Welcome to Look again, mental illness re-examined, I'm Faydra Aldridge.
Teddy, please, please don't do this. -- A year ago, I met a man who was down on his luck. He's got a gift. Thought I might be able to help.
Are you out of your mind?
She paints, she reads...
Yeah, she paints, she reads, she lights things on fire. I got a fire extinguisher, just bring her. Help you? Do I look like I could help you? What are you doing? You threw the goddamn ball into the fence -- you threw the ball into the fence - Christ almighty -- there's nobody there! John has Schizophrenia. P eople with this disorder are often paranoid... I'm not.
If Hollywood is to be believed, all people with schizophrenia hear voices telling them to do bad things. The truth, though, is a little more complex than that. Hearing voices can be a symptom of mental illness. Some people do hear voices or experience other kinds of hallucinations, of course, but others do not. Some hallucinations are actually not negative or violent. Well, some cause a person to want to harm themselves or others. So what's it really like to hear voices anyway? Why
is there so much stigma around this? And what can we do about it if we do encounter someone who seems to be experiencing hallucinations? These are just some of the fascinating questions we're going to be looking at on today's episode of Look Again. Today, I'm very happy to introduce you to Dr. Randall White. Dr. White is the medical director of Community Mental Health in Vancouver and the clinical director of the BC Psychosis Program at UBC Hospital.
He is also a clinical professor of psychiatry at UBC and on the Medical Advisory Board of the BC Schizophrenia Society. And Dr. White has also been awarded the status of Distinguished Fellow by the American Psychiatric Association this year. Randall, welcome to Look Again.
Thank you, Faydra.
Now, before we really get into things, I want to kick things off by sharing some thoughts from our panel. We're going to hear from some people with lived experience about what it's actually like to hear voices. So let's take a listen now.
I have experienced auditory hallucinations and olfactory hallucinations and physical hallucinations. I thought I was in labor and that was very interesting, to say the least. Needless to say, I didn't go to the hospital. My family was with me and they said, oh, it's just your imagination, which I accepted. And then I had olfactory hallucinations where I smell things.
I started hearing audio hallucinations again and they actually were about hallucinations. And I actually get up on the psych ward and I don't know if you feel like I don't have to listen this. So but yeah, I did have them anyways and it just kind of scared me just having them. So I went to the psych ward and I'm doing much better. I was really, really anxious when I took myself to the psych ward.
So those were some thoughts from our panel. People living with mental illness, pretty powerful. Dr. White, we just heard from people living with mental illness and the fact that many of them hear voices, but not all people with schizophrenia hear voices. In your clinical experience, how prevalent is this symptom?
Hallucinations are one of the five main symptoms listed in the diagnostic manual we use to diagnose schizophrenia. They're very common, but as you said, they're not universal. I would say that probably three quarters or more of people with schizophrenia experience that at some point it can be episodic. So at a given time, somebody with this diagnosis might not be having that, but then we may have relapse or illness gets worse. It may come back.
You talk about psychosis and sometimes I've heard people use schizophrenia and the term psychosis as the same term they use it synonymously. Can we delve into that? Because hearing voices is a symptom of psychosis, which is associated with many mental illnesses, not just schizophrenia. Can you tell us more about that?
Correct. Hallucinations, hearing voices or auditory hallucinations is one symptom of psychosis, and psychosis refers to an abnormal state of mind that could be due to any variety of causes. Schizophrenia is one one of the more common causes of especially chronic or ongoing hallucinations. When we talk about psychosis in general, we talk about this abnormal mental state that lasts for anywhere from usually days to weeks. And in
the case of schizophrenia, it could be years. Another common form of psychosis is schizoaffective disorder, which is similar to schizophrenia, but also has elements of depression or mania or mood problems mixed in as well.
We all hear voices right now. There's a voice in my head saying, sit up, don't talk so fast, remember to breathe. So how do we know the difference between the voice that's in... or example, my head right now, my inner voice and an auditory hallucination?
