Auricular Hallucinations in Alienation - Term Paper Example

Auditory Hallucinations in Psychosis (Name) (University) Abstract Psychosis refers to mental health conditions which make a person to stop thinking clearly. The person is unable to differentiate between imagination and reality. Hallucinations and delusions are the main symptoms of psychotic conditions. While the research done so far has been inconclusive, a lot of progress has been made in determining the causes and possible treatments of psychotic disorders (Hollon et al., 2005). It is important that there is learned differentiation between possible spiritual/ religious and pathological explanations of psychosis. This paper examines the research done so far on psychosis while narrowing down to auditory hallucinations. The paper will discuss the key approaches in addressing this problem while laying emphasis to medical and psychological evidence of the last ten years. The first section will introduce the concept of psychosis, its causes, symptoms and courses then narrow down to the literature on auditory hallucinations. The second section will discuss the approaches to the problem and a give conclusion on the findings. Keywords: psychosis, hallucinations, delusions INTRODUCTION Psychotic disorders refer to severe mental conditions that result in delusional thinking and twisted perceptions. Psychotic victims’ reality is distorted and they experience various symptoms, key among them being hallucinations, delusions, confused thinking and rapidly changing feelings. Schizophrenia and bipolar disorder are common examples of psychotic disorders. Problems that can cause psychosis include drug and substance abuse, brain infections, stroke and brain tumours (Turkington et al., 2008). Many theories exist on the evolution, causes and possible treatments of psychosis. However, neither the psychosocial nor the biological approach has been conclusive in terms of finding the actual causes that can be applied uniformly to all victims (Zimmerman, 2005). Consequently, it is widely acknowledged today that there exists an interaction of multifunctional causes that explain the occurrence of psychosis, hence the three approaches of biological, psychosocial and psychotherapeutic treatment. Psychosis has been established to occur mainly amongst young adults and 3 out of 100 young people are likely to experience psychotic conditions, while 2 percent of the general population will have a psychotic episode at some point of their lives. Victims of psychosis will behave in a different way compared to their usual behaviors (Tarrier et al., 2004). They might experience lethargy, be unusually active or get angry for no apparent reason and even will laugh inappropriately. These inconsistent symptoms and behaviors make treatment difficult as there is no set pattern in individuals with psychotic disorders and one victim is as different from the first as the second. One victim might stop eating in the belief that someone is trying to poison them, while another will stay awake the whole night awaiting a visit from God. The first episode in psychosis is the first time when an individual experiences a psychotic condition and symptoms (Bateman, 2003). Such a person will be very confused and distressed as the symptoms are disturbingly unfamiliar. Since there is relatively low information on psychosis, many myths have been formulated concerning psychosis and mental illnesses, with references to the supernatural and witchcraft. Course and Cause of illness A psychotic episode occurs in phases, the first being Prodrome. Here, the first signs of illness occur and are hardly noticeable. Such signs will include depression, irritability, anxiety, thought changes and preoccupation with unusual ideas. In the acute phase, clear symptoms such as delusions and hallucinations are experienced, with auditory hallucinations being prominent (SCIE, 2008). Other hallucinations include tactile, visual, olfactory and gustatory. Delusions will take many forms and could be delusions of reference, religious delusions, somatic delusions, persecutory delusions, passivity delusions and grandiose delusions. In the recovery phase, the psychotic condition is treatable and many victims recover, although a minority will continue developing symptoms. Psychosis can be categorized into types based on perceived cause, course of illness and symptoms. The first type is Drug-Induced Psychosis. Use of drugs is associated with occurrence of psychotic conditions and either wears off with stoppage of use or the illness continues until some form of clinical intervention (Tarrier 2004). The second type is Organic Psychosis which results from a physical illness and head injuries which affect brain function. In this case, the psychotic symptoms will be accompanied by other non-psychotic symptoms such as memory loss. The third type is Delusional Disorder which characterized by belief in untruths and false ideas. The fourth type is Schizophrenia and connotes psychotic illness where reported symptoms have been experienced continually for at least six months. The fifth type is Bipolar Disorder which occurs as more of a general mood disturbance. The sixth type is Psychotic Depression which means depression mixed with psychotic symptoms, but without occurrences of elevated mood. Additional types include Schizoaffective and Scizophreniform Disorders (Bateman 2003). This paper will focus on auditory hallucinations as a mental health problem in the field of psychosis AUDITORY HALLUCINATIONS Auditory hallucinations are shrouded in complexity. Hallucinations are explained as “the internal mental happenings and events, such as cognition, that are perceived by the victim to be of a non-self origin” (Stinson et.al, 2010). The