Hallucination: The Five Senses.

Volume 13 Issues 6 June, 2023

Schizophrenia is one of the most important psychiatric conditions prevailing in the modern world. A disease that often bring to mind a myriad of symptoms, often dramatic and sensational. It’s difficult not to, when a key hallmark of the disease is hallucination.

Hallucination: Seeing the music and hearing the colours. But is that all there is to it? Let’s explore.

Today I want to focus on the hallucination aspect, mainly for two reasons:

One, the most important presenting problem a schizophrenic patient has will be hallucination. It’s the hallucination that often let’s people know something is wrong. And two, the total spectrum of hallucinations, with its ranging variety tells a damn interesting story.

Let’s just dive in.

First up, we’ll have a look at hearing. Hearing abnormalities are the most common presentation in Schizophrenia. Auditory hallucinations are extremely difficult to understand, mainly because even normal people have it. Yes, you read that right. Normal people also report of hearing their names called out, when a look around confirms that’s not the case. It’s not a concern for most people, and is one of the reasons why true auditory hallucinations can be tricky to attribute to a disorder. Schizophrenics often say, they think everything is normal until a doctor tells them it’s not. Common instances also include hearing full blown conversations in empty rooms. Some patients think they are actually hearing other people’s thoughts, which often leads to false delusions. Even their internal voice gathers interesting quirks and characters, and at peak of depressive episodes can get demonic and self-reproaching. The voices can influence their personality, relationship as well as actions of the individual, with expected detrimental effects.

Next up, we have visual hallucinations. Just from the sound of it you get a sense of doom. It’s a saying that humans are visual creatures. In schizophrenia, that takes the form of conjuring apparitions in thin air. Ghostly figures that feel as real as you and me. Patients conjure strangers, celebrities as well as people they know, people they love. Worst cases, a patient’s imagination runs amok. They see demons and ghouls, with gruesome appearances, conversing in equally terrifying messages and whispers. Understandably, the realistic visions cause great unease to the patient. Milder forms of visual hallucination can have persistent accompaniments of imaginary people, as portrayed in the TV show Dexter.

Smell and taste are also sometimes altered, but are very less frequent and rarely as severe as the above symptoms. Patients complain of abnormal food taste and appetite changes. It can sometime heighten the sensation of taste or decrease it. The olfactory hallucination similarly can sensitise the patient to foul and putrid smells. The changes can be synergistic with visual hallucinations and lead the patient into harm’s way.

Last but not the least is tactile hallucinations. There is a classic ‘ants crawling’ sensation, that is also seen in schizophrenia along with various other disorders. Patients even complain of being grabbed by someone’s hand in empty rooms. The altered sensation can cause patients to injure themselves in order to ‘get rid’ of the feeling.

Thus we are reminded of the diaspora of manifestations affecting vital senses. They paint a pretty grim picture of the disease as a whole. Where your mind is fighting a battle with itself, and it’s the body who is losing. But it’s important we remember the actual importance of medication and therapy in such cases. Patients report excellent prognosis with targeted and compliant control. After a period, patients even get to wean off the medication and live normal lives. Or as close to normal as possible.

Although schizophrenia is a long battle, it definitely is a winnable one. Our awareness about it and the empathy we have for its sufferers, certainly go a long way in making it so.