(READ THE KARON ARTICLE ON Bb -- FOUND IN MODULE 9 -- THEN READ THIS AND POST)
Historically, people with schizophrenia have been told that their symptoms (i.e., hallucinations) need to be medicated away. "Once you are stable, then we can address your other needs..." This week, as we consider deinstitutionalization and people's rights in the community, often it is hallucinations that mark people as "other" or "crazy." Hallucinations can be very stigmatizing.
The recovery movement offers a different narrative. One does not have to be "stable" and "symptom-free" before recovery can begin, quite the opposite in fact. The community is a place one can recover and learn to advocate for rights. One can have symptoms and live well in the community.
What if hallucinations were recast as unconscious needs? What if people in the community, family, and support professionals viewed hallucinations not as an aberration, but as communication? We all have dreams, and some of us even dabble in dream interpretation....what if hallucinations are just waking dreams? What if a recurrent theme in a person's hallucinations means something? A need breaking through into wakeful consciousness?
If we viewed hallucinations as communication, would we still want to medicate them away? Would people be seen as "crazy" by providers and/or society at large?
Reply with your reaction to this premise (using hallucinations in therapy), and the questions above. Then reply to at least 2 of your classmates' posts.
There are many cultures that historically have sought out those who hallucinate and value their hallucinations as being insightful. While the content of some hallucinations may be frightening to some, hallucinations in and of themselves should be viewed as a form of communication. I think many people hallucinate as a coping mechanism to a traumatic event. Recurring themes can be used therapeutically to get at the root of the trauma to develop healthier alternative and long lasting means of recovery.
ReplyDeleteKen, I think this class has made me feel less anxious when working with people with Schizophrenia. Just today I did an intake with a person who experiences psychosis. I felt more comfortable asking him about these experiences. He said that he has heard voices his entire adult life. I must admit I was interested in this, where as in the past I would have moved quickly past the comment. All I could muster up was the question “are the voices good or bad?” Not a great question…I know, but he did respond that the voices were mostly bad. He said that the voices typically contributed to his paranoia and mistrust of people. It made me think of his past or possible trauma that he experienced that may be linked to this feeling. He said that in the past he has reacted to the voices to protect himself which usually meant leaving the situation. Today, he said that a combination of Seroquel and Thorazine make the voices more manageable. He said that he absolutely needs these meds to cope. I asked him if he has ever had talk therapy to explore any of his voices. He said that he has not. He has only had medication management.
DeleteKen, your point about historical views of hallucinations is really interesting. You raise a great point that society plays a strong role in determining that hallucinations are somehow a problem. When viewed as communication, we are much more able to interact with each other.
DeleteKen,
DeleteYou provide a nice summary of the content from the Karon article. I agree from the limited experience that I have working with people who have been diagnosed with schizophrenia, that trauma is of major influence to their hallucinations. I really appreciate Karon's conceptualization of hallucinations much the same as we view dreams- as having symbolic meaning that is subjective to the personal experience of the person having them (as opposed to a universal symbol).
Kenneth, thank you for the reminder regarding the use of hallucinations in various cultures. I grew up in Montana where Native American tribes and cultures were a big part of the literature, history, and traditions that I experienced. I loved that the Native American stories included the such beautiful imagery and symbolism, and I thought it especially amazing the way in which they celebrated and made significant decisions based on their hallucinations. This is something that I have carried with me, and although I have not had hallucinations to any great degree that I recall, I do find meaning in my dreams and gut feelings and use them to make important decisions. I believe that our bodies and brains find a variety of ways to help us makes sense of the world and make decisions that lead us to health and happiness. It is when we ignore these signals that we begin to get off track with our health and happiness. Because these makes such perfect sense to me, I wonder where it is that we have gone wrong and what led us to having such a negative, stigmatizing view of hallucinations. What aspects of mental health history have led us to so heavily rely on the use of chemicals and medications?