victim hears sounds that are non-stimulated occurring in their heads. Moreover, auditory hallucinations can be seen as subjective perceptions of externally originating speech with the absence of any external stimuli. Somebody suffering from such hallucinations could be walking in a quiet environment and suddenly start to hear a non-present person talking to them. While most research done on this topic mentions auditory hallucinations in terms of normal sounds, Oliver Sacks (2007) mentions his lurid interactions with psychotic and non-psychotic people who have musical hallucinations. Sacks, in his acclaimed research book Musicophilia (2007) gives accounts of people without histories of psychotic conditions having auditory hallucinations. In this case, Sacks seems to try to dissociate some auditory hallucinations from the broader field of psychosis. However, if somebody experiences auditory hallucinations, must they be psychotic? Moreover, is there an association between psychotic and non-psychotic victims of hallucinations, and if so, where is the line drawn between the two as separate clinical cases? Hence, a question arises, do auditory hallucinations mean more than is largely believed and are they divorceable from psychosis? A study conducted by Delespaul et. al. (2002) showcased that the context of visual or auditory hallucinations affects the intensity of that particular psychotic episode. These researchers established that the type of activity either increased or decreased the level of intensity of the hallucinations. As such, non-static activities reduced the intensity. However, the research was inconclusive since observations for other hallucinations such as visual and olfactory varied inconsistently. Consequently, common patterns could not be establised. It has been known that several factors contribute to and cause auditory hallucinations. Thus, hallucinations cannot be explained in schizophrenic terms alone. Such non-psychotic factors include use of psychoactive drugs such as marijuana and sleep deprivation. Auditory hallucinations have also been reported to occur as a result of some infectious ailments such as Lyme disease and HIV, that cause chemical and neurotransmitters imbalances in the patient’s brain (Beck, 2005). The psychiatric or medical model is the more prevailing paradigm when considering auditory hallucinations in schizophrenia. This paradigm has led to various attitudes; for example, in the founding of asylums for the “mad people” in the Victorian age (Bentall, 2008). This model explains mental illness as a chemical problem whose solution must also be chemical. Consequently, this has led to mentally ill people not being consulted in their treatment (Stinson et al., 2010).The National Alliance of Mental Illness (NAMI) believes in the “eradication of mental illness.” This idea however is vehemently refuted by Turkington et al. (2003) who believe that those that patients can offer useful insights into the nature and possible treatment of those conditions. Currently, there seems to be a biased over-reliance on psychiatric medications in the belief that psychosis is almost purely biological. Indeed, research by Escarti et al. (2010) suggests that there must be symbolism and meaning in hallucinations. This means that proper inquiries into the condition, independent of prejudice will be of great relevance and that hallucinations, seen as mere symptoms of a larger brain malfunction cannot yield much result. Additionally, Hugdahl (2007) brings forward two probable explanations to the true nature of auditory hallucinations. The first explanation is that there exists some inner speech or self-talk. However, most of the hallucinatory patients refute this and point to some other distinctive voice in their heads. Hugdahl argues that, it is this inner hearing that makes the condition “a condition” distinctive from the usual self-talk that non-hallucinatory people experience occasionally as a normal thought process. The other explanation is the condition of traumatic surfacing of the memory (Turkington, 2008). This study established that some patients claim that whatever they hear comes from within their heads, rather than externally. This study also emphasized that auditory hallucinations must be verbal, hence discounting other types of hearings such as musical hallucinations. Musical hallucinations refer to the hearing of music when no music is being played. A relatively small number of people have these emotive and complex experiences of musical hallucination. Oliver Sacks research indicated that context plays a big part in shaping auditory hallucinations (Sacks O., 2007). Sacks made an important observation that at the onset of deafness, musical hallucinations are quite common. The research showed that certain specific triggers in the temporal region of the brain cause these hallucinations. A theory formulated explained that the apparent impoverishment of activity resulting from deafness caused the patient’s brain to “make up” for this by creating the hallucinations. DISCUSSION Psychosocial approaches Psychosocial models of mental illness are drawn from psychosocial elements such as, family, relationships and society. Psychosocial treatment for auditory hallucinations may take various shapes but all will rely on interpersonal relations and interactions towards therapeutic gain (Crits et al., 2005). Behavioural factors and social phenomena are intertwined to offer a remedy. These could include: Family interventions, supportive employment, social skills training, community treatment, token economy, social learning intervention and cognitive - behavioural therapy (Lataster et al., 2006). Psycho- education imparts knowledge on auditory hallucinations while behavioural