Wednesday, March 30, 2011

Hallucinations in non-psychotic people

In the Seventies when I was doing my residency patients would get diagnosed as schizophrenic at the drop of a hat. Added to this was the evidence-based science of that era which proclaimed that "Once a schizophrenic always a schizophrenic."

Schizophrenics never recovered was the dictum. And they really believed in this self-serving medical fact.  To complete this demonic vision of the illness, the psychiatrists in those days took awful pride in being the kind of guy who did not flinch at prescribing gargantuan dosages of antipsychotics. It is not surprising the hospitals overflowed with patients who did nothing but drool and do the Thorazine shuffle, lending further evidence to the "evidence-based" scientific thinking of those days that schizophrenia was a life long malady.

And a single confession of hearing voices could garner the diagnosis.

Over the years I have done Disability Determination evaluation for Social Security in poor sections of Detroit, examining hundreds of African-American patients and have been struck by as to how often they report presence of hallucinations. And it hardly seems to be confined to those suffering from psychosis.  Hallucinations in general is more prevalent in African American patients than whites even when they are suffering from identical psychotic illness.  But it was an eye opener as to how many non-psychotic African-American patients also report hallucinations.

I came across two such patients today reporting of which may have some scientific value.

Case I

A 59 year old African-American woman who is severely depressed and does not leave her room since her 18 year old son was shot dead emerging from a grocery store, reported that she sees her son every day.

When asked where does she see him, she replied, "Standing at the door of my bedroom." And for how long, she replied, "Ten minutes. And he is clear as can be, and looks straight at me." When asked does he talk she replied, "He tells me he is alright. Sometimes he tells me I am still with you."

This assurance was easily analyzed as her extreme desire to know that he is happy wherever he is for she cannot forgive herself for not protecting him from death. He was her favorite child. "He was Momma's boy, who hung around me more than any of my other children."

She was in the vicinity of the grocery store where he was killed, and had actually heard the gunshots that had bled him to death, and though came quickly to where the shooting occurred, he was already unresponsive.  When she heard the gunshots, something told her that it was him getting shot and so she feels guilty that somehow she had a role in his death. Furthermore she feels that it was a failure on her part that the killers could not be brought to justice, though nobody found the assailant/s, or even discovered the motive of the crime.
So hearing the dead boy telling her in the vision that he is alright acts as a balm to her sense of guilt.

This motive to create hallucination to feel less guilty I saw in another girl, whose sister died in a car accident, and the reality of whose death she constantly forgets, often living in the make-belief that her sister is still alive. This 17 year old girl, one night woke up to find her sister lying next to her in bed. The sister said, "Sister it is not as bad here as you think," and then disappeared.

In both cases the hallucinations were produced to assuage the guilt over the death and a need for the reassurance that the dead person is not suffering but is happy.

Case II

An 18 year old African American boy reported that his father, while in the hospital for collapsed lung and pneumonia, on brink of death, had an extraordinary out-of-body experience. He died for 20 seconds, which was, per patient, confirmed by his brother and sister. When asked how did they know he was dead, the boy stated that his father rolled up his eyes, which is a sure sign of dying.

The boy then narrated to me what his father experienced while he was dead. It was like a blackout in which he came out of his body and saw himself lying dead on the hospital bed. While hovering he cried out that his time is not due yet. He then heard a voice, "Yes, his time is not due yet."

The voice caused his soul to immediately return to his body. The father swears by the reality of the voice and the brothers and sister insist that he was definitely dead for 20 seconds.

Now here is a shared magical thinking. To call it shared psychosis would not be correct.

But there is no doubt this was a hallucinatory experience.

Why did it happen?

Perhaps the man had two contradictory wishes towards death. One was to get it over with it and embrace eternal peace and the other was that he still has unfinished business in this life. His youngest child is just 18, and very much vulnerable to harshness of this exploitative world, about which the father worries. And anyway the desire to cling to life is perhaps the strongest drive in all organisms, and is given up only when there is complete hopelessness. So he cried that his time is not due yet, and heard the projection of his own father's voice, telling him that his time is not due yet.

Do white people have hallucinations without psychosis? Yes, they do, but not that often.

Here is one case.

A 47 year old man, in midlife crisis, in throes of severe agitated depression, that was precipitated by the closing down of the machine shop in which he had worked for 20 years, and with his particular skill no longer in demand was faced with the prospect of working for minimum wages, which his pride would not let him, for he was used to making over 25 dollars an hour, and his finances dwindling to the point of having literally no food in the house to feed his wife and children, went into severe panic attacks, insomnia and nasty mood towards everybody.