DeleteWHUT???? It’s interesting to think that hallucinations can be used to understand the people who experience them. I think the knee-jerk reaction is to assume anything that isn’t “reality” is at the very least a distraction or at worst could be considered a danger. It sounds like medicating away a schizophrenic’s hallucination may be getting rid of the very tool that necessary to treat the individual, if treating the individual is even necessary to begin with. After reading this article one could argue that medication to treat hallucinations could be considered mal-practice. It’s like surgically removing someone’s immune system. As counselors how can we help a person change if we have no way to understand them? This must not be a very accepted or popular method to treat schizophrenia? Or maybe it just me?
ReplyDeleteReading your comments about malpractice reminded me of a client I worked with about 10 years ago. He was a 14 year old boy who lived in a therapeutic residential home and would hear voices, often urging him to make unsafe choices. I know it is easy to read new material and viewpoints - as hindsight is always 20/20 - and cringe at the mistakes of the past; because at the time licensed and experienced professionals thought we were responding appropriately. But when that teenager would hear voices, protocol was for him to leave the milieu, go to his room, write them down, and save them for only his therapist to review. I remember discussions of increasing his Haldol prescription when hallucinations became more frequent. A couple times he did want to talk with the staff he trusted the most, who could help him process his feelings in real time. Now all I can think about is this child who could have been supported in a more meaningful way.
DeleteI like your point about how medicating someone's hallucinations away is like removing their immune system. I think people often have a lot of tools and strengths to cope with whatever they are going through but they may need to be empowered to do so. I think that has been taken away for a lot of people who are hallucinating or experiencing these similar symptoms. Experts have tried to impose treatments, medications, etc. that just are not always that effective. I don't want to completely dismiss the role medications can play, but I think a different approach that seeks to understand the hallucinations and the root of them seems reasonable.
DeleteDustin, your story is so sad! The idea that only the therapist has the skill to treat the child undoubtedly made sense in the wisdom and philosophies of residential treatment 10 years ago. It is very much a "medical model" way of thinking. I still see a good deal of that today in some residential and hospital settings for kids. I think you're right that it's too bad this child missed out on an opportunity to receive support and acceptance from staff who were with him at the time he experienced the hallucinations. It's also too bad the staff missed out on the opportunity to interact with him during times of hallucinations.
DeleteGeoffrey,
DeleteMy impression is that we are on the cutting edge of something here at USM, and I feel grateful to be a part of this trend in the treatment of mental illness. I think I have long been unsure of how I would approach those with shizophrenia in a therapeutic setting, but this article is a game changer for me. I hope that this is more commonly talked about in graduate programs around the country/world, as I am certain that the outcomes of many clients depends upon it.
I have been working with a gentleman for about 3 years in a therapeutic work milieu. He is a handsome, middle aged man, with many skills and a persistent desire to be helpful and busy. He is also a person who hears voices talking to him and occasionally sees people or animals. He will often be in the middle of a task and respond to his history teacher from middle school. This man is smart and capable but sometimes his dual diagnosis inconveniences his progress with employment.
ReplyDeleteOur reaction to hallucinations could be cultural stigmatization that is further fueled by our choices for horror movies and scary stories. We could be writing a dangerous myth that hurts people who are processing trauma through audio and visual hallucinations. Hallucinations can be chemically induced, toxically induced, or trauma induced. The man who I mentioned in the previous paragraph had a severe addiction to street drugs and has been hallucinating since his mid 20’s and is diagnosed with Schizophrenia. He is accepted by his local community and is well liked by most people who know him. He was working in a Humane Society as a maintenance man and he was having hallucinations of a pile of dead dogs thanking him for keeping their area clean. I wish I had read this article because I did not talk with him more about his visions and I redirected him.
Could hallucinations be condensation or manifestations of wishes or unmet needs? It makes sense to me and according to this reading, many symptoms reduce or go away after they are discussed. It is fine to dream when you are sleeping, why not dream when you are awake?
Medication is a tool to use when it is safe and effective. Hallucinations may require medication, CBT, or talk therapy depending on the individual and how his/her health is influencing his/her daily life. The man in this post, has hallucinations daily and goes on with his day which does not require being medicated away, however, if a person is having self-injurious or dangerous to others thoughts then medication may be desirable.
I agree that treatment is completely individual based even with schizophrenia. After reading this articles Its eye opening to see that their are so many other therapy options that are successful with some individuals with hallucinations, but that is not society's narrative when it comes to the disorder.
