No Way...Therapeutic Use of Hallucinations?
(READ THE KARON ARTICLE ON Bb -- FOUND IN MODULE 9 -- THEN READ THIS AND POST)
Historically, people with schizophrenia have been told that their symptoms (i.e., hallucinations) need to be medicated away. "Once you are stable, then we can address your other needs..." This week, as we consider deinstitutionalization and people's rights in the community, often it is hallucinations that mark people as "other" or "crazy." Hallucinations can be very stigmatizing.
The recovery movement offers a different narrative. One does not have to be "stable" and "symptom-free" before recovery can begin, quite the opposite in fact. The community is a place one can recover and learn to advocate for rights. One can have symptoms and live well in the community.
What if hallucinations were recast as unconscious needs? What if people in the community, family, and support professionals viewed hallucinations not as an aberration, but as communication? We all have dreams, and some of us even dabble in dream interpretation....what if hallucinations are just waking dreams? What if a recurrent theme in a person's hallucinations means something? A need breaking through into wakeful consciousness?
If we viewed hallucinations as communication, would we still want to medicate them away? Would people be seen as "crazy" by providers and/or society at large?
Reply with your reaction to this premise (using hallucinations in therapy), and the questions above. Then reply to at least 2 of your classmates' posts.
Historically, people with schizophrenia have been told that their symptoms (i.e., hallucinations) need to be medicated away. "Once you are stable, then we can address your other needs..." This week, as we consider deinstitutionalization and people's rights in the community, often it is hallucinations that mark people as "other" or "crazy." Hallucinations can be very stigmatizing.
The recovery movement offers a different narrative. One does not have to be "stable" and "symptom-free" before recovery can begin, quite the opposite in fact. The community is a place one can recover and learn to advocate for rights. One can have symptoms and live well in the community.
What if hallucinations were recast as unconscious needs? What if people in the community, family, and support professionals viewed hallucinations not as an aberration, but as communication? We all have dreams, and some of us even dabble in dream interpretation....what if hallucinations are just waking dreams? What if a recurrent theme in a person's hallucinations means something? A need breaking through into wakeful consciousness?
If we viewed hallucinations as communication, would we still want to medicate them away? Would people be seen as "crazy" by providers and/or society at large?
Reply with your reaction to this premise (using hallucinations in therapy), and the questions above. Then reply to at least 2 of your classmates' posts.
It seems much less likely, if we viewed hallucinations as waking dreams, that we would want to medicate them away. Society would be much more accepting of hallucinations if people thought of them (or they were relabeled) as waking dreams. After all, nobody wants to medicate dreams (nightmares) away now. What a novel idea -- taking hallucinations, which make most people very uncomfortable and viewing them as a form of communication. I wonder how long it would take society to actually buy into this concept?
ReplyDeleteThe answer to the above question is quite a while, because after all, although I am nearly the end of my CLRC program (I start my practicum in one month), I have never heard of viewing hallucinations as communication or waking dreams. It is a concept, however, that I would definitely be willing to try. After all, we are taught that we should acknowledge and work with client strengths. If hallucinations can be viewed (and worked with) as a strength, rather than a weakness, it seems that the client could benefit.
Lisa,
DeleteI have not had any reference in any of my other classes to hallucinations as waking dreams. I agree that we as a society do not change our ideas about mental illness or persons with mental illness quickly. I do think if providers viewed hallucinations as a strength and worked with clients where they are, it would offer opportunites for clients to benefit.
Nancy
Hello Lisa and Nancy,
DeleteI am in the same boat. I am am almost to end of my CRC program and have never discussed using hallucinations as a form of therapy. I think that it is a humanistic approach. I am in full support of that and I think it would be beneficial if providers would be able to spend more time and explore these hallucinations. Rather than prescribe medications that subdue them.
Hi Lisa, Devil's advocate here... People do try to get rid of bad dreams / nightmares. In fact, nightmares are part of some mental illnesses like PTSD. I have a friend whose husband is a veteran and she says he will have nightmares where he tries to strangle her in his sleep.... I imagine therapy is used to address this. I also know Prazosin is commonly prescribed to reduce nightmares. I'm sure other approaches exist. But I do think even though dreams are normal... sometimes they need intervention..
DeleteI think to get on board with Karon's stance, I would need to believe that dreams have meaning and I just really don't think they do. I think that dream interpretation has cultural value but that doesn't translate into a neuro-bio-physiological meaning of dreams as they pertain to our behavior and personal ecology. I commented on Noelani's post below that I have more faith that a person's delusions have significant meaning than hallucinations. I'm just pretty skeptical.
DeleteI'm with you on the skepticism of dreams having meaning, Bronte. However, I would be willing to give Karon's tactics a whirl in counseling, if I viewed this tactic as beneficial to the client.
DeleteThis is a great group of posts. The piece of this conversation that I am really drawn to is how do we support and individual who has been defined as a "schizophrenic" not as someone whose every thought is immediately dismissed because it is attributed to the illness and disconnected to reality. What if, instead, we approach it as getting to know the individual who stands before us, his/her/their hopes, dreams, goals, challenges, and the mental illness is secondary to that process? It then creates a space in which to look at what they are experiencing in a different way. Is it possible that what they are having delusions and hallucinations about is actually one way that the psyche is trying to make sense of the world?
DeleteI am pretty skeptical myself about the differences between dreams and hallucinations. I have always separated them by thinking that one you are well asleep and the other you are wide awake, but I get that you can not control either one. When they come on they are happening to you, and you may not at times want the to be real, but they seem real to the client. So it would be more about understanding your dreams or hallucinations, and trying to make sense of them, so they do not rule your life, whether it would be with medication or therapy.
DeleteHi Lisa,
DeleteLike you, I'd be willing to try out this concept. Throughout history, there have been a lot of theories that people were skeptical about at first, but then warmed up to. However, since this theory is pretty unique, I'm sure it'd be harder to make this idea more mainstream. It'd be great if we could view hallucinations as strengths rather than weaknesses, as long as the provider is able to successfully work with the client to try to find meaning behind their hallucinations. Definitely something interesting to think about!
