How to Recognize and Respond to Hallucinations and Delusions

How to Recognize and Respond to Hallucinations and Delusions

Hallucinations and Delusions are the hallmark symptoms of psychosis. A person in psychosis experiences reality very differently from the general population. The juxtaposition of a person in psychosis and a person not in psychosis often leads to feelings of great discomfort, fear, confusion, and stress for both parties. Whether from schizophrenia, bipolar disorder, brain injury, or the increased use of drugs such as crystal methamphetamine, experiencing these symptoms in some form is not entirely uncommon. This article describes what hallucinations and delusions are and suggests ways to respond to the people in our lives who experience these symptoms as distressful.

What are Hallucinations?

Hallucinations involve hearing, seeing, feeling, tasting or smelling something that does not actually exist. Hallucinations feel very vivid and real. The most common type of hallucination is hearing things that are not there, such as voices. Some people find comfort in their hallucinations, but typically the experience is alienating, stressful and often terrifying. With paranoid schizophrenia, for instance, hallucinations are commonly experienced as a belief that people, even loved ones and healthcare workers, intend to do the person harm. As a result, the person experiencing hallucinations often feels immense distrust, discomfort, and even terror of those around them. In turn, this person’s community (family, healthcare workers, friends) can feel similarly uncomfortable, confused, awkward, and at times, fearful.

What are Delusions?

Delusions are firmly held beliefs that are not true. There are many types of delusions, such as delusions of grandeur, control, or reference, but the most common one is the delusion of persecution. This is where it often becomes extremely difficult to connect and build trust with a person who firmly believes they are in danger. Imagine how terrifying it would be to “know” you are going to get hurt and nobody believes you or helps you in a way that makes sense. Imagine what it would be like to want to help someone who is experiencing delusions, but everything you say and do translates differently from your intentions and in turn, causes more distress and distrust.

How Can We Respond to People Experiencing Hallucinations and Delusions?

The best way to engage with someone experiencing hallucinations and/or delusions is to focus on building trust, safety, and connection. Generally speaking, there are some rules you can use as a guideline. The first rule is to establish a calm and safe environment. Give the person ample physical space, talk quietly and concretely, and try to eliminate environmental stressors such as bright lights, or sounds from a radio or TV. Be aware of your non-verbal communication and reposition yourself in a non-threatening way. For instance, sit down if the person is sitting, keep the palms of your hands open and visible, and relax your body. Eye contact is very important. You need to take your cues from the person. Eye contact can increase your ability to connect, but it can also be conveyed as very threatening. Therefore, you must attend to the person’s own body language and reactions so you can adjust your stance accordingly.

The second rule is to engage with the person in such a way that elicits more information, reinforces a safer reality, establishes rapport and empathy, and conveys a clear and persistent message. It’s ok, and in fact often necessary, to ask the person if they believe they are going to get hurt, or are thinking of hurting themselves or others. Here, you can establish rapport and empathy at the same time as you can try to reinforce a safer reality. Don’t go along with the person’s hallucinations or delusions and don’t refute them either. As a suggestion, convey empathy by saying “that sounds really scary,” and reinforce a safer reality by saying “I believe you are hearing these voices and I want you to try to just hear my voice instead.” Follow up with “my voice is a safe voice and I’m here to help you.” This provides a focal point of safety and encourages less reliance on the hallucinations or delusions.

The third rule is don’t push it, and back off if you need to. This is especially true if you have been incorporated into a delusional belief in such a way that makes you a threat. If your attempts at engagement increase the level of distress, you will likely need to take a step back or remove yourself completely. Remembering that one of the rules of engagement is to not refute delusional beliefs (unless you know what you’re doing), it is very difficult, if not impossible, to establish yourself as a safe person. The situation is a psychiatric emergency if you cannot establish safety and you believe the person may harm themselves or others. Maintaining physical distance and calling for professional help is likely the best course of action in this situation.

People who experience hallucinations and/or delusions often respond to the same elements that foster human connection in anyone. Empathy, safety, trust, rapport, transparency, and support are the universal ingredients of positive human relationships. The main difference between someone in psychosis and someone not in psychosis is the altered perception of reality. Tragically, it is this clash of realities that often leads to a sense of danger and fear for both parties. Fortunately, an understanding of hallucinations and/or delusions and how to approach a person in this state will help build a relationship that increases safety for everyone.

Jocelyn Aleiadih, LCSW

www.yourlifepathcenter.com