DeleteLike Michelle wrote, I think you're right that treatment should be individualized and that just because someone may have a diagnosis of schizophrenia, it does not have to mean a heavy dose of anti-psychotic medication. And Toni brings up another great point about the community support and how that perhaps has impacted his symptoms in a positive manner. Being exposed to different ideas such as viewing hallucinations as something to be analyzed and embraced as a part of the recovery process is really empowering as a professional. I think there is a lot of fear that exists in our society still around mental illness, and in particular disorders such as schizophrenia. It can be easy to fear what you don't know or understand. That's why it's exciting to hear more about approaches that are less fear-based.
DeleteLiz- Your story about the man you work with encourages thoughtful consideration about people with Schizophrenia diagnoses and impact on their lives. It seems like Schizophrenia is a diagnosis that people assume must result in medication to manage. As you pointed out, medications and CBT may be valuable tools for people with symptoms that may have significant impact on safety for the individual and others. On the other hand, some may not need it or choose that path. I like how you discuss acceptance of people with a diagnosis that is considered severe mental illness. I wonder if this man's acceptance by many in the community has had a positive impact on his symptoms.
ReplyDeleteI suppose when people think about hallucinations, they probably tend to associate them with diagnoses like Schizophrenia. To be honest, I tend to think of hallucinations as being related to trauma, which is based on my own experiences as a foster/adoptive parent and my previous residential experience. The approach taken in the Karon article provoked thought around how hallucinations are viewed. The article raised questions around treating hallucinations more as dreams and asking the person to describe them in detail. It made sense to me to view hallucinations as serving a useful purpose. It also made sense that the hallucinations may go away once the purpose was served or the hallucinations were processed in counseling.
ReplyDeleteFor a few years I had a young man living in my home who experienced constant hallucinations. He often heard voices and sometimes had visual hallucinations. He occasionally smelled, felt, and tasted things that seemingly weren't there. There were questions of Schizophrenia. He also had significant trauma history. We accepted the hallucinations as part of everyday life and talked about them in that way. He became comfortable sharing what he was hearing and seeing. Many times his hallucinations made sense when context was given. He felt bugs crawling on him-he came into foster care with severe scabies and had experienced bed bugs in his home. While he may have been hallucinating about them at this point, they were reality in his life at one point. Many of his hallucinations made sense in the context of his life story. He heard voices threatening him, being mean to him and putting him down, a situation he endured far too often in his early life. He heard command voices, which when understood also made sense. He could be unsafe, and his command voices were telling him to do unsafe things to himself and others, so this had to be addressed with structure, support, counseling and medication in the short run while he processed and came to terms with his trauma and his desire for safety for himself and others. Some would say he needed medications and should stay on them for the rest of his life regardless. Others would say medications are terrible and he shouldn't have been given them at all as a child. I only know that the medications allowed him to attend school, participate in activities, get some much needed sleep that he hadn't been able to get, and reduced his suffering and anguish. The medications allowed him to remain in the community and caused him to be much, much safer for himself and others. Would he have needed the medications if society was more accepting of people who experience hallucinations? I wonder about that.
Toni, I appreciate your take on hallucinations being trauma related, and it sounds like you have first hand experience trying to interpret the meaning of someone's hallucinations. I thought it was impressive you were able to make sense of the hallucinations in the context of their life story. Like many have discussed in this class, I am also skeptical of the way medications have been utilized, but I think it is important to have reminders that medications can be used to help people recover in less intrusive community settings.
DeleteHi Toni, I believe that the diagnosis of Schizophrenia has a stigma of shame that is attached to it in the community. I am wondering if the shame comes from the knowledge that Schizophrenia appears to be a severe reaction to trauma. This could be a historical reaction of blaming the victim. I believe that medication can be very helpful and may be necessary for some people. We have many tools to assist with recovery and it is really important that we do not deem any of them as wrong or bad.