I do think that if we changed our view of hallucinations, then we might be less likely to medicate. Yet I often use the same analogy in terms of seeing kids behavior as a form of communication that is often non-verbal . I think if we have a tendency to pathologize behavior that does not fit our current definition of normal. I like Lisa am near the end of my program and I have not heard of a therapeutic use of hallucinations. I do think we need to look at things differently in terms of the recovery movement that provides a different script. I do think our reading this week does make the point that we are slow as a society to learn from our mistakes and continue to implement programs and practices that have been found not to work for persons with mental illness. I would hope that providers would be willing to look at new perspectives. I do think that society at large often holds on to ideas that are not helpful for the persons they are hoping to serve. Stigma is often so much a part of programs and practices that makes change difficult.
ReplyDeleteNancy,
DeleteThe odd, or perhaps refreshing, thing is that some psychiatric providers are aware of the societal pressure brought to bear on the psychiatric profession. My physician assistant daughter periodically works with a psychiatrist who once astutely told her that psychiatric patients are too often on psychotropic medications for the benefit of society. The question is do psychiatric providers change their approach because of their knowledge or do they maintain the status quo -- we all know how powerful societal influence can be!
This comment has been removed by the author.
DeleteNancy,
DeleteThere have been new strategies developing offering new scripts CBT cognitive behavioral therapy is support in recovery on one therapy. The main goals are to achieve patient’s safety and assist in curing the patient by in assisting them to develop independent rational thoughts and perspectives challenging their delusions and hallucinations. This type of one on one support therapy offers the patient the tools to help the patient in real time to deal with their illness.
Nancy,
DeleteThanks for your post. I agree that social environment, both within the hospital and outside, plays a huge role in sense of self and recovery, as referenced in Davidson, Rakfeldt, and Strauss (2010). I really like this article in that it humanizes the experience of those having hallucinations rather than objectifying, as often seen within state institutions; "rather than questioning the fact that patients are objectified, they continue to analyze the various forms of their objectification" (p. 166). This perspective sees the person as a human being with thoughts and feelings that is worthy of spending time with and getting to know rather than dismissing as "crazy".
Nancy - I like how you relate it to interpreting children's behaviors. Adults act out, just like kids, when their needs aren't getting met. Some don't even realize they are doing it. More insight should always be a goal for therapy.
DeleteI agree it is frustrating how slow progress is. I once had a professor tell me it takes 20 years to go from new idea to implementing it. This is probably due to scientific community testing it for validity and then once it is proven evidence based practice it goes into textbooks and classrooms and then those new young providers disseminate the new knowledge as they join the workforce.
Hi Nancy and all-
DeleteThis is the first time I have heard the concept of hallucinations as a form of communication, perhaps as a sort of primitive cry for help when the brain is hurting, when the soul is so wounded it can no longer communicate. Having a skilled facilitator who can listen and interpret the individual's "wide awake dream" would indeed validate the person's experience and let them know at least one person in the world is listening.
I like your analogy about kid's behavior as a form of unexpressed communication. Particularly with children and young adults who have mental health issues, they need to have listeners, mentors and supporters who can help them process their feelings, thoughts as part of their own being-ness and not as be considered crazy or somebody who needs to be medicated or muted.
Hi Nancy,
DeleteI'm glad you bring up how society is often slow to accept change and often holds onto ideas that aren't helpful to the people they think they're helping. I think part of the reason this happens is because society doesn't fully understand the issues these people are facing. Instead of taking the time to talk with them and see what their needs are, they often times assume their needs and then make programs that they think will work. This is frustrating for sure, but hopefully as time goes on and more theories change, society will learn to adapt at a faster rate.
The article titled The Use of Hallucinations in the Treatment of Psychotic Patients is an article that references many other articles and most of the references date back to the 1950’s. This article showcases that hallucinations and treatment of hallucinations has been around for a long time. The contrast of how the author uses the voice of god and the voice of satan resembles what we have seen in the past as the struggle of good and evil. Hallucinations can be classified as a struggle between the conscious and the unconscious mind of a person who has a mental illness. The hallucinations can very well be fantasies or accounts of bizarreness that attributes to one’s mental disturbance. If a recurrent theme in a person’s hallucinations means something we could take a deep look at a patient past to see if anything dramatic happened during their lifetime and try to corroborate the patients present state to what may have been a dramatic event to have caused the patients mental illness. Hallucinations may or may not be considered as waking dreams or a way of communicating, however hallucinations may be a gateway to a person’s past. The author discusses ways on how to work with a person who faces hallucinations and how to deal with their psychosis head on by making them feel safe and by building a rapport of trust to talk about what the patient may be hearing or seeing. This reminds me of the part of the article when the subject blurted “Don’t hit me! Don’t hit me! and the therapist remarked “I won’t hit you” the subject then stated “Not you him,” pointing to the center of the room. The therapist in front of the subject began an argument with the hallucinated “him” and created a safe zone for the patient and remarked “You see, he’s gone.” This technique may allow the patient to breakdown the barriers of communication and be comfortable enough to share more information about their hallucinations. This type of psychotherapy aims to improve a person’s safety and help to capture their thoughts and emotions to get a closer look of the patient’s illness. Not only people who have schizophrenia hallucinate but also patients who have dementia and Alzheimer’s disease. The loss of contact with reality is a psychotic experience that brings forth hallucinations and what I learned from this article is patients who hallucinate must be treated with cautious manner and with somewhat of a form of strong authority.
ReplyDeleteGary
DeleteThe article does provide references that help us understand the the person with mental illness from a different perspective.I think the tendency to medicate quickly may get in the way of working with a person and helping them feel safe. I think the use of medication sometimes is a barrier to building trust. Trust is a foundation of work as we saw in the two videos for this week. Understanding the person as a person is a good place to begin.
Nancy
Hi Gary,
DeleteCan you elaborate what you mean in your final sentence by "strong authority"?