tailoring enhances adherence to prescript medication. Relapse prevention focuses on reducing recurrent symptoms and repeated hospitalization of patients. On the other hand, cognitive-behavioural training imparts skills to reduce distress and severity of persistent symptoms (Kingdon et al., 2007). Social Skills Training (SST) refers to structured behavioural instructions. It involves corrective feedback, modelling and socially biased reinforcement to enhance competence in social skills, independent skills of living and proper self care (Dickerson, 2004). On the other hand, psycho-education involves dissemination of correct information concerning the patient’s diagnosis, consequent treatment as well as prognosis and how the patients should help themselves in recovering. This education is not limited to the patient but should also be given to the family members and friends (Bentall, 2008). However, the concept of psycho-education is very general and can incorporate many things depending on the severity of the condition (Addington, 2003). Although the main goal of psycho-education is the provision of accurate information, other objectives include improving self-management skills and collaborative relationships in treatment. Biological approaches Biological psychiatry is an approach that seeks to understand mental illness as a biological function of the human nervous system. The approach is interdisciplinary and encompasses various sciences such as psychopharmacology, genetics, neuroscience, physiology and epigenetics, to biologically investigate mental illnesses and behaviours (Rosenheck et al., 2005).However, biological psychiatry is not mutually exclusive and only deals with mental phenomena at various levels of treatment. Due to focus on biological functions of the brain and nervous systems, biological psychiatry comes in handy in developing and subsequently prescribing drug-based treatments (Bateman, 2003). Nonetheless, in practice, psychiatrists will advocate medication combined with other therapies. New tools in neuroimaging and genetics have made it possible to decipher underlying biological causes of mental disorders (Escarti et al., 2010). However, the experts concerned have disagreed on the issue of how far this model can be pushed. Additionally, an important question arises. Are mental disorders simply physical illnesses that strike on the brain just like heart diseases happen to the heart? If so, do they belong to the general class of common illnesses, or can they be separated? Furthermore, why use non-biological therapies if biology is the culprit? A parallel has been drawn to heart disease, where decades ago, doctors had little information on the biological basis of chronic heart diseases. The doctors usually observed physical representations and heard subjective complaints from patients. Today, it is possible to measure cholesterol levels, take CT imagery of blood vessels and examine electrical impulses in the heart with EKG and thus give correct diagnosis. The result has been a dramatic drop in heart attack mortalities in the recent past. Hence, the biological perspective pertaining mental illness has gained momentum, as expressed by Nobel laureate Eric Kandel, professor of brain science at Columbia University, who says “The brain is an organ of the mind. Where else would mental illness be, if not inside the brain?” However, experts such as Richard McNally, clinical psychologist at Harvard University disagrees with absolute biological models. He points out that, while certain illnesses such as schizophrenia and autism properly fit the biological model, other conditions such as depression fail to fit a purely biological model (Dickerson, 2004). Psychological approaches While recent studies and researches conducted have yielded evidence suggesting biological causes for most mental illnesses, the actual causes of the illnesses is not yet clearly understood. The psychological model of mental illnesses goes back to the Victorian age and suggests that victims of mental illness are not actually ill, but have only developed maladaptive behaviours conceived of irrational thought and perceptions (Beck, 2005). Consequently, psychological approaches tend to focus on what it is like to exhibit behaviours that are contrary to societal expectations and how such people are dealt with by societies. However, the psychological viewpoint does not totally exclude biological aetiologies. It only disagrees with the amount and level of attention given to biological factors in ensuing treatment models (Kingdon, 2007). Psychological formulation refers to a summation of knowledge gathered during an assessment exercise (Stinson et al., 2010). These formulations attempt to give explanations why people behave the way they do and why the differences in behaviour. Formulations examine and explain various events in a person’s life, especially difficult ones. Additionally, formulations can be seen as hypotheses about origins and nature of conditions so as to design therapies to control the particular condition (Zimmerman et al. 2005). Numerous psychological treatments exist and have been effectively proven. Common among them are: Cognitive behaviour therapy (CBT) – is a therapy aimed at changing patients’ harmful patterns of thought, feelings and behaviours by encouraging more positive outcomes through repetition of various exercises (Tarrier, 2004). Dialectical behaviour therapy (DBT) – is a therapy based on the deep understanding of patients with difficulty in handling their emotions and arising distresses (Crits et al., 2005). Interpersonal psychotherapy (IPT) – is a treatment that seeks to establish how various personal and inter-personal relationships have impacted a patient, in terms of how they