Mental illness and hallucinations

Schizophrenia is characterized by hallucinations and delusions. As are some types of brain injury. The other symptoms are individual but can include such things as paranoia and OCD.

There is a little difference depending on whether you want auditory or visual.

Pretty much schizophrenia or any psychotic illness are the main candidates. Auditory hallucinations are the main types but visual are possible if less common. if you want to add some more detail, then auditory hallucinations sound real. They sound as though they have a point of origin in the room around you (you should be able to point to where they are coming from) and if it's a voice then you should be able to describe the voice. Then they get clasified as being either second person (talking to the character) or third person (like overhearing a voice talking about you). Third person hallucinations are what's called a first rank symptom of schizizophrenia meaning they are very uncommon in someone who isn't psychotic and almost (but not quite) diagnostic of an illness like schizophrenia. The hallucinations in a psychotic illness can be as wierd as you like.

Visual hallucinations do happen in psychosis, but are much more common in organic illness such as brain tumours, head injury, delirium or alcohol withdrawal (delirium tremens). Drugs are another major cause.

Mood disorders, if they become psychotic, tend to create hallucinations and delusions consistant with the mood. A depressed person may have illness, death, etc as themes. A manic person is more likely to hear some sort of meaningful message telling them how great they are.

Final pointer is that apart from confusion and delirium, most hallucinations limit themselves to one sense. The first thing i think when someone tells me there is a person in the room that they can clearly see and who is talking to them is that they are delirious or making it up. If they add in the smell of his cigarette and say they can feel him touching them then I'm pretty certain it's their imagination. The different senses are mapped out to different parts of the brain and they do odd things independently of each other, not usually in synch.

Craig

shaldna said:

This is exactly what I needed. So, just so I get this right, someone should only have an hallucination of one sense? Either see something, or hear it, or feel it, but not all of them, assuming it's not delirium.?

So if I had a character who was experiencing hallucinations of a person that they could see and talk to and touch it would, under normal circumstances, most likely be considered to be making it up? Would that still be considered the case if this person has a history of an illness like schizophrenia?

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People are still people. They still have their own agendas and someone with schizophrenia can still lie to me...either to make me think they're well or, sometimes to make me think they're ill.

Hallucinations that cross senses don't make logical sense if you think about the neurology. Delirium basically equates to confusion. A confused person will not be able to make sense of their experience to describe it accurately. They confabulate (meaning make it up as they go along) and so something that is part true gets embelished or just plain jumbled up.

My thought process if someone told me that they had an all singing, all dancing hallucination they could see, hear and touch would make me instantly suspicious. If they had no history of mental illness I'd suspect a confusional state or a drug high and run blood tests to check for both. I'd also want to book an MRI. If the tests were fine, I might admit them to a ward for observation. I'd be cautious enough to think they might be ill, but extremely suspicious and probably wouldn't give them any medication. I'd have the nurses watch them very closely.

If they had a history of mentla illness then I'd start thinking they might be ill but also wonder what they had to gain by making me think they were more ill than they actually were. Same blood tests would happen. Might do an MRI but might leave it a couple of days. I'd wonder if they owed someone money and wanted to be admitted to hospital to hide from them (seen that happen before), or suspect they might have committed a crime and be looking for a doctor to tell the police how ill they were. (seen that too). I'd probably admit them to hospital for observation, but be looking for signs of what they had to gain from it.

These situations work on the principle that delirium is dangerous so exclude that first. Drug high is very likely so check for that. Malingering or something to gain are also likely but having them on a ward is safest so probably admit, wait, watch and try to solve the puzzle.

Craig

I have been with a member of my family who is schizophrenic when she was hallucinating.

Severe mania, as part of manic-depressive episode, can cause hallucinations.

So interesting Remember that schizophrenia usually has at least a handful of other noticeable symptoms; those differ based on the type of schizophrenia it is. Depression or bipolar can also coexist with schizophrenia; in fact, it's relatively common.

I don't recall if schizoaffective disorder usually has full-blown hallucinations? I'm leaning toward not, but that's just a heads up...

