Pseudohallucinations – OK to see things?

By David Joel Miller.

Pseudohallucinations – sometimes we expect people to “see things.”

Sometimes it’s okay to see things that are not really there. When someone is under

Pseudohallucinations

Pseudohallucinations.
Photo courtesy of Pixabay.com

the influence of drugs, particularly hallucinogens or powerful stimulants, it is common for them to see things that others don’t.

When crack cocaine first became common, the emergency rooms in large cities experienced a rash of people who were “seeing things.” Many of these people received a diagnosis of schizophrenia or a related psychosis.

The same phenomenon occurred again when methamphetamine became cheap and readily available. More recently we are seeing people under the influence of “bath salts,” who are hallucinating.

None of these drug-induced hallucinations should be used as symptoms for making the diagnosis of schizophrenia or related psychosis.

True hallucinations can be a feature of several mental illnesses. In addition to schizophrenia, people with severe major depressive disorder, bipolar disorder, and other mental illnesses may experience hallucinations. Sometimes people with severe mental illness also use drugs which can create Pseudohallucinations. Sorting out the meaning of hallucinations is a job for a professional.

Some authorities differentiate between Hallucinations, Pseudohallucinations, and Parahallucinations.

If someone is experiencing hallucinations and they know it is the result of “good drugs,” this is a Pseudohallucination and likely will be diagnosed as a drug intoxication disorder, Hallucinogen Persisting Perception Disorder F16.983 or stimulant-induced psychotic disorder if the hallucinations continue after withdrawal from a stimulant.

Alcohol can also cause hallucinations.

When chronic alcoholics are withdrawing from alcohol that can experience a condition called delirium tremens or the DT’s for short. DT’s consists of shakes and hallucinations when the level of alcohol in the bloodstream declines. This is a very serious condition and can lead to death. If someone has ever had the shakes or hallucinated while withdrawing from alcohol they should be sent to a hospital to detox. Friends don’t let friends die from DT, s.

Staying connected with David Joel Miller

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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Delusion or reality?

By David Joel Miller.

Sometimes delusions get people into trouble.

One problem area for mental health is distinguishing between delusions and reality. If

Delusions.

Delusions.
Photo courtesy of Pixabay.com

something is highly unlikely and yet despite mounds of evidence that can’t be true, that someone still firmly believes in its truth, it’s likely to be a delusion. Unfortunately, one person’s belief may be another person’s delusion. Disagreements about the truth often result in violence. After there’s been a violent incident, the question often arises why hadn’t someone spotted that person who was likely to become violent?

Identifying when someone is delusional is the first step. Figuring out when that delusion will lead that person to violence is a much more difficult task.

Defining delusions.

The technical definition of delusions is fixed beliefs which people are unwilling to change even when presented with evidence to the contrary. The harder it is to tell what is truth and what is delusion the more likely it is to result in violence. Religion and politics are two areas particularly prone to disagreements that lead to violence.

Here’s a list of the recognized themes of delusions.

  1. Someone’s out to get me, technically called persecutory delusions.
  2. Grandiose delusions, the person believes they are special and have exceptional abilities.
  3. Love and sex delusions are technically called erotomanic delusions, during which the delusional person believes someone is in love with them or wants them sexually.
  4. Nihilistic delusions involve the fixed belief that a major disaster will occur.
  5. Delusions regarding health and body functioning are called somatic delusions.

Is that delusion bizarre?

When other people in your culture don’t believe, something could happen, it would not be a normal experience for them. Common examples of beliefs that would be considered bizarre delusions include the idea that someone is beaming thoughts into your head or removing your thoughts. Some people also believe that an outside force is controlling them.

The problem with diagnosing delusions.

Delusions can occur in the course of several mental illnesses. There is also one specific category titled Delusional Disorder (F-22) which is a catchall for several distinct kinds of delusions which occur outside the course of another mental illness.

One type of delusion which results in a lot of problematic behavior is the delusional form of jealousy. Jealousy is a complicated topic; not all jealousy is delusional. But delusional jealousy, sometimes described as morbid or pathological jealousy, can result in stalking and interpersonal violence.

In upcoming blog posts, we will look at delusional disorder and then some of the varieties of jealous behavior, when is jealousy good for relationships, as well as how and when jealousy become dangerous.

