Of the entire spectrum of mental health problems , those with hallucinations as symptoms are perhaps the most stigmatized. Under simplifications such as ‘hearing voices’, many people understand this phenomenon as an unequivocal sign of ‘being crazy’ or, even, of posing a danger to oneself or to others.
The reality, however, is much more complex. Not only is it common to confuse hallucinations and other similar symptoms, but they can take many more forms and are much more frequent than popular wisdom often assumes.
The first thing: What are (exactly) hallucinations?
“The concept of hallucination”, explains to 20Minutos María Such de Lorenzo-Cáceres, psychologist at the Quartz Center – Scientific Psychology , “has acquired a colloquial use under which different perceptual phenomena are protected that a subject can refer to as anomalous; that is: as a sensory experience, of the environment or of oneself, which differs from the usual one “.
An investigation relates traumatic experiences in childhood with the appearance of schizophrenia.
However, he points out, “at a technical level, hallucinations would be included in the category of sensory and perceptual errors. A sensory-perceptual error would come to be, in short, a phenomenon in which an individual refers to a sensory experience (visual , auditory, tactile …) in the absence, a priori, of an identifiable stimulus that provokes said experience. The classic example that most would come to mind is that of seeing something that is not present in the physical plane, or hearing sounds that are not being produced. “
That is, it is important to differentiate hallucinations from other perceptual phenomena that are often not distinguished from them in colloquial language, such as illusions (which “are caused by the initial presence of a stimulus”, the expert points out, but as a result it produces “an erroneous elaboration of the information received by the senses”) or delusions (in which case “we would be talking about an alteration of the construction of the information, rather than its perception”).
To explain it with examples, an illusion would be “to confuse a bundle of clothing in a chair with a person in a dark room” and a delusion “to affirm that said bundle was (or could be) a person or a presence that disappears when the power is turned on. light”.
Apart from this, hallucinations usually have other characteristics. “Other qualities to take into account”, Such enumerates, “is that hallucinations are usually referred to as an ‘external’ or differentiated event of the individual (that is, the person does not describe them as a self-generated experience or their own, as when we imagine, for example) and with entity, with substance: the hallucinatory experience is usually intense enough to be confused with a ‘real’ perception “. Other qualities are “involuntariness and lack of control in its appearance” and, according to certain approaches, “the conviction of the person about the validity of what is experienced”.
Schizophrenia and psychosis
By virtue of these defining elements, hallucinations can be classified into different types. As the psychologist points out, “they are usually classified either by the complexity of the hallucinated product (a whisper is not the same as voices that articulate sentences and a flash is not the same as a corporeal image), or in relation to the senses involved in hallucination “.
“The most well-known to the population are visual or auditory hallucinations , but there are also (although they are less frequent) olfactory, taste or tactile hallucinations and, finally, those related to the perception of one’s own body: hallucinations of movement, somatic … . “he concludes.
Who is hallucinating?
Contrary to what many generalized beliefs about hallucinatory phenomena indicate, they are not always linked to mental health problems. In this sense, Such explains that “hallucinations, by themselves, do not constitute a sign of disease , and must be accompanied by another series of symptoms to determine the reason for their appearance, the possible underlying psychophysiological process and whether or not they belong to a pathological picture “. In fact, he points out, “this phenomenon can appear in a wide range of people and situations, including healthy people .”
“Often”, he continues, “we associate hallucination with psychopathology (more specifically, with schizophrenia and other psychotic disorders ). However, they can appear, for example, in the context of extreme physiological states , such as febrile states, dehydration or malnutrition, etc.”
And he adds: “Another example could be the hallucinations experienced by some people with blindness or deafness, the result of sensory deprivation. And, of course, hallucinations can arise from damage or alterations to the nervous system , such as migraines, neurodegenerative diseases, brain tumors, epilepsy, encephalitis, delirium tremens … “.
