0 
0 By Max Guttman (Licensed Clinical Social Worker, USA)
One of the most canonical features or symptoms of mental illness is the hallucination. There are many known types including a voice or noise. They can sound as though they are outside our body, or they can seem internal. There can be many voices, and some talk with each other. Some tell us to do things (command hallucinations). Others just prattle on and speak ad infinitum about just about anything.
By the time most people with schizophrenia (or those carrying a diagnosis with psychotic symptoms) begin to hallucinate they are usually in the final stages of the illness’ onset. Very likely, they are already isolated, delusional, and experiencing a litany of active symptoms. This is why so many people do not realise they are hallucinating: that they are hearing voices or seeing people and objects that don’t exist for the rest of the world.
Treatment
The right treatment is critical for someone actively hallucinating: one that allows space for their personal denial, uncertainty, erratic behavior and compromised safety. This is to disrupt and limit the delusional systems that begin to form and fix around certain ideas. Therefore, home-based care is essential. Most likely, the person hallucinating is already too disordered to make it into a clinic for treatment. Without a connection to any services, the person is likely to be hospitalized.
In the end, voices can be so disruptive that they are frightening, and so compelling that they can tell us to harm ourselves or others. Even tactile hallucinations can seem painful. They can feel as though worms are crawling underneath the skin. People hallucinating may hear or see weapons that don’t exist for others, and will fear for their personal safety. I have had adverse experiences in which I heard a countdown timer to what seemed to be a bomb. And I have heard loudspeakers threaten my home with force unless I stole from my roommates.
Just as compelling are the hallucinations of supportive voices or people, that operate as friendly allies, in a person’s growing delusional system.
Projections of my subconscious
Speaking from personal experience, and as a gesture to the title of this blog post, my hallucinations were projections of my subconscious. I was isolated from peers. I was paranoid, fearful, and without support from friends and other students in the college I was attending. This was partly due to the nature of the delusional system that was at work. When I spoke of it to others they got angry. My friends chose to alienate me instead of confronting the real issue at the time, that I needed mental health treatment. Indeed, by the time I was finally hospitalized, only two friends out of a dozen visited me during that healing phase.
Alienation
Alienation and mental illness go hand in hand when unchecked. And my experience went unchecked. I was living in a room, isolated, and living out my fantasies. I even had a person close to me who instead of refuting my delusions, enabled me to continue living in the community. This was despite my dwindling mental status and ability to care for myself. When my friends finally kicked me out of our home when my behaviour became threatening, this person found me a new one. It was far away, and less likely to be visible to those who might have looked into my well-being.
People victimise those with mental illness. They will do just about anything to ignore or quiet a person labelled a problem who really needs help. People will bully, harm and steal from those with a mental illness, out of ignorance, misunderstanding or misdiagnosis. This is to get their way or assert themselves over someone less able to voice their problems or seek the supportive counselling they need: counselling that would help them to make sense of the people around them. Those people may be manipulative, enablers, or just unsupportive players in their recovery.
Ultimately, a friend will hold space for you. And they will do this in a way that allies with your recovery, and furthers your chances of ultimate survival in the world when you really need the help.
Reproduced with permission, originally posted on mentalhealthaffairs
UNITED STATES
UNITED KINGDOM
