As someone who's had acute psychosis, I think the discussion here is profoundly silly.

This remark got my goat in particular: "So you're saying that people who say things that are obviously not true, also happen to often report having hallucinations. What if maybe, just maybe, reports of hallucinations are one of the obviously not true things." This is like the musings of a ten-year-old flat-earther. Who needs to learn medicine or neuroscience when you can just speculate about how the brain works?

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Great post. Honestly don't understand why the hallucinations and delusions are so difficult for people to understand. Psychiatry gives them fancy names like delusions or hallucinations, but they are really just self-reported imaginings. People report seeing weird things all the time, ghosts, goblins, UFOs, Jesus, aliens. It's so frequent that it really needs to be considered a normal part of the human experience. And when people are polled, typically more than half of the people polled openly admit to seeing things that other people don't see or to hearing things that other people don't. Look up Jim Van Os and his research on schizophrenia on YT. These are just normal human experiences that other people find annoying.

Typically the problem is not with the schizophrenic but it's the problem is the schizophrenic family. They get sick of hearing the annoying stuff the "schizophrenic" does and says that are weird and outside of social norms.

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> They get sick of hearing the annoying stuff that outside of social norms that the schizophrenic says and does.

Like when my best friend's schizophrenic brother jumped on him one night and started stabbing him in the chest. That was annoying!

Thus, my problem with Szasz. His politicking of the problem down to "persecution" and "just the normal human experience" misses something pretty important.

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Have you read Szasz? He says not only that non-violent "mentally-ill" should not be persecuted, but that the violent ones should be put to justice just as the undiagnosed people. From what you wrote it seems like you should be a bigger supporter of the Szaszian view than 99,9 percent of people who excuse such violent criminals on the basis of "illness", and fact that you seem to be quite the opposite shows that you either missed the point or did not read him.

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But you are wrong about that. I've read Szasz and I think his approach is totally unhelpful. In the case of my friend's brother, he shouldn't have been thrown in jail (and that's not what my friend wanted... he recovered). On the other hand, he can't very well be treated as non-threatening by the people who ultimately have to take care of him.

Aaron's comment above is the particular aspect of the view I'm taking issue with.

> Typically the problem is not with the schizophrenic but it's the problem is the schizophrenic family.

His generalization is dramatically off base. And dismissive of the difficulties these folks have to go through. Having a relative with severe mental illness is a fucking curse. One without a neat solution or clear moral lines. He doubles down in his reply and just comes off even more clueless. It's Szasz in a nutshell. Plenty of big picture truth, but also lots of simplistic bullshit that lets people think they have answers to problems they've never had to actually deal with.

It can be true that much of what is called mental illness is not and many criminals who claim to be mentally ill shouldn't be excused, but also true that mental illness does exist and not all criminals should be treated the same.

Szasz offers nothing of use for people who have true mental illness. It's a myth! Although he if pushed, he would concede that while "mental illness" doesn't exist, some people have true, detectable neurological issues. But he doesn't offer much for them either. Treat them like everyone else. It's stupid. It's like saying most 10 year olds are functionally just little people.

I guess that's what I find most objectionable. Szasz fundamentally based his views off an older conception of psychiatry (Freud and all) and instead of evolving and updating his views with evidence (and there is plenty about the neurological reality of various mental illnesses) he largely dug in and kept banging on the "mental illness is a myth" drum that brought him to prominence. It's unfortunate, because as I said, there's some truth there, but the end product of that evolution was dogmatic, simplistic, cultish, and, well... untrue.

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"It's like saying 10 test old children are functionally like 10 gwar old people"

Its like saying they are responsive to incentives and their choices are free, which they are.

Nobody advocates drugging children for behaving weirdly or excusing them when they do, but everyone supports giving them rewards and penalties, as if they were free acting people, even if less intelligent (Szasz never denied things like mental retardation, which is not responsive to incentives, Down syndrome boy wont get smarter if you put a gun to his head).