think, feel and act. Family interventions – these are therapies aimed at supporting the patient’s family so as to help them cope with the psychotic illness. These therapies vary in terms of time taken to achieve any positive results (Bateman, 2003). People allowed to give these treatments include General Practitioners, Psychologists, Psychiatrists and other mental health professionals. CONCLUSION Considering the research done so far on mental illness, it is obvious that the actual causes of these ailments are not well known and many theories exist of the same. This has led to the existence of many treatments. In light of this, it would be inappropriate for one to champion one form of treatment and overlook other therapies that have been used with varying degrees of success. The best treatment approach to use for effective results would be a proper synergy of psychosocial, psychological and biological methods. The choice of the actual methods and their levels of interaction will depend on the severity of the condition, history of the patient and more importantly, the decision of the involved expert. REFERENCES Addington, J., Coldham, E. L., Jones, B., Ko, T., & Addington, D. (2003). The first episode of psychosis: the experience of relatives. Acta Psychiatrica Scandinavica, 108(4), 285-289. Bateman A, Margison F. 2003 Psychotherapy: a new era. Australian and New Zealand Journal of Psychiatry, 37:512–514. Beck, A. T. 2005. The current state of cognitive therapy. Archives of General Psychiatry, 62. Bentall, R.P.; Fernyhough, C. 2008. Social predictors of psychotic experiences: Specificity and psychological mechanisms. Schizophr. Bull., 34, 1012–1020. Crits-Christoph, P., Wilson, G., & Hollon, S. (2005). Empirically supported psychotherapies: Comment on Western, Novotny, and Dickerson, F. B. (2004). Update on cognitive behavioral psychotherapy for schizophrenia: Review of recent studies. Journal of Cognitive Psychotherapy, 18(3), 189–205. Delespaul, P., deVries, M., & van Os, J. (2002). Determinants of occurrence andrecoveryfrom hallucinations in daily life. Social Psychiatry and Psychiatric Epidemiology, 37(3), 97-104. Escartí, M., de la Iglesia-Vayá, M., Martí-Bonmatí, L., Robles, M., Carbonell, J., Lull, J. (2010). Increased amygdala and parahippocampal gyrus activation in schizophrenic patients withauditory hallucinations: An fMRI study using independent component analysis. Schizophrenia Research, 117(1), 31-41. Harvard Mahoney Neuroscience Institute, 2013. On the Brain. The Harvard Mahoney NeuroScience Institute Journal. Vol. 19(1) Kingdon, D., Rathod, S. R., Hansen, L., Naeem, F., & Wright, J. H. (2007). Combining cognitive therapy and pharmacotherapy for schizophrenia. Journal of Cognitive Psychotherapy, 21, 28–36. Lataster, T.; van Os, J.; Drukker, M.; Henquet, C.; Feron, F.; Gunther, N.; Myin-Germeys, I. Childhood victimisation and developmental expression of non-clinical delusional ideation and hallucinatory experiences: Victimisation and non-clinical psychotic experiences. Soc. Psychiatry Psychiatr Epidemiol. 2006, 41, 423–428. Rosenheck, R. A., Perkins, D. O., et al. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine, 353, 1209–1223. Sacks, O. (2006). The power of music. Brain: A Journal of Neurology, 129(10), 2528-2532. Sacks, O. (2007). Musicophilia: Tales of Music and the Brain (1st ed.). New York: Knopf. Social Care Institute for Excellence. (2008). SCIE position paper 08: A common purpose: Recovery in future mental health services. Retrieved March, 27,2014, from http://www.scie.org.uk/publications/ positionpapers/pp08.asp. Stinson, K., Valmaggia, L., Antley, A., Slater, M., & Freeman, D. (2010). Cognitive triggers of auditory hallucinations: An experimental investigation. Journal of Behavior Therapy and Experimental Psychiatry, 41(3), 179-184. Thompson-Brenner, 2004. Psychological Bulletin, 131(3), 412– 430 Tarrier, N., Lewis, S., Haddock, G., Bentall, R., Drake, R., Kinderman, P., et al. (2004). Cognitive-behavioural therapy in first-episode and early schizophrenia. 18-month follow-up of a randomised controlled trial. British Journal of Psychiatry, 184, 231-239. Tarrier, N., & Wykes, T. (2004). Is there evidence that cognitive behavior therapy is an effective treatment for schizophrenia: A cautious or cautionary tale? Behaviour Research and Therapy, 42, 1377–1401 Turkington, D., & McKenna, P. (2003). Is cognitive-behavioural therapy a worthwhile treatment for psychosis? British Journal of Psychiatry, 182, 477–479. Turkington, D., Sensky, T., Scott, J., Barnes, T., Nur, U., Siddle, R., et al. (2008). A randomized controlled trial of cognitive-behavior therapy for persistent symptoms in schizophrenia: A five-year follow-up. Schizophrenia Research, 98, 1–7. Zimmermann, G., Favrod, J., Trieu, V. H., & Pomini, V. (2005). The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: A meta-analysis. Schizophrenia Research, 77, 1–9. APPENDIX 1 Search strategy This review was conducted using 5 electronic databases namely EBSCO, PUBMED, Global Health, CINAHL and Google Scholar. Studies and research on psychosis and auditory hallucinations were identified and various factors analyzes on the same. The searches were done in the 5 databases for research done in the last 10 years starting 1st January 2003 - 25th March 2014. Searches were done using keywords that are inclusive of psychosis and hallucinations (e.g. psych*, mental*, schiz*).Other keywords included psychotic disorders, psychosocial intervention, mental health, auditory hallucination and biological. A full electronic search strategy for PubMed is shown below. Datebase (MEDLINE), Dates covered (2003-present), Scope (Cumulative Index to Psychology + Psychosis and allied health journals), Website (www.Pubmed.com). Read More

