How Can You Tell if You're Hallucinating?

[mahagonny]

As to physicians overreacting, during the ordeal I described above, one doctor prescribed me 100 mg of thorazine and sent me on my way. Another doctor, later said, 'that's a crazy high dose for a young man of your weight (120 lb). That's irresponsible.'  Then another doctor put me on stelazine. He had asked me if I heard voices. I said no then later, yes. I wasn't sure. My college roommate said 'you sure sleep a lot.' Always,  remember you can get second or third opinion. You know what they call the guy who graduated last in his class? 'Doctor.'

At the same time, reading some of smallcleanrat's posts on other threads, I see there is another issue. Smallcleanrat, you are apparently in frequent contact with your parents. It seems to me they are concerned but also meddlesome and second-guessing. And they have funny attitudes about the use of medication, which you recognize. So maybe handle this without involving them? If they're kept in the background, maybe you can think and decide better.

[Puget]

Folks, I'm sure you're well-intentioned, but the OP has reported serious depression and self-harm elsewhere on the fora-- please stop minimizing and suggesting waiting to go to the doctor-- that is not the situation here, and the OP needs to see her psychiatrist ASAP.

[zuzu_]

Folks, I'm sure you're well-intentioned, but the OP has reported serious depression and self-harm elsewhere on the fora-- please stop minimizing and suggesting waiting to go to the doctor-- that is not the situation here, and the OP needs to see her psychiatrist ASAP.

I wasn't aware of that background. OP: sounds like this could be a part of something bigger. I'm glad you're reaching out to caring strangers on the internet, but please also see a doctor ASAP.

[mahagonny]

When I say 'time is your friend' I mean there is light at the end of the tunnel. My experience with derealization was that the belief that the world was no longer real never became fact to me. There was always the possibility that the world was still real and some shift had occurred in my experience of it. That's why there is so much thinking and analyzing going on. Sure enough, things got back to normal. But it did take a lot of therapy and some time.

Family members can also find support groups if they are open to it. Like, a parent of someone who is getting treatment for mental health could find a support group to meet others/ help them through it. They may not be too old for more education.

[mamselle]

Trying to think your way out of mental health problems never works. I suspect academics are particularly prone to this, because collecting evidence and putting it together into a coherent picture is what we do for our job. I always think that if I can really understand what is happening then I can fix it, but all that does is send you deeper into the weeds. It seems clear that whatever is going on is causing you a lot of distress and having a significant impact on your ability to go about your life. You don't mention anything about feelings of harming yourself or anyone else, but if any of that is involved you should get immediate help. If that isn't the case, I hope you have been able to discuss all this with your SO. It seems like it would be a good thing if there was someone around who was keeping an eye on things.

Caracal, I'm sorry. I'm not trying to be difficult, but I really don't understand this. If you don't think to solve a problem, what do you do?

Practically every therapeutic technique that has ever helped me involves some type of thought: evaluating the situation, attempting to recognize when your thinking might be distorted, behaving rationally instead of reactively...

Thinking keeps me functioning. Thinking keeps me alive. When nothing feels real you can lose your sense of danger: walk into traffic, jump off a building, why not? If nothing is real, there are no consequences. If I can't trust my senses or intuition because they are sending distorted signals, what is a non-thinking solution?

There's an element of truth in the fact that one's mentality is involved in healing in these situations: one does need to learn to see patterns in ones thinking and action, and figure out different pathways of interpretation and response. So I agree that there's definitely a thinking part in the work needed to do to avoid harm, including self-harm.

But from my experience, the greater issue is in finding out how to transcend past experiences which have been unhelpful or harmful--whether physically or psychologically, or both--and transform ones interpretive responses and insights towards more healthy patterns of believing, thinking, and acting.

That's like a systems problem: "No system knows what it doesn't know," as someone told me once. 

So while one definitely wants to keep thinking--it's one of the things that separate us from the plankton (I think...or maybe we've discovered that they think, too? :--})--part of that thinking has by definition to be done with others trained in how to help you spot your patterns and devise ways out of the thicket of self-recrimination, self-blame, and self-punishment.

It's really hard work (I dealt with this after leaving my abusive marriage long ago) and I found I just didn't have the parallax to see myself in a different way than I already saw myself. That systems thing, again. I'd go 'round and 'round trying to think my way out of it--and I couldn't.

I needed another person's trained vision, their support as I figured out what to do about what I had experienced that had injured my sense of self, and how to cope with things like people telling me I should just "forgive and go back to him" (yes, we were at the tail end of that era then).

I came to realize I could forgive, and did, to the extent that I dismissed the other person's hold on me, and stopped seeking a way to exact further communication or caring from them--but that without their apology (or in more ritualized religious terms, their repentance) and an amendment of life (which can only be seen over a longer period of time) they had no further call on me for engagement in the relationship, and no further right to rent space in my brain.

