Hallucination Versus Reality

This article about hallucination versus reality is more of a philosophical article in nature than medical, yet very relevant to the issue of psychosis or schizophrenia. I will attempt to use our common vernacular when possible; however, at times I will be compelled to use the nomenclature of philosophy. I will even raise some issues that challenge our commonsense views of reality and life; but this is good and we can all learn from probing some of these weighty philosophical issues. I believe that understanding one of the leading theories of perception viz. Representative Realism; will show us how the mind perceives the world and how easily it can be “tricked”.Understanding this will then show us how real a hallucination or illusion appears to someone suffering from psychosis and maybe provide us a mind-shift as to how we convince or teach someone to discern hallucination vs reality. After we briefly discuss this truncated discussion of Representative Realism, I think you might be surprised how close hallucination is to reality; there are other popular views of epistemology viz. Phenonemalism which postulate that everything is illusion! If I succeed in presenting this material, you may begin to question what is real and how can you prove it hence – hallucination versus reality!As a psychiatrist in Scottsdale I treat Schizophrenia and Schizoaffective disorder, often with good results. One of the greatest challenges in dealing with a patient having a form of psychosis is to convince them that what they may hear, smell, see, or think are hallucinations and have no basis in reality (hallucination vs reality). The problem, I believe has to do with perception and how the mind corresponds to the extended world or reality.As humans we cannot know the extended world (reality) intrinsically. This is one thing that all philosophers agree on. Nobody will every know what subsumes sub-sub-sub-sub atomic particles…which ultimately constitute reality. And I can say this with certainty because we will never know “when we reached the bottom”, but I digress. This view excludes the view of Naive Realism which would not be apropos to the discussion. Nobody can know the world outside of their humanity. What I mean by this is the we cannot know the world, in an unbiased fashion apart from our senses and human limitations. These biases are based on our our senses, our minds, presuppositions and worldviews. Nobody can make a claim to possessing “Brute facts” of science, the world, or anything of the empirical realm. All we can know is what our minds experience based on the mediation of several factors.For example we see a moth, yet what does a Fruit Bat see? Descartes summed this up in his cogito viz. “I think therefore I am”. Descartes knew the only thing he could indefeasibly know was that he existed, beyond that we cannot prove anything else because we don’t have privileged access to an object view of the world. Even David Hume wrote: “Tis vain to ask if there be a body”. Hume said it was impossible to prove that there is an extended world -yet we believe it exists, we just can’t find an incorrigible thesis to prove it. You may detect I am laying some groundwork to exhibit that “reality” is not a settled fact and the line between hallucination and reality is much thinner than most of us believe. Hallucinations and reality share a lot in common and this is the difficulty of convincing someone that their beliefs, thoughts, and what their senses are telling them are not true.Consider that no two people can see, smell, or hear the exact same thing — everyone’s understanding of reality is different. We might go as far as to say that reality is an issue of convention or agreement, or what the majority calls normal. This is what is called naive realism or a common-sense reality approach to epistemology, perception, and life.What we perceive about the world is really seen through our conceptual framework and senses which according to the theory of representative realism or indirect realism-all that we know of the world is mediated through sense datum. We don’t necessarily see things as they are but what our humanity enables or limits us to see mediated by sense datum (images). Remember that what we see as a moth, a Fruit Bat might see as a radar blip. To further demonstrate this lets begin with color. Does color exist (Talking about color not light frequency)? No, color does not exist apart from a sentient being having the ability to look at some molecules that posses essential qualities or power to reflect a frequency of light, and then this light is perceived by the rods and cones in the eyes which then convey this information or image (Sense datum) to the mind. So we perceive color indirectly and is mediated through light, our senses and ultimately through sense datum or images.Back to the issue of convention, if everyone were color blind, then nobody would see any color, hence color would not exist. This is the same with the ancient riddle “if a tree falls in the forest and there is nobody there to hear it; did it make a noise?” Again the answer is no. There may have been shock waves rippling through the medium of “air” but if there is no sentient being with ears, then there is no “noise”. Again we have an example of our perceiving the world indirectly through sense datum (in this case the sense datum is sound) and not perceiving the world directly and intrinsically.How about objects? Let’s assume that five of us are sitting around the coffee table and we see an apple on this table, do any of us see the same thing and are we seeing what is really there? What we see is an image or sense datum that exists some where between (or in) our minds and our senses. If this image or sense datum is causally linked to an atomic mass in the location of the image; then we would say yes an apple truly exists. Yet what we see is not intrinsically reality but rather what our humanity limits us to see. So we might conclude that our reality is mediated by an image that our mind creates through our senses and is provoked by an object in the real world that has a causal influence to produce the sense datum which is presented to our minds. This theory we call representative realism is a causal theory in that it relies on there being a causal connection between these atoms that occupy time and space and the image (sense datum) that we see and is presented to our minds through our senses. Are you still with me? So far we can conclude that for an image to be real it must be grounded in a causal connection between atomic matter, that occupies the space where the image is perceived, and a causal relationship between this matter and the image it corresponds to; otherwise the image is an ungrounded hallucination and would be said to have no basis in reality – yet this hallucination is sort of a “partial truth”.The problem with psychosis in many cases is that someone who is psychotic and sees an hallucination sees exactly what we would see, only there is no causal link between the image and any molecules occupying the proximity of the image. We too often think that these hallucinations are like mirages, blurry, or surreal; however, that is not always the case. When someone sees, hears, or smells something, it is either causally related to some atomic structure in the extended world which grounds it’s reality or it is not and is mere hallucination. This is the very subtle issue of hallucination versus reality.A person suffering from psychosis having trouble with the issue of hallucination vs reality; who claims to have seen a red apple on her coffee table an hour ago, as far as her perception goes, she saw the red apple; this much is true. The problem is: were there any molecules occupying the location of the image which had a causal effect that produced the image or sense datum?I hope this has demonstrated the difficulty of discerning hallucination vs reality and how difficult it can be to convince someone otherwise. Has this made it any easier to work with a patient with regards to hallucination vs reality? Or has it demonstrated the near impossibility of discerning the differences between hallucination vs reality? In some cases a psychotic patient might have hallucinations that are so far removed from reality that with medication and time they might gain some insight into their illness. Or a patient might have hallucinations that are so close to reality such as olfactory or auditory hallucinations where it is extremely difficult to discern between a hallucination and reality.I think that one thing we can learn from this exercise in perception is to maybe find a simple way of explaining this theory or representative realism to the patient, and then challenge them to prove the existence of a causal object that provoked the sense datum or image that they smelled, heard, or saw. Maybe based on this, they can gain some insight into the what they are seeing or hearing or smelling and it’s lack of correspondence to the reality or extended world. This article on hallucination versus reality is based on one of many theories of perception and epistemology and is obviously not an indefeasible theory and with all theories subject to great debate. Hallucination vs reality has been the subject of philosophical inquiry for centuries – nothing new.If I may address any points of interest in this article on hallucination versus reality that I failed to articulate, or need further clarification on some issues that I addressed, please let me know. Questioning Hallucination vs Reality – you must have grasped the theme of this article!This article on hallucination vs reality is not for diagnosing or treating any mental illness and strictly for informative purposes