Bronte, caution should be taken when engaging with a patient of mental illness due to anything unexpected can and may happen and have somewhat of stern but not over powering authority with a velvet glove.
DeleteHi Gary:
DeleteThanks for your thoughtful post. I also wonder, as Bronte did, about the concept of strong authority with the example your provided from our reading. I wonder if you could provide another example of what that might look like?
There is an aspect of not knowing what the individual might be seeing or hearing in the moment, which could create that sense of the unexpected regarding their behavior. It is interesting that you mention Alzheimer's and dementia as well in this conversation. My sense is that this is a feeling of disconnection from the present, which progressively moves from the individual having a sense of what is happening to decreasingly less awareness. For individuals with schizophrenia, they are typically told from the onset that what they are seeing and hearing is not reality. I would be curious to hear more about this connection between Alzheimer's and schizophrenia as well.
Tara Please read what I posted on Bronte's post.
DeleteI too believe that dreams and hallucinations are part of your past or are in your subconscious mind. The thing is that we need to learn how to handle them so that they do not consume our everyday thoughts, and for people who have nightmares or hallucinations this is the issue they face, is with learning to live with these thoughts and learning to manage them so they do not consume their whole well being. For some people it can be done with meds, and for some they can just do it with therapy. But it is important to address these issues early on when they start consuming your life.
DeleteBeatrice,
DeleteAccording to an article from PsycholoGenie hallucinations can occur when a person hears a certain sound, or sees something that triggers the mind to default to stressors this is when the brain cannot distinguish between reality and the unconsciousness. For a person going through a hallucination it appears very real to them. Hallucinations are like an aneurysm or a stroke you never know when they are going to occur for a patient so we have to be vigilant and prepared what precautions and steps to take once it occurs.
ref:
PsychoGenie retrieved 8/12/201 https://psychologenie.com/hallucinations-causes
The therapeutic use of hallucinations is a new subject for me. I work with individuals that are blind or visually impaired, so I have not had much experience with mental illnesses that include hallucinations. I think that the article portrays a humanist approach to helping an individual with hallucinations. Instead of viewing it as negative symptoms, so to speak, the hallucinations can be interpreted in a form of communication. Karon said, “hallucinations gets across to the patient the power of psychotherapy, that the problems become the means of solution.” (p. 163). With that being said, the hallucinations can another meaning from the past. It seems that medications to subdue these “negative symptoms” would be detrimental to the recovery or coping of the problem itself. It seems that it would be take with the patient to discuss and work through these hallucinations.
ReplyDeleteHi Taya,
DeleteI also wonder if just by the provider showing a client or patient that they are willing to talk with them on this level of trying to fully understand their experience (including their hallucinations) that this would help significantly with building rapport and trust. I would certainly think so and I would bet that also plays a role here in how this concept can be beneficial. One of the key components of any counseling relationship in the initial interactions is developing a therapeutic alliance and this would seem to be a step in the right direction in achieving that.
Joe - This is a great point about building trust and developing therapeutic alliance.
DeleteMany of the comments have been about addressing hallucinations and the possibility that medication might not be necessary (even mine). I have just been thinking, what if the hallucinations are not the only factor of the mental illness? Would we still want to medicate if we know that there are other factors contributing to the mental illness and it is not just an issue of hallucinations? I think the answer is dependent upon the individual circumstance, but wondered what others thought about this.
Joe - I also like your point about the empathy helping to build rapport between provider and patient.
DeleteLisa - I think we would still medicate. At least in today's current model. With depression we know there are so many factors that contribute to the onset and course of the disorder. But medication is still used. Medication and talk therapy together is the recommended best treatment. Talk therapy takes longer to be effective, but if effective can have longer lasting effects. Medication is often thought to be the bridge to stabilize a person to a place where they are better able to engage in talk therapy. And if you've ever known someone plagued by hallucinations, you know hallucinations can really be quite unbearable, often bringing a person to become suicidal. So, I believe this combination would be the best for hallucinations as well, especially for acute patients. I am curious what therapists currently do with patients with hallucinations though. Perhaps a more distress tolerance skills based approach is currently standard practice?
Taya,
DeleteI think the message across many of the lessons of this class have been recovery starts when we (the providers) are able to listen and hear the story. Karon provides another example of the provider taking the time to pay attention to the client and not be fearful of asking what they are seeing and trying to interrupt the meaning of the hallucination. Until I read this article the thought never occurred to me to ask someone about what they are seeing. Karon stated the dream has the purpose of keeping the dreamer asleep in the face of disturbances, the most important of which for therapy are conscious, preconscious, and unconscious wishes. The hallucinations, too, consist of wish fulfillments.
Cindy
I really enjoy this thread and topic, as I was always told not to engage with an individual who is actively hallucinating and ask about what is being seen or heard. Other professionals would further explain that it somehow reinforced that what was being seen was reality and it would negatively impact behavior. At the time, I did not really question it though I was curious to know more about the individuals and their stories, and did have conversations sometimes, trying not to ask more about what was being experienced in the moment.
DeleteThe discussions this week help me process these past experiences in a different way. I was drawn to the human being and their story, and knew that being on a locked psychiatric unit, sometimes against their will, would be scary and lonely. There is part of me that would like to go back and try a different approach, and see if it had any impact. I think that medication does have a place in treating mental illness, but the question that arises is more around how to engage with the individual who is experiencing mental illness in a way that maintains their rights and autonomy.
Hi Taya and all! Wonderful post and discussion... As others have mentioned, this is the first time I've heard of hallucinations as a form of communication. Developing a therapeutic relationship with the individual who experiences hallucinations is a first step towards providing a trusting environment where the person can describe and receive real feedback about their experience.
DeleteAs Karon described the possibility that a psychotic hallucination can simply mean the person is lonely - and the voices they hear represent someone who cares about them...If the only voice of caring is the one they self-create or imagine - then this would appear to be a measure of the inner self trying to heal, to process.
