By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
Auditory, Visual, Tactile, Olfactory, Gustatory and Proprioceptive Hallucinations.
Of the six types of hallucinations, one is a characteristic of mental illness, two are most commonly found coupled with drug use or abuse and the others are rare occurrences.
Hearing voices is one of the commonly reported symptoms of psychosis. For perfectly normal people hearing all sorts of sounds and not being able to find a source is common. Mostly this happens at night or when there some sort of sensory deprivation. Many people have had the experience of thinking they heard someone calling their name only to look around and find no one there. But if someone has psychosis the sounds they hear occur when others are present who don’t hear them.
People with schizophrenia have described the progression of these sounds to me. No one pattern seems to be consistent but here is the way in which auditory hallucinations might develop.
In the early stages, the person might hear humming sounds. They may get their hearing checked and there is nothing wrong. Later on, the sounds become voices. But the voices are mumbling, the person can’t make out what they say. The voices may get louder over time.
There may be one voice or many. The voices can be men, women or a group of people. Occasionally the voice will sound just like someone from the persons past.
The voice may comment on them – say “you’re no good” or “you will never be anything.” The voice may tell them to do or not do something. The most troubling auditory hallucinations are the “command” hallucinations when the voice or voices tell the client to harm themselves or others.
Occasionally the voices may be experienced as good or helpful voices. Sometimes the person experiencing auditory hallucinations can’t tell the difference between their own thoughts and “voices” as their thoughts become more negative and persecutory.
An occasional “hear your name and no one is there” or “hear chains rattling in the night” can be written off, but voices that recur or say negative things about the person are a sign of a serious mental illness and they need immediate treatment.
Seeing wisps or shadows can happen from lack of sleep, low light levels or other physical problems. Most of the more elaborate visual hallucinations are the result of drug use, intoxication or withdrawals. Seeing things when withdrawing from alcohol is life-threatening and needs immediate medical treatment.
A few people with mental illness only and no reports of substance abuse see things but most of the time if someone sees things they are doing drugs. Seeing things on drugs is so common that if the client knows that the drugs caused this we don’t diagnose it as a psychosis.
Three types of drugs cause visual hallucinations. Hallucinogens like LSD etc are a well-known cause. High levels of stimulants especially methamphetamine can cause Amphetamine-Induced Psychotic Disorder. Collectively all the psychosis caused by stimulants is referred to as “Stimulant Psychosis.”
Meth users are familiar with “petting the shadow puppy” and being chased by the giant green meth monster.
Drug-induced visual hallucinations often persist even after the eyes are closed.
Alcoholic Delirium Tremens (D. T’s) also involve visual hallucinations. This is life-threatening and is usually a lot more terrifying than the prosaic references to “pink elephants.”
These involve feeling things on your skin and body that aren’t there. These are almost exclusively drug induced.
Alcoholics may report the sensation of snakes crawling over their legs, mostly associated with restless leg syndrome.
Stimulant abusers are all familiar with Meth or cocaine bugs. They feel these sensations so often and scratch so much the characteristic scabs appear.
Some people smell dead people, even before the people die. This makes good horror flick material but in real life, olfactory hallucinations are a lot rarer than auditory or visual hallucinations.
Smelling things that are not there and hypersensitivity to smells may have a physical cause or more rarely it may be a mental illness.
This one makes me think I need a doctor, sometimes for the client, sometimes for me. If the client thinks they taste metal or poison this may be a medical issue, side effect of meds. Some clients have delusions of being poisoned and anything can taste like poison to them.
This is also a relatively rare issue in my experience.
This was covered under the category of sleep paralysis. These sensations of floating, flying, out-of-body experiences and other dissociative movement events are most likely when in bed before and after sleeping. They have also been reported under the influence of anesthetics and other hospital-related incidents. There are some historical references to this type of hallucination being caused by certain herbs and potions but most likely it is the result of sleep disruptions. I can think of no mental illness that features these sorts of hallucinations.
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