Staying connected with David Joel Miller

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Why you should talk to yourself.

By David Joel Miller.

Talking to yourself, especially out loud has some benefits.

Girl talking out loud.

Girl Talking.
Photo courtesy of Pixabay.com

People who talk to themselves out loud can make people around them very nervous.  When we think about somebody who is talking out loud many people are likely to think of the psychotic person who was speaking to the voices or the disturbed person who is rambling on and on for no particular reason.  There can be some very definite positive benefits to talking to yourself.

Children are particularly likely to be talking to themselves out loud.  They have not yet developed the skills to self-monitoring and only speaking out loud when they are alone.  If you find that you are still talking out loud to yourself, this does not necessarily mean that are losing your mind.  But it may mean is that you have something very important on your mind and are forgetting to self-monitoring for other people around.  Below are some reasons that speaking to yourself out loud may be helpful.

You become a better public speaker.

Many famous public speakers began by practicing their speeches out loud.  If you know that you’re going to need to make a presentation, it can really improve your performance to practice that speech out loud.

Talking to yourself out loud reinforces memories.

If you just heard something and you need to remember it, saying it over and over again to yourself can help.  Going over a chain of events A happened and then B can help you to remember those events in sequence.

Talking allows you to practice what you are going to say.

Sometimes we know we’re going to have to have one of those difficult talks with someone.  It’s important to get the words just right.  Practicing what you’re going to say can help you identify things that may come out other than the way you want them to.  Listening to what you have to say can help you find just the right way to a convey that information.

Talking to yourself helps you learn the step of a process.

When you’re trying to learn a new procedure and there are several steps, it can help you to remember this process if you repeat each step as you do it.  In skills training, the trainer may initially repeat the steps out loud to the client.  They will then have the client do the process while repeating the steps out loud.  Finally, the client repeats the process while saying the steps silently in their head.

Talking aloud helps to clear a crowded mind.

People with very active, busy minds find that it can be helpful to clear that mind by going ahead and saying the things that are bothering them.  Sometimes this can be an automatic unconscious behavior.  While this is helpful to the person with a busy crowded mind it can be upsetting to others who might accidentally overhear.

You develop storytelling skills.

Good storytellers practice telling their story over and over.  If you’re going to be telling that story out loud to others it’s best to practice the story out loud.  Highly creative people often tell themselves stories. Sometimes when they’re alone they tell them out loud.  As you develop your storytelling and your self-monitoring skills you are likely to learn to tell the stories with your mouth closed and the words retained in your head.

You develop a supportive of relationship with yourself.

You’re going to spend a lot of time with yourself.  Work of becoming your own best friend.  One way of becoming supportive of yourself is to have those self-talks that you wish you could have with other people.  The more you practice these self-talks the better you will be able to contain them within your head instead of having them leak out and others hear them.

It helps you to focus on a task or conversation at hand.

Sometimes we repeat things out loud during a conversation with another person.  It can help to confirm that we’ve heard things accurately.  You can also use talking aloud to help you focus your attention on what is being discussed or what you need to do.

It improves self-monitoring skills.

People who are working on their self-monitoring skills may find it useful to comment on their activities as they do them.

Self-talk helps you self-sooth.

When you’re feeling upset or on edge talking to yourself can be helpful.  Remind yourself that you are safe.

You improve your creativity by exploring possibilities.

Creative people may find it useful to have these conversations out loud to explore possible conversations.

So if you or someone in your life makes a habit of talking out loud consider whether this is a helpful skill or a lack of self-monitoring.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Types of auditory hallucinations – hearing voices.

By David Joel Miller.

How many types of auditory hallucinations are there?

Street art - confusing

Hearing Voices – sensory confusion.
Photo courtesy of Pixabay.com

Hearing voices or sounds that no one else hears occurs in people both with and without a diagnosable mental illness. Originally this question came in from a reader who asked about types of voices. What that reader was asking about was, voices that speak in first, second or third person, a very different discussion from what we are talking about here. Their question got me thinking that all those things that get referred to as “auditory hallucinations” can be quite different experiences.

Since these auditory events can vary so much it may be useful to consider some types of auditory hallucinations, “hearing voices” as the auditory hallucinations are often referred to, and we can see just how different these auditory hallucinations might be. Some of these events are easily explained and other sound events are reasons to suspect a long-term mental illness is present.

