(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.
I found the article very interesting and informative. I enjoyed learning about the latent content and manifest content. As a future mental health professional, I have briefly learned about hallucinations in my classes, but we were never taught how to ask patients about their experience. After reading the article, I do believe that hallucinations are a form of communicating which I did not before. I thought of hallucinations as just a part of the individual's mental illness. In reality, people hallucinate to communicate their feelings deep inside. After reading the article, I better understand hallucinations. Clients perceive what they do not know how to share through hallucinations. As a child, I can remember growing up watching TV shows and thinking people who hallucinate were crazy. As I get older and learn more, I began to realize the stigma around people who hallucinate. The world needs to know they are trying to communicate. If the world was able to understand people who hallucinate are trying to express themselves, I do not believe these individuals would be medicated and put away. If all mental health providers were to read "The Use of Hallucinations in the Treatment of Psychotic Patients," clients would not be seen as crazy. Professionals would realize that these clients can live in the community when given the correct tools.
ReplyDeleteVictoria Codrey
Victoria,
DeleteThis is such an interesting topic for me. I spent many years working with individuals who were actively experiencing hallucinations and delusions. Every individual's background was different. They all had experienced different things throughout their lives, and very few had similar hallucinations. I agree that if all mental health providers were to really focus on this and follow the research, there would be a great deal more compassion in treatment. Rather than just trying to force the hallucinations away, they could be used to help the client put puzzle pieces together about their own lives. They could possibly be used to help a client understand what his or her needs are, if they do not know already. What an incredible tool it would be, if used without judgement, to help a client move forward in a healthy way.
(Kaitlynn Littlefield)
Kaitlynn, Thank you for the response I hope the future will be filled with non-judgmental mental health professionals that will help their clients move forward.
DeleteI am a firm believer that there is a bit of truth in everything. Conspiracy theories, dream theories, hocus pocus, ghosts and basically anything, there is a little truth in there. I think that is the important piece to understand when we are working with clients experiencing such scary and at times traumatizing symptoms.
ReplyDeleteHallucinations are important to the person experiencing them, there is an emotion attached to what is going on, negative or positive. What I struggle with is the use of hallucinations, is becoming a part of the hallucination. The article by Karon illustrates a situation where one client was scared of the person in the middle of the room, the therapist entered into that hallucination and told the person to go away, or indeed they would hurt them and protect the client, it worked, the client felt comfortable with the therapist and the hallucination ended, but was it on the right pretense? Would it not have been better to help the client verbally fight off the person, tell them I am here to protect you, become a part of it perhaps through the client's voice and personal advocacy? Wouldn’t that be beneficial not only for the instant but ongoing treatment?
Clients are seeking support for one reason or another, they want to get “better” they want to recover, it is our duty to listen to all aspects, whether it makes sense or not but use it to develop the bigger meaning and understanding of what is really going on for that person in each moment and for their future treatment in recovery.
Sean K
Sean,
DeleteYes!! You bring up such a wonderful point in that it is so important to remain separate from the hallucination so that you do not become part of it. If we as providers are going to help our clients understand their hallucinations and effectively communicate, we need to also practice effective communication. I do not believe that it is helpful in most cases to enter into the hallucination, as it may create more confusion for everyone involved. It also may create stress fractures and inhibit trust if the client eventually believes that he or she was lied to or patronized. This is such a difficult topic to fully address or master because every client and situation is different. I do agree with you in that everything has at least a little bit of truth in it. If we remain respectful, listen, and help our clients work on their individual concerns and/or point of view, I do believe that we can be a very effective part of their recovery.
(Kaitlynn Littlefield)
Sean,
DeleteI appreciate your point of view in this post. When I read the article to myself I didnt think about the interaction all that much, but after reading your post about it I do agree with you. Its hard for me to tell if the counselor is helping or hurting here. Yes, in the short term the counselor helped that specific encounter stop, but Im not sure if that approach would be helpful as a long term method. I always appreciate how you find ways to make sure the client is taking the lead role in their journey, like you mentioned had the client used their own voice not only would the client be handling the "in the moment" situation themselves, but also building that toolbox with self advocacy and confidence.
-Spencer
Sean, You brought up so many good points! I agree with you that the therapist should have helped the client overcome the hallucination by giving them their own voice instead of taking away their voice. I am a firm believer that clients need to be part of their treatment. I look forward to reading more of your post in the future!
DeleteSean,
DeleteYes, yes and more yes!! I completely agree. Our society is built on freedom and individualism, yet we want to categorized everyone and make judgments. If only everyone could take a piece of your perspective; it is all real if you believe it is real, and move forward with treatment versus "curing," we may really see a huge shift in societal-stigma, self-stigma, and a sense of recovery for each individual living with a mental disorder.
