I have a friend who sees things that aren't there.

In My Humble Opinion
1

So, I know someone who sees things that aren’t there – usually people or creatures of various kinds. These hallucinations seem to be visual only. According to my friend, he/she has never “heard voices” or anything like that. This also sometimes manifests as vivid, unwanted daydreams about harm coming to his/her loved ones in car crashes or natural disasters, depending on what my friend is nervous about at a given moment. (Apologies for playing the pronoun game here, but it’s for the sake of my friend’s privacy – I’m one of two people in the world to whom he/she has ever revealed this.)

My friend has explained to me that this has been happening since her/his childhood. They also say they’ve always been able to tell that these hallucinations aren’t real, but sometimes when they get stressed the hallucinations are more intense and more frequent. That being said, this person has never remotely been a threat to her/himself or others, and doesn’t act “crazy” – no talking to or interacting with people who aren’t there or anything of the sort. I would never have even guessed any of this was going on if my friend hadn’t told me.

My friend hasn’t had access to comprehensive health insurance for a long time now, but soon will. However, he/she is worried that going to a mental health professional about this could have consequences. Specifically, they’re afraid that they could be committed, or that getting help might somehow cause Child Services to be alerted to their problem, possibly causing them to lose custody of their child(ren).

Can any lawyers or anyone else with experience in this kind of thing sound off on how likely either of those two possibilities are? This friend lives in California, if that helps. If more specific information would be helpful, let me know and I may be able to provide it.

Anything you can tell me about this could really help set my friend’s mind at ease about getting help with this problem. Thank you in advance!

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Moderator Action

This is more of an advice question than a factual question. Let’s move this over to IMHO where folks can give their opinion about the legal and medical issues mentioned.

Moving thread from General Questions to In My Humble Opinion.

3

I am not sure what your friend might be diagnosed with, but simply having visual hallucinations, especially if one is fully aware that they are not real, is not in itself a sign of being mentally ill, and doctors will generally know this (and psychiatrists certainly will). Actually, such hallucinations are quite common in people with certain sorts of vision problems, such as macular degeneration. The condition is known as Charles Bonnet syndrome, and the principal recommended treatment (there being no actual cure) is to reassure sufferers that they are not going crazy and that they do not really need to worry too much about it.

It does not sound as though your friend actually has Charles Bonnet syndrome (unless they have visual impairments that you have not mentioned). It is possible that the cause is some sort of neurological problem, and, if so, they would be well advised to seek treatment for it. I do not think that there is any risk that they will be diagnosed as crazy (schizophrenic) or whatever (unless they actually are!).

In fact, a large proportion of mentally healthy people (perhaps even most of them) occasionally suffer from hallucinations.* People who have, or are on the verge of having, certain mental illnesses (especially schizophrenia) are certainly more likely to have frequent hallucinations than others, and so if a patient says they have frequent hallucinations (especially auditory ones, such as voices, which are much more strongly associated with schizophrenia than visual ones are) it might worry their doctor, and they might get a referral to a psychiatrist, especially if there are other worrying signs about their mental health, but no competent medical professional is going to conclude that someone is crazy and needs to be committed just on the basis that they suffer from visual hallucinations.

*Ohayon, M. M. (2000). Prevalence of hallucinations and their pathological associations in the general population. Psychiatry Research, 97(2), 153-164.

4

When I worked for DBHDS in Virginia, if you went to a mental health professional they could generally have someone held under a TDO (temporary detention order) up to 96 hours. Normally 48, the 96 hours only applies if the 48 hours overlaps with a weekend, so you could end up in for 96 hours if it starts on Friday and they can’t have a commitment hearing on Sat/Sun, and then you can be held for 24 more hours on Monday.

A mental health professional would only do that if they essentially assessed you as being a danger to yourself or a danger to others. Just seeing hallucinations with no other problems would not, for most mental health pros, meet that criteria. At the end of the TDO there is a full formal commitment hearing before a magistrate or a specially appointed justice (appointed by the circuit court.) You can be represented by an attorney in the hearing and there will be evidence submitted to support committing you and etc. If you end up getting committed it can be for up to 180 days, and then they have to re-commit every 180 days going forward.

Even if your friend had a frankly bad psychiatrist evaluate them and decide based solely on visual hallucinations that were recognized as not real by the patient that he was a risk to himself/others and got a TDO it’s very unlikely he would get a full commitment. It’s really unlikely the psychiatrist would go for a TDO from that, despite the stereotypes psychiatrists don’t like in-patient treatment for no reason and they don’t directly profit from it in most cases so there isn’t a profit motivation there.