Some “voices” are misinterpreted sounds.

Hearing voices or other sounds and then finding out that others did not hear what you heard, happens more often than most people realize. At several times in the human lifespan, this is so common that it appears normal. In children and adolescents and then again among the elderly these auditory hallucination type “hearing voices” are common enough that we are inclined to think this is a normal developmental event.

Mistaking one sound for another is a type of auditory hallucination.

Say you are sitting at a table eating lunch and then you think you hear someone calling your name. You look around and no one is there. Leaving out religious or supernatural interpretations here, you have just had an “auditory hallucination.”  If you hear an indistinct sound, your brain is likely to interpret this sound as something familiar, like your own name.

We have limited information on what these auditory hallucinations are like.

Auditory hallucinations are very individual experiences. Since part of the definition of auditory hallucinations is that they are heard by one person and not others we have only two sources of information most of the time. We, as in counselors, can rely on the reports of those who hear them or we can have observers who see people they believe are having auditory hallucinations describe how this is affecting the person who presumably is hearing voices. More information’s is coming in from brain scans but it will be some time before this begins to be widely used for diagnosis.

This more “objective” evidence of auditory hallucinations based on professional’s observations is subjective and involves a lot of guesswork and inferences. Clinicians may refer to a client as “internally preoccupied” and the presumption is that the client is listening to voices but they may also be lost in thought or because of concussions or dementia be unable to think coherently.

The experience of having an auditory hallucination has many personal features. The voice can vary in frequency from one time only to constant running commentary that never stops. Voices or other sounds can vary in intensity. Some voices are louder than others. Those hearing voices report varying degrees of ability to control the voices.

A person hearing voices may develop unique or special relationships with the voices for good or bad. Young children, especially those who have been under stress or traumatized, can begin to hear voices.

Here are some of the possible auditory hallucinations that have been reported by both clinical and non-clinical populations. Auditory hallucinations have been described in many ways and this list is far from inclusive.

Hearing hums or rhythmic sounds.

People who later develop distinct voices sometimes have told me that the “voices” began as indistinct humming or tapping sounds. For some people, this progresses and for others, it does not. Hearing issues, tinnitus, and hearing loss have similar symptoms.

Non-word sounds are more commonly heard by seniors, which does not automatically mean they are developing a psychotic condition. One research study I read recently reported that an imbalance in hearing between the two ears increases the risk that sounds will be miss-attributed. This is more pronounced if the left ear has less hearing ability than the right.

For this reason and a bunch of others, seniors are getting prescribed a lot of sedating antipsychotic medication.

Mumbling, whispers or indistinct conversations or laughter.

Clients whose auditory hallucinations went on to become distinct voices have told me that in the early stages this was more like whispering or several people talking at once. Over time the voices are likely to get more distinct and clearer.

Positive voice or voices.

This kind of voice may be a departed relative or friend, guardian angel or other spiritual force offering you encouragement. Clients have reported that they hear their grandfather, grandmother or other relative telling them they can do something.

This coincides with research that reports hearing voices does not appear to make you mentally ill or worsen an existing mental illness if you take the voices to be positive things. Your beliefs about hearing voices determine how much it will bother you when you do hear those voices (Hill, et. al., 2012)

A recognizable person who is known to the client.

Young children especially those who have been under stress or traumatized can begin to hear voices. These voices are often someone who has been negative, criticizing or even abusive. These kinds of voices may well be more a matter of memory failure, not being able to remember who said this to you in the past, than a current auditory hallucination.

A single unknown voice.

These voices do not appear to be anyone the person recognizes having heard in the past. This voice may be good, bad or may vary over time. What this voice says and how the person hearing it interprets this experience is important in how it will affect them.

Male only or female only voices.

This may be a part of a single voice as above or multiple voices described next. Sometimes this connects to a specific life experience and sometimes not. Freudian psychoanalysts can have a field day with these kinds of voices.

Multiple voices speaking at the same time or taking turns.

These voices may be talking to each other or they may be talking to the hearer. What they are talking about is sometimes significant. With this one and most of the ones to follow medication is highly indicated if it has not been tried yet.

A malevolent threatening voice.

This is a bad sign. Especially if the person hearing this voice has lost the ability to shut the voice up.

