"Pseudohallucinations" vs "True Hallucinations"

[Steel Maiden]

I've never personally been labelled as having "pseudohallucinations" (my psychiatrist writes "hallucinations" when she refers to my visual/auditory ones), but I do know some people that have been.

What do you think about these two terms ("pseudohallucinations" and "true hallucinations")? I would like to know if there is any neurological difference between the two - surely they're both the result of overactivity of certain neurotransmitters (serotonin and dopamine come to mind)? Or am I wrong?

I personally do not like the usage of the term "pseudohallucinations", because it makes them seem "lesser", just because the person knows they're not real, does that really make it easier to cope? And anyhow, my psychiatrist said I suffer from hallucinations, she never mentioned the "psuedo-" term, even though at the moment I know they're not real (although I lose the insight when I relapse....).

I would like your views.

Sorry if this post doesn't make sense.

[whirlpools]

My understanding (and I'm sorry to not be more specific, I don't have any scientific knowledge, just experience) is that psychotic experiences can have a psychological or biological cause (or both in my situation). The latter would be the result of dopamine. The former is likely to be the effect of one's environmental past experiences of the world around one.

My personal experience of pseudohallucinations (though this has never been diagnosed, to my knowledge; I hear ANY kind of 'voice' very rarely as my difficulties are usually around delusions) is that I heard voices inside my head, rather than externally. I believed they were not a part of me, and they became more part of the delusional process. I know that some people, though, hear voices externally from themselves and know they are 'not real', and would sometimes be diagnosed with pseudohallucinations. The term 'non-psychotic hallucinations' is being used increasingly as it's a more compassionate and validating way of describing what is happening.

Psychotic experiences with a psychological cause are less likely to respond to antipsychotic medication than those with a biological cause (not including more treatment-resistant forms of biological psychosis).

My understanding and experience of different sorts of professionals is that the view of what is happening can differ between types of professionals/schools of thought. Psychiatrists in my life have been generally more likely to take a 'medical' point of view on psychotic experiences, ie. see the biological factor, with psychotherapists taking a view that they are parts of the unconscious mind/thoughts/feelings breaking through for whatever reason. That is a generalisation, though, and increasingly all professionals are trying to see the whole picture.

Like I said, I have very little real knowledge of all of this to go on; only my experiences, so I'm sorry if what I have said has muddied the waters.

[shadow-light]

I expiriance somethings that are currently been put down on my file as "pseudohallucinations", though they are still looking into what they are. THe GP sent me to the early intervention team, but they said that for now they are just going to keep an eye on it as they think that most of my expiriances are PTSD and dissociation related, and the ones that might not be are not at the level that they would need to be for them to help me as I am aware that they are not real and I am able to ignore the things that they say most of the time.


I will admit when they first said "pseudohallucination" I thought it meant that they thought I was making things up or being overly dramatic or something... but they told me that that is not the case, that they just need to differentiate for treatment reasons.


I am not sure what I think of the term now... I hope that people understand that even though 99% of the time I know that they are not real they re still distressing. I think personally I would prefer it to be pseudohallucinations and hallucination, the "true" or "real" makes it feel like the alternative are fake or something...

[Steel Maiden]

Thanks both of you. That makes it a bit clearer. I think my psychosis is definitely neurological. I often struggle to understand psychology behind things, and see deeper meanings. If someone was diagnosed with a type of psychological psychosis, what would their ICD-10 code be? Just wondering as I find it easier to understand the clinical side of things. Your posts have been helpful.

[beautiful_seclusion]

Yeah I think the terminology is a bit misleading. Especially since you can have "pseudo" hallucinations for non-environmental causes. Hallucinations are really on a gradient of severity anyway, and I think just labeling them only when they distress you and not differentiating would be more helpful.

Also, a thing I don't get is that even if something is "psychological", it's still changing how the neurons in your brain function. Emotional/sexual abuse, for example, has physical implications on the way your brain is structured even if no other parts of your body are harmed. Whether that's a specific neurotransmitter or a way of connecting, environmental causes still change the physiology of your brain. It still has physical consequences.

