Warning! You Might Be Delusional: How Hallucinations and Delusions Affect Healthy People (and why they aren't all bad)

Wednesday, November 01, 2017 by Meg   •   Filed under General

"You're delusional! Did the voice inside your head tell you that?"

Last week, this was actually said to me during a disagreement, though I'll get to the why in a minute.

While I suspect, but am not certain, that I was the only one in the conversation who could read, I am very certain that I am the only one with a psychology blog where it would be completely appropriate to bridge such a topic.

Checkmate, motherfucker.

"I'm the king of the world," and other delusional assumptions can have serious consequences for individuals experiencing them. But there is a difference between thinking you're the king of the world and feeling the crown on your head, and it may not even affect you until you believe that your skinny ass will survive on a door in an ocean of ice. 

But here's the thing: hallucinations and delusional thoughts are way more common than we think. You probably have a few of your own.

This blog should not be taken as medical advice. Anyone experiencing hallucinations or delusions should seek professional assistance.

The terms hallucinations and delusions seem to be used interchangeably in social conversation. Then there are statements like, "Dude, I am totally tripping my balls off," which may refer to hallucinations, delusions or a combination of both that occur simultaneously, depending on the speaker. 

For the record, there are a few differences between hallucinations and delusions. Let's start with the ones that are less common in healthy people.

Hallucinations

Hallucinations are usually divided into five main categories:
1. Seeing things that are not really there
2. Hearing things that are not really there
3. Feeling things that are not really there
4. Smelling things that aren't really there
5. Tasting things that aren't really there

As an illustration, it's the difference between:
1. I see a dancing orange over there!
2. Why do I hear someone talking about oranges? 
3. My arm feels like it is covered in orange juice!
4. It smells like oranges in here!
5. Damn, I taste oranges.

Some people have a combination of these types of hallucinations at once, perhaps experiencing a dancing, singing orange tapping across their arm. Sounds fun, right? It isn't, not usually anyway, though acid lovers may disagree. 

In many cases, the orange is a negative fellow, with hurtful words and actions. Picture an orange coming after you with a knife, while he talks smack about your mother. You get the gist.

Causes of Hallucinations

Researchers believe that during our evolution from hominid to Homo sapiens, a change in brain structure allowed the separation of thought from speech output (talking). This change also separated meaning from speech input.So, we suddenly had a more abstract process which enabled us to consider things like the future, the nature of the world and concepts such as God, all things that those before us were unable to do. However, this may have also paved the way for hallucinations when the boundaries between the regions break down, as they do in schizophrenia1. Research has shown that there is a reduction in grey matter in the brains of schizophrenic patients 2, as well as increased connections between temporal, prefrontal and anterior cingulate regions in the brain. 

Obviously, there are quite a few triggers. Here is a list of the more physical causes 3.

Quick and Dirty Causes of Hallucinations:

  • Psychotic conditions like schizophrenia or schizoaffective disorder
  • Malformation of brain structure
  • Trouble with neurotransmitters (chemical relay systems)
  • Delirium: This one is most commonly associated with medical conditions or alcohol/drug overdoses. Think high fever, confusion and a lack of awareness of surroundings.
  • Dementia, either in relation to Alzheimer's, Dementia with Lewy bodies (DLB) or Parkinson's disease; may be related to structural problems in the amygdala and parahippocampus
  • Posterior cortical atrophy, brain damage 
  • Increased excitability in certain brain regions
  • Charles Bonnet syndrome, or visual hallucinations in the visually impaired
  • Anton's syndrome, where those with visual blindness deny they have vision loss
  • Seizures or irritation of brain regions, that usually involve brief flashing lights or spots
  • Midbrain infarction
  • Lesions or tumors, such as those in the temporal lobe
  • Genetic metabolism issues, or defects along certain metabolism pathways
  • Creutzfeldt-Jakob disease, a rare and fatal disease triggered by an infection in the central nervous system

The physical brain changes present in the above are not generally seen in cases where healthy individuals just happen to hallucinate, though researchers still believe that brain regions including the anterior cingulate may be involved in some hallucinogenic experiences. 
 