StephanieFox said:

Severe mania, as part of manic-depressive episode, can cause hallucinations.

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So can the depressive phase if it's severe


Mostly auditory for me, either way.

1 - not necessarily anything. Unless I answer back Though it can be obvious, that's not a given

2 - Absolutely though it would depend on a) the severity of the symptoms and b) if the sufferer is either ashamed of what the hallucinations are showing / telling him and / or knows something isn't quite right


I was the only one who knew I had them until last year when I 'fessed all to my doc ( I Knew something wasn't right, wasn't sure what. We soon found out) I'd had these things for years and because I knew other people didn't experience these things, I didn't want to appear even odder than I was, in fact, being during those times.

Does it need to be a mental illness? Some of the sleep disorders can cause very vivid hypnopompic and hypnagocic hallucinations. They can mix senses since it's basically dreaming while awake (not psychosis). When combined with sleep paralysis, these are very unpleasant experiences. They're a common symptom in narcolepsy.

shaldna said:

Also, can I ask a couple more questions.

1. as a bystander what would you experience or notice about someone having an hallucination - of any type, but specifically a visual or auditory

2. is it possible for someone to hide their illness from family and friends? other than a few odd moments/incidents of the sort that can be written off as stress or similar?

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Glad to help.

1. The hallucination seems real to the person. The reaction depends on the emotion it generates. Just describe what you'd do.

If it's auditory and I was alone in a room, I'd start looking around to see where the sound came from. When i couldn't see anything I might answer it and ask who was there. I might walk over to the part the the room the sound was coming from and look around carefully. I might look out of the wondow and poke my head out of the door to see if anyone was playing a trick on me. I'd react differently to a voice calming saying my name than I would to a voice screaming at me that I was about to die.

If I was sitting and talking to you when i heard something, it would distract me. You'd notice that you didn't have my full attention. My gaze might keep flicking to something that you couldn't see. I might have to ask you to repeat what you said as at times I'd be listening to the voice more than I was listening to you. I might even ask you if you could hear it. if it was a scary hallucination i might look, anxious, scared, uncomfortable.

A visual hallucination is going to going to be similar. Without sound it won't be as distracting during a conversation but the temptation to look at it is greater. If I'm alone I might talk to it, if it's a person ask who they are. Maybe walk across to it and try to touch it (my hand would go through a hallucination) Again, different reaction if I see a nice friendly old lady in the corner of the room than if I see a clown holding a knife and a human head.

The key is to recognise that the hallucination is as real as anything else in the room to the sufferer. The way they react to a hallucination of a clown holding a human head will be the same as how they'd react to a clown holding a human head......but if it's happened before. If they've already investigated it....if they've recognised that it's not real then they may try to hide their reaction.

2. Definately. Many people hide hallucinations very successfully for ages. Whether you can hide an illness depends on the illness. If it's psychosis, you can more successfully hide a delusion that aliens want to eat your brain than a belief that your wife wants to eat your brain. If you believe that, you won't want to sleep next to her anymore and you'll start checking your meals for posion. It's hard to hide the low mood and low energy that goes with depression, people will notice you're not yourself even if they don't know why....it's also hard to hide the general elation that goes with mania from someone who knows you well.

Craig

Wiskel said:

It's hard to hide the low mood and low energy that goes with depression, people will notice you're not yourself even if they don't know why....

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Just a quick comment - from experience, it's very easy to hide even deep depression from family and friends. Look at all the suicides where no one realized they were at all depressed. But that's for another thread, another time.

shaldna said:

So while people might notice something was off, they wouldn't necessarily know what?

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They might notice nothing more than the person looking distracted or uncomfortable. They might notice nothing.

There have been times when it's taken weeks for doctors and nurses to realise someone was hallucinating while under observation on a psychiatric ward. There are probably some people who have masked ther symptoms so completely that professionals still don't know they have them. There are also some people who I can tell are hallucinating with absolute certainity after meeting them for 5 minutes even if they deny it. Most people are somewhere in the middle.


