Dealing With Hallucinations – Is Telling Better Than Doing?

Hallucinations are what result from the compounding of delusions upon delusions. A variety of psychotherapeutic techniques are used with psychotic individuals that are aimed at dealing with hallucinations and delusions.

Some common group therapies are as follows:

  1. Thought-stopping, or imagining a large stop sign in one’s mind when hallucinatory or delusional material enters one’s consciousness.
  2. Demonstration and practice of social skills that will allow the psychotic individual to behave in a more appropriate way to help eliminate stigma.
  3. Requiring clients to create narratives or stories — any stories other than the ones to which they adhere, to explain their symptoms. This may alleviate to an extent the entrenched qualities of their delusional systems.
  4. Record-keeping of delusional material that could be later reviewed, perhaps on a weekly basis, for the clients’ personal assessment of its validity. Given the changes in delusional material that the psychotic individual experiences, this material may be more or less evaluated by that individual as believable or as not believable, with respect to his perhaps rapid changes in delusional beliefs.
  5. Relative to the technique expressed above, Socratic questioning, or engaging in dialogue with therapists or clients that allows the psychotic individual to question her beliefs.
  6. Engaging an individual in disclosure of paranoid beliefs in group therapy, and then allowing the therapist to question another group member as to how he thinks that those beliefs are subjectively experienced by the disclosing individual.
  7. Psycho-education: For example, education about biochemical mechanisms regarding how medication works or conveyance of ideas related to how delusional beliefs are reinforced in one’s environment, perhaps by chance alone.

Some approaches are thought to be more effective in psychotic individuals who are concrete thinkers (thinking characterized by objects and events) and others are thought to be effective with abstract thinkers (thinking about concepts, removed from fact).

All of these are good ways of confronting and deconstructing delusional material. However overall, it may be easier for an abstract thinker to dismiss his or her hallucinations as false. Therefore, perhaps cognitive ability can be aligned with mental health.

Can valid delusional systems emerge from the mind of a schizophrenic? There is very little basis for valid, emergent belief systems in this regard. Nevertheless, the idea that biochemistry causes symptoms of hallucinations, may be inadequate in the mind of a schizophrenic, whether that schizophrenia is an abstract or concrete thinker. Hallucinations are visceral experiences and the schizophrenic individual may not be able to adequately renounce his delusions. In fact, the desire to be sane may cause the schizophrenic to rationalize his delusional beliefs.

It’s certainly true that in addition to biochemistry, he mentally ill individual becomes increasingly psychotic by means of psychological and emotional involvement within her mental realm. As the psychotic individual becomes emotionally involved with her hallucinations, she may bond with her hallucinations in a relational way — a form of emotional anarchy.

Hallucinations are not empathic or dependable, and they are not predicable other than the fact that they provide a basis for delusions constituting general habits of thought in the mind of the individual. The psychotic person to some extent creates patterns or habits of mind that may amount to following a train of thought that moves forward as one creates it.

One can tell a mentally ill person that his hallucinations do not exist. But what is really needed instead of “telling” an individual about the nature of his hallucinations is “doing’ something about them. Psychiatric medication represents “doing” as opposed to “telling”. It is essential that administering medications is the presumed “cure”, even if the individual does not notice that his psychopathology is diminishing.

The ideas for enriching group psychotherapy as described above point toward another idea: Intellectualization, while clearly an aspect of “telling”, may also contain a quality of “doing”. The act of thinking logically and analytically about hallucinations and delusional material allows the psychotic individual a sense of detachment from his hallucinations and delusions. If individuals understand the process involved, it may allow for greater detachment, objectivity, and diminished emotionality regarding psychotic experience.

Image via wavebreakmedia / Shutterstock.

Ann Reitan, PsyD

Ann Reitan, PsyD, is a clinical psychologist and well published essayist of fiction and creative nonfiction. She holds a Bachelor of Arts in Psychology from University of Washington, Master of Arts in Psychology from Pepperdine University, and Doctorate of Clinical Psychology from Alliant International University. Her post-doctoral research at Washington University in St. Louis, MO, involved personality theory, idiodynamics and creativity in literature. She recently published Illuminating Schizophrenia: Insights into the Uncommon Mind.
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