5

I should add, I would advise your friend that they should tell a doctor about the hallucinations as soon as they have insurance in place. It is possible that they might be symptom of a neurological problem, such as a slow growing tumor, that is curable, but is best dealt with as quickly as possible. I don’t want to worry them unnecessarily in saying this. I am not saying it is a tumor. More likely it is not a serious problem at all, but it will be best to know. As I said before, there is really no reason to fear that they will be falsely diagnosed as mentally ill.

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I concur that no competent doctor is going to call CPS on him/her if it is what you describe. If she is able to always tell these are hallucinations, and isn’t disoriented or confused, there would be no reason to.

A person has to be an unfit parent to usually have their kids taken away. I am no expert on the kids thing, but everything I’ve seen seems to suggest that. I know much more about the involuntary commitment thing. She could be drooling all over herself - think that Jesus does the dishes for her when she is away, and hear and see people that aren’t there. As long as she doesn’t represent a danger to herself - or others - they aren’t going to lock her up. Especially if she is seeking treatment.

She might not even be mentally ill. I believe hallucinations can be a symptom of various both medical and psychological conditions. It is possible it is hereditary and she passed this on to her kids. Probably not, but her getting treatment - especially if she finds it disturbing - might help more than just her.

To be on the safe side - she could just lie about having kids when asked if she is really concerned. They aren’t going to start an investigation or anything. And once she feels comfortable - she can say “sorry - I wasn’t sure if you were going to think I was crazy and try and take my kids away.” I’m pretty sure doctors are used to that sort of thing - and if it makes her more likely to seek help - I think even a doc would say it was ok for her to lie.

I’d tell him/her to see a regular doctor first (they are cheaper anyway - to rule out possible medical problems). Say it is nothing to be ashamed of - and if it isn’t a medical issue - the doctor can best recommend someone he/she knows to help with the mental part. For some people - going to see a regular doctor first is easier. Also when the doctor basically acts totally nonplussed when he/she is told your friend is having these hallucinations - and doesn’t react by looking at them like they are crazy - it will reinforce the idea that this isn’t something REALLY CRAZY or anything.

7

I would recommend reading Oliver Sach’s book “Hallucinations,” which confirms njtt’s point that experiencing hallucinations does not mean a person is psychotic and can occur for a variety of reasons, having nothing to do with mental health. On the other hand, I think it is wise to be cautious about mental health professionals. I suggest reading the Wikipedia entry on the Rosenhan Experiment, a highly controversial but very interesting study in which 8 people feigned very mild auditory hallucinations, all were diagnosed with psychiatric disorders and confined to a psychiatric hospital for an average of 19 days, despite reporting no further symptoms after admission. All but one were diagnosed with schizophrenia in remission, all were administered anti-psychotic drugs, and all were released only after promising to keep taking the drugs. All this despite the fact that most people with auditory hallucinations, as in the case of visual ones, are not psychotic.

I’m no expert and don’t know any more about that study than the Wikipedia article. The psychiatric community calls it pseudoscience, but I think your friend’s concerns are not without merit. I don’t agree with the advice to lie about his/her children, but I would go to a neurologist before going to a psychiatrist.

8

Meh. These people essentially faked the symptoms of the onset of schizophrenia in order to get diagnosed with it, and they succeeded. So what? Anyway, Neo-Calredic’s friend’s symptoms don’t even match those of schizophrenia.

9

Thanks to everyone for replying. Most of this is pretty reassuring, though I will definitely suggest to my friend that he/she visit a neurologist.

Regarding the Rosenhan Experiment: That’s rather disturbing, but it was also 40 years ago. Aren’t the rules for committing someone different now? My understanding is that a court has to find a person legally incompetent before they can be forced into an institution. Barring some kind of tangible proof of mental instability expressed in a person’s actions, can they really just be locked up in this day and age because they claimed to see things?

If I tell a psychiatrist that I hear voices, they try to have me committed based solely on that claim, and then I swear in court that I don’t hear voices anymore – assuming my behavior otherwise has been normal – how likely would a modern court be to still have me committed? Are these determinations subject to the same kind of “beyond reasonable doubt” standard as deciding guilt in a criminal trial? I assume there has to be more to it than one mental health professional saying “This person told me they hear voices. Lock 'em up!”