To me mental illness with an environmental cause is still a physical illness just like a mental illness that was caused by something a person was born with, and to treat it as such might help rid some of the stigma. The reality is most mental illnesses are a combination of both; it's impossible to determine what's an environmental cause and what's non-environmental. You'd have to know every change in the neurons from every single experience and compare it to what you were born with. But then that brings up the issue, what about before you're born? Conditions in the womb can affect development, so is there really a point where you can say something is "nature" or "nurture"?

That's my take on psychology anyway, that it's really just a biological phenomenon that can't currently be as well explained as what we call "biological causes". They're all biological; we just know more about the mechanisms of some than others.

[foxfly]

Beautiful_seclusion, I think a lot of what you said makes sense, and I really appreciate all the thoughtful and considered replies on this thread.

In my own experience, I have been told I have pseudo-hallucinations, because I see and hear things that are not there, but I know they are not there. After having a lot of therapy I've realised that I see these things due to my extensive history of sexual abuse, and that a lot of my hallucinations are my brain's way of processing flashbacks. For example, a lot of the voices I see repeat things abusers have said to me in the past.

When I first sought help for my problems, I was given two different kinds of anti-psychotics, both of which did absolutely nothing to help my pseudo-hallucinations. I suppose this was because they are a form of flashback? It was something I found frustrating at the time, particularly because my psychiatrist seemed to lose interest in me when I said the anti-psychotics were not helping. The only thing that has helped is therapy to deal with the flashbacks/trauma. It hasn't reduced my pseudo-hallucinations to any great extent, but it has made living with them less painful.

[Steel Maiden]

I agree with your idea that all "psychological"/"emotional" things are actually biological/neurological. I never really understood how an "emotional" issue could be distinct in any way from what your neurons are processing.

[whirlpools]

I don't think that the result is different, but because the cause is different, psychological symptoms may respond in a different way to biological symptoms. I mean, that's a really black-and-white way of viewing it, but I *think* that's what professionals have in mind when they generally refer someone whose symptoms are mainly environmentally caused for therapy, whereas where biology is the main cause, it tends to be medication.

Like I said, though, life's not that black-and-white, and psychiatry isn't an exact science.

It's like, I have this theory that paranoid schizophrenia and other psychotic illnesses must have some environmental factors in play, otherwise how else would one explain why some people have mainly paranoid delusions and others have mainly grandiose delusions (that said, mood congruence could come into it). Like, why do some people have more religious delusions and others more 'electronic' ie. microchips, cameras and stuff. I think there's often something cultural there.

[beautiful_seclusion]

Well as far as treating "psychological" vs "biological" mental illness differently, I view that as because we don't know the physiological mechanisms for the former, whereas we do (although very crudely) for the latter. The brain is so complicated, and its so hard to study things like mental illness. Neurotransmitters are things you can measure at least to some extent (often indirectly by finding what neurons that release x neurotransmitter are activated in what conditions, but neurons can release more than one type), but specific location of ion channels, ways in which neurons connect, patterns of dendritic spines, etc., are much more difficult on a macroscopic scale, especially when relating to living organisms experiences.

Especially since you're quite limited ethically in humans, and its hard to argue for much psychology in animals like rats/mice. Basically I don't think that problem will go away until there is a technique to measure such tiny and intricate things on people in a non-invasive, non-harmful way. Not to mention an average adult has about a billion neurons, so even if you could measure such things, the computational power of your measuring technique would have to be enormous. Not to mention you'd have to compute on innumerable subjects to average the nuances of neuronal organization/physiology to actually know why a non-neurostransmitter related illness is as it is let alone how to treat it.

That's also the reason medications don't always work even for illnesses like schizophrenia or bipolar where they can work great, because each individual was born with different physiology and then each individual had different experiences. Even a tiny experience can drastically change how your body does things. Another issue is that your body tends to compensate when a foreign substance is put in it, and that causes medications to sometimes stop working. You also have the issue that even if its an issue with the amount of neurotransmitter in your brain, neurotransmitters aren't these black and white levels of chemicals that your body just puts out. They are very complicated, very different in different areas of the brain, can affect networks entirely outside their own network (they're called neuromodulators), and medications most often target either what the neurotransmitter binds to or what degrades it rather than the neurotransmitter itself, which leads to so many complications that it really makes sense why medications are so hit and miss for mental illnesses. You also have the issue of diagnostics being so subjective, all based on another human's interpretation of a person's self-reported experience.