Sacks, in his acclaimed research book Musicophilia (2007) gives accounts of people without histories of psychotic conditions having auditory hallucinations. In this case, Sacks seems to try to dissociate some auditory hallucinations from the broader field of psychosis. However, if somebody experiences auditory hallucinations, must they be psychotic? Moreover, is there an association between psychotic and non-psychotic victims of hallucinations, and if so, where is the line drawn between the two as separate clinical cases?

Hence, a question arises, do auditory hallucinations mean more than is largely believed and are they divorceable from psychosis? A study conducted by Delespaul et. al. (2002) showcased that the context of visual or auditory hallucinations affects the intensity of that particular psychotic episode. These researchers established that the type of activity either increased or decreased the level of intensity of the hallucinations. As such, non-static activities reduced the intensity. However, the research was inconclusive since observations for other hallucinations such as visual and olfactory varied inconsistently.

Consequently, common patterns could not be establised. It has been known that several factors contribute to and cause auditory hallucinations. Thus, hallucinations cannot be explained in schizophrenic terms alone. Such non-psychotic factors include use of psychoactive drugs such as marijuana and sleep deprivation. Auditory hallucinations have also been reported to occur as a result of some infectious ailments such as Lyme disease and HIV, that cause chemical and neurotransmitters imbalances in the patient’s brain (Beck, 2005).

The psychiatric or medical model is the more prevailing paradigm when considering auditory hallucinations in schizophrenia. This paradigm has led to various attitudes; for example, in the founding of asylums for the “mad people” in the Victorian age (Bentall, 2008). This model explains mental illness as a chemical problem whose solution must also be chemical. Consequently, this has led to mentally ill people not being consulted in their treatment (Stinson et al., 2010).The National Alliance of Mental Illness (NAMI) believes in the “eradication of mental illness.

” This idea however is vehemently refuted by Turkington et al. (2003) who believe that those that patients can offer useful insights into the nature and possible treatment of those conditions. Currently, there seems to be a biased over-reliance on psychiatric medications in the belief that psychosis is almost purely biological. Indeed, research by Escarti et al. (2010) suggests that there must be symbolism and meaning in hallucinations. This means that proper inquiries into the condition, independent of prejudice will be of great relevance and that hallucinations, seen as mere symptoms of a larger brain malfunction cannot yield much result.

Additionally, Hugdahl (2007) brings forward two probable explanations to the true nature of auditory hallucinations. The first explanation is that there exists some inner speech or self-talk. However, most of the hallucinatory patients refute this and point to some other distinctive voice in their heads. Hugdahl argues that, it is this inner hearing that makes the condition “a condition” distinctive from the usual self-talk that non-hallucinatory people experience occasionally as a normal thought process.

The other explanation is the condition of traumatic surfacing of the memory (Turkington, 2008). This study established that some patients claim that whatever they hear comes from within their heads, rather than externally. This study also emphasized that auditory hallucinations must be verbal, hence discounting other types of hearings such as musical hallucinations. Musical hallucinations refer to the hearing of music when no music is being played. A relatively small number of people have these emotive and complex experiences of musical hallucination.

Oliver Sacks research indicated that context plays a big part in shaping auditory hallucinations (Sacks O., 2007).

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