Hi, I hope you're having a good day! I have a schizophrenic OC and have some questions about psychosis:
What are moments of clarity in the middle of an episode like, as in realizing a delusion isn't true? Can a moment of clarity fully take you out of an episode on its own, or would you just spiral again without intervention?
If you get closer to where a hallucination is "coming from" in physical space, does the sound get closer?
What would it be like if you tried to physically interact with a visual hallucination?
-Anon đ
Anon đ here again with more questions about psychosis:
How common is it to hallucinate (visually or auditorily) people you know in real life?
Can you have consistently positive experiences with a recurring hallucination?
Thanks so much for everything you do!
I have psychosis but not schizophrenia, so please keep this in mind. I'll also say that psychotic symptoms and experiences are extremely individualized, and these answers are based on my own experience, they're by no means universal.
Can a moment of clarity fully take you out of an episode on its own, or would you just spiral again without intervention?
This will depend on a few factors, I think. If someone is in general aware that they have a psychosis spectrum disorder, go into a psychotic episode, and realize "oh I'm Actively Having a Psychotic Episode" then that might take them right out of it, or do so gradually, or at least help them stop freaking out. If someone has the insight of knowing what is happening to them, there's a higher chance they will go back to "normal" faster.
On the other hand, if someone is unaware that they are in psychosis, or what is going on, there's a higher chance they will go back to it. But there are no hard rules - someone who is normally extremely self-aware of their psychotic episodes might spiral into it over and over if they're under more stress than usual, for example.
Another thing is whether the hallucination/delusion is "bizarre" (fantastical, literally couldn't happen, not understandable even in the person's religious/cultural context) or "non-bizarre" (possible, even if highly unusual/improbable). If someone is aware they could be in psychosis, it's much easier to clock something as fake if it's of the bizarre variety (since having an alien in your bedroom is weirder and raises more questions than someone knocking at your doors a lot). That can provide that moment of clarity if you have enough self awareness to go "but aliens aren't real, I must be in psychosis" - though it's not a guarantee by any means ("what if I'm the first person to discover aliens?" -> starts spiraling all over again).
The same above goes for "simple"/"complex" visual hallucinations - if you realize that the "person" is actually just a vaguely person-shaped blob of color, it could just take you out of it, since well, that's not very convincing after you notice that.
There are also ways to "solidify" that clarity. A really common trick I know is to take a photo of the hallucination; if it's not here then you know it's not there either. Some people also take off their glasses and check if there's a mismatch in how the hallucination should look like if it was real vs if it's made up by the brain (if it suddenly looks like an interactive object in a 2000s video game or looks weirdly HD, it's probably a hallucination), though this one never worked for me personally.
What would it be like if you tried to physically interact with a visual hallucination?
I only ever tried to do this while I was fully unaware that I was in a psychotic episode, so keep that in mind.
Looking at it now, I didn't "feel the hallucination" at all. I was hallucinating thing A, and touching real existing thing B (that I thought A was on/under), and I felt exactly what I would if it was just the real physical object B. But because I was hallucinating, I didn't pay attention to that fact, and it certainly didn't "take me out of the hallucination" that the hallucination didn't feel how it should. It obviously depends on the person, but if someone is trying to touch the hallucination and expecting it to feel like the thing, they probably won't notice even if it doesn't feel like it at all. You could be hallucinating a dog and be touching a chair, and it wouldn't feel out of the ordinary.
As for the hallucination touching the person - again, can only speak for myself - tactile hallucinations can be extremely real. Mine felt 100% how they would (if they could logically happen, since mine were of the "bizarre" variety), even looking back at it now.
If you get closer to where a hallucination is "coming from" in physical space, does the sound get closer?
A lot of the points from the answer above will be true for this one too. If someone is completely "in" that hallucination, they might not notice/care even if the sound doesn't get any closer despite them getting closer. But yes, some people can have very realistic hallucinations and be able to tell exactly where its sounds are coming from according to them. If it's a static hallucination that e.g. only shows up in a specific area, they might avoid going anywhere near there.
Also: not all hallucinations that should logically produce sounds actually do. Another thing that the brain might ignore and not question for some people, and take someone else out of the hallucination entirely.
How common is it to hallucinate (visually or auditorily) people you know in real life?
I think media makes it seem way more common than it actually is, but it does happen. This could also be affected by the person's life events, e.g. if a psychotic person has recently experienced something major regarding a certain person, there's a higher chance they could be hallucinating them - because it's Recent and Traumatic. Some people will be hallucinating people they know 24/7 nonstop, others will literally never have it, and a big portion will have a few of those throughout their life.
It is also fairly common to hallucinate recently lost loved ones after their death for people who aren't (long-term) psychotic as well. It's basically a trauma response to high stress, and can happen to anyone.
I'll say, you can hallucinate all sorts of real people: they sure could be your closest loved ones, but they could also be your classmates, your annoying coworker, the cashier at your local grocery store, a religious figure, etc.
Can you have consistently positive experiences with a recurring hallucination?
You can, though I personally never did. I'll leave this question to mods who have more experience with it, though I'll say that you can especially have a positive hallucination if it's a hallucination of something you already like (like a friend, for example).
For the end I'll also mention that there are many more types of hallucinations than just visual and auditory; olfactory (smell), tactile, sexual, somatic (e.g. pain, or feeling like you're moving when you aren't), and command ("the voices telling you to do something", it's usually categorized differently from auditory ones).
I have schizoaffective with depression and only have a few things to add because Sasza put everything so well! :)
There's a concept in psychosis you'll hear a lot called double bookkeeping. It's the idea that you both know something is delusional or part of psychosis but believe it anyways. This is something that I experience during early episodes or in the beginning that goes away as my episode gets longer. Some people do not have this at all, some people this is the only way their psychosis shows up. But a lot of how strong a hallucination or delusion is will depend on if you're truly believing it without question or double bookkeeping, or how "in" the hallucination or delusion you are, as Sasza said.
Personally, it's harder to have a "moment of insight" when I am double bookkeeping because I already know what I'm believing or doing is unrealistic or bizarre but I still keep doing it. When I am fully in the delusion, it's easier for something to pull me out (one time a very well timed text message from a friend made me start to question a very dangerous delusion) and for me to go to the double bookkeeping mindset.
As for hallucinations and where they are physically located, I've mainly had hallucinations that feel like they are anchored in place but the opposite is also possible!
I sometimes hallucinate real people, but those times have often been related to strong emotion or trauma, like mentioned. I more often see strangers.
It is possible to have a positive hallucination or delusion, or to have a hallucination that is regularly positive! I have a British voice that brought me a lot of comfort in my last serious episode. He would say very positive things compared to the other meaner voices. I actually miss him sometimes, although I am glad to no longer be hearing voices.
Last little bit I'll add is please remember schizophrenia and schizoaffective involve at least 2 of 5 components, only one of which have to be hallucinations, disorganized speech, or delusions! The others are abnormal movements/catatonia and negative symptoms (asociality, anhedonia, avolition, alogia, and (blunt) affect, the beautiful five As).
