Having hallucinations, paranoia and delusions

People’s experiences of psychosis can be very varied. In our interviews people described experiences including:
  • Visual hallucinations
  • Tactile hallucinations
  • Auditory hallucinations
  • Delusions
  • Paranoia
  • False memories
  • Thought broadcasting and thought blocking
  • Heightened senses
  • Loss of Inhibitions

Hannah thinks it’s a misconception that everyone who experiences psychosis hears voices. She describes the first time she saw a visions.

Age at interview 19

Gender Female

Age at diagnosis 15

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People could experience one or more of these at one time and these different psychotic experiences could feed into each other. But experiences didn’t always fit neatly into any of these descriptions, and could be harder to describe, such as invasive negative thoughts or losing touch with reality.

Andrew Z, had buzzy thoughts and couldn’st concentrate on his studies or when he was talking to his friends.

Age at interview 23

Gender Male

Age at diagnosis 20

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Invasive thoughts and ‘voices’

The most common sign of psychosis is hearing voices that others don’t hear,’but not everyone who hears voices is distressed by them or seeks help (for example research suggests that as many as 10-15% of the population report experiencing hallucinations*)’
Some of the people we spoke to easily identified with ‘hearing voices’ but others talked about having intrusive ‘thoughts’. Lucy describes: ‘thoughts in my head not being from me almost like a voice. In that I didn’t feel like I was in control, or thinking it myself.’ She didn’t think of her uncontrollable thoughts as ‘voices’, until a nurse used the word.

Peter’s thoughts are like a running commentary that make it difficult to concentrate or have a conversation with someone on the phone.

Age at interview 24

Gender Male

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But some very clearly heard ‘voices’ which could seem to be internal or external. Voices from outside the head could seem very clear as if there were someone standing nearby and speaking.

When Emily first heard a voice, she was sitting in a classroom and turned around to ask her friends if they had heard it too.

Age at interview 23

Gender Female

Age at diagnosis 21

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Joe, who had studied biology, said his voices come from different places in and around his body and he associated them with colours. He wonders if different voices come from different parts of the brain.

Age at interview 23

Gender Male

Age at diagnosis 21

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Nikki has been hearing voices since she was 14. She hears up to twenty or thirty voices at a time, some are just sounds rather than words. For her they are real and always negative.

Age at interview 19

Gender Female

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Voices varied considerably and were described in different ways by people, for example like a background noise, like overhearing people talking, or hearing crying or screaming, or they could be describing or commenting on something the person was doing. Voices could also talk directly to the person, criticising them or telling them to do things. For a few people there were familiar voices – someone they knew like a father, grandfather or acquaintance, or it could be their own voice. Joe described the voice as the ‘younger me’. Voices could also be unfamiliar, but might have specific personalities that were recognisable. Voices could be ‘persecutory’: Nikki’s voices say ‘you’re disgusting why would you do that this person hates you’.
When voices gave direct orders or ‘commands’ this could sometimes have devastating consequences. Chapman hears voices telling him to steal things or take drugs. Lucy and Emily have thoughts/voices that are like bullies telling them to kill or hurt themselves. People also talked about voices giving them an ultimatum. Green Lettuce’s voices told him he would die if he slept, and he said ‘once, I was up for eight days because I thought I’d die if I went to sleep, that was a nightmare I literally just passed out on the eighth day.’ But people didn’t always act on them: Sam hears voices telling her to hurt others but has never acted on them. People who hear commanding voices could also learn to manage them.

Dominic hears clearly identifiable voices. At one point he heard seven voices. The constant chit chat was intense and made him angry. The loudest voice would give him commands telling him to hurt others.

Age at interview 24

Gender Male

Age at diagnosis 21

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Green Lettuce describes his voices having conversations with each other as well as commenting on what he was doing, and telling him not to leave the house.

Age at interview 25

Gender Male

Age at diagnosis 20

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Andrew X describes his voices as the good the bad and the ugly and explains how they fed into delusions and have caused him to hurt himself.

Age at interview 24

Gender Male

Age at diagnosis 14

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Ruby hears the voices of her younger self and her abusive father, which she now calls Alice and Darren. Sometimes Darren tells her to do things that involve self -harm or putting herself in danger.

Age at interview 22

Gender Female

Age at diagnosis 19

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Dominic hears clearly identifiable voices. At one point he heard seven voices. The constant chit chat was intense and made him angry. The loudest voice would give him commands telling him to hurt others.

Age at interview 24

Gender Male

Age at diagnosis 21

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Seeing visions and images

A few people saw images or ‘visions’. These could be people, objects or characters that were familiar – for example, that they’d seen on TV – or totally unexpected. Visions could seem out of place. Barry saw a red car on a curtain and Lucy saw ‘people jumping out’ of street signs. Sometimes visions could be horrific, frightening or violent. Some saw blood on the faces of people around them or scenes of a loved one or friend being hurt. Hannah described it as being like when people in films are remembering or dreaming of something which flashes up and then is gone. Tariq said he used to see dead people in graves and had visions of people following him around. The visions were so clear he was able to describe them in detail to the crisis team.
Visions could be extremely upsetting and feed into people’s fears, such as fear for their own, or their loved one’s safety.

Joe’s first visual hallucination was very upsetting. When it finished he believed he had hurt people he cared about. Afterwards he discovered none of it had happened but to him it felt as though two realities had happened at the same time.