And if you think schizophrenics are analogous to children, what stops you from saying that about everybody who commits a crime or behaves unusually? Again the neurological imbalance talk? Should we just try to forcibly drug everybody and never put anyone to prison, because "they apparently must be like children, if they do weird and dangerous stuff"?

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Okay but why exactly shouldn't he be in prison. Don't get me wrong I do believe that the victims and the family can sometimes forgive the person so that the person avoids the penalty. But why do you think that it's the case for the do called mentally ill, but not for regular undiagnosed criminals? Why do the latter inherently deserve the prisons and the former not? Because of the chemical imbalance truism? I though Bryan explained thousand times that every decision is caused by Brain chemistry. You say there's a lot of evidence on neurological origins of mental illness, but there is also for one's political views and, you guessed it, criminal behavior.

You might raised some utlilitarian arguments on why prison is bad for their well being and only make them worse, and you might be correct, but the same applies to the undiagnosed. And also prison is not the only justice method that me and Bryan advocate, he even defended corporal punishment and retribution.

And the most important point of Bryan is that he showed many times that mentally ill are actually responsive to incentives, so saying he shouldn't be punished has simply no real basis exept for insisting that the laws of justice somehow magically don't apply to him because some brain scan.

And no, saying that Szasz doesn't give them alternatives... Well first that was not his point. He was philospher of mind, pondering whether the concept of metal illness is ontologically justified, not a self help tutorial writer. It's like accusing a botanician of not giving real advice on best vegetables to eat for losing weight.

And even that is not true, Szasz was a great proponent of all types of therapy, incliluding freedom of ALL drugs. So he would have nothing against giving your friends brother some drugs (or even forcing him to take them, as he wasn't non violent, so some use of force would be justified.) He would simply emphasize that it was not an illness and his choice, which Bryan often proves showing that mentally ill are equally responsive to incentives.

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>But why do you think that it's the case for the do called mentally ill, but not for regular undiagnosed criminals?

I didn't say that only mentally ill criminals deserve consideration.

> You say there's a lot of evidence on neurological origins of mental illness, but there is also for one's political views and, you guessed it, criminal behavior.

But to vastly differing degrees and with vastly different levels of harm. So much so as to make the distinction meaningless.

> And even that is not true, Szasz was a great proponent of all types of therapy, incliluding freedom of ALL drugs. So he would have nothing against giving your friends brother some drugs (or even forcing him to take them, as he wasn't non violent, so some use of force would be justified.)

Well, no, he had quite a lot to say against coercion. That was largely his point.

> simply emphasize that it was not an illness and his choice, which Bryan often proves showing that mentally ill are equally responsive to incentives.

Saying that mentally ill people respond to incentives doesn't prove that everything is a choice.

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"I didn't say that only mentally ill criminals deserve consideration."

Yeah, everyone deserves consideration, and you might make a solid argument against prisons, but not agains laws against violent behaior in general, even if you limit not enforcing these laws only to diagnosed "mentally ill." But if you apply laws against violent behavior to both these groups to the same extent, then... well, the concept of mentall illness becomes meaningless, doesn't it?

But to vastly differing degrees and with vastly different levels of harm. So much so as to make the distinction meaningless.

To different degrees? To what degree is any of our decision not caused by chemistry of the brain? Sorry, I don't buy the stories about the soul floating somewhere in the ethereal realm. To a different degree of harm? Yes, of course, and law is for preventing harm, which includes prisons, and other forms of disincentives against violent behavior.

"Well, no, he had quite a lot to say against coercion. That was largely his point."

Coersion against non-violent people. You won't say that he was also against prison, house arrest, financial penelaties, etc. being used against murderers and thieves (such penalties against them would technically also instutute a form of "coersion"). So I guess he wouldn't be in principle agains drugging such people as a form of justified use of force. He could have been disagreeing on effectiveness on such drugging, but I'm not sure about that.

