Does Having Hallucinations Mean You Have Lost Your Mind?

Robert (his real name) was having an especially trying week. Hospitalized for a heart attack, early one morning he started hearing puppies barking outside his door. Annoying, but not all that unusual. A few minutes later, he heard puppies inside his room. Finally, he saw dozens of cute, cuddly, white puppies floating around his bed, frolicking in the air. He even felt them nipping at his toes.

Robert didn't add a bowl of dog food to the egg white omelet on his breakfast order. Instead, he made the decision to call his nurse and asked if he could be taken off morphine. When the morphine drip stopped, the cute, cuddly, floating puppies abruptly disappeared a few hours later.

Robert's experience was not unique. Many kinds of intoxication, illness, and injury can lead to hallucinations of sight and sound and even hallucinations involving taste, smell, and touch. But when is seeing, hearing, smelling, tasting, or feeling things that aren't there a sign of mental illness, something that would warrant a DSM diagnosis, and when is a hallucinatory experience a sign something is going on in the brain? Something that may need to be treated in a whole different way?

Hallucinations versus Delusions

Simply sensing something that is not objectively, physically present is a hallucination. Having a hallucination is not necessarily the sign of a mental illness.

People who experience hallucinations but who retain insight, such as Robert, for instance, who did not believe puppies were actually floating through his hospital room, know that their hallucinations are not real and act accordingly. Such experiences are relatively common. They can occur while someone is on certain medications or street drugs, as they are waking up from anesthesia, or even when they are simply severely sleep deprived.

People who experience delusions, however, take their hallucinations seriously. Had Robert been delusional, for example, he might have ordered that bowl of dog food to feed his new canine friends. Or he may asked if the floating puppies had had their rabies shots. Or he might have demanded a dog-free room.

People who suffer from hallucinations might, for instance, see a tiny man on their shoulder (something beyond Robert's experience with morphine). People who suffer delusions might take orders from the tiny man or try to buy him a tiny suit or a tiny pipe for his tobacco.

Hallucinations are an unexpected sensory experience. Delusions, persistent false beliefs that don't go away despite all evidence pointing to the idea that they are not real, are an indicator of mental illness.

Hallucinations versus Imagination

Hallucinations can also be distinguished from imagination. The identifying characteristic of imagination is that is expected. Imagination is self-directed. If you mourn the death of your grandmother, for example, and when you intentionally think about her, even if you "see" your deceased grandmother, the activity is more likely to be imagination than hallucination.

If, on the other hand, you come home after work and find your deceased grandmother and her deceased best friends playing pinochle, and that expeirence doesn't go away even after you try to snap out of it, you are likely suffering a hallucination. And if you order them a pizza, you are likely to be delusional.

When Are Hallucinations Something To Worry About?

Hallucinations tend to come on without warning and go as quickly as they come. When a hallucination is triggered by a medication, or by drinking too much, or by taking hallucinogens, the hallucination will disappear when the body has metabolized the hallucinogen. Other kinds of hallucinations, however, may be more persistent.

Hallucinations Caused by Migraines

Migraine headaches are often accompanied by a prodome, a period of neurological symptoms preceding the onset of migraine pain. Many people who have migraines experience visual hallucinations during this phase.

Some people who get migraines will see something that looks like a crescent of "static" in the center of the visual fields. The visual distortion may spread out across the entire field of vision until everything looks like the image through a kaleidoscope. Some migraine sufferers may see little people, dead people, or objects floating in space.

Neurologists liken this condition to a brain condition called cortical blindness. The inflammatory substances that cause migraine also irritate the visual cortex of the brain. When they stop being produced, vision returns to normal, although this may sometimes take several hours to several days. Hallucinations caused by migraines, however, seldom result in life-altering delusional states.

Hallucinations Caused by Parkinson's Disease

One of the more troubling symptoms of Parkinson's Disease, at least for family members and friends of people who have Parkinson's disease, is hallucinations of living or dead people. When this tendency for hallucination is accompanied by loss of "executive function," or reasoning ability, there is serious reason for concern. A person who has Parkinson's Disease may not only see people who are not there, but interact with them as if they were. Serious disruption to day to day life may result.

Hallucinations of Night Hags

Another common hallucination is the sensation of being visited by a night hag, a being who paralyzes her victims in their sleep, sometimes sitting on their chests so they cannot breathe. Neurologists have a rather straight-forward explanation for this phenomenon, narcolepsy. Sometimes the thinking part of the brain wakes up but the body doesn't wake up with it. The brain interprets this narcoleptic seizure in various ways, sometimes conjuring up an image of a being like a night hag to explain the sensation. 

There is a very simple way to make the night hag go away. Go back to sleep. Your brain will reset itself, and when both brain and body wake up at the same time, the night hag will have disappeared.

Hallucinations Caused by Schizophrenia

Schizophrenia causes hallucinations experienced without insight. Someone who has a different kind of brain disease, for example, may imagine or hallucinate being chased by vampires. Someone who has schizophrenia will look for garlic, silver bullets, and a wooden stake. The critical consideration in whether a hallucination is "schizophrenic" is not whether someone is seeing something that isn't there, but whether the person acts as if it were. Interestingly, nicotine, from smoking cigarettes, helps activate the parts of the brain that helps schizophrenics distinguish delusion from the shared reality.

Hallucinations, especially as we get older, are a very common experience of which most people dare not speak. The simple fact is, however, people who remain in charge of their lives find hallucinations to be an inconvenience rather than a life-altering disability.

If you experience hallucinations, you do have a medical issue requiring a doctor's care. But the doctor you need to see may be a neurologist, not a psychiatrist.