Usually, when discussing mental illness, one would start with the most common conditions known, such as depression or anxiety. However, I think we will shake things up a bit and start with something slightly different. Let's begin with psychosis. For the most part, everyone thinks psychosis is hearing voices, seeing things, or some form of paranoia. In the simplest terms, psychosis can include auditory, visual and tactile (touch) hallucinations and paranoia, but there is so much more. The word psychosis means to lose contact with reality. Whose reality? The existence of one's surroundings, societal and personal aspects. Surprisingly psychosis is more common than you think; most people experience some form of psychosis within their lifetime. So what does that mean exactly? How could so many people experience psychosis and others not realize it? As mentioned above, everyone believes there are only a few psychotic symptoms; however, this is the farthest from the truth. Today's topic will cover hallucinations and some delusional types. Obviously, there are more topics to cover with psychosis, but we can save those for another time.
Hallucinations are well known but did you realize that all five sensory modalities could be affected? Most commonly, people experience auditory hallucinations where they "hear" things. People could hear names being called, yelling, arguing, derogatory terms (cursing), commands, and commendations, just to name a few.
Auditory hallucinations become dangerous when a person begins having commands, which essentially means someone else is telling them what to do. Serious actions could be to harm yourself or others, including detailed plans. In contrast, others experience pleasant voices, which are could be viewed as friendly. Auditory hallucinations are not limited to hearing your voice but usually is someone else's voice that you know or are unfamiliar with and sounds. At times the "voices" could have names and seemly be holding back and forth conversations with the person experiencing them. Related environmental sounds such as a dog barking, trains, gunshots, horns, wind, or anything you have ever heard in your lifetime could become irritants. There is no limit to the sounds you hear and the realization that sounds are present, but knowing others cannot listen to them is scary. Hearing noises typically can lead to paranoia, but we are not there yet.
Visual hallucinations are just what it sounds like, visions of familiar people, places, objects, or shapes in regular form or distorted to unrecognizable images. Those suffering from visual hallucinations can often be seen attempting to touch, readjust or chase what they believe is real. Yes, a person can be fully aware that the images are not truly present, such as when a deceased relative appears; however, coupled with auditory hallucinations, frequency, and intensity, it may be difficult to distinguish.
Tactile hallucinations are more uncommon, usually happening to those intoxicated/withdrawing from substances (ex: cocaine), brain tumors, or some other organic (medical) condition; however, they can be a part of a severe psychotic episode. Tactile hallucinations can feel as if insects are crawling over you, movement under your skin, air rushing past you, penetration, and another form of touching.
Paranoia belongs to a broader form of psychosis called delusions. Delusions are fixed and firm beliefs that are typically not viewed as "normal" in one's culture or society. There are many types of delusions, but the most common is paranoia. Paranoia could include persecutory delusions that others are out to get you; someone is following you, talking about you, against you, using you, or tricking you. These particular paranoias can cause significant distress as a person feels no one can be trusted, leading to behaviors to prevent deception. Such actions also cause isolation, irritability, and fearfulness, leaving a person sleepless. Other delusion types include grandiose delusions such as having a lot of money or being famous, erotomanic delusions that a famous person is in love with or in a relationship with you, somatic delusions that something is causing physical symptoms like the ringing in your ear is actually hornets flying around in their hive located in your right ear, delusions of control feeling as if someone or something else is controlling your thoughts, movements or actions, delusion of reference believing a character on your favorite tv show is directly relating the episode to you, and my one of my favorites capgras delusion believing someone close to you has been replaced or is an imposter. Now I could carry on about delusions and the behaviors they cause, but this is a good place to stop. If anyone is interested in learning more about delusions, leave a comment below. Maybe it could be the highlight of our next topic.
---Dr. K
***This blog is not intended to medical advice, this does not constitute a physician-patient relationship. If you are experiencing a medical/psychiatric emergency please call 911.