"Um....did you say healthy people who hallucinate? What have you been smoking?"

More Common Causes of Hallucinations Among Healthy Individuals:

  • Sleep disorders may lead to trouble separating reality from dream state upon waking
  • Migraines may involve an "aura" type hallucination around objects, flickering lights or zig-zag hallucinations, though more complex ones may occur
  • Drugs including mescaline, PCP, ecstasy, atropine psilocybin,and LSD mess with serotonin and 5-HT2A receptors, though researchers note that the ability to produce hallucinations may depend on how the individual feels before they take it and the amount of the drug taken3 
  • Psychodynamic causes, or outward manifestations of unconscious thoughts

That sleep thing, many of us have experienced. While some may realize that they are dreaming, many have partial hallucinations upon awakening. Studies show that women, but not men, who are awoken from REM (rapid eye movement) sleep tend to have more difficulty distinguishing between things happening in the environment and things happening inside their heads until they are fully awake2

This is yet another reason for everyone to leave us the heck alone while we're resting. 

"I'm sorry I punched you in the face, honey. My anterior cingulate region was still being stimulated when you decided to poke me and ask me about your socks."

Even in the absence of sleep issues, drugs or migraines,"normal" people can still have these experiences. All hallucinations are not of the orange variety. According to a review of research conducted by Dr. Patricia Boska, and published in the "Journal of Psychiatry & Neuroscience," 7%-30% of children and adolescents experience hallucinations. Furthermore, one-third to one-half of bereaved spouses experience hallucinations of the deceased, probably as a part of that psychodynamic thing, an outward show of strong internal desire. 

Hallucinations can also be induced fairly easily in healthy adults using sensory deprivation, such as placing halves of ping-pong balls over the eyes and playing sounds of waterfalls2. Whose brilliant idea it was to use ping-pong balls in that study I have no idea, but now frat boys everywhere have a great new party trick. 

You're welcome. 

Unfortunately, while some brain regions can be linked to hallucinations in both healthy individuals and those with issues such as schizophrenia, they cannot be shown to definitively cause the hallucinations, making the issue harder to treat. 

Then, there are delusions, which can be slightly more obscure because of the complication of perspective.

Unhealthy Delusions

Many of the physical causes of hallucinations listed above can also trigger delusions. Delusions are the belief that something is absolutely true when it is not based in reality. Often these beliefs cannot be shaken, and can involve a range of ideas surrounding one theme or a series of themes.

Here are some illustrations in keeping with the original model:
1. "I am the king of the oranges! Bow down to me!"
2. "Oranges are out to get me and will be my demise. I must hide."
3. "I was grown in a lab as the third generation orange/human hybrid, the most delicious and fruity entity ever to walk the planet."
4. "Someone keeps planting thoughts about oranges inside my brain."

Obviously, these are not the truly frightening ones that befall most individuals with delusional thoughts, though it probably works as an overall illustration. 

It also avoids the inadvertent complication of laying out a ton of potentially scary things for people to read about.

The delusions that tend to cause a great deal of trouble in daily life are usually (though not always) those thoughts that are more negative. In unhealthy delusions, governmental control themes are very popular as are religious themes. And in most cases where scary delusions are present, therapy doesn't work too well at first, mostly because paranoia and distrust are major players. 

Often in these cases, family members notice the individual pulling away first or becoming more and more distrustful. Changes in the functioning of a loved one should be addressed as soon as possible, particularly if one suspects a delusion may be to blame. For those with deeply ingrained scary delusions, drug therapy is often necessary to help decrease the frequency and improve quality of life for those dealing with these issues. 

Healthy People Delusions

So, some delusions are obviously detrimental and may be triggered by actual changes in brain structure. But, delusions are a tricky thing, because of the importance of subjective thought. What constitutes a delusional thought pattern varies depending on common knowledge at the time. Galileo was considered a delusional guy when he dared to propose that the Earth may not be the center of the universe. 

"Whoops. Our bad?"