"Saying that mentally ill people respond to incentives doesn't prove that everything is a choice. "

It doesn't prove everything is a choice, but proves that things responsive to incentives are. I know, that sounds like some nitpicking, but that's just true. Otherwise, if responsiveness to incentives doesn't prove that, then what? There must be some empirical test on what is and what isn't a free choice. Otherwise the mental illness hypothesis is unfalsifiable, which means it is literally pseudoscience [it isn't though, it's just largely false science, but it's not unfalsifiable]

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Also, nobody "has to" take care of him. They can dissassociate from him, which would be a smart thing to do, as he has been violent. Yeah, its emotionally challenging and hard and no one denies that. But the fact of the matter is that every thing he or any other "mentally ill" person does is their responsive to incentives choice, and the unwise (even if emotionally understandable) decision of the family to stay with him is also a choice.

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No it doesn't. You didn't give any context about why he attacked his brother. Did they have a dispute? Did he want to be committed and taken care of? What he did was called an assault, why does a person need to be labelled a schizophrenic to assault someone? Cain killed Able - story as old as time. Doesn't mean he had a mysterious disease.

Now if he had attacked his brother with something idiotic like a carrot instead of a knife, and try to stab his brother to death with the carrot, then perhaps I would think that is actually crazy/schizophrenic, but what he actually did was a highly coordinated act that involved a lot of thought and foresight. He had to grab a sharp implement intended to harm and then assault his brother with it.

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Just as many families have problems with mentally "healthy" people; it doesn't change anything

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Also it's an amazing strawman on your part. Aaron says, TYPICALLY achizos are just annoying. You say, no my friends brother was more than annoying. Yeah, Szasz is right that schizos are typically annoying, but that's not the entire truth.

Why are we arguing if we agree? Aaron never said it is ALWAYS the case that the family Has NEVER real problem, he even used the Word typically

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And, even more importantly, your anecdote (might seem like hypocrisy on my part, as I also used my personal anecdotal experience with close "menatlly-ill" ones, but I at least acknowledged that one should take it with a grain of salt), does not change the fact that schizophrenics are not more likely to commit violent crimes, but 10 times more likely to be a victim of ones.

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"What if maybe, just maybe, reports of hallucinations are one of the obviously not true things."

Hallucinations are not unique to schizophrenia, bipolar disorder etc. There are plenty of patients with neurodegenerative and other disorders who have hallucinations. They are often are embarrassed to admit having them. Family members need to be asked to leave the exam room to make the patient feel more comfortable disclosing these things to their doctor. Patient with severe visual impairment may often have visual hallucinations (Charles Bonnet). Patients with severe hearing loss may have auditory hallucinations (musical ear syndrome). Patients with temporal lobe seizures may have olfactory hallucinations. None of the above patient types usually have delusions (unless there is a coexisting psychiatric comorbidity). Patients with dementia with Lewy bodies have profound hallucinations (visual and, less commonly, auditory). Saying that reports of hallucinations are not true is simply not true...

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I did not say that hallucinations are unique. I myself acknowledged psychedelic trips and (and, in my comment above) dreams (if you want to call it a hallucination), the latter of which I myself experience all the time. I simply state that they in fact seem to possess all the traits of a malfunction, randomness, incoherence, etc. Not sure how random the hallucinations of people you mentioned are. I guess those are random strings of colors, shapes, dots, etc.

I simply stated how suspicious it is that people with delusions (i.e. who say not-true things all the time) are pretty much the only people who have SUCH SURPRISINGLY COHERENT visual hallucinations.

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WIth all due respect, this post so thoroughly misunderstands the nature of psychosis it is difficult to know where to start.

I invite you to spend time talking with someone who has schizophrenia and then tell me that the main or only problem is a deficient respect social rules for some reason. Many of my patients with schizophrenia are in fact desperate to be able to better follow social rules because they know that is how you get along in the world. It is obviously a brain illness, and if you want to be consistent then you should also arguing the epileptics just love to thrash around on the ground from time to time.