Along these lines, it helps to understand how and why hallucinations occur. “There are several theories”, the expert starts, “but there is currently agreement that hallucinations are related to alterations in the perception processes and could represent a functional attempt by the person to integrate and give a coherent meaning to these disordered or little sensations balanced. That is why the aforementioned sensory deprivation can lead to its appearance. “
“In fact,” he concludes, “a good anecdote of hallucinations in people without physical or mental pathologies are those reported by those who have passed through the so-called Chamber of Silence, or anechoic chamber (anechoic chambers are rooms with walls designed to achieve high soundproofing), from Orfield Laboratories (Minnesota), where sound deprivation is 99% “.
What does its content mean?
From all this, it is understood that the clinical relevance of the simple appearance of hallucinations depends largely on the context in which it appears. But, taking this into account, it is worth asking whether its content (for example, what the person who suffers from them sees or hears) is important to understand a possible underlying pathology (if any) or even to guide possible therapies or understand the person who experiences them.
In this regard, Such responds that “again, it would depend on whether there are other symptoms that accompany the hallucinations and, therefore, according to the type of pathology we are talking about. A priori, the form, complexity and the sensory channel affected by hallucination. “
Representations made on a wall by a patient diagnosed with schizophrenia.
“In general,” he continues, “hallucinations of the simple type (such as perceiving flashes or colors when suffering a migraine) and predominantly visual ones are more associated with pathologies of a neurological nature , while the more complex ones (hearing voices, seeing faces or people, feeling that something or someone touches or holds us, perceives changes in one’s own body …) have a higher prevalence in psychopathologies , mainly (although not exclusively) in those of a psychotic nature “.
It is in this last framework, he clarifies, in which the content “can (and usually) be interesting.” If, as the psychologist previously pointed out, “a fundamental component of hallucination is the degree of conviction about its veracity, validity or relevance in the objective plane for the person who experiences them” and knowing that “they probably have a functional component (that of give a meaning, coherent for the individual, to those sensations), it seems likely that this content is influenced both by the emotional state of the individual at that moment (which can be pleasant or very unpleasant), and by their personal history: their beliefs, experiences and learning “.
“For example, one of the best known explanatory hypotheses of schizophrenia is that of the experience of traumatic or very stressful events in the person’s childhood or youth (different types of abuse, significant losses, etc.) that add up to a genetic and neurobiological profile that predisposes to this very particular style of processing and integrating sensory information “.
“It is not the only explanation for such a complex pathological profile, of course”, he adds, “but since these patients often refer, for example, auditory hallucinations with voices that punish, criticize or ridicule and that, on the other hand, Despite the formal similarities, the hallucinatory experience also has a very personal component for those who live it, it is possible to think that the content could be relevant in relation to the history of the individual and, of course, to the extent that it is relevant to said experience. person”.
And he reflects: “I think it is reasonable, respectful and ethical to give it the appropriate importance in a clinical context, yes. Both because of what it reveals in terms of the patient’s history, and because of the emotions that this experience reflects or provokes”
And what about hallucinations caused by substance use?
There is a context in which, however, the content of hallucinations has been attributed great relevance since time immemorial. These are those caused by the use of psychedelic or hallucinogenic substances , a custom that has been part of ancient religious rituals in cultures around the world.
Despite this rich history, its popularization among certain sectors of youth in the middle of the last century has caused that, at present, the use of this type of drugs is more related to adolescent leisure or addictive behaviors and even criminal. Still, Such argues that studying its content can be revealing if certain conditions are met.
“It is important to first clarify the popular confusion that may exist between a hallucination and another series of perceptual phenomena that usually occur under the use of substances,” he clarifies. “Surely, it is common for people to refer as” hallucination “what, in reality, is another category of altered sensory experience: that of perceptual distortions. In a perceptual distortion , there is always an identifiable stimulus present, and what is altered are the qualities of said stimulus: size, shape, colors; the sensoriality of the environment or of oneself at that moment … In this type of non-hallucinatory experiences, what is being altered is the process of sensory integration, not the process perception in itself “.
Three-dimensional atlas of the human body where the brain is highlighted.
However, he adds, “there is no reason to rule out that, in a hallucination proper under the influence of a substance, the content may be relevant. Above all, it will be relevant to the extent that it is significant for the person.”