DeleteI think medications may have a place as 1 tool in treating people with hallucinations, especially if the person is experiencing suffering and anguish, which is sometimes the case. I also think it's important to continue to assess the use of medications and other strategies on an ongoing basis. The young man I described only used medication for a period of time. That met his need. Liz, I think you're right about the diagnosis of Schizophrenia and the shame that continues to be attached to it. For a while, I received several referrals in my role as VR counselor for people diagnosed with Schizophrenia. There was a particular agency in my area with a psychiatric nurse who viewed community inclusion, including work, as positive for people with Schizophrenia. It was both an opportunity and quite an effort to get people on board with this idea. Job coaches, employers, and some of the mental health providers were appalled we would "set these people up in this way." Eventually, sadly, the psych nurse left the agency and the referrals dried up. I should reach out to them again and remind them of VR services.
DeleteKaron (2007) discussed how hallucinations should be treated like a dream and how “it should be described, associated to, made sense of, and brought meaningfully into the context of the patient’s problem” (p. 156). The people who are supporting an individual experiencing hallucinations need to utilize the power of psychotherapy by trying to understand the meaning of a hallucinations instead of wanting to medicate symptoms away. By doing this they are throwing away an alternative to understand the client and their needs. This cycles back to a reoccurring theme in many of our discussions, that thorough assessment and understanding – which is achieved by taking the time to actually talk and get to know the person – are necessary and crucial to identifying and meeting treatment needs. After reading Karon (2007), I think taking the time to decipher hallucinations as client communication is worthy of consideration, if not absolutely necessary.
ReplyDeleteDustin, I see your point about the need for thorough assessment to meet treatment needs, but I would argue that in some cases it is the needs of the treatment provider that are being met, not the person with the MI disability. I believe the idea that assessment is essential for a person with MI to reach their goals to be problematic in some instances. In the past and still today assessment is used by treatment providers to “grade” the individual on whether or not he or she is well enough to carry on in life. I see this in my work as a Voc Rehab counselor when collaborating with clinicians in supporting mutual client’s employment goals. It is still widely believed that clients with MI need to be well enough or “work ready” before carrying on with their goal of employment. So it is the treatment provider who holds the power and uses assessment as a means to control a person from moving forward in their life. Don’t get me wrong, thorough assessment can be good too.
DeleteHi Dustin, this approach of viewing a hallucination as an unmet need or an opportunity to decipher a code to the challenges may help move this problem into the room and not isolate it within the client. The acceptance of hallucinations as communication and responses to trauma put this illness into a systems realm. This client has possibly been abused or harmed and is a victim not a person to be feared because of his/her expression of trauma.
DeleteI agree that patients should be treated as a whole including the origins of their hallucinations. I think that their is a combination of a lack of resources and familiarity with medicines to treat psychosis. We even saw in the Bellevue documentary that some patients did not want to take their medications because of the side effects and were given no others options. Taking the time to work with each individual patient is sometimes a luxury that is so vital for any patient with a disorder, but especially one that is seen by society as unable to recover from.
DeleteDustin, Geoffrey, Liz, and Michelle - I really appreciate each of your points. I think the conversations that can be had between client and therapist with regard to hallucinations can be incredibly useful in terms of revealing and navigating client needs and goals. I would also agree though that we have to be very careful to make sure that our clients are leading the charge in terms of making sense of such hallucinations so that we do not place any of our own biases or needs on the client. In terms of prior trauma and the ways this may or may not affect a person's hallucinations, it is also important to find a balance that keeps the client safe and moving forward to a place of healing as opposed to unhealthy levels of re-experiencing the trauma. Of course, this is something that I do not yet have a lot of experience with and I look forward to further exploring and learning how this balance is best accomplished.
DeleteI found this article truly fascinating. Hallucinations have a lot of negative associations. Hearing, seeing, smelling things that aren't there -- these things are not typically seen as "normal." But reframing hallucinations as communication and a way to cope with some sort of trauma or experience, I believe, could start to erase the notion that there is something wrong with the person. In my opinion, it shows so much more compassion for the person and his or her experience when you can look at hallucinations as a means to process something really difficult.
ReplyDeleteWhat sounds incredibly challenging is accurately interpreting a hallucination. Particularly if the therapist is not familiar with the person and the hallucinations are difficult to follow. But still, the concept of allowing the acceptance of the hallunication(s) to be normal would be a pretty dramatic shift away from where we have been or are currently. I suspect that some of the more frightening hallucinations might be harder for the general public to accept or understand. But even if we could just try to understand something that could be frightening I feel like that is a powerful step towards greater compassion and understanding.