But again, that's hard work, and I couldn't have done it without support and the input of others (some group work, some individual work, was what I found most helpful) and I maintain a circle of friends with whom I stay in communication to keep on track and stay centered around the positives in life.

I also discovered the themes of transcendence and transformation are not only operant in the teachings from my own religious background (I call myself a peripatetic ecumenical charismatic Christian Episcopalian, and I work in interfaith settings beyond those of Christianity as well): they appear in many other religious systems throughout the world, either overtly or as elements to be discovered within their thematic and narrative texts.

So, again, there is an element of thinking, but it's more about finding the will to enact alternative approaches to one's difficulties, and finding reinforcement for those approaches and help in developing the vision to see them--which have to come from others, especially trained others.

I know you know that because you've been trying so very hard to get this help and you've found some serious (idiotic, in the cases you've most recently described) roadblocks to getting the help you're seeking.

That's maybe a roundabout way of saying that there is caring and support for you here, and a nearly univocal agreement with your basic assessment, that you need help, and you deserve to be helped, and it sounds as if you will make good use of that help--so you can learn in a supported and affirmative way to actualize your best instincts and abilities to thrive throughout your life.

M.

[smallcleanrat]

The other suggestion I found was ghosts. Those would be some pretty bored ghosts. Who haunts a grad student?

Well.
Who haunts a grad student? Bored ghosts?
Well. Um.
But, it wasn't me, promise.

Good luck sorting this out, wishing you brilliant, attentive, and insightful doctors who are able to give you sound medical advice.

hungry_ghost, thanks for making me smile.

You aren't going to be able to figure this out because you don't have perspective and it sounds like trying to is just making the whole thing worse. I'm not sure when your appointment is, but I'd really urge you to try to get in to see someone sooner.

Fair point.

I just want to add that it may be something, or it may not. I remember a report about the number of people who "hear voices" but don't report it because they fear they're going crazy. It appears that a certain percentage of people tend to hear voices without any other symptoms, and that's that. Ten percent or something. I also encourage you to look for what has been called, justifiably, the most beautiful academic article ever written: Carlos E. Sluzki, "Saudades at the Edge of the Self and the Merits of 'Portable Families'," Transcultural Psychiatry 45 (2008), 379- (https://journals.sagepub.com/doi/abs/10.1177/1363461508094672 behind a paywall, but probably available via your library site). He starts out with how his cat has recently died and yet he keeps thinking he sees her, and goes on to explore related phenomena.

Thanks for the article, Hegemony. I've heard voices before, but I never really worried about it much except for the few times the voices were hostile. I think what bothers me about the new stuff is that it's hard to ignore when you think someone is trying to get your attention by touching you or someone is right beside you. Earlier this morning, I saw one of the peripheral people raise an arm and make a throwing motion; I flinched, couldn't help it, thought I was about to get hit with something. I wouldn't mind seeing a dead pet.

I'd say in the context of the depression you've discussed on other threads this is definitely something and not nothing. Delusions and hallucinations are not that uncommon in severe depression (these are called "psychotic features" which does NOT mean you have schizophrenia-- they generally resolve when the depression gets better). That doesn't mean panic, but it does mean go see your psychiatrist as soon as possible and give a complete and accurate description-- if it's easier, print your post here describing these phenomena and bring it with you.

I've seen in my medical records there is a prior diagnosis of "affective psychosis". But I don't know when or why that was added to my file. If I asked for my full records, do you think they would have this info? I think I've had delusions while depressed before, but I can't remember if I ever described them to a doctor.

mouseman, thank you for the words of support.

mahagonny, if you are comfortable with it, would you mind sharing more about your experience with dissociation (post or PM, whatever feels best)? I've experienced extremely long bouts and it can make life feel truly intolerable. I would love to hear about whatever may have helped you break free.

bopper, I do have some vestibular issues so it is certainly possible that the feelings of being pushed are related.

I started Day 1 of my outpatient program today. Mentioned the unusual sensory experiences. Psychiatrist's response: "Hmm...those don't sound like typical hallucinations...maybe it's related to your migraines." Then he shrugged and moved on. I guess he doesn't see it as a high priority.

Maybe I should try to get a referral to a neurologist to ask if this could be related to migraine aura (I did have a pretty bad one this week; lasted 2 days, nauseous and vomiting). Haven't been to one in a while; the last neurologist I saw told me not to bother coming back: "There's no cure; I can't do anything for you. You just have to learn to live with it. Lots of people do."

[mahagonny]

mahagonny, if you are comfortable with it, would you mind sharing more about your experience with dissociation (post or PM, whatever feels best)? I've experienced extremely long bouts and it can make life feel truly intolerable. I would love to hear about whatever may have helped you break free.

