We often see pop artists refer to themselves as “delusional” in songs about lost love or characters in mainstream shows saying to one another, “You’re just hallucinating, that never happened,” blurring the line between imagination and disordered psychosis. While a person imagining is aware that their occurring thoughts are “just thoughts,” it is difficult for people with schizophrenia to tell a psychotic episode apart from reality. Positive symptoms of psychosis are not usually present before the onset of the disorder, such as delusions and hallucinations. Delusions are false beliefs or thoughts, whereas hallucinations are usually in the form of seeing or hearing things when there is no such stimulus present. They are two of the most common symptoms of schizophrenia. Approximately 70% of individuals with schizophrenia experience them, especially hearing voices (Hugdahl et al, 2008), but not everyone is distressed by them or feels the need to seek help. The fact that these experiences feel so real to the patients and that they are covert and idiosyncratic, which may factor into the difficulty of diagnosing schizophrenia.
Scientists have been trying to explain what is happening to people’s brains when they experience auditory hallucinations. One study used functional magnetic resonance imaging, or fMRI, to scan the patients’ brain activity, then later asked them to report whether they experienced hallucinations during each interval of scanning. They found that multiple areas of the brain, including the inferior frontal/insular, anterior cingulate, temporal cortex bilaterally, right thalamus and inferior colliculus, and the left hippocampus and parahippocampal cortex, were active when the patients reported hearing voices (Shergill et al, 2000). Another study used the dichotic listening test to present two consonant-vowel syllables simultaneously, one in each ear and had the participants report the syllable identified best on each trial. The results demonstrated that there is an inverse relationship between auditory hallucinations and right ear performance, which suggests that “auditory hallucinations interferes with the perception of an externally presented speech sound, localized to the left temporal lobe” (Hugdahl et al, 2008).
Many people with schizophrenia shared their unique experiences with hallucinations in interviews. According to healthtalk.org, one patient, Nikki, described the voices she heard as coming from multiple different people simultaneously, known or unknown. Other patients, Lucy and Emily, recalled that the voices were persecutory, persuading them into self-harm or even suicide. Although auditory hallucinations are common among people with schizophrenia, some people experience visual hallucinations more, such as Joe, who has experienced hallucinations about hurting his loved ones. For some patients, auditory and visual hallucinations can go hand in hand, as seen in Dominic’s case, where he visualized hurting others and heard voices commanding him to do so. Each of these accounts of experiencing hallucinations is covert and distinct in each person’s case. Unless the patients themselves or the people around them realize that what they are struggling with is a serious psychological disorder, it is difficult for the patients to receive professional intervention.
Even though researchers cannot pinpoint the exact cause of hallucinating episodes for each person yet, they have identified a few possible factors. Environmental and genetic dispositions may trigger the onset, as well as life stressors. With these discoveries, scientists have then come up with rehabilitation methods for patients with schizophrenia. For example, psychosocial therapy is a widely used treatment method to help patients cope with stress and establish a support system within the patient’s family to reduce the chances of relapse. Overall, though hallucinations are very pervasive, they can be controlled with the right interventions.
Felix Torres (2020). What Is Schizophrenia? American Psychiatric Association.
Psychosis (young people). Healthtalk.org.
Hugdahl, K., Løberg, E. M., Specht, K., Steen, V. M., van Wageningen, H., & Jørgensen, H. A. (2008). Auditory hallucinations in schizophrenia: the role of cognitive, brain structural and genetic disturbances in the left temporal lobe. Frontiers in human neuroscience.
Shergill SS, Brammer MJ, Williams SCR, Murray RM, McGuire PK. (2000). Mapping Auditory Hallucinations in Schizophrenia Using Functional Magnetic Resonance Imaging. Arch Gen Psychiatry. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/481670