Shadowwalker...totally take your point. Anything except frank thought disorder can be masked with enough effort, although the better someone knows you, the more likely they are to see through the mask.

Craig

Schizophrenics usually seem odd in other ways (if unmedicated), but someone could just think they were odd. Their language can be strange (a symptom), they can take things very literally (a symptom), and I've found they ask strange questions. In other words, they tend to have a bit of a world of their own, although they try to seem normal, of course.

But it has levels of severity too. You might think they were just behaving a little strangely if it's not severe.

Bipolars are harder to spot, imho. The mania can be very fun for folks around them, and they don't have as much odd stuff, frankly: big plans, maybe lots of sex Things that sound more relatable, if that makes sense. The bipolars I know who hallucinated also didn't let on about that part, and I wouldn't have known.

I'm generalizing a lot here, btw. There are levels of severity that make a huge difference!

StephanieFox said:

Severe mania, as part of manic-depressive episode, can cause hallucinations.

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Yes.

Hey, I dont mind sharing a bit, but I'm not sure how helpful it will be

I have bipolar and OCPD. I have had it since late teens, but was formally diagnosed two years ago. I have had various paranoid ideas at different stages, but only once have I had hallucinations and that was last year.

I was on the verge of a major depressive/manic episode (I was in a bit of a mixed state).

I was very jumpy and on edge and not sleeping, anxious, etc. At this point, I also became paranoid: Our fridge was having problems -- the seal thing wasnt working, as a result, the carrots kept going slimy. Anyway, I became convinced that the carrots going funny was a sign, proof that they "saw through me" and it was also an omen that bad things were going to happen to me. I am including this so you can get a feel for my state of mind. (I dont know what they were seeing through me, they just were and I knew I was going to be exposed. As what or for what, I have no idea, but it was very real).

Then, I started "seeing" dead mice around. I would just suddenly see a dead mouse on the floor of the lounge room out of the corner of my eye and then when I looked again, it would be gone. For a period of about a week, I would see about three or four a day in random spots. On the lawn, the road, the floor of the car. Everytime after seeing them though, I would look back and they wouldnt be there.

At this time, I believed what I saw, and knew it meant bad things were going to happen. I also knew deep down that no one else was aware of the dead mice, so I didnt say anything. It's hard to explain, knowing something is real, and yet knowing I shouldnt talk about it as it was only a sign for me or something.

incidentally, I also saw a dead mouse while in my psychaitrists office but I wasnt' saying a word about it, as i didnt want to alert anyone that I was getting unwell. On this occasion (my mice hallucinations), I didnt end up having a full episode of mania or major depressive episode. I ended up using my Stay well Plan and managed to stave off a full blown incident. I only spoke of the mice and carrots to my husband a few months after, when I was able to see the incidents for what it was: my bipolar state and not real life.

now to your questions.

1. No one knew about the dead mice. I didnt talk about it and I was mostly by myself when I saw them. I think my reaction would have been noticable in my facial expressions only -- and even then, I didnt have a theatrical reaction, more a muted response (not that I wasnt unnerved). Although I was particularly jumpy anyway, in the weeks up to this. (whenever someone said my name, walked into a room, I'd be startled.)

2. Yes, I got to a full state of mania before anyone really knew I was sick. Although my parents were thinking I had post-natal depression, and then I was having anxiety/panic attacks/insomnia, etc and was diagnosed with Grave's disease, which I think masked a lot of my bi-polarness (or explained some of it away) so maybe i am not a good example of this? Anyway, everyone just thought I was stressed


I have only incuded the one story about my hallucinations, but I did some odd/unusual things in my late teens and masked it all. It was like I was living a secret life and now I realise I had minor episodes and no one really noticed apart from thinking I was a moody teenager, hyperactive teenager, etc. When my diagnosis came out, my family were able to look back and see that, yes, I suffered with bipolar as a late teen (from around 16yrs) but at the time they didnt pick up on it.

In other words, I hid my mental state from my family and friends for a long period of time If you have any specific questions for me, I'm happy for you to PM me