Hi Sean,
DeleteI actually really loved when he "was in" the hallucination with this patient in that specific situation. In fact, I thought that it was a profound moment of relationship building with him. In my (limited) experience with folks who hallucinations, I have heard how exhausting it can be for them to consistently be reminded that their reality is not real, that what they are seeing is not real, and what they are hearing is not real. When Karon did that for the patient, he was acknowledging to the patient that he knew it was real to him. What a beautiful thing a provider can do for a patient - make him feel seen and validated.
Karon explicitly says later on how important it was to ensure that the patient knows that what they are experiencing are hallucinations and what that means. I feel that there was a way for him to balance this moment of "engaging" with the patient's hallucinations but then to later on and circle back and delve into what was actually real and what was not.
In fact, would the patient have been able to really absorb it, should Karon have chosen to insist right then and there that the scary hallucination was not real? My thought is no.
not sure you really understood what I wrote, but I did not state in anyway to discredit the hallucination or not condone the scary situation as real for the individual.
DeleteRespectfully, I think that I do understand your post - I feel that it is more so that we just disagree! I did not mean to insinuate that you would not validate the patient. What we disagree with is more on timing. As I understand it, you were concerned about Karon's decision to "enter into" the hallucination. We both agree on this front - providers certainly do need to be careful of this.
DeleteHowever, I think that Karon gave that patient a real gift by making that choice. People who have hallucinations or any sort of psychosis are often isolated and defeated, because they are told time and time again that what they are seeing/hearing/experiencing is not real. In that moment, Karon decided to take a risk and join the patient's team in fighting whatever the scary hallucination was. Karon had two choices in that moment: to join the hallucination and help build trust with the patient, or to step back and remind the client ASAP that what he was seeing wasn't real (which could have help build trust too, depending). I really like that Karon took the risk that he did.
I do not think we disagree, I think communication is broken down through blogging and I appreciate your rephrasing of the original statement.
DeleteTaking risks is something we do every time we enter into a relationship with a client, very quickly we have to determine how to approach the individual based off our instincts and basic knowledge, at times we hit the nail on the head and at others, we are off point.
-Sean K
I think these are great points. I remember my summer class with Alicia Wein in Vermont. Students were hesitant to make a mistake in their counseling process. She shared that we can just try and usually the client will tell us if we are off base. In thinking about becoming the best counselor we can be we need to take some heathy risks. I also like the idea of asking the client for feedback. I wonder what the client would have said if Karon asked, “how was it when I stepped into your hallucination?
DeleteThis comment has been removed by the author.
ReplyDeleteHallucinations
ReplyDeleteI am curious about Assisted Outpatient Treatment (AOT) and the flyer has created more questions for me than answers. I noticed that the flyer mentioned the program leads to “increased medication adherence”. I noticed that the flyer advertising the decrease in criminal activity. Is this assuming that those who are bipolar or schizophrenic more dangerous than the general population? Are they viewed as criminals? And what qualifies as criminal behavior? Sleeping on park benches?
I also wonder what type of counseling they receive. In the article, The Use of Hallucinations in Treatment of Psychotic Patients, by Dr. Bertram Karon I was impressed with her ability of using client’s hallucinations to provide therapy. It was stated in the article that “a terrifying hallucination or a recurrent nightmare is a symptom in its own right, and proper interpretative work will relieve that symptom as the issues are dealt with consciously.” (Karon, 2007 p. 161). The author also continues to reflect a belief that the client is doing the work in the therapeutic relationship. For example, the article states, “What do you communicate to the patient about a hallucination? Communicate whatever part of your understanding you feel the patient can make use of.” (Karon, 2007 p. 162)
I have some hesitations in fully embracing AOT as I am not sure our goal is medication adherence or is providing a therapeutic relationship that helps the client move toward health? Viewing the hallucinations as an unmet need, might decrease the belief that medications are needed.
Becky, thanks for your perspective on the AOT flyer. I too was concerned with the fact that the flyer indicated with this treatment, there was less criminal activity. Again, society gets to place a stigma on people who have hallucinations as being "threatening" and "criminal" And the only thing that has worked to keep them from being criminals is medication. I'm kind of a pessimist when it comes to AOT, because I don't know if it actually prepares the clients to embrace the world without medications, be curious about their connections with others, and then look at medication treatment.
DeleteIt was my understanding that people were referred for AOT treatment because they had a long history of criminal activity and lack of mental health treatment. I don't think it was necessarily assuming people who are diagnosed with bipolar disorder or schizophrenia are more dangerous but I wonder with the group of people they used for these statistics if those two diagnoses were the most common. Criminal activity is such a broad term and I think we have to remember some people can be charged with misdemeanors like suspicious activity in the community or disorderly conduct and then it can range to felonies such as attempted murder and dealing drugs. I do think it would be helpful to see a breakdown of what criminal activity they are referring to with people who utilized AOT services.
