NAVEEN heard the voices clearly. There were two male and two female voices. They were discussing him. “Let us get him arrested. Then he won’t trouble us”. They were also continuously discussing his activities as if giving a running commentary.
Naveen was puzzled. Initially he did not know where the voices came from. Gradually he was convinced that it was from the apartment above.
He told his family but they did not believe him or take him seriously. They could not hear the voices when he heard them. To make them believe him, he tried recording the voices with a tape recorder. When he played the tape, he was surprised that no voices were recorded.
As he persisted, his brother took him to the apartment above. The residents there were amazed at his allegation. They asked his brother to take him to a doctor. His family sent him to stay with his sister in another town.
A week later, he told his family that his old neighbours had also moved to a house close by and were continuing to talk about him. Only then did the family think that it could be an illness.
Hallucination is a perception without any stimuli. Naveen hears a voice, though no one is actually speaking. For him, it will seem real. Hallucination can occur in all sensory modalities.
Auditory: This is the commonest hallucination. The voices could be single or multiple. The voices either talk to the person directly (“sit down”, “do this”, “you are in danger”) or two or more talk to each other about the person (“let us attack him”). The voices could give a running commentary about the person’s activities or just discuss about him. Sometimes, the voices may even discuss the person’s thoughts.
Visual: It could be elementary like flashes of light or complex like having a vision of god or scenery. In alcohol-withdrawal delirium, at times, the hallucinations take the form of small people (Lilliputian hallucinations).
Olfactory: The smell could be pleasant like fragrance of a flower or unpleasant like rotten or burning smell.
Gustatory: This refers to taste. This is very difficult to assess due to the individual nature of this sensation.
Tactile: Hallucination of touch could be elementary like being touched or tapped or complex like having sex or being tortured.
Hallucinations can occur in
- Acute Psychosis
- Mania with psychotic symptoms
- Severe depression with psychotic symptoms
- Delirium due to any cause like alcohol withdrawal, electrolyte imbalance etc.
- Chronic alcohol use
- Drugs like cannabis, Amphetamines
- Tumours along the visual tract of the brain
Hallucination is often confused with illusion. In illusion, there is a stimulus but it is perceived in a distorted fashion. In hallucination, there are no stimuli. During dusk, a rope across a dim street can be perceived as a snake. The rope is the stimulus and the snake is an illusion.
Illusion occurs when the environment is unclear and the person has fear or anticipation. Seeing ghosts in the clothesline or thieves in the bushes are common illusions. Illusion is normal and usually does not denote an illness. As a person drifts into or out of sleep, he may have hallucinations, which are called hypnogogic or hypnopompic hallucinations respectively. These are normal. In addition, if a person is kept in isolation and is sensory deprived, he would develop hallucinations. The hallucinations disappear once the person is exposed to normal environment. All other hallucinations are pathological.
Fear and being puzzled are the initial responses. Later, the person develops delusions (false, fixed beliefs) to explain the voices. He may converse with the voices, answer their questions or laugh at some remark. For an observer, he would appear to be talking or laughing to himself.
The person believes the content of the voices and will act accordingly. If the voices are threatening, he will try to protect himself and be scared of any move by others. Some persons follow the instructions of the voices.
Some families ignore the initial report of voices or dismiss them as a practical joke. They take the problem seriously only after more symptoms develop and the person’s functioning deteriorates.
At the other extreme, visual and auditory hallucinations of god can make a person into a godman. The hallucinations are interpreted as god’s vision and god’s orders. Strange cults are formed based on the person’s symptoms.
Certain families resort to magico-religious remedies based on the belief that the voices are due to spirits and black magic. Increased awareness about mental illness is gradually making many families seek medical help early.
* * *This article was published first in The Hindu on 26 June 2005.
Author: Dr. Mohan Raj S