He had the following two hallucinations.

My mother, who is now dead for over 15 years, is sitting across the room looking her usual no-nonsense West Virginian self. She makes an admonishing sign at me with her index finger. As usual a smoking cigarette is on her mouth.

The hallucination was easy to interpret and actually done by the patient himself. "I was seriously contemplating suicide or just walking out on my family for they would be better off without me. My mother who did everything by the book once told me that departed souls are allowed one visit from the beyond was using that one-time privilege to save me. And the motion of her finger was admonishment to not give up on living and that walking out on my children was not an option."

It is interesting that this patient's father had walked out on the family when he was a child. And his mother had brought him up. Taking advantage of life's adversities, he was trying to do to his kids what his father had done to him.

The second hallucination which took place a few weeks later was about his best friend.

I see this friend of mine sitting next to me. He was as real as you. He inquired after Mom and Dad and then asked, "How have you been. I have missed you." I told him, "I am going fucking nuts." Then I went to the kitchen to get coke and when I came back he was gone.

The person who appeared was his best friend and someone he grew up with and whose opinion he valued. One day he visited his friend, who was just 29 then, and while he went to get some coke in the kitchen, he heard a thud, and rushed back to his friend, who was lying on the floor his eyes showing no life. He had been struck dead by a ruptured brain aneurysm. The patient attributed the hallucinatory return of his friend from the dead to tell him as to how fragile and valuable life is and even if he is going nuts it is better to be nuts than be amongst the dead.

 He added that his mother and his friend were the two most important people in his life. It was not difficult to analyze that when life became unbearable it was natural that he thought of joining them. But in the hallucination his good sense made them reject this desire of his and tell him that he should return to his family and that being alive however miserable is better than being dead.

In all the above hallucinations a common thread is of death and of departed people. It appears that dead people are made to return as hallucinations to help the person in dealing with life's difficulties. So many of the African-American patients I have evaluated and who report hallucinations on further questioning report that the people who they see or feel the presence of are those who had been kind and helpful to them when they were alive. A beloved grandmother, or a favorite aunt, or some other parental substitute becomes one's constant companion and takes on hallucinatory proportions when under extreme stress. Not too different than how a child who feels helpless creates an imaginary friend whom he always carries around with him.
However, it is not always that hallucinatory figures are there to be a helpful companion. Sometimes one may bring a dead person back to life to help him or her from a difficult situation where one could not help when it was actually occurring.

A 19 year old girl reported hallucinations of seeing her mother screaming and yelling for help. The mother had died when the girl was barely 12. In those 12 years she had frequently and helplessly witnessed her mother being subjected to brutal beatings by her stepfather. Now when she was grown up enough to fight back with her stepfather and protect her mother, her mother was already dead. The vow to protect her mother could now be filled only in her hallucinations.

In an even more moving account of a hallucination I heard from an African-American woman, whose 18 year old son was shot right in front of their house. In fact he was shot 8 times, and as he bled from all over his body, he turned to his mother and beseeched her with his last breath,"Don't let me die on the street mother. I want to die in my bed."

"He did no harm to nobody. Why did they shoot my baby?" the mother cried once again in the interview.

His last words, "Don't let me die on the street mother. I want to die in my bed," keep echoing in her head and sometimes turn in to hallucinations.

The motive behind the hallucination, besides to see her son alive again, was the praise for her son's indomitable spirit, which even seconds before dying expressed his desire to be triumphant, having a say on the manner of his death, opting for his own bed and its security over the contemptuous, dirty, dangerous street.


  1. I was suggested this web site by my cousin. I'm not sure whether this post is written by him as no one else know such detailed about my difficulty. You're
    incredible! Thanks!

    my web page; Louis Vuitton Handbags

  2. Way cool! Some very valid points! I appreciate you writing
    this article plus the rest of the website is really good.

    Here is my homepage: Cheap Louis Vuitton Bags

  3. Hi there just wanted to give you a quick heads up. The
    words in your content seem to be running off the screen in Firefox.