“The best example of this is the statement regarding the culturality of psychotic experiences and hallucinations in particular: In how many cultures do we know that hallucinogenic substances are traditionally used as mediation in rituals (for example, religious, playful or transitional between stages), or in order to unravel vital, spiritual questions … or to obtain some kind of revelation or answer ? ” He says.
That is, “it will be relevant as long as it is relevant to the person who experiences it, and the degree of conviction or meaning that the person has about the experience.”
How to deal with hallucinations?
Be that as it may, it is clear that in many cases detecting that we are experiencing hallucinations (which, as we have seen, is not always easy) or that a close person suffers from them can be cause for concern.
If this is the case, the expert explains that the most appropriate way to act “depends on the age, the context and the type of hallucination experienced”.
For example, he argues, “If we are talking about a hallucination in a fever in a child , it would call for calm since it is a relatively normal phenomenon and without clinical importance (except that there are repetitions in afebrile states or in the company of other symptoms , in which case neurological disorders should be ruled out) “.
By contrast, “in adult people”, he continues, “if they had never suffered a similar experience, and they are simple perceptions, such as auras, flashes, sounds or vague tactile sensations … I would recommend consulting with your doctor and, again, assessing the presence of some disorder of the nervous system, especially if they are repeated. And especially in the elderly, to evaluate the presence of a possible neurodegenerative process (although it usually begins and is accompanied by other symptoms and prolegomena) “.
On the other hand, “if we are talking about more complex, repeated hallucinatory experiences that are accompanied by alterations in mood or behavior (either marked sadness or apathy, generally very negative content of thoughts, insecurity or doubts regarding others or oneself, distrust, anxiety, ideas or a strange speech regarding objective reality …), I recommend, without any doubt, to go or accompany the person to receive an appropriate psychiatric and psychological evaluation as soon as possible “.
In these cases, Such warns, it could be that we are faced with “a psychopathology with a psychotic profile (schizophrenia, brief psychotic disorder, delusional disorder …) or with psychotic symptoms (psychotic depression, some bipolar disorders …)”.
“And I say accompany because, unfortunately, it usually happens that either the person tries to conceal or hide these symptoms until they have acquired a relevant intensity and severity, or that they are reticent, distrustful or scared enough to ask or accept to receive help themselves. “
In addition, it must be taken into account that due to the circumstances that usually surround these health problems, “together with the scarcity of resources and solidity in the system for the care of these psychopathologies and the taboo and even stigma that exist with respect to psychotic symptoms (in our culture and in others) “often receiving the appropriate help is a delicate and stressful process both for patients with this profile and for those close to them,” the psychologist says.
Breaking the stigmata
Thus, as we have seen, ignorance and prejudice can cause pain and an additional burden on people who, for one reason or another, experience hallucinations and on their loved ones. For this reason, Such defends that “by no means the experience of hallucinations is synonymous with madness, nor, in general terms, with imminent danger . Just as psychopathologies where they frequently appear are not.”
“On the contrary,” he develops, “the hypothesis that they are part of a more processing and thinking style is increasingly accepted ; different from the one assumed as normative, yes. But it is estimated that more clinically healthy people occasionally have hallucinatory experiences as one more way to organize and integrate the information that has been detected “.
From this perspective, it is understood that “even some of the patients with a psychotic profile refer that treating their hallucinations as another component of their cognition , or as a symptom indicative of an alteration in their mood (increased stress, anxiety, sadness, worry …) it is more useful for them in managing and living with them than its approach as an alarming symptom that must be suppressed “.
Mental health problems, an invisible scourge to which anyone is exposed
In conclusion, Such affirms that “treating any symptom or diverse experience from the validation, naturalness and unconditional acceptance of the person, is infinitely more useful, therapeutic and ethical than doing it from fear, suppression and even shame and guilt “.
“For this reason,” he concludes, “it is necessary to continue calling for a reflection on the stigma and deep-rooted prejudices around mental health, and especially around this type of experience, whether or not they are part of a pathological picture. Confronting those prejudices, of course, saves lives . “