Well, yeah, we talk about our inner voice. And another way people describe that is maybe their conscience. That's not what people with schizophrenia are experiencing when they talk about hearing voices. They talk about an experience that's very similar to what our listeners are having right now, where someone else is talking to them. They don't necessarily call it their inner voice. They call it often an alien voice that's coming from outside their head. Sometimes it sounds more
like it's hitting their head, but it can vary. But frequently it's completely alien. They may or may not give an identity to it. It may say things that seem totally uncharacteristic for the thoughts they usually have. It may tell them to do risky, dangerous things. And so it's a very compelling experience in many cases that could lead to irresponsible or dangerous. That's very different from what we might call our inner voice or our conscience or even our repetitive thoughts,
And when we think about auditory hallucinations, there are many other kinds, and you alluded to this earlier, including tactile, which you don't really hear a lot about. Can we talk about those other hallucinations that we may not hear a lot about?
Yes. So in psychosis and especially in schizophrenia, the hallucinations can occur in any sense. We call them sensory modalities. So touch, smell, vision and hearing, of course, so people can have visual hallucinations, they can see other people, they can see animals or other things that aren't present. They can have odors, they can smell strange things, even their taste can be distorted. And then they can feel things on their skin like someone is touching them. That may
be very complex. They may feel as though they're being sexually assaulted, which is obviously very distressing. These can occur in different combinations. So they might hear the voice and then they feel something and they think someone is trying to harm them or possess them. And that can lead into another symptom, very common in psychosis, which is delusions.
Delusions are false beliefs. So somebody who's having a hallucination where they feel like they're being sexually assaulted may then develop a delusion that an unseen person or their neighbor or whoever is repeatedly assaulting them.
Now, if somebody does experience hallucinations, what are some treatment options with schizophrenia?
The cause is not completely understood. Therefore, we only have treatments that can sometimes partially, sometimes fully suppress that symptom, but not necessarily cure it. And it comes down to medications, antipsychotic medications. At the same time, I should mention, we have some psychological and behavioral interventions that can help as well. They won't necessarily eliminate it, but it can help people to manage the distress that goes along with the experience
You're listening to. Look Again, Mental Illness Re-Examined, a podcast brought to you by the BC Schizophrenia Society and B.C. partner organizations. I'm your host, Faydra Aldridge . This podcast would not be possible without the support of the entire community. From the bottom of our hearts, we want to thank you for caring about mental illness together. We truly can
make a difference. So we're speaking with Dr. White about hallucinations, earlier, we heard from people with lived experience and what it's like to experience these hallucinations, and now we're going to hear from family members and what it's like for them to see a loved one experiencing them.
I remember one day coming home, it still upsets me to this day. He was walking around my living room and then just kneeling, staring, and then slowly get up and take a few steps to the left or the right and he'd kneel down on one knee again. And he did that -- just in a circle in my living room. And I just couldn't reach him in that moment, just watching his body move so slowly in response to something that I couldn't see or hear. It's quite it's very terrifying.
I mean, I remember those those years. And I'm just so grateful that we're past those.
The feeling of helplessness, not not so much fear, but you just see the torment that these folks are going through. It's just distressing to see them. Sometimes it's his paranoia how it bothers him. And it's there. It's really unfortunate. There are places where people have tried to reproduce auditory hallucinations on YouTube. And if some of those are true, it is scary if if in fact those renditions are even close to what people are hearing in their heads.
And I just feel so, so sad for the torture that this symptom gives to gives to these folks, to my sons.
You can just see the torment that they're going through and how how badly he felt about himself because of what the voices were telling him about how awful he was. And he's going to go to hell. You know, he didn't want to live anymore. You wanted to be put out of his misery when he was so afraid they were right that he's going to go to hell.
I can see my son's eyes. They go flat when he's somewhere else. They were a comfort to him and they told him he was really smart. But they also warned him that people were after him all the time and stuff, too. So that's been stolen, the candle is blown out, feeling pretty awful to witness in your child.
So those were just a few thoughts from some family members, from our family panel made up of families of people with schizophrenia. And we asked them to share what it's like to witness someone who is experiencing active hallucinations from the outside. We're back with Dr. Randall White, clinical professor in the U.S. Department of Psychiatry and distinguished fellow in the American Psychiatric Association. Randall, that was tough to hear
families express. Obviously, a lot of concern about seeing their loved one going through psychosis. And it's not easy to see. It certainly wasn't easy to to listen to, that's for sure. So in your experience, what does it look like from the outside for someone to witness that?