I suggest you go and meet more people with chronic, serious mental illness and see if your views change.

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Indeed, the social preference theory seems simple from an economist's point of view but not from many others. For example, what would be the evolutionary argument for some people to have just 'extreme social preferences'? Especially when those preferences are harmful to them and their interests?

Something going wrong with how the brain processes has the advantage of making sense. There's a evolutionary incentive to a complex brain able to process subtle social cues in a social animal like man. Complex machines, though, can 'crash' in more ways than simple machines. Therefore you have reason to consider a mental illness model more likely to be closer to the truth than simply extreme preference.

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hallucinations and delusions somewhat similar to those in psychosis are also seen in anticholinergics like benadryl or datura. ive suffered from acute psychosis (before trying any psychotropic drugs) and the states these substances induce felt pretty similar, in fact i got even more delusional and experienced more "coherent" hallucinations than in acute psychosis.

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The mental illness deniers remind me of my childhood, before I knew about evolution. What was Szasz opinion about evolution? It seems to me that he believed in creationism.

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OK, so let's consider that people with schizophrenia report that medication works for them sometimes, yet with unpleasent side effects. So how does this square with a extreme preference model? If schizophrenics just have an extreme preference for some anti-social behavior, then what happens when they take medication and such behavior decreases?

That would seem to imply their extreme preference became less of a preference hence they choose to engage in less anti-social behavior. But then why take the medication with its side effects? If their preferences shifted, they could just behave better without taking the medication. Do they want the medication despite what seem to be side effects? Is the medication altering their preferences? But if preferences can be altered externally, are they really preferences as that implies a person is simply a deterministic system.

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you can simply look up the disorders I mentioned earlier to learn about them. Visual hallucinations in those cases may include seeing persons or groups of people engaged in various activities. I had a patient with lewy body dementia seeing people having sex in his bed that was quite disturbing to him to say the least...

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I am not sure I understood that argument correctly, but why would a human brain malfunction in the same way as a simple electronic device?

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Wasn't sure either how to put it into words, it just seemed intuitive that a malfunction of any kind will have some intrinsic randomness, and that properly working things in general are inherently more orderly. Electronic device was just an analogy that would put this universal intuition of mine into more concrete light. Now, after reading some comments here, I'm not that sure about this rule, but it still strikes me as intuitively true, despite some reasonable counter-arguments/counter-examples.

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The most influential modern philosopher, Kant, split mind from reality. "I have denied knowledge therefore, in order to make room for faith." This is an intellectual, not psychological, split. Psychiatrist, Louis Sass, in _Madness And Modernism_, says there has been a big increase in schizophrenia since Kant. Interesting "coincidence." There is some effect to a long-term evasion of focusing onto reality. Philosophy provides the intellectual context, inc/method, that science necessarily uses. Most scientists in Pragmatist America, are too poorly educated to know this.

Szasz may be correct in saying that scientific fraud has been used to persecute people. However, mental illness is real.

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It's worth mentioning that this was my update on an earlier message. I hope I can write IT here:

Second thing I wanted to tell you is another quite plausible argument for schizophrenia, particularly supposed hallucinations, not existing. It's supposed to be the last stand in this battle on the side of psychiatry, even people who get your arguments on addiction/ADHD believe in this one little "illness" (BTW, it would be really awkward if it turned out that there exists only one illness in the entire field of psychiatry). The real problem is that we can't get into peoples' heads, but we still can use some Bayesian rule of thumb (or if we couldn't, we would have to bite the bullet and not believe anyone on all their internal impressions, or believe literally everyone). But...

1 If it's really brain MALFUNCTION of the supposedly ill, then shouldn't we expect some random shit appearing in front of the eyes of the sick. From what I know it's always some weird, but generally coherent like a secret agent talking to you or some shadow people, but rarely or never some random colors appearing, some random shapes, non-existing toasters, blue pancakes on the ceiling, etc. Why?

