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Salud mental

Print version ISSN 0185-3325


ROJAS MALPICA, Carlos. Hallucinations and delusions as anankastic representations. Salud Ment [online]. 2010, vol.33, n.5, pp.379-387. ISSN 0185-3325.

The problem of representations Karl Jaspers introduced a distinction between perception and representation that presents a false dilemma when given a closer look. According to the renowned German psychopathologist, perceptions are corporeal and originate in the exterior objective space while representations are incorporeal and are derived from the interior subjective world. From his point of view, physicalness-imagination, 'exterior space-interior space', are absolute oppositions that permanently separate perception and representation by an abysm that allows no transition. For Amaral the confusion derives from the German word for perception «.wahrnehmung», composed by the noun wahr (truth) and by the verb nehmen (take as). In this manner and according to the language, anything that we consider true is necessarily treated as a perception. Nothing is more natural that German thinkers would loose, from such terminology, some flexibility in the evaluation of the phenomenon. Amaral has also reminded that Wundt, in 1874, already distinguished between sensation where stimuli not yet differentiated are perceived; perception, when stimuli organize themselves in a more or less defined manner, and apperception, where an attribution of meaning and a comprehension of the perceived scene or situation occurs. Crick and Koch propose aspects of great relevance to understand the so called Neural Correlates of the Conscience. They propose that the main function of the sensory cortex is to construct and use feature or specific qualities detectors such as those activated for orientation, movements, and face identification. Therefore, we may affirm that most of the sensory and motor activities are already made and available in the entire cerebral cortex, in the manner of what Changeux has called previous global representations. The conscious qualification process of the different sensory hues and their progressive complexity is a progressive feature, which in the phylogenetic evolution leads to the Homo sapiens sapiens. In fact, in the so called conscious media promoted by the thai amo-cortical activation that is performed in a task that requires effort and attention, we find spontaneously co-activated neural structures coordinated in time and space of the previous global representations type, which in turn generate other processes in the CNS. Hallucination and delusions: Anankastic representations? Since the times of Esquirol, the definition that a hallucination is a perception without object remained unaltered. Only recently, Alonso-Fernandez questioned Esquirol's scheme upon affirming «a hallucination is anything but a perception without object, because it is not a perception and because it does have an object. Contrary to the sensoperception activity that goes from the outside to the inside, a centripetal psychic function by excellence, the hallucination is produced upon objectivizing a psychic ¡mage providing it with sensoriality and subsequently projecting it to the exterior, shortly an objectivizing projection with, a clear centrifugal transit». In addition, today it is accepted that hallucinatory phenomena exist in sane individuals, related to some personality traits among which the imagination must be highlighted. The topic of delusion has been the object of the most varied reflections. In our case, we are interested in studying the phenomenon whereby the delusion installs itself in the center of the patient's life as a mineralized representation of the world and of himself, until structuring most of his behavior and relations, which we propose to call anankastic representation. To understand the phenomenon, we believe fundamental Llopis' idea that nature does not possess different laws to produce similar phenomena, therefore, both the delusion and hallucinations observed in the different clinical entities must obey the same pathogenetic mechanism, whereby «thought and perception disorders, in reality, are not different disorders qualitatively but only ways of expressing the different degrees of intensity in a disorder». From the psycho-physiological point of view, it must be underlined that what is activated in the hallucinatory phenomenon is a sensory network that carries a threatening signal for the patient, which is only possible because it is not under his superior control. Everything indicates that we are then dealing with representations that are presentified before a consciousness that does not recognize them as its own, because they have avoided the coincident mechanism of detection for afferent and re-entrysignals that support the conscious perception, according to the findings revealed by contemporary neurobiology. That is a critical aspect of the debate on the manner in which neurophysiology must approach the topic of representations, the information storage, the engrams, and the recognition of memories constituting a person. Simulation and supervision processes intervene in the different states of consciousness that make global access to the past, present and future possible. The individual is not only the receptor of stimuli derived from the environment, to which he responds from his brain with the innate guidelines registered in his genome, but he is also an agent maker of new realities and conducts. He is a poietic and autopoieticfador and because of that he has dignity. In the dialogue between genetic endowment and the environment and in the constitution of the epigenetic, consciousness and neuroplasticity are fundamental. In order for everything to function harmoniously, it would be necessary a balance of activity between the sensory cortex and the primary motor with the association areas scattered all over the cerebral cortex, and arranged from the prefrontal cortex. The constructs contained in previous representations must be reviewed in each opportunity and suffer some circumstantial arrangement or deep transformation, according to the case. We are dealing with a metacognition process through which the mind examines its own contents. Whenever a pathological situation alters this process, the constructs can become raw material for hallucinatory-delusional contents. The autopoiesis is interrupted and the mental dynamics is trapped by anankastic representations. Crick's zombies, Changeux's previous representation or Tellez's «timophanias», independent from the Self, imposed hallucinatorilly and automatically on a conscience that cannot differentiate them from reality, constitute therefore a symptomatic expression of what we have called mental illness as anánké.

Keywords : Hallucination; delussion; representation; anankastic phenomena; neurobehavioral manifestations.

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