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Tuesday, 16 October 2012

Dissociation syndromes - scope for misinterpretations

@HealthMed The complex phrases 'dissociation syndrome', 'extinction syndrome' and 'neglect syndrome' embraces a wide range of categories of altered perception from 'out of body' experience to failure to recognize parts of the body as one's own. Causes may include generalised altered perception in response for example to effects of inflammatory cytokines/toxins/prescribed and recreational drugs. And localised altered perception, typically due to a stroke affecting the pre-motor cortex altering proprioception of the affected contra-lateral part of the body or the visual cortex.

Visual perception may compensate for tactile extinction or neglect however patients with these problems find it more difficult to convalesce, for example in returning to normal physical aspects of daily life from dressing to other complex motor tasks. Physicians need to take care to assess for occult visual or other forms of sensory dissociation (or extinction) syndromes in at risk patients.

Psychotic disorders are a further category, either due to endogenous syndromes or to neuroleptic effects of prescribed or recreational drugs. As a caution for patients and health professionals wishing to know more about the syndromes and their consequences, writers have been attracted to this theme and texts may be misunderstood as literal description, from generalised dissociation, to local abnormal perception e.g. Le bras cassé (The broken arm) by Belgian-born French poet, writer and artist Henri Michaux.

With evolving digital repositories meshed with expert multi-focus editing, it will become possible to provide appropriate 'health warnings' for the patient, health professional or casual reader, explaining the complex nature of the work. However, it would not be surprising to discover works largely of the imagination misfiled in factual medical sections in conventional libraries and bookshops.

It is unclear what inspired Michaux to write on this theme, beyond his personal experience of breaking his arm. Or whether his descriptions and text were influenced by the coincidence of his self-declared experimentation with mescalin and other drugs: through long-term effects on his personal perception of his body or perhaps through use of these drugs during convalescence from his fracture.

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