What's behind schizophrenic hallucinations?
June 6, 2013 3:20 PM   Subscribe

Is there a such thing as "happy" schizophrenic hallucination? Or are they inherently destructive?

Disclaimer: I am aware that having schizophrenia doesn't predispose one to violence; and there are different forms of schizophrenia. Also I am not familiar with the proper terminology and please forgive me if I use words that offend. If I do, please correct me.

Popular media tend to portray paranoid schizophrenic hallucination as something inherently paranoid, destructive, and violent. Also, I came across a Reddit AMA, where a schizophrenic described the voices in her head that would implore her to kill and maim.

My question is twofold:

Is there such thing as a "happy" hallucination (auditory, visual, or otherwise) in schizophrenics?

What is the brain mechanism behind paranoid hallucinations, particularly why they tend towards destruction?
posted by pakoothefakoo to Health & Fitness (15 answers total) 3 users marked this as a favorite
My friend worked at a halfway house for previously homeless schizophrenics and said that yes, some of the delusions were pleasant. One guy she said had Joan Jett in his head and she was his (pleasant) girlfriend. Another guy had voices that approved of him ("that was very clever! you're doing a good job!") and sometimes even told him useful "psychic" information.

I think Chester Brown also discusses this in one of his comics. I read it a million years ago but as I remember it his mom is schizophrenic and he was talking about how he thought it was some dark element of our culture that made such a large percentage of schizophrenic delusions negative, rather than an inherent element in the disease itself. i.e., that one could be schizophrenic without being paranoid.

Dunno how useful either of these things are, though I can vouch that the friend in the first instance is almost always a reliable narrator.
posted by feets at 3:36 PM on June 6, 2013 [1 favorite]

Used to do academic research with a scz patient population. (Not so much on the clinical side, so ignore me if an actual clinician chimes in.)

From what I coukd tell, some people are really happy with their delusions (also hallucinations to some degree). (The distinction is clinically important; not sure whether you want to distinguish between them.) It's one of the reasons getting them to stay on medication is difficult. People have delusions of themselves as superheroes, for example. You wouldn't want to put the populace at risk be not being a superhero anymore, would you?

Not sure whether you mean "destructive" in terms of the end result (which, yes, usually are destructive) or in terms of the patient's affect/direct actions. They're often quite upbeat. And of course it varies within a patient; they could be very paranoid one week but happy about some "project" the next. Both are informed by their disease, of course, but they have peaks and troughs just like anyone.
posted by supercres at 3:37 PM on June 6, 2013 [1 favorite]

Yeah, it would be great if you could clarify delusions vs. hallucinations. Thanks! And as for destructive, I mean the voices that encourage a person to maim and kill. Including visual hallucinations of dangerous things.
posted by pakoothefakoo at 3:39 PM on June 6, 2013

The composer Robert Schumann is believed to have had schizophrenia and reported that the pleasant hallucinations he saw inspired his music. He did, however, end up committing himself to a facility later in life once those pleasant hallucinations were joined by not so pleasant ones. He was concerned he would hurt his wife, Clara.

FWIW There is some debate over whether he had schizophrenia or if his hallucinations were induced by a controversial treatment to his syphilis.
posted by donut_princess at 3:43 PM on June 6, 2013

Hallucinations are strictly sensory-- hearing something that isn't there, seeing something, smelling something, feeling ants on one's skin. Delusions are false beliefs, like thinking the government is after you or that you're a superhero. Obviously, they're closely related, and people will often have hallucinations that reinforce the delusions, or invent delusions to explain the hallucinations.
posted by supercres at 3:44 PM on June 6, 2013 [3 favorites]

When my dad believed he was John the Baptist and regularly speaking to God during the same breakdown he was happy as a pig in shit.
posted by fluffy battle kitten at 3:50 PM on June 6, 2013 [4 favorites]

My 20s were basically comprised of three major psychotic episodes, each of which took several years to "recover" from. I had many, many pleasant auditory and visual hallucinations during all three of those prolonged events. In a strictly sensational sense, divorced from the immense negativity of concurrent delusions, they were some of the most pleasurable experiences of my life. So, yes, absolutely.
posted by Lorin at 3:59 PM on June 6, 2013 [1 favorite]

My mother has delusions that I would describe as mostly benign (believing that she was a triplet and her mother gave away the other siblings, etc). I wouldn't call any of them happy delusions. The biggest problem with them is the rest of the family gets tired of hearing about all the made up crap and she has often done things as a result of her delusions that had a severe impact on her relationships. When unmediated she has active hallucinations like hearing footsteps in the ceiling and thinking someone is living in the attic or the delusions might become more extreme and fixated. She once believed a bird ornament was sending her secret messages from the FBI.
posted by tamitang at 4:09 PM on June 6, 2013

I am not making a neurobiological argument, but in terms of why the negative hallucinations or delusions exist, I suspect that it has something to do with the non-delusional people in the delusional person's life arguing against his or her delusions.