Age at interview 23

Gender Male

Age at diagnosis 21

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Dominic had visions of hurting people and heard commanding voices. He didn’st leave the house for three years after his diagnosis because he was afraid he might hurt people.

Age at interview 24

Gender Male

Age at diagnosis 21

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Chapman once saw a group of people gathering in his house and opened the door to find no one was there.

Age at interview 23

Gender Male

Age at diagnosis 20

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The faces of those who had bullied and tormented Tariq flooded back and he couldn’st put them to back of his mind.

Age at interview 21

Gender Male

Age at diagnosis 18

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Joe’s first visual hallucination was very upsetting. When it finished he believed he had hurt people he cared about. Afterwards he discovered none of it had happened but to him it felt as though two realities had happened at the same time.

Age at interview 23

Gender Male

Age at diagnosis 21

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Paranoia and delusions

Delusions and paranoia often involved what Andrew X described as ‘weird interpretations of social events’. Chapman and Emily thought that the television was talking to or about them. While Barry was in hospital he thought people he knew were being ‘trapped’ inside the TV and so he would turn it off.

Sameeha describes being very out of touch with reality. Her mind seemed to be creating a storyline of its own, which she was acting out.

Age at interview 22

Gender Female

Age at diagnosis 21

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When Barry was in hospital he had paranoia. He would sit for the whole day just staring.

Age at interview 19

Gender Male

Age at diagnosis 16

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When Joseph’s mum didn’st make it to see him in hospital one day he thought she had died.

Age at interview 22

Gender Male

Age at diagnosis 21

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When they were having delusions a few people said it felt as though their brains were speeding up, and they sometimes believed they could achieve things they would not normally be able to do. Luke, who was diagnosed with bipolar disorder, was two weeks into a new job when he began experiencing delusions and feeling ‘omnipotent’: ‘I started to think MI6 were onto me. I started to think that I was God. I thought I could predict the result of the Scottish referendum’. When he was in hospital Luke remembers going around to people’s beds and putting his hands on their heads and saying ‘you are healed’.

Luke describes putting information together in illogical ways and reading meaning into everything.

Age at interview 21

Gender Male

Age at diagnosis 19

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Sometimes Joseph felt like he was bumping along the bottom and at other times he felt like he was flying. He compared it to moving up levels in a computer game.

Age at interview 22

Gender Male

Age at diagnosis 21

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People also described ‘thought broadcasting’, when they believed that other people could hear their thoughts, and ‘thought blocking’, when they believed that others were stopping their thoughts: Tariq said, ‘I had thought blocking where on occasions I couldn’t think for myself. Sometimes I’d think that people were taking thoughts away from me.’

Andrew X describes how difficult it was for him when he believed that others could hear his thoughts.

Age at interview 24

Gender Male

Age at diagnosis 14

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Green lettuce thought his thoughts were being broadcast to the world.

Age at interview 25

Gender Male

Age at diagnosis 20

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Delusions could lead people to do things that were out of character. Max had a delusion in hospital that one of the staff members was going to hurt him and he ‘went after her’ and was stopped by staff. This was the ‘complete opposite’ of his usual behaviour. Ruby thought she could fly and kept trying to jump off things. For some people delusions could come at the same time as, and feed into, visions and voice hearing.

Dominic describes how paranoia, visions, voices and delusions can come together when he is walking down a street. He has learnt to manage them and says how important it is to celebrate the small triumphs.

Age at interview 24

Gender Male

Age at diagnosis 21

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While people knew with hindsight that hallucinations and delusions weren’t real, there were sometimes real sensory experiences associated with them. For some the experience gave them valuable insights into another way of seeing things. Luke said that while bipolar disorder is ‘catastrophic’ it also gives you a ‘different level of perception’, and allows you to see things differently.

Although Green Lettuce knows now that things that seemed real during his psychotic episodes, weren’st actually real, he still believes certain things that most people don’st, for example he thinks it might be possible to predict what others are going to say

Age at interview 25

Gender Male

Age at diagnosis 20

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False memories

Some people had false memories: they could remember things that didn’t happen at all, or could remember events from a long time ago as though they had happened yesterday.

Joe had memories that weren’st real or remembered things happening in the wrong order.

Age at interview 23

Gender Male

Age at diagnosis 21

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Having false memories could be like experiencing a different version of reality. Dominic says, ‘I was at some place and in my mind I’m in another place and I’m doing something else which was surreal’. Some people were aware that the false memories were not quite right but others didn’t realise until sometime later that they had had a psychotic experience. Andrew Z’s first experience was when he was acting in a play and found himself remembering quite elaborate ‘very strange happenings’. While there was a ‘kind of subconscious pull’ telling him it was real he describes a ‘rational reality check’ telling him that he couldn’t have forgotten and then suddenly remembered something so elaborate.
False memories could be continual, but often stopped eventually. Andrew Z has short periods of having false memories and Joe used to have them but they haven’t happened for a long time now.

After six months of feeling real happiness Dominic describes the moment when he realised everything he had been experiencing had been a false memory.

Age at interview 24

Gender Male

Age at diagnosis 21

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Whilst the people we interviewed identified their experiences as ‘psychotic’, there are organisations worldwide, for example the Hearing Voices Network, which offer alternatives to psychiatric ways of understanding the experiences discussed here.
*Tien A. Y. (1991). Distributions of hallucination in the population. Soc. Psychiatry Psychiatr. Epidemiol. 26, 287-292 10.1007/BF00789221