Hi Sandy, it seems like compassion and active listening were two "tools" Karon utilized when counseling the clients with hallucinations. He was ultimately able to uncover the root cause/issue/event that his client was suffering from. It seemed like by using even simple counseling skills (active listening), that it may lead to recovery as opposed to medications.
DeleteHi Sandy, I think you are onto something with moving towards "greater compassion and understanding." Historically, the diagnosis of Schizophrenia has been a life sentence with no hope. Could this new way of normalizing a hallucination as a coping skills or communication tool, bring hope back to the client and his/her family?
ReplyDeleteIf we viewed hallucinations as communication, comparable to night terrors or dreams, I believe there could be more of a discussion about medication. I learned a lot about trauma and night terrors in a undergrad course, and the debate that if you medicate people with trauma induced night terrors to sleep without dreams that you can be missing out on really treating the person. Some say that people have dreams to work out issues in the subconscious and if you aren't working things out subconsciously then it may be hard or impossible to work through. Individuals that have hallucinations could be seen as reaching out for help, and in need of cognitive therapy foremost. The fear that hallucinations project in society is incomparable to the fear of the individual whose reality is being questioned. Just because medication can work doesn't mean that it's the only way, or that it's even ethical in every individual case.
ReplyDeleteHi Michelle, when I was reading the article, I was also thinking that medication might be one option, if exploring the persons hallucinations as if they were dreams did not lead to the root cause such as in the article's examples. There is a lot of documentation regarding dreams/subconscious that can lead a person to understanding what help they need or to an area/event in their life that is causing their mental health symptoms. Also your information regarding trauma/night terrors seems to be similar to what Karon (2007) is revealing in his article.
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ReplyDeleteI found the article by Betram Karon to be absolutely refreshing, as I was unaware of such techniques used to address hallucinations therapeutically. I was especially moved by the statement "The problems that lead to schizophrenia are the result of disturbed relations with other people, and it is these disturbed relations that the patient is trying to resolve."(Karon, 2007, p. 156) This statement is simple, harkens to basic psychoanalytic and Jungian philosophy, and yet is somehow profound within the current context of contemporary treatment modalities (medication, trying to "get rid" of the hallucinations...) Despite the fact that in many cultures, hallucinations have been viewed historically without ill-regard, and often times with reverence and as having spiritual connotations, the larger part of recorded history offers us insight into humankind's tendency to be at odds with the diversity of human psychological experiences. Whether driven by religiosity or superstition, or moralization and medicalization, many human groups have seen hallucinations as a problem, and have imposed culturally relevant solutions.
ReplyDeleteThe view that hallucinations are communication to ourselves, representing unmet needs, would greatly improve the outcomes for those individuals affected. I believe that such a shift would also be a marker of having a spiritual awakening as a society, in the sense that we are quite sick overall, the least of which is represented by someone with schizophrenia. Our spiritual sickness involves greed and being divorced from our own inner needs- not needs for gain and esteem, as the Kardashian's and their ilk would promulgate, but rather gains in terms of social support, love, community, tolerance, and having the awareness that human beings are part of a greater ecosystem (earth) and that we should care for one-another and that earth community.
I have no doubt that we would cease to medicate most instances of schizophrenia if we were to view these hallucinations as dream-like messages. I am so inspired by Karon's writings, that I think it may affect my career trajectory ultimately as an LCPC (the credential I will be working towards post-graduate studies.)
References:
Karon, Betram.(2007) The Use of Hallucinations in the Treatment of Psychotic Patients, Ethical Human Psychology and Psychiatry, 9:3, pp. 155-164
Hi Shae - I found this article to be very interesting as well and I want to read more about hallucinations and examples of treatment. I think our society has placed a stigma on any psychotic symptoms due to misinformation and misunderstanding. I was surprised to hear that deaf people experience hallucinations because they are "shut off" from the world (sound) whereas blind people are less affected by that specific symptom (a hallucination). I also have no doubt that many people would not be given medication if we incorporated dreams as information to the root cause of the hallucination, giving us a better chance of helping the patient towards recovery or improved living.