God or religious figure can talk to you.

Some people find this comforting, others think the devil is in their head and freak out.

Voices from inside the head.

It has been suggested this is the result of an “attribution” error. If you lose track of when you are having internal thoughts and your own thoughts begin to sound like voices this is a problem.

Voices from outside the head.

More problematic, less likely the person hearing these voices will accept that these are their own thoughts or misinterpretations of sounds.

Voices that are only heard in certain situations.

Some people only hear voices when they are very depressed or when they are very anxious. These can be their own depression and anxiety taking on the role of speaking to them or we might interpret this as problems with the brain as a result of a deficit in a neurotransmitter. Treat the depression and these kinds of voices usually go away.

Voices giving commands – command hallucinations.

This is very worrisome to me. How can the person who hears the voices all the time resist these commands? Anyone having command hallucinations, even potentially good commands, needs treatment. If the voices never stop, people will act on the voices, sometimes giving in and sometimes self-harming just to get the voices to shut up.

Voice is part of re-experiencing a past event.

Sometimes voices are the result of re-experiencing the past. An abuser said bad things about you and you remember their voice calling you names. But then again I tell my students that when they take licensing exams I hope they will remember my voice telling them the answers. A good teacher hopes their student will take their voice with them. Bad teachers find the student can’t get that critical voice out of their head.

Hearing voices is not always a bad thing.

I should also mention that not everyone agrees that hearing voices, is a bad nor an abnormal event. Take a look at some of the things that the Hearing Voices Movement has to say about their perspective on hearing voices.

If you have experienced voices or have talked with someone who does feel free to comment. I will get to the comments as quickly as I can and this time of year that may take a while but rest assured eventually I will respond to your comments.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Do people really need to stay on anti-psychotic medications over the long haul?

By David Joel Miller.

Are psychiatric meds for life?

Medication

Medication
Photo courtesy of Flickr

The conventional wisdom has been that one you were put on an anti-psychotic you were going to be on it for life. People who stopped taking their meds were at high risk for a relapse.

Now comes a blog post, from no other than the director of the National Institute of Mental Health, reporting that we may have been wrong about this.

You can read the full director’s report at the link below.

http://www.nimh.nih.gov/about/director/2013/antipsychotics-taking-the-long-view.shtml

Please do not read my post or even the Director of NIMH and stop taking your meds. Talk to your doctor first.

But consider that meds and meds alone may not be what you or others with a mental illness really need.

You might also want to talk a look at Aaron Becks book on cognitive therapy and schizophrenia. The link is below.

Schizophrenia: Cognitive Theory, Research, and Therapy

“Counselorssoapbox is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com.” We recommend only books we think are good and maybe occasionally make a buck.

So as with all other treatments, one size, one method is not the right approach for everyone.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What sense of smell – odors – tells us about mental illness?

By David Joel Miller.

Is there a connection between the sense of smell and mental illness?

Feeling Better

Smells and odors.

There is a body of research that tells us that there is a connection between the sense of smell, your ability to recognize and identify odors and the chance you have or will develop a mental illness. There are also cases of olfactory hallucinations; smelling things that everyone else is sure is not there.

While this research suggests some connections, to me the articles I have read are short of conclusive.

An altered sense of smell has been linked to disorders as divergent as Schizophrenia, Bipolar disorder, autism and eating and feeding disorders.

Smelling it does not mean you can identify the smell.

One thing we do know is that the ability to identify an odor is not the same thing as the ability to detect one. People are more likely to like a smell they can identify and unknown smells are more likely to be considered unpleasant. Memory and its connection to smells are important for many reasons.

Smells trigger memories.

This is significant because smells are powerful memory cures. People who have a poor ability to notice smells or to remember them are at a disadvantage in remembering things that might be associated with those smells.

Schizophrenia and odors.

The disorder most cited as having olfactory (odor or smell) impairment is Schizophrenia. More interesting yet is the repeated observation that males with schizophrenia are far more likely to have olfactory disruption than females (Nguyen et al, 2010.) These males with schizophrenia had disruption of odor identification, memory, odor detection abilities and poor odor discrimination, the ability to tell one smell from another.

Females in these studies rather than not being able to recognize or identify smells were more likely to smell foul or unpleasant things that were in fact not detectable to others. The conclusion was that women have more olfactory hallucinations and men more loss of ability to smell.

