What are hallucinations? The experience of hearing voice in Schizophrenia.

This blog is a part of our series to develop a detailed understanding of schizophrenia.

Schizophrenia is known for its typical symptoms. These symptoms have been typically portrayed in a stigmatised manner, which has led to people associating words like “mad”, “cuckoo’s” etc. with this illness.

One of the most fascinating symptoms of schizophrenia is known as Hallucinations. Hallucination means experiencing something that is not present. It can happen in each sensory modality (sound, smell, touch, vision, taste).

The most common hallucination in schizophrenia is auditory.

Patients report hearing voices which can be directly telling them, or multiple voices talking in-between them. The nature of auditory hallucinations is as follows:

1. Auditory hallucinations (voices) can be heard only by the patient.
2. They appear as having a conversation with the patient.
3. They appear real to the patient and they often find themselves responding to these voices.

During the course of the illness, the nature of these voices changes. They tend to become more aggressive, more personal and start causing significant issues in living a normal life.

The reason that this symptom is fascinating is because schizophrenia as an illness causes:

1. Gain of function: New additions that previously did not exist
2. Loss of function: Loss of existing abilities due to the illness

💡 Presence of hallucinations represents a gain in function.

However hallucinations are not imaginary. Patients actually perceive the sound, they are not imagining these voices.

This is the confusing part for caregivers. They think that the patients are imagining these voices, that they are their own thoughts and not some illness. They believe that they should be able to control these thoughts.

The fact of the matter is, that this phenomenon of hearing voices/sounds represents an illness and it’s the illness that needs to be treated.

Key Points:

1. Hallucinations refers to the experiencing something that is not real.
2. The most common hallucination in schizophrenia is Auditory. i.e. the experience of patients hearing voices of self or others as talking to them.
3. These voices are not real, but the experience to the patient is.
4. These voices cannot be controlled by the patient. They only respond to medicines.
5. These voices increase over time, and can becoming commanding in nature, threatening the patients to take steps which can harm themselves or their loved ones.

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