Schizophrenia: Coping With Delusions and Hallucinations
Simple and practical advice on the day-to-day management of schizophrenia.
Updated June 23, 2024 | Reviewed by Ekua Hagan
The symptoms of schizophrenia are manifold, and present in such a variety of combinations and severities that it is impossible to describe a "typical case" of schizophrenia.
The so-called "positive symptoms" of schizophrenia consist of psychotic phenomena (hallucinations and delusions), which are usually as real to the schizophrenia sufferer as they are unreal to everybody else.
Positive symptoms are usually considered to be the hallmark of schizophrenia and are often most prominent in the early stages of the illness. They can be provoked or aggravated by stressful situations, such as succumbing to a physical illness, breaking off a relationship, or leaving home to go to university.
Psychiatrists define a hallucination as "a sense perception that arises in the absence of a stimulus." Hallucinations involve hearing, seeing, smelling, tasting, or feeling things that are not actually there.
The most common hallucinations in schizophrenia are auditory hallucinations—hallucinations of sounds and voices. Voices can either speak to the schizophrenia sufferer (second-person, "you" voices) or about him (third-person, "he" voices).
Voices can be highly distressing, especially if they involve threats or abuse, or if they are loud and incessant. (Carers might begin to experience something of the distress of hearing voices by turning on both the radio and the television at the same time, both at full volume, and then trying to hold a normal conversation.)
On the other hand, some voices—such as the voices of old acquaintances, dead ancestors, or "guardian angels"—can be a source of comfort and reassurance rather than of distress.
Delusions are defined as "strongly held beliefs that are not amenable to logic or persuasion and that are out of keeping with their holder's background. Although delusions need not necessarily be false, the process by which they are arrived at is usually bizarre and illogical. In schizophrenia, delusions are most often of being persecuted or controlled, although they can also follow a number of other themes.
Positive symptoms correspond to the general public's idea of "madness," and people with prominent hallucinations or delusions may evoke fear and anxiety in others. Such feelings are often reinforced by selective reporting by the media of the rare headline tragedies involving people with (usually untreated) mental illness.
The reality is that the vast majority of schizophrenia sufferers are no more likely than the average person to pose a risk to others, but far more likely than the average person to pose a risk to themselves. For example, they may neglect their safety and personal care, or they may leave themselves open to emotional, physical, or financial exploitation.
How to Deal with Delusions and Hallucinations
For obvious reasons, there is little in the way of self-help that people can do to address their delusions—other than, of course, engaging with their carers, care team, and treatment plan.
But there are a few simple and fairly effective strategies for managing distressing or dangerous auditory hallucinations—although I should stress that they are no substitute for more formal care, which should be sought at the soonest opportunity.
If you’re assailed by voices, try some or all of the following:
Psychotic symptoms can also be extremely distressing to carers.
Carers typically find themselves challenging their loved one’s delusions and hallucinations, partly out of sympathy and compassion, and partly out of understandable feelings of fear and helplessness.
Unfortunately, this can be counterproductive, insofar as it can frustrate and alienate their loved one at the very time when they are most in need of support.
Difficult though it may be, carers should remind themselves that their loved one’s experiences are as real to them as they are unreal to everyone else.
A more constructive, less confrontational approach for carers is to acknowledge that their loved one’s symptoms are meaningful to them, while making it clear that they themselves do not personally buy into them.
It can be a very fine line to tread.
"The devil told me that I'm to blame for everything that's happened."
"Are you hearing him now?"
"No, he's just stopped talking."
"What else did he say?"
"That I'm a very bad person and don't deserve to be looked after."
"Has he been telling you to harm yourself?"
"No, he hasn't, although I sometimes feel as though I should."
"Would you actually harm yourself?"
"No, no, of course not."
"Gosh, this all sounds terrifying. How are you feeling?"
"I've never felt so frightened in all my life."
"I feel your pain, although I myself have never heard the devil you speak of."
"Didn't you hear him earlier on?"
"No, not at all. I've never heard or seen him."
"What about all the evil spirits?"
"No, I haven't heard them either, not at all. Have you tried ignoring all these voices?"
"If I listen to my iPod they don't seem so loud, and I can actually hear myself think."
"What about when we talk together, like now?"
This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.