Hearing Voices

One of the more common symptoms of schizophrenia, particularly paranoid schizophrenia, is hallucinations of some form. Hallucinations always involve one of the senses: sight, hearing, touch, taste, or smell. When a person is hallucinating, he/she is experiencing something related to one of his/her senses, but the experience is not caused by anything that is actually there. It is, essentially, in his/her mind but not part of reality.

What the voices are like

Most of the time, the hallucinations experienced by schizophrenics are auditory in nature, which mean they are hearing something. These are usually in the form of hearing voices. Schizophrenics may believe they are hearing two or more voices, such as people having conversations or several people talking to them. Or, they may hear one voice. To the schizophrenic, the voice or voices seem very real. They often have no insight into the fact that it is a hallucination.

Often the voices are commenting on the schizophrenic’s thoughts or actions. And to make it even more distressing, the voices may be threatening or disparaging. Sometimes the voice or voices are familiar, but this is not always the case.

Command hallucinations

Another fairly common experience with regards to the voices is that they tell the schizophrenic to do certain things. Clinically, these are referred to as “command hallucinations”, and in some cases they can cause significant problems. The voices may tell the schizophrenic to harm or kill himself/herself or to harm someone else. Because the voices seem very real, they can be very compelling, making it difficult for the schizophrenic to resist acting on the command.

Disassociated from own thoughts

Normal people often “hear” their own voice in their head as they are thinking, or may be replaying something in their mind said by someone else. But we recognize that it is still part of our own thoughts. Schizophrenics, on the other hand, experience the voices as separate from his/her own thoughts.

Treatment for hearing voices

Typically, hallucinations are treated with neuroleptic medications. Neuroleptics (and the newer atypical neuroleptics) are antipsychotic medications. While every individual is different, in many cases medication will at least reduce the experience of voices, or alleviate them altogether. However, in many cases the voices will eventually return at some point if the person stops taking the medication.

by Dr. C. Lane, Psy.D.

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