Think about it this way: If every time the sun was shining and you said, "What a pretty day!", the people around you gave you a look like you were crazy and said, "What are you talking about??? It's raining and awful and cold!", you'd probably eventually start to think that the people around you were either nuts or trying to make you nuts. We rely on our senses to figure out what's real, and if what your senses are experiencing does not line up with what people are telling you, it's pretty rational, at least initially, to doubt those people rather than your senses.

So if you're primed to think that everyone else is already lying to you about reality, it's a quick hop over to assuming they're out to do you harm. I also think that a lot of paranoia (schizophrenic or otherwise) tends to come from anxiety, and if you're constantly feeling like your grip on reality is being assaulted, it's likely to cause anxiety, so the fight-or-flight instinct kicks in and suddenly you believe that you're in a fight with everyone else -- which can certainly easily create a delusion that everyone else is fighting against you.
posted by jaguar at 5:57 PM on June 6, 2013 [6 favorites]

A couple of years out of college I worked on a research project that involved spending a lot of time with a group of schizophrenic women. One of them once told me that most of her voices were bad (as in, telling her she was a loser, useless, etc) but she had a couple of encouraging ones that would tell her she was beautiful and a good person. At one point she had cut a picture out of a magazine that she felt looked like her favorite good voice would look if he really existed, and she kept it in her wallet always.
posted by The Elusive Architeuthis at 6:15 PM on June 6, 2013 [5 favorites]

There is considerable research showing a large percentage of people with psychosis suffered significant abuse in childhood and that repeat trauma could be a causative factor for psychosis (in those with a predisposition). Thus it would stand to reason that many delusions and voices are critical and/or threatening -- sort of like regurgitating the abuse in a distorted form. Perhaps the "happy" delusions and voices are a wish for what never was.

The days of biological reductionism and claims that all mental illness is purely a chemical imbalance (and hence that it is pointless to talk to people about what they are experiencing or experienced in the past) are numbered. Medication can be helpful, but any suffering person should be encouraged to do talk therapy.
posted by RRgal at 7:31 PM on June 6, 2013 [4 favorites]

I don't know what people think about Guattari and Deleuze in the context of clinical schizophrenia, but as far as I can gather, they were interested in "schizophrenia" as a productive force. Their use of the term is intentionally generic, so that for example a lot of art would be considered "schizophrenic" -- if it involves imagination, desire, some kind of chaos or breaking from cognitive norms. They actually have a whole philosophical project centered around the character of the "happy schizo" taking a stroll in the sunshine, instead of being held down by some authoritarian psychologist who wants to make all their productions into delusions revolving around family and society... Or something like that, I could never quite understand their writing.
posted by mbrock at 4:43 AM on June 7, 2013

You also asked about terminology. Be aware that some emphasize referring to "people/person with schitzophrenia" or "schitzophrenic people/person" rather than using the term "schitzophrenic/s." They wish to separate the condition from the individual, much as it's becoming standard to refer to "enslaved people" rather than "slaves." Others, however, argue that "schitzophrenics" is an acceptable term because the disease strips the afflicted of their core personalities. This abstract summarizes the debate.
posted by carmicha at 8:12 AM on June 7, 2013 [1 favorite]

I had a patient once whose "command hallucinations" told him to get his shit together, go see his doctor, take his meds, and try to find a job. It was the most helpful hallucination that I'd ever seen, and the patient actually experienced it as a supportive voice. On the other hand, when he would listen to the voice, he would take his meds, which made the voice go away, which generally led to the patient failing to take his meds and decompensating. And the cycle would begin again.

I'm not a psychiatrist, but a friend of mine who is hypothesizes that the happy hallucinations are a) less common generally; and b) present less often to healthcare, since they don't cause as high of a degree of distress as the bad or neutral ones.
posted by LittleMissCranky at 11:56 AM on June 7, 2013 [2 favorites]

You might find Agnes's Jacket interesting-- it's written by a psychologist who worked with people with auditory hallucinations. She wanted to understand their experience rather than "make it go away"-- I found it a fascinating read.
posted by tuesdayschild at 5:29 PM on June 7, 2013

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