While we don't call them delusions per se, individuals engage in delusional thought patterns all the time. Ku Klux Klan members firmly believe, in an unshakable way, that other races are absolutely below them, despite evidence to the contrary. While this has obvious negative implications for society at large, we don't consider them delusional, we just consider them assholes.

For the record, if you happen to inform a bigot that Jesus was probably darker than the blonde-haired blue-eyed dude on his T-shirt, it is possible that he will respond with:

"You're delusional! Did the voice inside your head tell you that?"
It is equally likely that if you scream, "Yes!" and cover your ears, people will walk away before shit escalates. 

Just in case you wondered. 

Turns out that although some of us might feel better if the KKK grand master was locked up in a psych ward and unable to reproduce, once you say something like that, the bigots assume that it must be you who is the delusional one.

Everyone is a little bit delusional according to someone.

The point is that delusion is sometimes a matter of perspective, and its treatment is usually based on the affects that the disturbed thought patterns are having on the life of the one experiencing them. Delusions are not all bad. If I have the mistaken belief that I'm the best ping-pong player in the world, it's unlikely to hurt me that much as long as I don't play against someone who happens to be better. Then all bets are off. 

I have also met those with positive beliefs that were not based in reality as most of the world saw it. Say some guy has a firmly held belief that the tree in his backyard is always watching him, and for whatever reason this makes him feel good about himself. Say the tree also whispers to him at night and encourages him to do his best, often praising him for things he did well during the day. It might be hard to force someone to get treatment for such a belief, particularly if they are functioning well...and why would you really want to? 

While the belief may be suspect based on the fact that only one guy thinks it's true, it isn't always the size of the following that leads to rightness or wrongness. Consequences matter when deciding to challenge thoughts, and rightness doesn't always lead to happiness. What ends up mattering is how any person sees themselves and the world around them, and how whatever thoughts they have can be used to their advantage instead of as a hindrance to their health or their life. And unlike in cases of unhealthy or scary delusions, more positive patterns can be used as an advantage in treatment. 

A novel approach, perhaps, but hey, I'm a little delusional, right?

 Stretching Definitions: Delusional Negative Thoughts

Now, this exercise won't work for everyone. However, for some, hearing that the things they think are blatantly false and even delusional can be helpful. If you stretch the definition of delusion a little, even negative thought patterns or anxious scary thoughts would fit. 

Let's play a game: You take a negative thought about yourself, and I'll tell you it's delusional. Sounds fun, right?

Okay, criteria for delusion:

  • Belief that an idea is true
  • Idea is not reality based
  • Trouble shaking the belief

Since I can't actually hear anyone right now (or can I?), I'm going to pretend I hear the following:

"I'm a terrible mother, I'm a failure as a parent."

Many hold onto this belief every day and quite a few have trouble shaking it. But guess what? Are your children living? That's really the evolutionary model of good motherhood. Will they likely survive into adulthood? Do they even seem to like you sometimes, even prefer you in times of stress? Yes? Ok, great. Then the thought is delusional. Congratulations. Are you motivated to change it now?

"I'm not delusional, I just have a negative self-image!"

While this is a stretch of delusional thought patterning, it's an interesting perspective to consider for those trying to find ways to challenge negative thoughts. Luckily, negative thought patterns are easier to treat than pervasive delusions, especially if the cause is a change in brain structure that may need to be treated with drug therapy. 

The more ingrained a thought or belief is, the harder it is to alter, and the more help you need to do so. Obviously, threatening or otherwise negative hallucinations and delusions can be terrifying for those experiencing them. For most, professional assistance is necessary to bring them under control. If you are experiencing hallucinations or delusions for any reason, seek professional assistance.

Acid lovers out there probably should too. 

Related Posts: 

Citations

1. http://www.ncbi.nlm.nih.gov/pubmed/16571578
2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702442/
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660156/




Topic-Relevant Resources

The Moral Animal
Journalist Robert Wright explores human nature from the perspective of evolutionary psychology.

Emotional Intelligence (why it can matter more than IQ)
Studies on emotional function, social prowess and their influence on success

Mindsight: The New Science of Personal Transformation
New techniques for mindfully altering the wiring of your own brain, leading to increased happiness.



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