Delete-Lindsay Hill
Lindsay, You bring up a great point! I think it would be helpful to see the breakdown of criminal activity. Society might not understand mental illness and view someone in a psychotic state as dangerous. It is helpful for police to have a good understanding of mental illness. Misunderstanding can lead to criminalization of what might be just typical behavior. Patricia Deegan, PhD with schizophrenia stated in her YouTube video that at one time she lived with hippies, her psychotic episodes when unnoticed. I think this is just another example of perspective. It is unfortunate that some people get saddled with dealing with the criminal system as well as their mental illness.
DeleteOne specific paragraph in Karon's article gave me immediate pause. As he stated, Psychotic hallucinations also may mean that the patient is lonely; the voices represent somebody who cares about them. But even malevolent voices are better than being alone. Any child would rather be punished than ignored; and all adults, sick or well, still carry the seeds of their childhood within them" (2007, p. 155). I was reminded of a client of whom I worked with in a crisis situation many years ago. She arrived at the emergency room via ambulance, against her will, because she was having paranoid hallucinations. She was hearing a familiar voice screaming at her to "wake up" and to "get help." She did not want to be in the hospital because she felt as though she must follow this voice and understand the commands. She was frightened and alone in the hospital room, and she could not tell anyone what her name was, where she lived, or when these symptoms began. I sat with her for several hours while she worked through her auditory hallucination. We ate snacks and discussed the life she had lead, up until this point. She was very forthcoming about the trauma she endured as a child, and how she feels she must bury it as an adult. After much processing, she admitted that she believed the voice she heard was her mother's, and it was her mother telling her to escape the difficulties in her life. She believed that her mother had become her own subconscious and was trying to protect her from abuse. As this client was not a danger to herself, she was voluntarily admitted to a crisis stabilization unit for further support in the community.
ReplyDeleteIt is entirely plausible to me that hallucinations in this respect can certainly be a subconscious way to connect and communicate. The client I described above felt that she had only ever been able to trust her mother. Her mother had passed away, and she felt incredibly lonely. It is certainly possible that, in order to get her needs met, she was hallucinating her mother's voice in an attempt to get her needs met. With these hallucinations, she felt less lonely and she was given guidance that she wanted so deeply. Though her processing wasn't entirely healthy, she was able to work through her concerns.
If our society began to truly view hallucinations in this way, I believe that we as a whole would have a much greater respect and understanding of our neighbors. Seeing hallucinations as a mode to communicate, we begin to "level the playing field" and gain and acceptance that we do not yet have. We could relate to those who experience them better than ever before, and our society may gain a little more compassion than what is seen today. Medication would ideally only be necessary/needed if a person is a danger to them self or others. If we were able to view hallucinations in this light, I do believe that recovery and rehabilitation could happen so much quicker and with far less judgement than ever before.
(Kaitlynn Littlefield)
What an inspiring story. I'm glad you were there to help the woman through her processing. Just as Karon mentions, if you don't know anything about a client with hallucinations and you just start trying to figure out why they're happening, this can confuse the client, make them feel like they're not being believed, and possibly shut down. Thanks for sharing your experience. I will use these techniques going forward in my practice
DeleteThe excerpt about how children would rather be punished than ignored really stood out to me, too. I think that was a great way to explain how auditory hallucinations are connected to a need for human relationships and connection, even if the content of the hallucinations is malevolent and therefore distressing. It seems that so many mental health issues that people seek support for really boil down to a need for human connection. If we approached treating this just by medicating to get rid of hallucinations, that need is not addressed.
DeleteKaiti,
DeleteThank you for sharing this story and offering another level to that portion of the reading. I think like many human behaviors or reactions we see, it is important to understand there is a reason behind that and not label. I think people in the human services field we need to assist in the understanding of people in all aspects and I think that computes with hallucinations. A staff member of mine recently struggled with the fact, that a client they had a good rapport with for quite some time reached out to the supervisor for support. This staff member has a great reputation and works hard but needed to be reminded that there is another reason we are working with our clients and at times we have to respect that things aren’t always as they seem and we may need to provide an additional level of support. Just like you did with your client, perhaps sharing the snacks really helped.