(Also, wouldn't that, including secret agents and shadow people hallucinations, have to be classified as a particularly complex vision impairment, and not a mental illness? Because where do we draw the line between some random non-existent red point jumping in front of your eyes, and some random non-existent cluster of points shaped like a talking man?)

Just as with other brain malfunctions, induced by psychedelic drugs or in dreams? Yeah, some of them are surprisingly coherent, but it's like 5 percent of that.

You might make an argument that people who see a random non-existent pancake in their home don't have their lives ruined because of this hallucination and don't want to be condemned and forcibly drugged. So they usually just don't talk about that to anybody. But wouldn't this go for people with more complex hallucinations, to an even greater extent? It's more likely that people will laugh at or avoid a guy who sees imaginary people than a guy who sees random stuff in front of their eyes. It's more likely that the former will be forcibly drugged. So wouldn't this simply imply that the hallucinating guys are just drama queens who crave attention?

Your argument of schizophrenics actually being figurative wasn't convincing for me. The whole schizophrenia type of stuff, though, still seemed quite fishy to me. I was inclined to believe that it does exist, but shouldn't be classified as a mental illness, but a vision impairment or neurological malfunction. But now I'm 99 percent sure that hallucinations exist almost exclusively in dreams, and under the influence of drugs. But, hey, the world has 8 billion people in it. Claiming that there's no, not even one, that there's literally zero actual schizophrenics would be even more insane. So clearly there must be some such instances. So here you have it, psychiatry, you won! Most of the illnesses invented by you don't exist, but one actually does, and it has probably like five guys suffering from it. You're clearly a useful and necessary and important branch of medicine!

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You make a lot of claims that appear empirically false. Sick people *do* hallucinate *all the time*, like in ICUs (ICU syndrome, and delusions/hallucinations are too common to be remarked on in many other illnesses). Blind people turn out to hallucinate *all the time* when people bother to survey them (Charles Bonnet syndrome). Every time someone looks at symptom questionnaires for things like bipolar or schizophrenia, it forms a spectrum (and this is also true at the genetic level with burden / common variants / polygenicity, as non-diagnosed relatives of a diagnosed person report, in increasing genetic relatedness, more hallucinations/delusive/depressive/manic symptoms & IQ decreases); there is never any taxonomic categorical distinction, and psychiatrists have tried very hard to find one because that's what they want - this is why having hallucinations is not sufficient for a diagnosis, you need other stuff and for the hallucinations to be problematic. (You ask why the hallucinations of diagnosed people are so extreme - because that's what you need for a diagnosis!) Regular people report hallucinations and other stuff *all the time* when surveyed, it's just not a big deal for them. It's not even hard to induce hallucinations in yourself: you can do it in 5 minutes in your bathroom with the 'strange face illusion'. There's a reason neuroscientists talk about 'perception as controlled hallucination'.

Your claim about electronics is also wrong. 'Emitting random gibberish when broken' is not, and has not been for many decades (if it ever was), the universal or even majority of failure modes, rendering your analogy non-analogous and highly misleading. Complex devices have errors which are highly structured rather than noise. The last time I visited my grandparents to fix their TV, it wasn't because it was emitting random white noise, it was because it was speaking in Spanish. (That one took an hour to figure out - I still have no idea how they managed to do it.) Yesterday OpenAI was apologizing for a ChatGPT website bug, where the site had suddenly started to show the titles of documents created by other users - real titles, not random ASCII gibberish. If I put in a prompt to GPT today and it started ranting about Secret Service agents and black helicopters, I wouldn't be in the slightest bit surprised. I've been shown random videos or random blog posts (last week I was looking at a blog where if you appended a single letter to a valid URL, it would spit you out at a random blog post, often years in the past - the author of an apparently to blame plugin acknowledged there was a bug, but to my irritation since I was rather wondering how on earth that behavior was happening, he unfortunately failed to explain how such a behavior could arise). In fact, I struggle to think of the last electronics bug that I ran into which could be described as the equivalent of random noise. If people reasoned like you did, and denied that bugs could be highly structured and had to look like random gibberish, then we would all be dead right now because both the USA and Russia would've launched nukes at various points when tapes of exercises got replayed as real or sensor errors showed a fleet of missiles inbound. I don't know how you use a computer in the modern world and come away with this idea that your electrical device analogy is at all analogous. It's not, and never has been, and as our devices get more and more intelligent (ie. *brain-like*), the patterns of errors and delusions and hallucinations get more and more sophisticated.