Schizophrenia is characterized by negative symptoms, which are the loss of some abilities others have, as well as positive symptoms such as hallucinations. Someone with schizophrenia will likely have or experience social withdrawal, attention problems, difficulty making decisions, and perceptual problems.

People with schizophrenia also have high rates of olfactory identification problems, discrimination of smells, olfactory memory and olfactory detection errors, principally in males. Poor olfactory discrimination is also found in close relatives of people who have been diagnosed with schizophrenia even when those relatives have not received the diagnosis themselves.

Olfactory identification problems do not appear to be found in people with Bipolar disorder, Major depressive disorder, other related psychosis or anorexia nervosa.

Alzheimer’s, and Parkinson’s diseases and smells.

Olfactory hallucinations and discrimination deficits are seen in those with Alzheimer’s, and Parkinson’s diseases in addition to Schizophrenia.

One researcher reports that people with Bipolar Disorder have some olfactory impairment but that they are less bothered by unpleasant smells that those people who have Schizophrenia (Cummings et al., 2010.)

Autism and odors.

In Autism olfactory identification is reported as impaired. Individuals who had been diagnosed with Autism preferred Lemon and Orange smells to lavender. They disliked most other strong smells. In Autism strong smells are linked to perceptions of taste and result in high rates of food refusal and selectivity (Hrdlicka et al., 2010.)

Olfactory hallucinations.

One condition of note is olfactory hallucinations. Some patients reported a foul-smelling order coming from themselves. This odor was not detected by staff. This olfactory hallucination is referred to as Reference Syndrome and was reported in patients with temporal lobe epilepsy. Other olfactory hallucinations have been reported in clients with substance-induced Psychotic Disorder, Hypomania with Alcohol dependence combined with hypomania (Luckhaus et al., 2003.)

There does not appear to be any connection between depression and olfactory dysfunction (Scinska et al., 2008.)

Migraines and odors.

Olfactory dysregulation has also been linked to people who have frequent migraines, with over 45% of people experiencing migraines reporting odors are triggers for those migraines. In migraine suffers almost 25% had a fear of a particular odor and an equal number reported taste abnormalities when having a migraine episode. MRI’s showed that women were eight times more likely to have brain activation from odors. This makes one wonder if many of the issues with odor detection, memory and discrimination are more linked to gender than to a particular psychiatric diagnosis.

Other studies have reported significant episodes of visual hallucinations during migraine attacks and make the point that visual and auditory hallucinations are so pronounced and readily identifiable most people are not asked about and do not report either olfactory (smells) or gustatory (taste) hallucinations.

In people with schizophrenia, 75% reported auditory hallucinations, 37% reported somatic hallucinations while olfactory hallucinations were reported by 18% of the patients which is slightly more than the 14% who reported visual hallucinations. Despite being so common, few clients report olfactory hallucinations and clinicians are not generally looking for them.

While people with schizophrenia may experience hallucinations in all modalities, providers frequently stop asking about hallucinations after the first or second reported hallucination.

Stress and hallucinations.

Researchers find that people who report being under “stress” are more likely to have experienced olfactory hallucinations and one study concludes that stress may lower the threshold for hallucinations of any type.

Because the major part of the olfactory sensing part of the brain is on one side of the brain researchers have suggested that there may be a difference in the way in which left-handed and right-handed people experience olfactory hallucinations.

While olfactory hallucinations are readily identifiable in people who have migraines they are less identifiable but more likely to be described as unpleasant in those with epilepsy.

While we still can’t use olfactory or gustatory hallucinations or dysfunction as makers for a particular mental illness, we know abnormalities in the sense of smell and taste may be factors in the development of a mental or emotional problem.

Have you experienced an alteration in your sense of smell or taste and no medical reason has been found? Care to share?

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Delusions are a leading cause of homicides; if you were delusional would you know?

By David Joel Miller.

What exactly is a delusion and why are they so hard to recognize beforehand?

One particular delusion has been implicated as a leading cause of homicides. Related delusions may also play a major role in other violent acts even though professionals have such a hard time recognizing them.

Delusions are one of those things like art or pornography we have a great difficulty in defining but we all think we will recognize it when we see it. Unfortunately, it often goes unrecognized until way too late.