-Sean K
I thought that the Karon article was really eye opening. One of the encounters mentioned was about a client who was having hallucinations of Satan, and the doctors mentioned to the counselor that they had tried everything and nothing was helping her. Tried everything to the doctors clearly meant tried a bunch of different medications and they were not helping the client. Within a few minutes of talking about the hallucinations the counselor seemed to effectively help the client overcome her visions. The counselor asked her to describe what she was seeing and if this Satan reminded her of anyone she knew. The clients hallucinations of Satan actually reminded her of her father who reportedly had a history of abusive behavior. Even in this very short interaction the counselor was able to learn a great amount more information about the clients perspective rather than the doctors who did not seem interested in talking with her. I too am a strong believer in people being able to visualize their needs and wants. Like mentioned in the blog some people choose to dabble in dream interpretation. I personally have noticed myself to have very intense “movie like” dreams when I am stressed about something meaningful in my life. I try to find meaning from these dreams and it helps me process the stress and release the stress is even there at times. Its almost like self communication, our body literally showing us what we need or what needs to change when verbal communication is not working. Our brain fascinates me in many ways.. To a point, hallucinations could totally be seen as an alternate way for some people to communicate, hallucinations seem to be more demanding of attention than verbal communication. Why shy away from this, why not as counselors and helpers embrace this as a form of getting to know our clients and their needs. I will say that before reading the Karon article I did think differently of hallucinations, I guess I never gave it much effort to try and understand the meaning of them, I always thought they were just something that happened, and never envisioned there being a rooted meaning from them. Reading about this has made me more curious to learn about hallucinations and how they connect to people's life stories. I am going to pass the Karon article along to some people around me and see their reaction to it as well.
ReplyDelete- Spencer
Spencer, I enjoyed reading your post and how you pulled information from the article. As you stated I also did not give much thought to hallucinations and never considered they have a meaning. I also enjoyed how the counselor was able to find the root of the problem by talking to the client. Conversations are so meaningful and sometimes that is all clients need.
DeleteSpencer,
DeleteYou made an excellent point in your post -- communication can come in so many different forms and fashions. It is common for individuals to express themselves in other ways. A child may act aggressively towards a peer because they have been abused; a teen may sexually act out because they were abused as a child and nobody was willing to address it, etc. Instead of looking at the behavior itself, we should be doing just as you point out above -- looking at the message and what the person is trying to tell us.
This article was fantastic! Finally, we get to see a more holistic and accepting version of treatment for people with hallucinations. Whatever their experience may be with or without counseling, it’s incredible that people are brave enough to share with (sometimes a stranger) what it is they’re seeing and hearing, that others cannot see or hear. I love how Karon describes the initial work that’s necessary for the therapist to connect with the client. She mentions that, “as a therapist you cannot deal with what you do not know,” meaning we have to observe our clients carefully, and let them tell their own story! It’s ineffective to jump into moments that the client is/could be hallucinating, because there is some kind of motivation for the client having that illusion. Also, I like how I learned that there’s a way to validate the client’s hallucinations, without necessarily being a part of them. For instance, when the client heard a loud bell like a phone, the counselor said something like I don’t even notice anymore, there are so many sounds, I get used to them.” As that trust is gained with the client, in the end the therapist realizes that there was context and reason for that hallucination. I believe this method of treatment is genius! Although there are limitations like any practice, at least we can focus on the people and their wants, needs, desires, without shutting these people out with medication. Knowledge tells us it’s “not appropriate” to hear voices or to see things, let alone acknowledge them. Who says it’s not appropriate? Society. It’s our job to change that.
ReplyDeleteI agree with your observations about Karon's article. It is very important for a therapist to connect with a client and build a level of trust before being able to explore the client's hallucinations and possibly confront them. I think building the trust starts with validating the hallucinations like Karon mentioned. I think hallucinations have become stigmatized to be a scary thing and people who experience them have learned they don't always want to admit to what they see or hear because they don't want to be labeled. I also think it has become easy for doctors to write prescriptions once someone does admit their symptoms because the medication should make them go away and the person will be fixed. I like Karon's approach because I think instead of using medication like a band-aid to cover the wound, his approach is actually healing the wound. It is a great way to help a person in their recovery.
Delete-Lindsay Hill
who is the unknown??
DeleteHi Unknown!
DeleteYour post reminded me of a client I worked with last year who saw raindrops on her window turn into moving, expressive faces. She was frightened of them at first, and then used them as a muse to create beautiful artwork. She stated that for years she would hide from windows until she realized that they were guiding her to express her creativity. I asked to see her art, and validated that it was beautiful and clear she had poured herself into them. This client was not looking for change, but instead had embraced what she experienced and made it work for her. In this sense, I think her hallucinations helped her express herself when she did not feel as though she could otherwise. I think about this client at times and wonder if she continues with that philosophy, or if she has chosen to try to eliminate it from her life. Either way, I was impressed by her steadfast nature and openness to share it all with me.
Kaitlynn Littlefield
The article written by Bertram P. Karon, PhD, provided phenomenal insight into how critical it is that we view individuals who live with sever mental illness disorders holistically. It is not only to important to look at the person individually, it is important to look at their hallucinations, environmental factors, substance abuse history, and their overall well being. At the beginning of Karon's article she stated, "psychotic hallucinations also may mean that the patient is lonely; the voices represent somebody who cares about them." This two part sentence really explains why we need to step back and remove the stigma off individuals who LIVE with a disability; NOT individuals who ARE their disability.