So yeah, I really see psychology and psychiatry as the same thing, just that we know slightly more about psychiatry on a chemical level (although like I said, not as much as you'd think). And I imagine you're right, that something like schizophrenia that you are born with is probably affected by environment too. Because even if you have schizophrenia, you're going to also be having your brain change constantly in response to environmental stimuli, and that's going to affect how your mind processes the delusions/hallucinations in schizophrenia.

So sorry for the essay. This is the field I'm going into, and I really find it fascinating. It's such an interesting subject and we really know so little about it.

[Steel Maiden]

That was an interesting post. I agree that psychology and psychiatry are the same thing. Besides nothing happens in the brain without a neurotransmitter or a nerve action potential.

[beautiful_seclusion]

^I definitely agree. Thanks, I'm glad it wasn't annoying.

One interesting thing is the visual system. Its amazing how although you have receptive fields (what area of stimulus a specific neuron will respond to) for simple locations of vision, the deeper you go into the cortex, the more abstract the receptive fields are. Like certain neurons will only send an action potential in responses to say specific colors or even faces you recognize (I think I'm lacking in those neurons lol).

So although emotions are not the visual system, I'm sure if we had a better way to test it, we'd find it works in the same way. Most things with sensory systems are done in simple animals like bees or flies. But you can't measure emotion/psychology in them for the most part. (Although there's a really interesting one where a bee learning via classical conditioning showed a huge increase in octopamine, which is a neurotransmitter that has a lot of neuromodulatory effects)

Unfortunately things like fMRI that you can do on humans can't tell us a whole lot, since it's only measuring oxygenation of the blood, which is only indirectly associated to neuronal activity. Yet that's pretty much the only way to study emotions right now, and even assuming it is representative of activity, activity doesn't always equal strict association (neuronal activity can have an inhibitory effect), and it's at such a large scale comparative to cells that you really can't tell enough to actually tease out the physiological aspects of it.

I really hope within my career a way is found to study emotions/psychology/behavior more accurately. I particularly think ion channels are fascinating and they have been shown to have effects on a lot of disease.

[Vanished-point]

Quote:

Originally Posted by reappear

It's like, I have this theory that paranoid schizophrenia and other psychotic illnesses must have some environmental factors in play, otherwise how else would one explain why some people have mainly paranoid delusions and others have mainly grandiose delusions (that said, mood congruence could come into it). Like, why do some people have more religious delusions and others more 'electronic' ie. microchips, cameras and stuff. I think there's often something cultural there.

You are a correct on some level, environmental factors do play a huge role but the delusions aren't consensus. Delusions of grandiose is one thing, delusions of persecution is another and deluded people have their own levels and stages.

An Atheist who begins hearing voices in their head claiming it is God and to spread the word of God throughout the land, doesn't have relation with the environment itself, since the Atheist had no belief from the start. The environment did not impact his fixed beliefs, but the voice will alter his factors into a fixed delusion of grandiose.

There is also a psychological disorder known as Scrupulosity is which the belief of God and his morals are being inflicted and held against you if you do anything wrong at ALL, including superstitious acts, but that category falls under OCD which would be dealt with by ritualized and compulsive praying.

I would know because I have OCD (including prayer rituals) and I'm not even that religious at all, but I am compelled to pray to prevent anything bad happening.

I'm dealing with persecutory delusions myself, and it certainly does suck.

[Steel Maiden]

Beautiful Seclusion, I can relate to not being able to recognise faces (prosopagnosia). I think your studies are very interesting and I hope they go well. Your post was very informative. I think more research into emotions is a good idea.

LSD is said to increase the amount of serotonin produced in the brain, which causes hallucinations, hence why 5HT2 antagonists are said to be helpful with hallucinations in schizophrenia.....the olanzapine I take is a D2/5HT2A antagonist.

I'm also intrigued at the mechanism of aripiprazole: a D2 partial agonist, it may be a step towards finding a drug as efficacious (or more!) than clozapine, but without the side-effects.....although clozapine is also a D1 antagonist....