Psychosis (young people)

Having hallucinations, paranoia and delusions

People’s experiences of psychosis can be very varied. In our interviews people described experiences including:
  • Visual hallucinations
  • Tactile hallucinations
  • Auditory hallucinations 
  • Delusions
  • Paranoia
  • False memories
  • Thought broadcasting and thought blocking
  • Heightened senses
  • Loss of Inhibitions
People could experience one or more of these at one time and these different psychotic experiences could feed into each other. But experiences didn’t always fit neatly into any of these descriptions, and could be harder to describe, such as invasive negative thoughts or losing touch with reality.
Invasive thoughts and “voices” 
 
The most common sign of psychosis is hearing voices that others don’t hear,“but not everyone who hears voices is distressed by them or seeks help (for example research suggests that as many as 10-15% of the population report experiencing hallucinations*)”
 
Some of the people we spoke to easily identified with “hearing voices” but others talked about having intrusive “thoughts”. Lucy describes: “thoughts in my head not being from me… almost like a voice. In that I didn't feel like I was in control, or thinking it myself.” She didn’t think of her uncontrollable thoughts as ‘voices’, until a nurse used the word.
But some very clearly heard “voices” which could seem to be internal or external. Voices from outside the head could seem very clear as if there were someone standing nearby and speaking.
Voices varied considerably and were described in different ways by people, for example like a background noise, like overhearing people talking, or hearing crying or screaming, or they could be describing or commenting on something the person was doing. Voices could also talk directly to the person, criticising them or telling them to do things. For a few people there were familiar voices - someone they knew like a father, grandfather or acquaintance, or it could be their own voice. Joe described the voice as the “younger me”. Voices could also be unfamiliar, but might have specific personalities that were recognisable. Voices could be “persecutory”: Nikki’s voices say “you’re disgusting… why would you do that… this person hates you”.
 
When voices gave direct orders or “commands” this could sometimes have devastating consequences. Chapman hears voices telling him to steal things or take drugs. Lucy and Emily have thoughts/voices that are like bullies telling them to kill or hurt themselves. People also talked about voices giving them an ultimatum. Green Lettuce’s voices told him he would die if he slept, and he said “once, I was up for eight days because I thought I’d die if I went to sleep, that was a nightmare… I literally just passed out on the eighth day.” But people didn’t always act on them: Sam hears voices telling her to hurt others but has never acted on them. People who hear commanding voices could also learn to manage them.
Seeing visions and images
 
A few people saw images or “visions”. These could be people, objects or characters that were familiar – for example, that they’d seen on TV – or totally unexpected. Visions could seem out of place. Barry saw a red car on a curtain and Lucy saw “people jumping out” of street signs. Sometimes visions could be horrific, frightening or violent. Some saw blood on the faces of people around them or scenes of a loved one or friend being hurt. Hannah described it as being like when people in films are remembering or dreaming of something which flashes up and then is gone. Tariq said he used to see dead people in graves and had visions of people following him around. The visions were so clear he was able to describe them in detail to the crisis team.  
 
Visions could be extremely upsetting and feed into people’s fears, such as fear for their own, or their loved one’s safety.
Paranoia and delusions
 
Delusions and paranoia often involved what Andrew X described as “weird interpretations of social events”. Chapman and Emily thought that the television was talking to or about them. While Barry was in hospital he thought people he knew were being “trapped” inside the TV and so he would turn it off.
When they were having delusions a few people said it felt as though their brains were speeding up, and they sometimes believed they could achieve things they would not normally be able to do. Luke, who was diagnosed with bipolar disorder, was two weeks into a new job when he began experiencing delusions and feeling “omnipotent”: “I started to think MI6 were onto me. I started to think that I was God. I thought I could predict the result of the Scottish referendum”. When he was in hospital Luke remembers going around to people’s beds and putting his hands on their heads and saying “you are healed”.
People also described ‘thought broadcasting’, when they believed that other people could hear their thoughts, and ‘thought blocking’, when they believed that others were stopping their thoughts: Tariq said, “I had thought blocking where on occasions I couldn’t think for myself. Sometimes I’d think that people were taking thoughts away from me.”
Delusions could lead people to do things that were out of character. Max had a delusion in hospital that one of the staff members was going to hurt him and he “went after her” and was stopped by staff. This was the “complete opposite” of his usual behaviour. Ruby thought she could fly and kept trying to jump off things. For some people delusions could come at the same time as, and feed into, visions and voice hearing.
While people knew with hindsight that hallucinations and delusions weren’t real, there were sometimes real sensory experiences associated with them. For some the experience gave them valuable insights into another way of seeing things. Luke said that while bipolar disorder is “catastrophic” it also gives you a “different level of perception”, and allows you to see things differently.
False memories 
 
Some people had false memories: they could remember things that didn’t happen at all, or could remember events from a long time ago as though they had happened yesterday.
Having false memories could be like experiencing a different version of reality. Dominic says, “I was at some place and in my mind I’m in another place and I’m doing something else… which was surreal”. Some people were aware that the false memories were not quite right but others didn’t realise until sometime later that they had had a psychotic experience. Andrew Z’s first experience was when he was acting in a play and found himself remembering quite elaborate “very strange happenings”. While there was a “kind of subconscious pull” telling him it was real he describes a “rational reality check” telling him that he couldn’t have forgotten and then suddenly remembered something so elaborate. 
 
False memories could be continual, but often stopped eventually. Andrew Z has short periods of having false memories and Joe used to have them but they haven’t happened for a long time now.
Whilst the people we interviewed identified their experiences as ‘psychotic’, there are organisations worldwide, for example the Hearing Voices Network, which offer alternatives to psychiatric ways of understanding the experiences discussed here. 
 
*Tien A. Y. (1991). Distributions of hallucination in the population. Soc. Psychiatry Psychiatr. Epidemiol. 26, 287–292 10.1007/BF00789221

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