Medication has it's place in helping those with certain mental illnesses be able to participate in daily activities, such as work, school, group activities. It seems important that how the therapeutic community initially interacts with the individual when their hallucinations/mental health are in acute stage could set the stage for a better health and personal outcome.
Tara, can you elaborate on who told you not to engage with a patient who is actively hallucinating, are you saying as a practitioner to take step back and let the hallucination take its course with a patient?.
DeleteGary, as I recall it was the psychiatrists who recommended that we not engage about the hallucinations, as their explanation was that it reinforced the belief system and would agitate rather than help the patient. This is not my perspective, but rather how it was framed for me when I was a new professional in the mental health field. It may have also been connected to believing that only the psychiatrist should really try to address these hallucinations and delusions.
DeleteHi Taya,
DeleteLike others in this thread have mentioned, I think that having a provider be more open to talking about the person's hallucinations would be beneficial. I think people with mental illnesses often have to try to defend themselves when it comes to talking about their hallucinations, or validate for themselves how they're feeling because their providers don't want to talk with them about it. If a client doesn't feel comfortable with their provider, then this can really hinder their recovery. If providers were open to discussing hallucinations, I think it could help the process.
Taya,
ReplyDeleteI think it is important to remember the phrase from the videos" nothing about us without us." Often the justification for using medication is to help clients be ore responsive to therapy. Yet I wonder how the often forced use of medication impacts the therapeutic relationship?
Nancy
As I was re-reading some of the posts the Pete Earley book came to mind. In his search for services and help within the system, he helps us understand that in some ways the system is a bit crazy and we need to begin to listen to the lived exerience of patients and their families.
DeleteNancy
Before reading this article, I had never before heard of using hallucinations in therapy. If you had asked me this question before I read this article, I probably would have thought it was strange and might not work. But after reading this and learning some of Karon’s outcomes, I think it’s a really intriguing idea. The way Karon presents this argument makes it seem so logical and helpful in most cases. He mentions towards the beginning of the article that many mental health professionals think individuals experiencing hallucinations should be directed towards reality and not encouraged to explore their hallucinations. This is the same message I’ve heard many times in my experience in the mental health field. Many practitioners think that exploring the hallucinations is detrimental to the patient, which I’m not sure I agree with anymore, especially after this reading.
ReplyDeleteI think if we viewed hallucinations as communications, we might not be so quick to medicate patients. If practitioners took the time to explore their patient’s hallucinations with them, I think they’d be able to get a much better insight at what is going on than if they were having a “regular” therapy session. As Karon explains, in a lot of cases, figuring out connections between the hallucinations and the patient’s life/history can make the hallucinations go away. Does this mean they will go away forever? Maybe not, but it is definitely a start. This would enable practitioners to perhaps hold off on deciding to medicate and see if they hallucinations go away or subside enough for medication to become unnecessary. In a perfect world where everyone understood the reasoning Karon argues in this article, I don’t think people would be seen as “crazy” by providers/society, especially after taking the time to explore the hallucinations and find the meaning in them. As I was reading the article, I had several “aha moments” where Karon was able to get to the bottom of some of his patient’s hallucinations, and the reasoning behind them made sense to me. Obviously this would be pretty difficult to actually accomplish throughout our society, as stigmas around people with schizophrenia are so pervasive.
Noelani,
DeleteThe article is enlightening in which the author uses references that date back to the 1950’s. zi would like to think that practices today have made strides in treating people with hallucinations than yesteryears practices. In the 1950’s drugs were not prescribed as they are readily prescribed here in the U.S in a whim. Some think not medicating a person will keep the person safe. This depends on what medical condition does the patient have and for how long has the patient has had the medical condition. As we know the earlier you can treat a person for their medical onset the better of a chance the patient has for their recovery. In some instances, medication does keep the patient and others around the patient safe. Practices of treatment and recovery methods progressively get better. The key of Dr. Karon’s article is to give us a snapshot of different subjects who hallucinated. The part that I liked from the article is when the author wrote “When they (patients) can pay careful attention to their perceptions, then they can learn to distinguish between fantasy and reality. I do hear what you are saying if we view hallucinations as communications, we might not be so quick to medicate patients. Going back to what Dr. Karon stated, if a person continues to be medicated in some cases heavily medicated the patient may never be able to distinguish between fantasy and reality. I enjoyed reading your post.
I think my problem with the Karon article is that I need a delineation between hallucinations and delusions. Do I believe that the nature and specifics of an indivual's delusional thoughts can provide a clinician with important information on the patient's illness and inform more effective treatment? Absolutely? Do I feel that way about hallucinations? Not really. Perhaps in some cases, but probably the reality of hallucinations is that only a tiny fraction of hallucinations actually have any real meaning. I buy into his example about the patient who heard a telephone ringing and that gave Karon insight that he was not communicating effectively with his patient. The rest was just sort of hard to believe. For me, anyway.
Delete*Absolutely. (No question mark...I wish we would edit our replies)
DeleteKaron's article (2007) looks at hallucinations as representations of unconscious needs, such as condensation, displacement, or wish fulfillment as Freud references. There can also be a cultural understanding in experiencing hallucinations, seeing it as a valuable tool similar to a dream. Some may also find it helpful to experience them, as it feels like someone is there when lonely.
ReplyDeleteMy perspective on the article is that it asks some great questions about how we make assumptions about the content of hallucinations. I think back to the movie Bellevue, Inside Out, and Connie's story. When she met with the psychiatric resident, she told an extensive story that included her and several other characters; the resident immediately dismissed it and said one could not understand a thing that she was saying. I felt like there was a story within that story about Connie that was missed. I would have liked to see more time spent on understanding her perspective rather than making assumptions. Later on in the movie, Connie discussed her father sexually abusing her and walking around naked; I though that maybe there was a connection between her past experiences and the story as a way to try to understand and process the trauma. As the movie progresses, she does start taking her medication to stop the hallucinations and delusions, seeing this as a way to get out and go home, not that it addresses her underlying trauma.