That's not the tone I was expecting. If you would love anything, you're not in the trouble I thought you were in. i envisioned someone in a state of prolonged anxiety, fear, and with thoughts of serious self harm or suicide, and flat affect (mood), like anhedonia. I am glad you're feeling better. We are both fine now. Maybe we'll talk about fishing some time. Cheers, over and out

[smallcleanrat]

mahagonny, if you are comfortable with it, would you mind sharing more about your experience with dissociation (post or PM, whatever feels best)? I've experienced extremely long bouts and it can make life feel truly intolerable. I would love to hear about whatever may have helped you break free.

That's not the tone I was expecting. If you would love anything, you're not in the trouble I thought you were in. i envisioned someone in a state of prolonged anxiety, fear, and with thoughts of serious self harm or suicide, and flat affect (mood), like anhedonia. I am glad you're feeling better. We are both fine now. Maybe we'll talk about fishing some time. Cheers, over and out

Huh? I was using "I would love to" as an expression of wanting to hear about your experience.

Can't tell if I offended or annoyed you, but if I did I'm sorry.

[mahagonny]

Folks, I'm sure you're well-intentioned, but the OP has reported serious depression and self-harm elsewhere on the fora-- please stop minimizing and suggesting waiting to go to the doctor-- that is not the situation here, and the OP needs to see her psychiatrist ASAP.

I doubt it. Then again...

[Caracal]

I started Day 1 of my outpatient program today. Mentioned the unusual sensory experiences. Psychiatrist's response: "Hmm...those don't sound like typical hallucinations...maybe it's related to your migraines." Then he shrugged and moved on. I guess he doesn't see it as a high priority.

Maybe I should try to get a referral to a neurologist to ask if this could be related to migraine aura (I did have a pretty bad one this week; lasted 2 days, nauseous and vomiting). Haven't been to one in a while; the last neurologist I saw told me not to bother coming back: "There's no cure; I can't do anything for you. You just have to learn to live with it. Lots of people do."

Wait, did you describe the stuff you described to us to him? Voices? Wandering around trying to find things that didn't seem to be there? Agitation and fear about these things? What is the outpatient program for? This seems off. For comparison, I saw a psychiatrist a while ago because my anxiety had been spiking and I wanted to see if a different drug regimen would help (it has) and even though he said right from the start that what I was describing sounded pretty clearly like manifestations of anxiety, he still asked me a battery of questions just to make sure that there wasn't anything more serious going on.

[smallcleanrat]

Folks, I'm sure you're well-intentioned, but the OP has reported serious depression and self-harm elsewhere on the fora-- please stop minimizing and suggesting waiting to go to the doctor-- that is not the situation here, and the OP needs to see her psychiatrist ASAP.

I doubt it. Then again...

mahagonny, I'm not sure what you mean by this comment, especially "Then again..." But I get the sense that I pissed you off somehow without meaning to; that you think I was misrepresenting my situation? I don't know exactly, but I never intended any of that. I've been posting my experiences as they are; I've felt stuck and I was desperate for advice and to hear about similar experiences other people have had (especially how they coped). I really appreciated your earlier posts on this thread; I felt pretty awful when I read your latest posts. I'm sorry if I said anything offensive.

Wait, did you describe the stuff you described to us to him? Voices? Wandering around trying to find things that didn't seem to be there? Agitation and fear about these things? What is the outpatient program for? This seems off. For comparison, I saw a psychiatrist a while ago because my anxiety had been spiking and I wanted to see if a different drug regimen would help (it has) and even though he said right from the start that what I was describing sounded pretty clearly like manifestations of anxiety, he still asked me a battery of questions just to make sure that there wasn't anything more serious going on.

I did describe being startled by the perceived movement and being scared enough not to leave the building until my SO could come get me. I also described trying to follow the footsteps and the person I thought I glimpsed in a reflection. He frowned, wrote it all down and shrugged. Said it sounds more like an illusion than a hallucination, interpreting actual sensory input incorrectly rather than internally generating sensations. I can see the possibility for the corner-of-the-eye stuff, but why am I seeing illusions now and not all the previous years of my life?. That explanation doesn't seem as good a fit for the tap-on-the-shoulder stuff. Anyway, his best explanation at moment is that it's most likely migraine-related. He thought it might be worth seeing a new neurologist because there have been a lot of treatment options developed in recent years.

Some doctors are far more thorough than others when it comes to attempting to rule out other possible causes for symptoms. I have had a few like that, but the majority I've met don't ask a lot of questions. In the past, I answered "I'm not sure" to questions about whether I've heard voices, because I've had experiences like I've described up-thread, but wasn't sure if that was what they were talking about. No one ever stopped and asked me to elaborate; they just said "ok", ticked some box on a form, and moved on through the questionnaire.