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Now I kinda see what's wrong with Your response, although I'm more willing to change my mind than before.

I did not deny people having hallucinations. On the contrary, in the comment that You responded to I even mentioned dreams, as a normal type of "hallucination." And, as I said, they are infamously random and incoherent. Similarly with the things that you mentioned, like sensory deprivation (I guess, though I've never tried it).

You did not adress the unreliability of schizophrenics, which is pretty much hidden within one of their symptomps, which is delusions.

"You ask why the hallucinations of diagnosed people are so extreme - because that's what you need for a diagnosis!) Regular people report hallucinations and other stuff *all the time* when surveyed, it's just not a big deal for them."

I did not suggest that people with small hallucinations don't exist or that they also should be diagnosed. I said that we should expect some people having EXTREME hallucinations that are as coherent as the hallucinations of schizophrenics, but who are more trustworthy, a.k.a. don't have the symptom of delusions. Instead we see some reliable (a.k.a. non delusional ) people who report having small (mostly) incoherent hallucinations, and unreliable (delusinal/lying people) who have extreme and surprisngly coherent hallucinations. I've never heard of anything inbetween. I even gave an example of hypothetical Huemer-like (don't know if you came to this article through libertarian circles, most of us will know this reference) person who has an extreme hallucination which he himself admits to be a big deal for him. Why don't we see people like that? Really, the dychotomy of small+random+reliable and extreme+coherent+unreliable should seem fishy to everyone.

The randomness of electronical devices is Your best argument, and I guess I simply have to admit that this epistemic rule of thumb of mine is false. The rest of my argument holds up, though, at least that's what it seems to me. On the other hand one could argue that chatGPT giving you a rant about CIA or StableDiffusion showing you a painting of Wendigo when you asked it about a human face is not quite malfunction. They were *intentionally* programmed to give such answers or paint such things, they just happen to react that particular way at that particular moment to that particular input of yours. A malfunction analogous to human disease would be GPT not using its functions of pattern analysis, which, by definition, would make it totally random. I am not sure about this argument, though, there seems to be something wrong with it, I just can't put my finger on it.

I also guess that more analogous to visual hallucinations would be Stable Diffusion, since it's, well, visual. Yes, you do expect some "malfunctions" like showing you a perfectly looking angel instead of a cup of tea that you asked for, but you also expect it to malfunction 100 times more often in a completely random and unstroctured way, like the entire painting being just as the infamous spaghetti hands, full of random shapes, dots and colors. But, again, not 100 percent sure about that.

Still, seems like the rest of my argument holds water.

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This is good stuff, and I appreciate the thought provoking post. I think you may be onto something with the small versus big and reliable versus unreliable bit. Part of delusion is misinterpreting inputs. A classic example is that if I walk out of a building and see a coin on a sidewalk, I'll probably ignore it. If I have schizophrenia, I might pick it up because it seems significant. Once I pick it up and look at it and read the date, I may remember something bad happening to me on that date. Perhaps I'll interpret the coin as a threat that someone is planning to do that same bad thing to me again.

Now imagine the same process going on except with a variety of little hallucinations throughout the day. I'm going to hype them up in my mind as significant and likely remember them as being bigger and more profound than they really are. While I don't have any particular stake in claiming that this does or even could account for the majority of schizophrenic hallucinations, it certainly could account for some of them.

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Fair critique, I need to think about it

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