I also think about my experiences in working with individuals who are actively seeing and hearing hallucinations, and always felt that there was an element of individuality to what they were seeing. Their experience was telling a story about part of who they were. I am not sure that I would suggest that all visual and auditory hallucinations are helpful, but to look at the content of them in a different way could provide a different experience and perspective on individuals rather than dismissing them as a lost cause and incurable.
Absolutely, Tara, I think that hallucinations are often related to life's experiences, but because society views them as so "taboo," most practitioners fail to address the individuality of hallucinations. Too, most practitioners tend to view hallucinations through a potentially harmful, rather than helpful prism. Unfortunately, the expeditious nature of medicine today does not allow for much time spent exploring the meaning of hallucinations; it seems that when Freud was psychoanalyzing patients, much more time was allotted for digging deeper. It also helped that the panacea of medication was not readily available.
DeleteHi Tara,
DeleteI liked how you stated that there is an element of individuality to a person's hallucinations and that there is the potential for something very unique and significant about their personal meaning and root cause. Obviously interpreting hallucinations is not always going to lead to a major breakthrough, but I get the sense that it is a worthwhile venture to see if this strategy might provide some validation for all of individual's perceptions (including the hallucinations), while also illuminating a clearer path for how to move forward towards a healthy self-concept and improved quality of life.
Hi Tara and all-
DeleteI recently worked with a young man who quietly described his mental health issues and psychoses. He knew he needed to be on medications - but described that even when he was on medication, his condition was not all that great. Yet he lives independently in the community, works out a the gym and likes being part of the community. As we in the VR and human service professions work with those who actively experience hallucinations, this article provides us with a new tool, and questions to respectfully engage so as to promote understanding and trust.
I think the importance of this new tool is that it helps build the relationship with the client. So often approaches used damage the relationship and prevents engaging to promote understanding.
DeleteNancy
Hi Tara,
DeleteI love the connections you made between this article compared to the Bellevue film we watched, and how differently the patients in these two scenarios were treated. Just because the staff at Bellevue didn't know what she was talking about in that moment, doesn't necessarily mean that that story had no meaning in Connie's life. Maybe she was trying to convey something, or there could have been a message there layered in with her story. I think by completely dismissing her it just frustrated her more and drove a wider gap between her and the staff there. Perhaps if she had been given more validation, then her experience there would have been different.
I love Karon’s perspective on hallucinations and Karon used hallucinations in therapy to dig deeper and get at the heart of some of the issues people were having by talking about the hallucinations and what they meant. Karon used people’s hallucinations as a means of communication and to really hear what the people were trying to convey through their hallucinations. I think this type of work would take a lot of training and retraining for some mental health professionals. I also believe that if this type of open communication surrounding hallucinations were used more frequently that the use of medication might decrease. That’s not to say I believe no one would still benefit from medication, it would be determined on a case by case basis, but for some, I think it would mean medication might not be warranted.
ReplyDeleteKaron indicated that some of the people who opened up about their hallucinations stopped having hallucinations after their work together. If hallucinations are a reason that people are seen as “crazy” and they stop when their meanings have been heard, understood, and examined, then that is a step in the direction of not being seen as “crazy” by society. It’s amazing work that I hope we all remember if we are faced with someone who is having hallucinations in our future work.
As I stated in my original reply, Lisa, I am nearing then end of my CLRC program and had never heard of viewing hallucinations in the context that Karon describes. I am glad that we were assigned this article because Karon's experiences can be another tool in my arsenal as I begin my work with clients.
DeleteHi Lisa and Lisa:
DeleteI always enjoy reading information that makes us stop and think as professionals to challenge the whys of the human and health services community. It is our fresh perspectives coming into the field that can shift belief systems that may be out of date, ineffective, or disrespecting client rights.
I also appreciated Karon's approach in sharing how cultures can see hallucinations in a different way, and sometimes use aids to elicit them. It does give me pause to think about the U.S. cultural majority perspective in what an individual who has schizophrenia is experiencing and its meaning. I do think that we try to name and explain things away as a way to dismiss perhaps something that would potentially change us as humans first, professionals second, to consider and embrace.
Hi Lisa,
DeleteI also think that if this kind of method was used more often, then i don't think that medication would be used as much to treat people. I think providers often prescribe medication for individuals who have hallucinations because they're just trying to get rid of them. This isn't necessarily a bad thing, but I think by talking with the client about the hallucinations and maybe trying to find a deeper meaning behind them could also make them less frequent or stop altogether. Of course, there would still be some people I'm sure that would require medication, but as you say, this would be on a case by case basis.
Hallucinations may well be unconscious thoughts. They also may not be. Or they may be only sometimes. Perhaps an individual's interpretation of their distorted perception is the better insight into their unconscious then the actual hallucination.
ReplyDeleteIf providers viewed hallucinations as communication would anything really change? I rather doubt it. Patients still need to learn reality testing and using coping skills whether we use psychoanalysis or not. For instance, if a person is depressed, does understanding their life circumstances that led them to depression help them become less depressed? Not really, they just understand why they are depressed better. Exploring the feelings they have towards their mother doesn't change much in their current life. A treatment plan with specific changes/actions and learning new coping skills seems more likely to benefit the patient, in my opinion, but I've always been more of a proponent for skills-based therapies. Generally, psychoanalytic approaches are reserved for higher functioning patients as they require a fair amount of insight. So, since a good number of patients experiencing hallucinations do not fall into that category, they would likely not be ideal candidates and psychoanalysis would not be fruitful. (Karon does concede this weakness in the article). Once a patient is functioning better, it may be possible to explore meaning behind hallucinations. But I still feel like exploring standard therapeutic teachings would be more useful. Like learning how to read what our body is trying to communicate with tense body, accelerated pulse, etc. and learning skills to calm myself down and avoid triggers might be more immediately useful than trying to decipher why I think I hear the TV telling me not to eat food. I don't think Freudian dream interpretations were ever found to be particularly helpful. There is a reason this type of therapy is not currently evidence-based practice.