I was referred to the outpatient program because of the persistent self-harm and suicidal urges which are mostly in the form of intrusive thoughts and images. There are therapy groups covering different issues and ways of coping with distress. I'm to go several times a week for the next few weeks. There are weekly check-ins with the psychiatrist and a case manager who helps with setting therapy goals.

[Puget]

I'm glad you're starting treatment!

First off, please ignore mahagonny. You didn't say anything wrong and you're not responsible for his(?) bizarre miss-interpretation of your perfectly ordinary phrasing. I have compassion for whatever is causing him to behave this way toward others, but you have nothing to apologize for.

The psychiatrist honestly sounds like a bit of dud. Caveat that I'm not a clinician, just a clinical researcher, but in the hoofbeats being horses metaphor here horses is psychotic features of depression (which is all that "affective psychosis" means, so that's probably why it was in your notes), not some neurological condition. I'd persist in telling various people in your treatment program exactly what you are experiencing and how distressing it is until someone takes you seriously.

Has anyone ever done a careful differential diagnosis for you -- i.e., asked you a bunch of questions in a semi-structured interview format? (The most common form of this is called the SCID). The exact label isn't that important in that individual people don't fit neatly into diagnostic boxes, but I get the sense with your analytic mind it might make it easier to cope if you felt like you had a clear picture of what's going on for you and could understand the mechanisms and how everything is related.

[mahagonny]

mahagonny, I'm not sure what you mean by this comment, especially "Then again..." But I get the sense that I pissed you off somehow without meaning to; that you think I was misrepresenting my situation?

Not pissed off at all. I am sorry. I probably assumed something not in evidence or took a guess. It's harder to figure things out than face to face. Take care.

[smallcleanrat]

I'd persist in telling various people in your treatment program exactly what you are experiencing and how distressing it is until someone takes you seriously.

Has anyone ever done a careful differential diagnosis for you -- i.e., asked you a bunch of questions in a semi-structured interview format? (The most common form of this is called the SCID). The exact label isn't that important in that individual people don't fit neatly into diagnostic boxes, but I get the sense with your analytic mind it might make it easier to cope if you felt like you had a clear picture of what's going on for you and could understand the mechanisms and how everything is related.

I will definitely keep bringing it up; I have noticed I sometimes have to mention something 3-4 times before this psychiatrist will try to address it. I've stuck with him because he was the first in a very long time to actually help me; without him, I would not have regained enough functionality to start school.

I believe I did have some type of in depth interview such as you describe. I recall an interview and a paper test; I think it was to diagnose personality disorders, but I'm not sure. This would have been over a decade ago when I got to a point where I couldn't function and was essentially forced into the hospital ("You can go voluntarily or we can send the police to make you go involuntarily; those are your only options"). I don't recall if I ever received any papers or had anyone explain the results to me in depth. Memories of those times are jumbled.

I'm going back to the clinic tomorrow. Will update as things progress. Didn't have any of the weird sensory experiences yesterday or today; just feeling pretty shut down and out of it.

[Puget]

I'd persist in telling various people in your treatment program exactly what you are experiencing and how distressing it is until someone takes you seriously.

Has anyone ever done a careful differential diagnosis for you -- i.e., asked you a bunch of questions in a semi-structured interview format? (The most common form of this is called the SCID). The exact label isn't that important in that individual people don't fit neatly into diagnostic boxes, but I get the sense with your analytic mind it might make it easier to cope if you felt like you had a clear picture of what's going on for you and could understand the mechanisms and how everything is related.

I will definitely keep bringing it up; I have noticed I sometimes have to mention something 3-4 times before this psychiatrist will try to address it. I've stuck with him because he was the first in a very long time to actually help me; without him, I would not have regained enough functionality to start school.

I believe I did have some type of in depth interview such as you describe. I recall an interview and a paper test; I think it was to diagnose personality disorders, but I'm not sure. This would have been over a decade ago when I got to a point where I couldn't function and was essentially forced into the hospital ("You can go voluntarily or we can send the police to make you go involuntarily; those are your only options"). I don't recall if I ever received any papers or had anyone explain the results to me in depth. Memories of those times are jumbled.

I'm going back to the clinic tomorrow. Will update as things progress. Didn't have any of the weird sensory experiences yesterday or today; just feeling pretty shut down and out of it.

Don't be afraid to ask for a second opinion from another psychiatrist or psychologist-- it's great he was able to help you but if he's not listening to what you have to say that's a real problem.

If you do want to go after a proper differential diagnosis-- Does your university or one nearby have a clinical psych PhD program? They will have a training clinic where well-supervised PhD candidates who are trained in rigorous assessment can do a diagnostic interview correctly. Usually, they have a sliding scale fee structure and discounted or even free services for students.