ReplyDeleteFurthermore, our society is able to "normalize" things such as imagination, so why do we have to create such a stigma towards hallucinations? How many people, either themselves or knew someone else, who had an imaginary friend as a child? How many people used creativity and imaginative play to occupy themselves on a rainy Sunday afternoon? We, as society, are able to view this as acceptable because a child is observed having an imaginary friend, but not if an adult is having auditory, tactile, and/or visual hallucinations.
-Ashley Williams
That's a great point about comparing the attitudes about imagination to the attitudes toward hearing voices and having visions. I mentioned the Hearing Voices Network in my post below, and I saw that on the UK site they have a list of famous people who heard voices: http://www.hearing-voices.org/voices-visions/famous-people/. It's interesting how our perception of the experience of hearing voices changes if we already have respect for the person (like any of these famous people) as compared to someone who is being admitted to a mental health facility with hallucinations.
DeleteYou bring up a great point about Karon discussing how hallucinations may occur because a patient is lonely. That is an interesting concept and it makes me think of the two members I mentioned in my post that I used to work with. Both members did not have family living in Maine and did not have support other than the community support they received through community services and support from friends they made through Clubhouse or neighbors in their apartment buildings. There is definitely a stigma with hallucinations, like you mentioned, and that's an interesting connection to make between hallucinations and children having an imaginary friend. Since schizophrenia isn't usually diagnosed until late teens/early 20s, I wonder what the percentage of people diagnosed had imaginary friends in their childhood and what those imaginary friend relationships were like for the patient when they were younger.
Delete-Lindsay Hill
Ashley,
DeleteI too appreciated your point of view on this topic. It makes a lot of sense to me that hallucinations could be related to loneliness, and like you mention, for any one of us this would probably be considered using our imaginations. It makes me think about my day to day life and even doing things like picking up around my apartment or doing the dishes gives me a ton of time to sort through things in my own mind weather it be work stuff, family, relationships, anything at all really. I think we all have constant imaginative things running through our minds, its part of being conscious I would say. The label that folks with severe mental health diagnoses have seem to allow society and doctors to automatically over evaluate things that we all do normally. I do understand though on the other side of this point that there is a difference between our conscious stream of thought and actual schizophrenic hallucinations, I just think it may be easy to overanalyze at times.
- Spencer
As many of my classmates stated above, I also really liked the Karon article. I love the idea that we can begin to incorporate the hallucinations that clients may have into treatment, rather than follow our instincts that they must be medicated away before the treatment can really be successful. I have thought about this in the context of my work, though I admit differently.
ReplyDeleteAs I have mentioned before, I work for a housing program that work with veterans who are already homeless or who are facing imminent homelessness in some way (i.e. through eviction). As you might imagine, we see all types of clients. We see those who have been more on the stable side of things for most of their lives and have just fallen on hard times, through the end of a relationship or a job loss. We see those who struggle after returning from combat and we see those who struggle post military even though they never saw any combat at all. We also see those who have severe mental illness, including various forms of psychosis and schizophrenia. These clients can be understandably challenging to work with. As we are housing workers, many on my team do not have clinical social work backgrounds. Even for those who are clinically trained, it is hard to get through to veterans who are actively seeing hallucinations.
There are some that are resistant to the idea that these veterans will be successful in housing, because they are "too sick." How can they pay rent on time or cook themselves a meal or clean when they are hearing voices are are seeing things that others do not see?! On one hand, I do have to admit that we see this extreme. There really are folks that are too ill to be able to live independently. However, what I am resistant to is the belief that this standard is applied to all of the folks that we work with that have some level of psychosis. I do not like the belief that just because someone experiences hallucinations that they need to be hospitalized and/or medicated before any work can be done. Relationship building can be done with these clients (I love the part in which he talked about pretending to "fight" a patient's hallucination when the patient was afraid of it) and tons of tangible case work can all be done. And yes, people can absolutely be successful in independent housing even with ongoing symptoms of severe mental illness. Anyway, my point in all of this is that I full -heartedly believe that we do not give people a chance when we make the assessment that the hallucinations need to go before anything productive can take place.
My final thought is while Karon's article is absolutely the goal for where I want to me, I also admit that working with clients who suffer from hallucinations can be intimidating. I have struggled in the past to figure out when it is appropriate to have the client understand that what they are seeing/hearing is not real, and when it is more productive to just go with what they are saying. I have been at a loss for woods in interactions in which clients are responding to things I can not say and hear. And finally, I do not feel that Karon's way of treatment is something that we are normally taught. Part of me was slightly resistant (even though I am also in full support) of some of the seemingly "crazy" things that he was doing to treat his patients. Hallucinations are often spoken about in a way that does not leave room for their possible use in treatment, and I think that that needs to be talked about more.