I maxxed out the amount of characters so here is the rest of my post:
DeleteWould changing the view of hallucinations to types of "subconciuos communication" reduce the likelihood of medicating them? I would have to say no. Sadly. In the world we live in, people prefer a magic pill cure to basic life changes or therapy. We see it with depression - instead of going outside more, exercising, eating right, increasing social supports, etc., people opt to take an antidepressant. We see it with medicine - people opt to take antihypertensives instead of increasing exercise, etc. So, I highly doubt people would begin enrolling in hallucination interpretation therapy in lieu of a magic pill. And the patients who are refusing the pill because they don't believe they are sick - good luck getting them to engage in any semblance of therapy. But along with medication - absolutely. I think this would be a valuable tool. Honestly, I have to wonder what therapists have been doing all along with patients experiencing hallucinations if not this type of approach. I do think it is commonly understood that hallucinations worsen in times of stress and are indicative of underlying distress - so I think perhaps therapists are focused on what the current stressor is - as opposed to what underlying parental dynamic disturbance that was manifested as a hallucination connected to this similar stressor. And that seems to me - more immediately useful. Though, I do hope they are training patients to recognize signs of worsening symptoms indicating they are overwhelmed and need additional supports. That seems more critical to me than knowing that the water sounds indicate urine.
Would society have a different opinion of these individuals? Again, I would say not. The most important aspect of people perceiving others as 'crazy' is how normal their behaviors are. So, if a person is walking down the street talking to themselves, I'm pretty sure they will be viewed as crazy, even if they properly interpret their hallucination as a manifestation of anger at their mother. The ability to determine reality from the hallucination will be the biggest determination of if they are "crazy."
Who gets to decide what's "normal"? Society?
DeleteIn that case, yes society decides what society deems as normal. Each society has different sets of norms. If you find a society where responding to internal stimuli is normal, currently or historically, please share, but I'm not aware of any time that has been perceived as a normal behavior. To my knowledge it is generally feared and/or shunned by society going back as far as ancient Roman times.
DeleteMy only caution here is to say that some behaviors, such as homosexuality and being transgender, were considered abnormal and cause for committal to insane asylums. Years later, they have become much more normalized -- it is difficult to say for certain that hallucinations will not be "normalized" in the future, just because they have not been since time immemorial.
DeleteLisa, I appreciate your point. It may someday be possible that mental illness symptoms are totally normal everyday occurrences and society welcomes them. My point was that I don't think having the belief that hallucinations are our subconscious trying to express latent messages will make that happen.
DeleteWho get to decide what is normal? I think we as a society influence what is normal and what is not. I also think that if we look at the changes in the DSM over time, we see that the thinking changes due to many factors including the economy, and what is going on in the world. I also think that normal is a social construction as is abnormal.
DeleteNancy
The Karon article makes a convincing argument for the potential benefits of psychotherapy and analysis of hallucinations when working clients who experience them. Karon (2007) stated that "When the issues are dealt with consciously, hallucinations sometimes simply disappear. In other cases, hallucinations gradually change from being indistinguishable from reality, to being distinct but equally real, to being less real, to eventually merging with and becoming a part of ordinary thought processes." (p. 16) Several examples were provided of how this can happen.
ReplyDeleteIf hallucinations are related to unconscious needs then it makes perfect sense that exploring them may help lead to some better understanding about what might be causing them to happen in the first place. The concepts described in the article are not the norm in regard to both societal views on hallucination or the views and practices of a large percentage of the services for mental illness. Long-standing stigma surrounding mental illness is very hard to change and takes a long time to make even gradual improvement, but I feel that taking on this viewpoint could help spread a more empathetic view of people experiencing hallucinations.
Joe, I agree that this could bring about more empathy from society as a whole. Since dreams are something we all experience and have little control over. Perhaps relating hallucinations to dreams would better enable a person to put themselves in the shoes of a person with mental illness. But I don't think a dream is quite as disruptive or unbearable as hallucinations tend to be, so I don't think they could ever fully relate. This is why I think peer support is so invaluable. Having someone who can truly sympathize due to shared experience is surely therapeutic.
DeleteI can see a little bit of value in the nuances of some of his examples of hallucination interpretation. However, overall I think he was working backwards from meaning in hallucination (which I think most of the time, hallucinations, like dreams, are pretty meaningless and just cerebral white noise) to discovery's about the person's personal ecology. This strikes me as a methodology prime for error and treatment missteps. His treatment methods seem more like unchecked experimentation dredged in the flour of Freudian psychology than actual recovery-oriented practice.
DeleteBronte, I agree with you on that conclusion for the most part. I think on a theoretical level Karon has some interesting ideas. But in practicality it falls short as you point out. He mentions at several occasions in the article that this tool would not work for all patients and that it is sometimes similar to guesswork (p. 160). I tried to imagine applying this type of approach with some of the many psychotic folks I know. I cannot imagine it working. I think a skills based approach would be far more useful to them because distress tolerance is low, insight and reality testing is poor. They wouldn't tolerate this type of therapy approach when they think they are undercover CIA agents or the dogs are outside their room and might attack or the hospital staff are trying to poison them. Karon states that it is "extremely important to help the patient see that hallucinations are not real." This may be what was actually beneficial to the patient more than finding the hidden meaning of the hallucination. And in folks who have good reality testing skills and good insight, would they be interested in this approach - perhaps. Do I see it being valuable to them? Hard to say.. they no longer need help with reality testing so it's of no use there. I can think of a few who would be candidates to try it on though... "maybe you think the TV is criticizing how you eat because someone in your life used to be critical of you like that?" maybe believing their hallucinations have purpose will give the patient more insight into their problems. Maybe. But it sounds to me like Karon's idea of creating meaning out of the hallucination gives a patient an answer to the pesky question of what is happening to me? Having an answer to that question might relieve some of the tension that the question itself causes. That alone might be more of a relief then insight into their issues with parents etc.