Well, I know that this is a really mystifying disease for families or for anyone who is observing. And it can look different, obviously, because everyone is unique. But I think one of the family members was describing somebody probably in the midst of of hearing intense voices who was kind of overwhelmed by it, showing a lot of disorganized or amped up behavior, doing repetitive movement. And that's something
that I observed. And the patients that I treat commonly, they have gestures or pacing, grimacing, talking to themselves, laughing, all those things. And it's the hallmark of what I guess historically was called madness. Sometimes it's clear that the patients are in anguish. Other times they might smile and laugh and it might look like they're enjoying themselves. But at the same time, we know they're cut off from others around them when they're in this experience and it
takes them away from meaningful relationships. And that's what hurts the family so much.
So I'd like to talk about the danger part of it. How much of a danger to others is someone in the state likely to be? Because I think there's a lot of misconceptions around this.
People with schizophrenia are more likely to be harmed or assaulted than they are to commit an assault or to commit murder. And they're actually quite vulnerable when they're in that state. They're vulnerable to being exploited because they're not as aware of their surroundings to getting, let's say, hit
by a car. At the same time, it's important to be truthful and honest about the fact that certain kinds of psychosis do elevate the risk for assault or harming other people, because people who are very paranoid and fearful may react unpredictably. In some cases, people with psychosis can develop a very intense, specific delusion about maybe someone in
their environment. It's rare, but it does happen. But I still need to emphasize that the average person with schizophrenia who is not adequately cared for and treated wandering on the street is really not dangerous to the public at large.
I've been hearing this term a lot lately, psychotic breaks. So I'd love to get your professional opinion on the difference between hearing voices and an actual psychotic break. What is a difference between those two?
Well, psychotic break is it's not actually a diagnosis. It's it's a term that we use a bit casually. The word break refers to a break with reality that sometimes our psychosis is characterized because in the psychotic state of mind, the person is preoccupied with these internal things that don't reflect reality. A psychotic break means the person becomes psychotic, and it often refers to the first episode of psychosis. Sometimes we call it the first break episode. Sometimes it
occurs abruptly, sometimes and more often it's rather gradual. And it typically would involve hearing voices...
If we ignore the fact that one out of a hundred people have schizophrenia and even more experience psychosis. So if we as a society choose to either ignore or keep it hidden that these illnesses exist, where will that take us?
I think the fear, the stigma result in the people affected in the patients, so to speak, not getting the care they need. So it just prolongs, I think, suffering when there's ignorance and stigma attached to an illness.
I'd like to talk about stigma. And I think stigma is a huge part of this, which is why I'm so happy we're doing this podcast. Randall, what do you think? As a frontline clinician, what do you think we can do as a society? To start to break down those silos and to really address the stigma associated with serious mental illness,
Although it's still substantial that stigma, I think there is some improvement. But, you know, there are plenty of books, you know, memoirs people have written about their experiences. So I think, you know, when we have people who can talk about their experience, that helps a lot more than
some doctor preaching to the public. I think I think things like what the Schizophrenia Society does like this, a podcast to try to demystify, I think, getting family members, if they're able to write into newspapers, op ed, you know, talking about how important it is to to stop stigmatizing and to be honest about mental illness. And I know that families and schizophrenia society are very active in their communities. So basically, it's a team effort.
Well Randall, thank you so much for joining me today. So that was Dr. Randall White. And we will be sure one hundred percent to post all our relevant links and items we talked about today from our conversation on our website. That website, again, w w w dot BCSS dot org. Dr. White. Thank you so much for joining us today.
It was a pleasure.
And now it's time to thank my incredible guests today on Look Again, Mental Illness Re-Examined. And I want to thank you for listening. Your support means absolutely everything. Mental illness literacy is so important. It's important to you, to me and to us as an entire society. We have to talk about this. And together, I know we can do a better job of taking action. Talk to you soon. This podcast is brought to you by the B.C. Schizophrenia
Society and the B.C. Partners for Mental Health and Substance Use Information, where a group of non-profit agencies providing good quality information to help individuals and families maintain or improve their mental well-being. The B.C. Partners Members are Anxiety. Canada, BC Schizophrenia Society, Canadian Institute for Substance Use Research. Canadian
Mental Health Associations, B.C. Division, Family Smart, Jessie's Legacy, the North Shore Family Services Program and Mood Disorders Association of B.C., a branch of Lookout, Housing and Health Society. The B.C. partners are funded and stewarded by B.C. Mental Health and Substance Use Services, an agency of the Provincial Health Services Authority. For more information, visit Here to Help dot BC dot CA.