What Is Your View on Hearing Voices and Seeing Images?

Reader’s Question

I wondered what your view was regarding hearing voices and seeing images? Is there any difference if you hear voices coming from outside, to voices which you think are occurring inside your head? From my very limited knowledge, it appears that voices that talk to you from the outside would be more likely linked to schizophrenia. Whereas voices that occur inside your head may be linked to depressive psychosis? Does it really matter where they come from? I know labels aren’t necessarily helpful anyway, but to someone who is trying to figure out what is going on in their mind, it is just another little clue perhaps. Would you use any talking treatments for people who hear voices? Some people live quite happily hearing voices without resorting to treatment of any kind.

Likewise is there any difference between images that occur inside the mind to those that occur on the outside? Are images outside considered to be hallucinations but visions that appear inside different, or would they be all lumped together as hallucinations? Would these minor details change your view on how to treat a client?

My experience is of a highly complicated terror plot being played in my mind. There are acts of terrorism and counter terrorism, a hideously complicated game of cat and mouse between good and evil. I jump from burning ships, and secretly gather formulas of complicated neurotoxins while being tortured. I plan and accomplish highly complicated escapes. I am almost at death’s door by the end of this great big conquest but I always pull through and the goodies always win. Yippee! Except I may have an out of body experience in theatre along the way, because I need patched up in hospital after such bad torture. The story comes in loops, only a little bit at a time and finally after a month or so the story is complete. When I have these experiences I feel mentally fragile because I am so involved in the process and it affects my sleep pattern. I revel in ‘normal life mode’ where my mind is much clearer and can concentrate on everyday things.

Psychologist’s Reply

Inside/Outside voices and visions are “symptoms” in mental health terms. In practice, we look for a pattern of symptoms that are known to occur together — creating the diagnosis. For example: schizophrenia is felt to be a product of excessive Dopamine (a neurotransmitter) in the brain. As this brain chemical gradually increases, the individual begins to hear voices — mumbling at first, then gradually becoming more distinct and projected outside the brain. At the same time, paranoia begins — at first being suspicious, then feeling the environment is giving “clues” about a conpiracy or plot (people talking on a cell phone are reporting them to the CIA). The brain speed increases to the point that, as you describe, a complicated plot or paranoid delusion develops. Most of the delusions involve problems with thoughts such as the feeling that your thoughts are being controlled or read by “agents” involved in the plot, the fact that your thoughts are being altered, and the fact that thoughts are being inserted into your brain. These episodes can occur randomly at first with breaks of clarity in between. Sadly, they then begin to occur more frequently until such time as the individual operates in the delusional world all the time.

What you are describing are changes in your neurotransmitter system. You are also describing the “pattern” we see in individuals who are experiencing brief psychotic episodes. As you’ve noticed, daily functioning is difficult if not impossible during these episodes when you are involved in the terrorist plot. I would urge you to seek consultation with a psychiatrist. While these terrorist fantasies are an adventure at this point, they will very soon become more terror than adventure. You will begin thinking people around you are involved in the fantasy — including your family. Untreated, this doesn’t move in a positive direction. With proper treatment, this situation can be stabilized and provide you with more “normal life mode”. You can read more about this topic in an article I’ve written entitled Chemical Imbalance. It’s on my website at www.drjoecarver.com. This website also has more information on your topic.

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