Hi Erin-
DeleteI definitely agree with you working with individuals experiencing hallucinations can be intimidating and there are so many stigmas out there about individuals experiencing hallucinations (many of which you wrote about). I think there is such an opportunity for us to do those tangible strategies such as "fighting" the hallucinations or reminding the client they are in control. I also agree that I hope as we move forward in practice as a society we will be able to improve the way hallucinations are spoken about to decrease all those stigmas.
(post by Jenn Luja)
I found this article to be very interesting, and I learned a lot. I haven't thought much about dream interpretation, but know anecdotally that people often put faith in it, so why not discuss the content of hallucinations more openly? Hallucinations are not random, they are information. I think it would be beneficial to use this information in therapy.
ReplyDeleteI noticed in the article that while the author disapproved of "medicating away" hallucinations, he still wanted to get rid of them. A healthy mind, in his view, is free of hallucinations. That makes sense to me if the hallucinations are distressing to the individual, but what if we were able to accept hallucinations as a "normal" and "healthy" part of neurodiversity? I learned recently about the Hearing Voices Network, which offers peer support groups and other resources for folks who hear voices, have visions, or other unusual experiences. (Here's a link to their website: https://www.hearingvoicesusa.org/about-us). There are 3 groups here in Maine. They work to de-stigmatize the experience of hearing voices and help people find nonjudgmental support and information that will help them "learn and grow in their own way." In this environment, it's totally fine to choose to live with the experience of hearing voices.
I enjoyed many of the points in the Karon article about bringing hallucinations into therapy. He advocates for validating the experience of the voices which I think is important. However, I think we can take it a few steps further, in the spirit of recovery (dignity and respect, uniqueness of the individual, self directed lives, etc...), we may want to consider shifting our thinking away from needing to cure people of hallucinations and toward an openness to a wider variety of experiences that may include hearing voices.
Brenna, this is such an interesting point! You reminded me of an article I read once about the importance of culture in defining mental illness, specifically hallucinations. It's called "Culture and Hallucinations: Overview and Future Directions" (link: https://academic.oup.com/schizophreniabulletin/article/40/Suppl_4/S213/1874317) and it's fascinating to think about how various different groups of people might look differently at the experience of hallucinations. Or even different religious groups! So much of what we define as "healthy" is embedded in what society at large believes is "normal" or "abnormal", and this article further drives home the importance of looking at clients holistically, as intrinsically valuable, and as important members of the social fabric of our community.
DeleteThis article was very interesting to read because I hadn't thought of hallucinations in this way before. It does make sense to relate them to dreams and how they can relate to wish fulfillment in certain situations. I think hallucinations have become stigmatized to be a scary symptom that people experience because of the things people say and sometimes do when experiencing hallucinations. One of the members I worked with at Capitol Clubhouse experienced auditory hallucinations throughout the day (and he took medication daily/as prescribed) and they were voices of people from his childhood. He would become very angry at these people and would yell at them because he didn’t like the things they would be saying. Because of his reactions, many people were afraid of him when he was talking to the voices because he was intimidating because he was so angry. On the other end of the hallucination spectrum, there was another client at Capitol Clubhouse who experienced happier hallucinations and would often be laughing from what the voices were saying to him. Because he was more approachable, people were not afraid to speak to him. One quote I liked the most in Karon’s article was “if the material seems incomprehensible, it is important to listen and tolerate it.” I think that is a valid statement to carry forward while working with people who experience hallucinations. The advice that Karon provided for therapists who work with clients who hallucinate was helpful, but I do think it takes certain therapists and certain clients to make those approaches work. The examples he provided of helping his clients to stop hallucinating was interesting because he believes the hallucinations stopped because Karon confronted them with the client. I think a client would need to be able to distinguish between fantasy and reality in order for Karon’s approach to work. I think in terms of medicating a person when they hallucinate or using the hallucinations as communication for therapy would depend on the person. I believe medication can be successful in reducing hallucinations for people, so they are able to have a better quality of life and not be distracted and bothered by the voices, sounds and smells they experience. But I can see Karon’s point in wanting the person to work with the hallucinations to figure out their purpose and resolve the underlying issue. I also think a therapist has to feel comfortable with confronting a hallucination the way Karon does. I do wonder how many other therapists have been successful in trying his technique.
