Mental Health Issues
Hallucinations & Delusions
What are hallucinations?
Hallucinations are sensory experiences in which a person hears, sees and, in some cases, feels, smells or tastes things that are not there. Hallucinations are sensory experiences in absence of stimuli that are produced by a malfunctioning brain. The most common form of hallucination is auditory hallucination, i.e. hearing voices when there is no one around.
A person who hallucinates finds it difficult to differentiate these sensory experiences from reality, because both external and internal stimuli are generated by the same brain. However, with experience, it is possible to identify real experiences from internally simulated ones.
In general, when we experience unusual experiences, we use logic to make sense of them. For example, when we hear voices criticising us, we assume that people around us are criticising us. Likewise, a teenager with auditory hallucinations in school will assume that classmates are gossiping; thus gradually creating a persecutory delusion.
What are delusions?
Delusions are fixed, false beliefs that one can form in spite of contrary evidence. It can arise as a result of distorted cognitive attributions and schematic elaborations. Intense, novel experiences such as hallucinations and delusions are paired with strong emotions which make them resistant to rebuttals from others. A person often forms delusions based on the content and context of their hallucinations, as well as their life history.
Common types of delusions:
Erotomanic – The conviction that someone (usually a public figure) is in love with the person
Grandiose – The conviction that the person has great but unrecognized talent and knowledge
Jealous – The conviction that the person’s spouse is unfaithful
Persecutory – The conviction that the person has been somehow thwarted and persecuted by others in the pursuit of long-term goals
Somatic – Revolves around bodily functions or sensations
Examples of hallucinations and delusions
A teenager with auditory hallucinations in school will assume that classmates are gossiping.
Hallucinations and Delusions may be symptoms of mental health issues such as:
Major depressive disorder
Elevated Mood & Depressed Mood
What are elevated moods?
Mania has been described as a state when the brain goes on overdrive. Thoughts are sped up and senses are heightened. The person has pressured speech with ideas thrown together in a disconnected manner. Behaviour becomes frantically goal-directed, but focusing becomes a challenge.
If one is to visualize mood as being on a continuum with mania and depression on vertical opposite poles, the state below mania is known as hypomania, a milder form of mania. This has been described as an enjoyable state when the person becomes more creative and effective in goal performance, needing little sleep or rest. The brain seems more activated in this stage and functioning is optimal.
However, this cannot be sustained in the long run as the mood eventually tilts towards mania or depression.
What is depressed mood?
Clinical depression is more than just a sad mood. When a person has clinical depression, the physical and psychological functioning is impaired.
Somatic symptoms may be present. The mnemonic “
in sad cages” is useful in remembering the symptoms of clinical depression:
Interests – A lack of interest in previously pleasurable activities
Sleep – Can’t sleep or sleeps too much
Appetite – Lack or increase in appetite
Depressed mood – Feelings of sadness, numbness, or hopelessness
Concentration – Difficulty in concentration
Activity – Activity initiation difficulty
Guilt – Excessive guilt
Energy – Loss of energy
Suicidal – Suicidal ideation
Andrew Solomon stated in his book ‘The Noonday Demon – An Atlas of Depression’:
‘Depression at its worst is the most horrifying loneliness, and from it I learned the value of intimacy…So many people have asked me what to do for depressed friends and relatives, and my answer is actually simple: blunt their isolation. Do it with cups of tea or with long talks or by sitting in a room nearby and staying silent or in whatever way suits the circumstances, but do that. And do it willingly.’ (Pages 436, 437)
What is anxiety?
Anxiety is a useful emotion that alerts us of potential danger and is crucial for survival. It motivates us towards task mastery and achievements. However, chronic high anxiety may become crippling because it interferes with our daily lives. It may also increase risk of medical conditions. In some psychiatric disorders, irrational thoughts and fears will trigger anxiety:
Eating Disorders: Fears of weight gain even when the person is quite emaciated
Phobias: Fears of things/situations which are actually not threatening
Generalised Anxiety Disorder: Fears generated by their worst imaginings
The physical sensations of intense anxiety can be distressing:
Chest discomfort as the heart begins to beat really hard and fast.
Nausea, weakness and dizziness
Cannot function normally
Such sensations can generate a fear of impending doom or dying, creating a vicious cycle of symptoms. When a person has agoraphobia, the memory of the physical and mental suffering during a panic attack can cause a person to seriously restrict their everyday life in order to avoid potential triggers.
Anxiety is a symptom of…
Anxiety is a symptom common to many mental health issues. But what is crucial to realise is that the brain sometimes gets flooded by thoughts and emotions that are completely illogical and not in tune with reality. Anxiety a biological dysfunction, not a character flaw.
All religions hold life to be sacred. We are born with the natural inclination to seek life rather than death.
What is suicide?
Suicide is the act of intentionally taking one’s own life. It is a thwarting of the survival instinct when life is held to be too painful, and suicide becomes an option.
Why would someone have suicidal ideation?
If one were to delve deeper, the person pondering suicide may just wish to end the problem of having to endure great psychic pain. The person would have struggled to find solutions but to no avail, then feel exhausted and fall in despair, before coming to believe that suicide is their only solution.
According to research, having these following factors can protect against suicide:
Effective mental health care
A sense of connectedness to family and community
Support from ongoing medical and mental health care relationships
Skills in problem solving and conflict resolution
Cultural and religious beliefs that discourage suicide
Neurocognitive Disorder (Dementia)
What is neurocognitive disorder?
Neurocognitive Disorder (NCD) is the newer term used in DSM-5 for dementia. ‘Neuro’ relates to neuron or brain cell, ‘cognitive’ relates to understanding and thinking – therefore NCD is an illness which affects how the brain functions.
NCD can be reversible (e.g. Thyroid disease) or irreversible (e.g. Alzheimer’s disease); and may arise from many conditions:
Frontotemporal lobar degeneration,
Lewy body disease, vascular disease
Traumatic brain injury
Other medical conditions.
Why would someone have neurocognitive disorder?
NCD comes about when brain functioning deteriorates. The person with NCD may experience impairments in:
Attention, learning & memory – the person finds it hard to focus, retain new information, and recall old information. The person’s processing speed becomes slowed, and the person feels overwhelmed by all that is going on in the environment.
Executive function – the person finds it hard to make sense of information, make decisions, and control actions. Daily activities become challenging.
Language – the person finds it hard to express themselves and understand others. Keeping track of conversations becomes challenging.
As a caregiver, what can I expect?
Caring for a person with NCD is exhausting mentally and emotionally. To survive the journey, caregivers need to understand first of all that your loved one does not make your life difficult on purpose.
Your loved one has brain atrophy. Christine Bryden in her book ‘Dancing With Dementia’ said that persons with dementia face a daily struggle to cope. Each day is filled with activities which becomes more and more difficult as time goes by. It is impossible to keep track of the sequence - nothing is automatic any more. Everything is strange and scary. One tends to keep asking the same questions to the frustration of caregivers because as soon as the answer is heard, it fades away. In their minds, the previous moment is just a blank.
Bryden said that caregivers can be ‘care-partners’ in this dance with dementia. It is important for the person with NCD to use the functions which is retained, in order not to lose them too quickly. Care-partners adjust their steps to keep in tune with each challenge of NCD, while helping their loved ones to maintain their independence as much as possible.