DeleteI am having a difficult time figuring out where to begin. I just (this morning) read a really illuminating online article about a schizoaffective woman and her right to refuse medication that really just fundamentally shifted (or perhaps codified is a better word) my stance on medication for patients with positive symptoms associated with schizophrenic disorders. If anyone is interested in the article here is the link - http://digg.com/2018/compulsory-treatment-laws. The mother of the woman says that she appreciates her daughter's right to refuse medication but that the right to refuse her medication must also be balanced with the right to a roof over her head and regular meals. Without her medication, the daughter is severely delusional and lacks complete insight into her illness. As a result, she is frequently homeless and often incarcerated (a fundamental removal of all of most human rights). This really altered my perception of the medication question. The point is extraordinarily insightful. I agree with the mother in that I DO believe that her daughter's right to safe housing, food, and freedom from incarceration does out weigh her right to refuse medication. Our duty as practitioners will be to maintain the balance between both rights - the right to refuse and the right to basic needs. I feel humbled and enlightened by the article.
ReplyDeleteAs per Karon, I think the article and his stance is just dreck. The only point he made that I felt was of value to recovery was the point about culturally appropriate hallucinations versus culturally inappropriate hallucinations. I don't think all hallucinations should be medicated away. Only the hallucinations that put patients in danger of violence or misery should be medicated away. I believe that we would all benefit from an expansion of what is an acceptable state of reality in which to live and perceive our world. Sometimes people with mental "illness" have a really brilliantly beautiful pan-temporal view of themselves and the universe. It would dim the light of the world to medicate that away. However, I have a sleep disorder that exhibits itself through hypnogogic hallucinations. These are hallucinations that occur during the first 45 minutes of sleep. They start in sleep and continue into waking. I have had some of them last for 10 minutes or more. Often I have to just ride them out, completely awake, until the hallucinations dissipate. They are aural, visual, and tactile hallucinations. They are tiresome, they have no meaning, and they absolutely wreck the quality of my sleep (and to a lesser degree, my life, when they are particularly bad or frequent). If this Karon joker tried to make meaning of the actually manifestation of the hallucination, I'd probably respond with little grace and a lot of pugilism.
Bronte, this is what I meant in being of stern authority, if a patient is telling you that they no longer need their medication what would you tell them, when you know that if the patient refuses their medication they will lose all sense of reality and spiral to a delusional state.
DeleteI see what you're saying but I still don't think the answer is cut and dry. Do I think that a patient who refuses their medication repeatedly should be forced by the court of law to take meds? No. That would be the same as using the courts to force someone with high cholesterol to take lipitor. Do I believe that a line can be drawn somewhere in the sand of a psychotic crisis? Yes. Does the person have a long history of homelessness and/or repeated incarcerations that can be traced to psychotic symptoms? If yes, then a very careful judicial decision can be made to require a person to take their meds in order to keep them housed, fed, and safe from violence. However, the big question is - How can you force someone to take their meds? Do you strap them down? Put it in an IV? Spike their food? Put them in jail until they agree to take it? Will they understand why they're in jail at that point? Do you engage in the tragic system failure of "success only for the successful" and tell them that they will be kicked out of treatment if they don't take their meds? In which case we have still taken away their right to not be homeless.
DeleteI guess what I meant by bringing up the online article was that the nebulous area in my stance on medication is been clarified by the mother's statement. That we may be forced, in a crisis, to make a decision for someone in a psychotic break about which rights they get to retain without veering into absolutism or condescending paternalism.
Bronte,
DeleteIn the past weeks we have covered the period of when Asylums were thriving, and we took a glimpse of how forceful employees were to patients. A patient may not be forced to take their medication however the Assertive Community Treatment team do use coercion on their patients to take their medication. The ACT team member may use the patient’s payee not to pay them their allowed monthly allowance or may take away independent living so that the patient will live in a group setting. These tactics of coercion are not nice but they are in use today.
ref:
Gomory, T., (2002), The origins of coercion in “assistive community treatment (act): a review of early publications from the special treatment unit (stu) of Mendota state hospital. https://redecomposition.files.wordpress.com/2012/12/historypact.pdf
Hi Bronte,
DeleteThank you for your post, and sharing your own experience. I think you bring up a good point about the different kinds of hallucinations, and whether not to medicate, etc. I have had very little experience working with folks who have hallucinations, so this article appealed to me. However, you have brought up some very real flaws with this approach.
If we viewed hallucinations as an unconscious need, then we could try to fix or understand why we feel we have this need. As stated in our article that "Hallucinations are even better then dreams, because they often lead to conflicts much more directly". Then we could understand the need, and work on a solution to the need, in order to recover.
ReplyDeleteIf people in the community, family, and supports viewed hallucinations as a communication, then I think people wouldn't feel the need to label others as a person with a scary illness, then they would understand that the person is just expressing his or her needs at that time, and they could learn to be o.k. with this, instead of judging.
If hallucinations were just waking dreams then, people could learn to control them and make decisions on how they would handle their dreams, when they are faced with them.
If a recurrent theme in a persons hallucinations mean something, then this may help the therapist be able to help the client understand, and acknowledge the need and work towards solving the issue of the needs.
If a need breaking through into wakeful consciousness, can help the client in the awake stage to understand his need better, then the client would be able to understand, and help with healing themselves.
And no, we would not want to medicate anyone with hallucinations, unless they are at risk of hurting themselves. And they should not be seem as crazy, but as someone who has an issue and needs support to address the issues, and learn coping skills to manage them.
Wouldn't it be great if we could educate family, friends, and the larger community about mental illness and hopefully begin to prevent people being labeled "crazy" for certain behaviors or hallucinations, or other issues they encounter. What if society interacted more with people who suffer from mental illness and understood more about people with mental illness, were more understanding and sympathetic to their needs - would the label "crazy" be so widespread and negative? I think educating the public about mental health issues is important and could help so many people both with mental illness and without mental illness lead more meaningful lives.