ReplyDelete-Lindsay Hill
Hey Lindsay, I appreciate your post here - I feel like our perspectives on the Karon article are very similar! I also found it powerful to read about someone willing to acknowledge that although most of the population cannot or will not look for logic in the descriptions of hallucinations from people experiencing them, there IS a logic there - it may not make sense to everyone else, or it may not make sense at first, but it is serving some sort of purpose. It is rooted in SOMETHING, some experience or prior trauma, and it is a different way the body is trying to communicate its needs. And I'm totally with you on feeling a little leery when it comes to using this approach with clients. Because people's experiences are so different, and the symbols that have meaning for them aren't universal, I imagine it would be complicated to tease out those meanings with a client unless the therapeutic relationship was rooted in trust.
DeleteI really enjoyed reading Dr. Karon’s article about the use of associations in understanding the role of hallucinations in the treatment of someone experiencing psychosis or diagnosed with schizophrenia. I also really appreciated the overall theme of the article – that people living with mental illness deserve to be as heard and respected as the experts of their experience as anyone else. I appreciate that Karon’s anecdotes illustrate how people find ways to communicate their thoughts, feelings, or their pain, and that blanketly medicating the symptoms not only doesn’t help identify the root cause, but it also undermines the importance of treating a patient holistically. Looking at individuals from a strengths-based perspective can help facilitate conversations like the one Karon described where the patient heard the bell ringing loudly, like a telephone, which helped Karon understand that his line of conversation was not as important as what the patient wanted to discuss.
ReplyDeleteI also admit to feeling a bit overwhelmed by the prospects of feeling like I, as a future practitioner, will someday have to learn to interpret the hallucinations my clients may experience in order to address the possible underlying issue. Trying to sift through the importance of certain features in a client’s hallucinatory experiences seems as daunting as trying to interpret dreams, especially when there are no universal symbols.
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DeleteHi Meg- I completely agree that I, too, enjoyed the anecdotes of how individuals are able to communicate their thoughts and feelings through hallucinations. I agree it is so helpful to use a more strengths based perspective.
DeleteI think it does feel like a daunting experience to interpret dreams or hallucinatory experiences but in the article I feel the key message was to build a relationship where clients can express these hallucinations in a safe and supportive environment. I feel sometimes as a provider I can get so wrapped up in providing the "right" information and "finding a solution" and this article really helped bring me back to the fact that in some scenarios listening and providing support can be just as beneficial.
(post by Jenn Luja)
Hi Megan,
DeleteI definitely relate to the feelings of overwhelm about reading this article! One piece that made it feel more manageable is that the author seems to emphasize the importance of supporting the client to make their own attempts at analysis and interpretation, rather than immediately jumping in as an observer and doing the analysis for the client. I think this makes so much sense because the client's mind is the one creating the hallucination for some reason that we are unaware of. Even if the client is unaware, it is likely connected to some emotion or experience that the client does have insight into. They may just need some support to make the connections, and the therapist can play that role. To me, that feels like a more manageable first option to try. Beyond that, or for clients who struggle to draw those connections, I'm just hoping it's something that comes with practice. :)
Megan,
ReplyDeleteI am glad that you admitted “feeling a bit overwhelmed” in the regards to interpreting dreams. I can relate to those thoughts. I question myself, will I be ready. For me, the answer is to learn more. I also liked your point of “those living with mental illness need to be heard”.
In respect to these two points, I did a little more searching as I am curious about treatment of schizophrenia. I googled schizophrenia and found that WebMd had a limited optimistic view saying that “some” people could work. In digging a bit farther, I found a very interesting article by Elyn Saks, a legal scholar, wrote and article about her experience with schizophrenia. She wrote the Diary of a High-Functioning Person with Schizophrenia. I think this speaks to your point of “people with mental illness need to be heard”.
Her story addressed so many stigmas we have in society today (people with scizophenia are not necessarily dangerous and they work etc.)
There were a couple of quotes I would like to note-
“Indeed, work is, for me, the last thing to go. I think I have always sensed that keeping active intellectually is a big support and a big source of wellbeing. Indeed, I really noticed how important work is to my stability when it became clear that the worst part of each day was always the evening—the time I didn’t have the structure of work to contain me and help keep my thoughts organized.” (Saks, 2009)
A second quote by Saks regarding restraints reflects the past topics of this class-
“These restraint episodes were extremely traumatic. It is frightening to be put and kept in restraints, causes feelings of degradation and helplessness, and over, say, ten hours is extremely painful.. This was the worst trauma I have ever been subjected to. I had nightmares about it for years and years.”(2009)
I am glad that Saks has shared her story and I thought I would add her comments into this weeks conversation. Probably the most relevant point to this weeks content is she admitting that she sometimes needed hospitalizations, but due the poor treatment she was reluctant to go back. (Saks, 2009)
I apologize for the long winded reply/post, but I think the idea that we as counselors won’t be the experts, but with using the learn principles of this class I think we will be just fine. :)
https://www.scientificamerican.com/article/diary-of-a-high-function/
Hi Becky,
DeleteThank you so much for your reply, and all the quotes! What a powerful story! I'm grateful that you passed it along. To me, it echoes what we've been learning all summer - people living with mental illness are PEOPLE, and if you forcibly restrain them or take away their ability to engage in meaningful work, their mental health will inevitably suffer as a result.