While not necessarily a particular mental illness, Delusions are a symptom of a number of mental illnesses. In practice professionals rarely seem to pick out the delusion first. The person gets diagnosed with a particular mental illness and then the descriptor with delusions gets tossed in later like that tells us much about what is going on.

Some mental status exam forms and assessment forms include checkboxes to mark off delusions. Since deciding if someone is delusional is such an extreme judgment call, this decision often comes after the diagnosis not before. Also, note that the one delusion that results in many homicides is not usually included in the list of delusions that we are presented to check off.

The commonly considered delusions are, Paranoid, Grandiose, Religious, and Persecutory. Let’s look at these one at a time and see why they can be problematic. Some of these examples are slightly exaggerated and embroidered for effect. Can you tell which are which?

When paranoia is not a delusion.

A client told me that he was being followed; that the police were out to get him and that it was not safe to walk the streets. Clearly, he was sounding paranoid. On Monday I learned that he had been arrested after the police responded to a shooting at his house. The police were quick to respond as they were only a couple of blocks down. They had been watching his house. He was found in possession of a large quantity of drugs.

Was he paranoid? As I tell students in the substance abuse counseling program, if the client thinks people are watching him and he has a kilo of dope in the trunk of his car this is not paranoia, it is common sense.

How Grandiose is Grandiose.

If I told you that an African-American though he could run for president and have a chance of winning in this the 21 century that would sound Grandiose wouldn’t it?  And if that Black man was a first-term Senator from the mid-west – any psychiatrist worth his salt would know right off that this person was Grandiose.

Thank goodness no one told President Obama those things. Or if they did, it is a good thing that he did not listen. Whatever your political affiliation, it is clear that President Obama ought not to be diagnosed as Grandiose, not since he won anyway.

So it is not grandiosity if you are actually able to do something. This makes me nervous when I put down that someone is having grandiose delusions. How do I know for a fact that they are delusional? In my mind, any doubt goes to the client.

Your religion is delusional mine is doing what God wants.

All religions are based on Beliefs. They customarily urge you to act on faith and have belief. Unfortunately, they all seem to have a different group of these essential beliefs.

In mental health, if something occurs to you and most of the other people in your community think this is correct, we do not diagnose this as a mental illness.

If a Catholic believes that they see the Virgin Mary we let that go.
Where this becomes a problem is if you move to a country where no one believes in the Virgin Mary and now if you keep seeing her they can lock you up as delusional. That whole community values thing is a rabbit hole down which the truth can disappear in an instant.

If you are now thinking of sending me a nasty comment or e-mail about how far off I am about your religious beliefs please read the next section before hitting send.

Persecutory Delusions.

It is not persecutory if people are after you. Like paranoid this one is a matter of degree and judgment.

If you think that people are out to get you and then you start getting written death threats, that is probably not a persecution delusion.

This like all the others is a matter of fact and judgment.

Which major delusion is not on a lot of forms?

We don’t like to look for and may miss jealousy delusions. People who believe that their partner is cheating on them can and do frequently get violent. Sometimes after they shot or kill someone they discover that their partner was not in fact cheating on them but at the time the evidence looked to them like that partner was clearly cheating.

One article I read recently reported that someone killed a man he believed was cheating with the client’s wife. He was arrested. The victim now dead was clearly not having an affair with the client’s wife. This belief was called a delusion.

Later it came out that the wife was, in fact, having an affair, the client just got the identity of the man she was cheating with wrong.

Was he delusional? I let you decide that.

Certain groups are far more likely than others to be described as delusional. I worry that if you do not agree with the assessor you will get called delusional.

Say you are sent for an evaluation and the assessor is a member of the Church of the Religious Egg. They teach that you should cover yourself with plastic and surround yourself with plastic objects three times a day to meditate. You report that this whole idea is crazy. The assessor reports that you are having religious delusions because you believe in some other deity.

At this point who are we thinking is delusional?

Please do not misunderstand here. I do believe that people, with or without mental illness, can and do have delusions, some more bizarre than others. My point is that we need to be careful about what we call a delusion and what we let go.

So in some future posts, we will need to talk about the research on delusions and why certain groups get that label more often than other groups.

Until next time, stay happy.

Staying connected with David Joel Miller

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Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.