DeleteBeatrice,
DeleteI'm of the same mind. If we could see this as a dream while you are awake and find some science that presents it as having a higher level of deep mind functioning it could be seen as a gift verses a curse. This teaches me how we listen to stories, take on a meaning, then live life through that vision. We develop judgments from the stories we are told without true understanding. This class has opened my mind and eyes to many different ways of being.
Hi Beatrice,
DeleteI had a very similar reaction to this article as you did. I think regardless of whether hallucinations have something valuable to offer in the therapeutic process (do they contain insights, etc.) --this article (and this class more broadly) has helped me to question why our society is so quick to turn to medication for every mental health condition. We (as a society) like to act like we have the answers to everything, but we are learning in this course that medications are still being prescribed that aren't necessarily effective, or are even harmful to the public. I think acknowledging an individual's hallucinations and asking them questions about their experience could only work to deepen the therapeutic relationship. And if there is something more to be gained from them, than that is even better.
This gets back to the stories we hear and tell about mental illness and we need to create new stories.
ReplyDeleteNancy
The Karon article provided me with a very different view of hallucinations in the treatment of psychotic patients. I never thought about trying to view the hallucinations as a message that could be used in the therapeutic process. Many years ago when working with someone it became clear that he might never be able to drive because that was when he was experiencing hallucinations. Without intention the team did a mapping process with him and his mother, because there was no movement towards any of the goals that had been set forth by the person and family. Through this process it was found that the person felt he was too ill to work on the driving goal, because they were going to be moving to another state. I wonder if we had asked what he was seeing when he drove if this would have given us information about his fears or what was getting in the way. I've always been concerned about asking due to not wanting to upset the person. Now I feel very curious to know more because it could be a opportunity to understand what is getting in the way. I think society could be much more accepting if there was a feeling that this was another way of dreaming...what if we put a positive spin on it like only really intelligent people can dream while they are awake. Maybe this perspective would wipe away the stigma of hallucinations. I feel like this is a deeper way of someone expressing their pain. I'm so curious and want to know more.
ReplyDeleteCindy,
DeleteThe article by Karon is a bird’s eye view of patients who hallucinate and the different ways of communicating with them and treating them. An article by Swink for Psychology Today shares that mental illness alone is not a risk of violence but when a patient with mental illness combines substance abuse with their mental illness that is when a patient can be dangerous and irritable to treat or deal with. The article also shares when treating someone with hallucinations and mental illness be respectful and be open minded and consider what the patient has to say and try to comprehend what they are communicating about. I recently paid a visit to Riverview Psychiatric Center on Hospital Street in Augusta and they have security guards on guard to de-escalate should the need of de-escalation arise. Perhaps the person you were working with has a had a phobia of driving since he was a child. Some people have phobias of driving over bridges so they rather take the long route and go all the way around. Whatever his fears were, I hope he was able to confront his fears and move on successfully with his life. I agree with you society could be more accepting for those who have a disability. With the assistance of the American Disability Act, society today has been more accepting of people with disabilities and have been more supportive than yesteryears. Communities have broken barriers of stigma and continue to make improvements in their cities to be safe for everyone to have safe access in all public settings. I enjoyed reading your post.
ref:
Swink, D., (2010), Communicating with people with mental illness: The public’s guide.
https://www.psychologytoday.com/us/blog/threat-management/201010/communicating-people-mental-illness-the-publics-guide .
I too would like to know more about what evidence-based practice says about how to treat patients with hallucinations.
ReplyDeleteNancy
Mental health systems have always treated those individuals with “psychotic” symptoms which included hallucinations as a problem to be treated. I like Karon’s (2007) analogies about how those who experience hallucination may mean the person is lonely, that often the voices, the person heard were helpful and comforting – those people were the least likely to want treatment. Culturally, ancient cultures considered this to be how the “well-adjusted” heard and saw these hallucinations and were considered acceptable under culturally acceptable conditions. I remember reading about the Beatles – and many other musical bands and artists who took hallucinogenic drugs to enhance their creativity.
ReplyDeleteKaron’s article described the importance of looking for the connections – helping the person process the hallucinations – to process it like a dream. Could it be that there are repressed memories, and wide-awake nightmares that are just too hard to process?
The Karon article well presented the connections between hallucinations and current problems in life? Karon described the therapist asking questions that encourage the individual to describe and process the hallucinations as well as to seeking meaning, the origin of their angst… Questions such as “What comes to mind when you think of_________?” This can help the person speak their experience out loud and can help them and their family process the hallucination.
If hallucination is to be viewed as a necessary communication, then medicating those symptoms would not be the recommended course of treatment. Counseling, forms of expressions such as art or dance therapy, expressive communication, journaling as well as group therapy with others who can appreciate and expand their feelings of self-worth.
Sue indeed Karon’s (2007) article covers different subjects and ways of potential treatment on hallucinations. The song that comes to mind when you bring up different bands singing about hallucinations is the Beatles’ song, Lucy In the Sky With Diamonds which stands for LSD there is a lot of go around if John Lennon was high when writing the song. This song is about a dream like state of Alice in Wonderland. Trippy, how could that even come to script without your thoughts being enhanced by as you state taking hallucinogenic drugs. This song has generated a lot of talk and the Beatles stated it is not about drugs or being high. True that the Karon article presented the connections between hallucinations and current problems in life the article gives guidance on measures that can be taken to treat people who are plagued with hallucinations in their daily living. I enjoyed reading your post.
Deleteref:
Blackbird, The meaning behind the song, retrieved 8/10/2018 https://www.quotev.com/story/8077134/The-Meaning-of-the-Song/9
I think that this is a really interesting point. Often times, I hear of friends and family members who are on anti-anxiety medication. While I understand that medication is beneficial and helps them overcome their anxiety--I can't help but wonder where their anxiety stems from, and if it is something that could be treated through therapy and other natural remedies. Thinking of hallucinations in a similar vein would certainly change my perspective on treatment and how these hallucinations could actually be utilized during treatment.
Delete