And thank you for your encouragement - you're right! We'll continue learn the more we engage in our work and our studies. And this article is such a great example of how our clients are our teachers! Karon asking his patients "What does this remind you of?" makes so much sense, because you could read all the books in the world about dream interpretation or what hallucinations mean but if your client has no idea what you're talking about, you're kind of stuck. Learn more about your client, build that trust and that relationship, and move forward from there!
Megan,
DeleteI love that you mentioned that our clients are our teachers. This is a great point. It makes me think of one of the counseling sessions during methods class. I’m not sure who stated the question, but it stayed with me.
Counselor, “What do you want me to say to you right now?”
Client, “It’s easier than I’m making it”.
I think this is an example of asking the client for direction at a time when the counselor might feel lost.
It sounds like you found an interesting article from Elyn Saks and I would be curious to read more from her given her experience. The quotes you provided sound inspiring for those who are unsure about work. I think employment can provide great supports for a person when they are in the right setting and doing a job that is a good fit for them. I think it makes sense that the structure can be beneficial. I'm sure Saks article has many more reasons why employment works for her and helps her in her recovery. It would be a great resource to pass along to clients who need inspiration and motivation.
Delete-Lindsay Hill
Lindsay, I think sharing Elyn Saks story as a resource is a great idea! They maybe in an hopeless state and need to believe that there is a chance to live with a hopeful heart. It is amazing how this class has evolved and build on concepts. I just rewatched the YouTube video, Patricia Deegan’s amazing story. Deegan stated that “relationship is the most powerful they have in working with people.” I think by sharing Deegan’s experience as well as Saks would provide hope. As Deegan stated, the diagnosis crushed her heart.
DeleteThe article by Karon was a very interesting read. I have had minimal experience working with individuals with hallucinations therefore I assumed they were a negative symptom (like many stereotypes) and assumed individuals experiencing them would want them to go away however the article definitely changed some of the stigmas I had. For example, in the beginning of the article it was discussed how some hallucinations can mean the patient is lonely and “the voices represent somebody who cares about them.” This struck me because I do think in general mental health can make individuals feel very isolates, especially if the symptoms cause an individual to struggle to function in aspects of their lives. Thinking about the voices being a companion and having these hallucinations meet a need would definitely make me think differently about providing an intervention which would extinguish them. Another piece in the article, which widened my awareness about hallucinations, is the statement that it is “important to let a patient know that you believe their experience and you do not consider them defective.” As a society we do tend to look at individuals with mental illness as defective and this tends to more true about individuals with hallucinations. I feel often there are stigmas if individuals have hallucinations they are perceived as “crazy” or “dangerous” and this is obviously not true. I think if as a society hallucinations were viewed as a tool of our body or mind telling us things this would improve the ability of individuals experiencing this to be more open and honest and I do feel we would not want to medicate them away.
ReplyDelete(Jenn Luja)
Hey Jenn - I found this to be a really important point from the reading, as well! I feel like we could take an entire class on public perception of mental illness, how the media factors into it (*cough* Split (2017) *cough*), etc. We're covering quite a bit of it in this class, already! But the notion that people who experience hallucinations are to be pitied or feared is so dehumanizing and IGNORANT. Perhaps if we looked at individuals experiencing mental illness as people first rather than just their symptoms, we (as a culture) would be more likely to understand the different facets of mental illness better.
DeleteJenn,
DeleteHallucinations seem to be so deeply personal to each individual who experiences them. I think some people do find comfort in them and try to use them as a communication tool. Others, however, would prefer not to ever have them again. I have worked with several individuals who felt both ways. I think that the key is working with each person and keeping it specific to them. What works for one person may not work for others, and that is OK. We have to make sure we are listening without judgement and offering all that we can to support our client in what their individual needs are at that time.
Kaitlynn Littlefield
Jenn, way to be honest! I think hallucinations do have such a negative connotation, we see in the media the "crazy" person and we hear stories of people being told to do bad things, etc. Like all areas of treatment, there is good and bad and there is a variety of severity to them. I have had the opportunity to work with some people that through hallucinations did some bad things, and became famous for those bad things. After intense and long care treatment those hallucinations are gone and the person has re-entered into society. They sometimes hear there name and story in the public portrayed as a negative and bad person but it is so misrepresented. Sure what they did was wrong, but now they are a different version of their former selves, something I think we are always trying to do.
ReplyDelete-Sean K