    I'm not sure if this is a formatting issue or something to do with internet browser compatibility but I figured I'd post to let you know.
    The style and design look great though! Hope you get the problem resolved
    soon. Kudos

    Also visit my blog post: Oakley Frogskins

  4. Great blog! Is your theme custom made or did you download it
    from somewhere? A design like yours with a few simple tweeks would
    really make my blog jump out. Please let me know where you got your design.
    With thanks

    my website - Louis Vuitton Bags

  5. This comment has been removed by a blog administrator.

  6. If some one needs to be updated with latest technologies therefore he must be pay a visit this web page and be up to date every day.

    Also visit my web blog :: Mario Lemieux Authentic Jersey

  7. Hello there! I know this is kinda off topic but
    I'd figured I'd ask. Would you be interested in trading links or maybe guest writing a blog article or
    vice-versa? My site goes over a lot of the same subjects as yours and I think we could greatly benefit from each other.
    If you happen to be interested feel free to send me an email.
    I look forward to hearing from you! Fantastic blog by the way!

    Here is my weblog: Evgeni Malkin Black Jersey

  8. These are really wonderful ideas in concerning blogging.
    You have touched some good points here. Any way keep up wrinting.

    Feel free to surf to my web page Solde Air Jordan

  9. I couldn't resist commenting. Very well written!

    Have a look at my blog post ... Wholesale NFL Jerseys

  10. An intriguing discussion is definitely worth comment. I believe that you ought to write more about this topic,
    it may not be a taboo subject but generally folks don't talk about these subjects. To the next! Many thanks!!

    Here is my webpage: Continue reading

  11. I love it when people come together and share views. Great site, keep it up!

    Stop by my blog post - Nike Pas Cher

  12. This is a topic which is close to my heart... Best wishes!
    Where are your contact details though?

    my homepage - Wholesale Jerseys

  13. Fine way of describing, and nice article to obtain information concerning my presentation subject matter, which i
    am going to deliver in institution of higher education.

    My webpage

  14. Hi there, I found your blog by way of Google even
    as looking for a comparable matter, your
    web site came up, it seems good. I've bookmarked it in my google bookmarks.
    Hello there, simply become alert to your blog via Google, and located that it is really informative. I am going to be careful for brussels. I will be grateful in case you continue this in future. Lots of other people will likely be benefited out of your writing. Cheers!

    Feel free to surf to my site: website

  15. I’m not that much of a internet reader to be honest but your blogs really nice, keep it up!
    I'll go ahead and bookmark your website to come back in the future. Cheers

    my web page Click Here

  16. Hello there! This blog post couldn't be written much better! Going through this article reminds me of my previous roommate! He constantly kept talking about this. I will send this article to him. Pretty sure he's going to have a good read.
    Thanks for sharing!

    my web blog :: check this out

  17. Hi, i think that i saw you visited my web site thus i came to “return the favor”.
    I'm trying to find things to improve my site!I suppose its ok to use some of your ideas!!

    Have a look at my blog :: Christian Louboutin **

  18. Good day I am so happy I found your blog page, I really found you by accident, while I was searching on Digg for something else, Anyways I am here
    now and would just like to say thank you for a
    marvelous post and a all round thrilling blog (I also love the theme/design), I don’t
    have time to read through it all at the moment but I have bookmarked it and
    also added your RSS feeds, so when I have time I will be
    back to read a lot more, Please do keep up the awesome work.

    Here is my web site Full Article

  19. We are a group of volunteers and opening a new scheme in our community.
    Your website offered us with helpful info to work on.

    You've done an impressive task and our whole group shall be grateful to you.

    Review my site; Air Jordan

  20. Hmm is anyone else having problems with the images on this blog loading?
    I'm trying to find out if its a problem on my end or if it's the blog.
    Any feedback would be greatly appreciated.

    My web page :: Chaussures Foot ()

  21. There's definately a great deal to know about this issue. I love all the points you made.

    my web page; Michael Kors

  22. I really like your blog.. very nice colors & theme. Did you create this website yourself or did
    you hire someone to do it for you? Plz respond as I'm looking to construct my own blog and would like to know where u got this from. cheers

    Also visit my web blog; Air Jordan Pas Cher

  23. Hi, I do believe this is an excellent web site. I stumbledupon
    it ;) I will return yet again since i have book-marked it.
    Money and freedom is the greatest way to change, may you be rich and continue
    to help others.

    Review my web-site :: Nike Free Tilbud

  24. Kerry Ann JacobsJune 21, 2013 at 3:15 AM

    You might be interested in my book about my psychotic hallucinations. - I have been labelled bipolar but some say I am schizophrenic and others say I am a psychic medium. What is your opinion? Visit Kerry Ann Jacobs