.  Numerous times I would be called into her room to verify that there were helicopters hovering near her window [our unit is on the 7th floor].  I saw no such flying objects and truthfully conveyed my observation.

A patient presented with a fix delusion that she was pregnant.  She was in her mid 80s, but vehemently believed that it was so, even acknowledging that it was physically impossible.  She was the recipient of a "miracle."

A male patient believed that his family was planning to storm the hospital unit and kill him for his money.  Subsequent review of the family dynamics showed this not to be true, yet the paranoid delusion persisted with the patient asking me to call the police, or to move him to a different room so as not to be found by family member.

A female patient believed that the "Holy Spirit" had demanded that she refuse all nutrition and that anything the color of purple be removed from her room.  Diagnosed with a late onset of schizophrenia with delusions of religiosity.

An elderly woman refused to see or talk to her son because she believed that he was an imposter.  He looked and acted like her son but her perceptions were that it was really someone else...classic Capgra's delusions.

The list of psychotic features have been numerous based on my 20 years of psychiatric observations.  Despite the obvious debilitating psychotic issues, they were all independently different.  Psychosis is a personalized manifestation.  None are alike, as each patient perceives the psychotic component via their construct of "self" awareness in different individualistic ways.

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