DeleteShae, I would love to hear more about your trajectory as a future LCPC. Are you thinking you might like to further study and utilize hallucination interpretations in your treatment and work with clients? I know there is still a stigma when it comes to hallucinations and mental health; how do you foresee helping to transform this stigma?
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ReplyDeleteAs a student in the vocational rehabilitation counseling world, I have not experienced clients with hallucinations, nor have I studied it prior to this class. I found the Karon's (2007) article to be very interesting and it helped me to better understand this experience for people.
ReplyDeleteAs I read it, I was thinking about how unnecessary it seemed to put people on medications or into inpatient facilities, when the professional could instead work on identifying the root cause. It made me sad to think about how many people have not been treated effectively for various psychotic conditions, including schizophrenia. As with the examples in this article, I think our culture should advocate for that type of treatment whereas we use the hallucinations as information, not suppress and discount them as a menacing symptom of the illness.
Our society is so quick to pop pills and/or take the easy way out with medications, that people are not given the natural alternative to recovery. That is, working to understand what event/situation may be causing the hallucinations. Examples in this article as significant proof of this concept.
I do believe dreams reveal information in our subconscious, thus another source to incorporate into the big picture. This statement was “my a-ha” in Karon’s article: “Hallucinatory material—whether auditory, visual, odoriferous, or any other—should be treated like a dream; that is, it should be described, associated to, made sense of, and brought meaningfully into the context of the patient’s problem.”
Karon, Betram.(2007) The Use of Hallucinations in the Treatment of Psychotic Patients, Ethical Human Psychology and Psychiatry, 9:3, pp. 155-164
Suzanne, I agree with your statement regarding the usefulness of hallucinations as a means of communication for one's subconscious needs. As I read your post I began to wonder what types of people might be more susceptible to communicating in such a way. Are there specific personality types that might communicate more readily via hallucination? And other personality types that might communicate through violence or dreams or sleep walking or other specific behaviors? If hallucinations are to be accepted as valid communication that are useful in treatment, it might be necessary to gain a greater understanding of who might hallucinate and how these might be most effectively interpreted.
DeleteI found Dr. Bertram Karon's article on hallucination in treatment to be both fascinating and a bit controversial. On the one hand, it makes complete sense to me that hallucinations must come from somewhere in our psyche, and I can see how the brain and body might use hallucinations as a means of communicating needs. And even if the brain and body is not explicitly doing so, then the conversation itself that takes place between patient and therapist as a result of the hallucinations does indeed lend itself to useful revelations regarding the needs of the patient. One thing that did concern me though, with regard to Dr. Karon's process is that there may have been some assumptions and leaps that he took in terms of assisting the client with interpretation, and I wonder if the client would have come to those same conclusions had they not had his direction and input. It is a very fine, but important, line that a therapist walks when it comes to supporting and assisting client's as they come to conclusions regarding their treatment (therapists must be careful to balance their support role while also refraining from pressuring or steering the client too heavily toward their own assumptions and biases). That said, it is clear that Dr. Karon took a kind and understanding approach as he assisted client's with their interpretations of their hallucinations, and he definitely conveyed a sense of security and practicality with regard to using hallucinations as helpful and positive tools of treatment within the community and home setting as opposed to negative, problematic symptoms that need squelching while being isolated from society.
ReplyDeleteBy recasting hallucinations as one of the brain and body's modes of communication, we take away the negative stigma and allow ourselves access to additional tools with which to work as we support clients and help them toward recovery. If we align hallucinations with our understanding of dreams, we offer family members and larger communities a relatable perspective and lense with which to view the mental health needs of others. By viewing hallucinations as a useful tool in treatment, we would opt to refrain from excessive use of medication as a means of numbing and stifling patients because we would not want to stifle any useful messages the brain and body might have for us. Those who have hallucinations would not be viewed as "crazy" nor as outsiders; rather they would merely be seen as human beings experiencing a normal mode of communication that everyone experiences when under duress. They would merely be seen as fellow human beings in need of support, and fellow human beings would respond with kindness.