I ask because my friend is, by all outward appearances, a very high-functioning person. If a court could find her/him mentally incompetent based on behavior alone, I’d think they could do the same to pretty much anyone. I realize one can’t really prove that this would be impossible, but it does seem like it would be extremely outside the contemporary norm.

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They faked a single symptom, having it happen only once. Any slightly decent psychologist would just dismiss this as being a one-off thing and not a mental disorder. Instead, they were not only treated like they definitely had a mental disorder, but were actually detained from leaving medical care.

It may not be a big deal in the OP’s situation, but is a very big deal within the psychological organization. It shows how quick they were to diagnose and how reluctant they are to recognize remission. It’s a good lesson for anyone previously diagnosed with a mental disorder to be sure and reevaluate and make sure their doctor isn’t just assuming they are ill.

I had it happen to me. I only have OCD, yet I was diagnosed with three illnesses (too quick to diagnose) and it took at least eight years to find someone who would actually deal with testing scientifically and go in blind.

11

Again, I don’t have any expertise, nor evidence beyond anecdotes, but I know one person who was misdiagnosed as schizophrenic. Fortunately, nothing untoward happened to her as a result. The family essentially ignored the diagnosis.

More frightening was the psychology graduate student I once knew who described a subject to whom she had given a Rorschach test. Now bear in mind she was only in training and hopefully learned better before practicing her craft, but she described the person as having serious mental problems, based on this evidence:

  1. He described one ink blot as looking like an android, which he described as part man, part machine.

  2. Another one looked to him like a Moebius strip, which he then went on to describe in detail, e.g. has only one side, if you cut it down the middle, it stays in one piece, etc.

This was > 30 years ago, before the term android was known as widely. She had never heard the term, nor had she ever heard of a Moebius strip. She thought he was nuts because he made up these words to describe such ridiculously impossible things that he talked about as if they were real.

It made me realize that everyone has his or her own knowledge-base and preconceptions that could cause well-meaning people to misdiagnose a mental condition. I would steer clear of anyone who had he power to get me incarcerated unless I thought I had a serious problem.

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Getting a professional diagnosis won’t alert DHS or anything like that. I have PTSD and that can cause the same hallucinations, especially during times of great stress. I have been in therapy two years, including CBT and EMDR. So far what has helped the most is an anti-psychotic, but taking this medication doesn’t mean one is psychotic. My anxiety and dissociative episodes keep me from working but I haven’t had any problems regarding my 8 year old daughter’s welfare. And I’m a single parent. I guess as long as I’m not violent or a threat to myself nobody really cares. I had to be investigated when she was raped last year and they seemed to think I was a fine mother.

13

The point was more she should see a regular medical doctor before a psychiatrist. What is that expression - if you are a hammer - every problem looks like a nail.

I think what we can gleam in part from that study - is that in many cases there is no objective test for these mental illnesses. Many people think psychiatrists are these experts that can see through the BS - but in many cases they can’t. Almost even more disturbing - is that some facility read about the experiment - and said we won’t fall for that. So the guy that ran the experiment said he would send at least one person there to test it out. That facility ended up identifying 41 out of 193 patients as potential fakes. As you probably read in the wiki article - no one was sent.

So even if you are total sane - 100% - if you make one complaint of episodes to a psychiatrist about auditory hallucinations - they think you are crazy (bad word) and even if you get better (which we know they did - cause they never were sick to begin with) - they don’t realize it.

I don’t think they would commit her. That isn’t why I am worried. I think it is better to have a non-biased medical doctor look at him/her and decide:

  1. If it is a medical problem. Many medical conditions CAN be objectively tested for.
  2. if not a strictly medical problem - he/she can perhaps direct the patient to a good choice for a psychiatrist

I believe - but don’t know - that if it is a medical condition - many doctors will be able to find and properly diagnose it. If not - I think the doc MAY be useful in determining who to send her to.

On the other hand - I think if she is sent to a psychiatrist she WILL be diagnosed with a psychiatric disorder. This in and of itself can be very distressing. Yes - I know psychiatrists are medical doctors too - and very likely might refer her to a medical doctor. Also what disorder she is diagnosed with is going to depend on who she sees.

I think JWTs suggestion of going to a neurologist first is a good one - and not cause I’m worried they would commit him/her.

Once you start on the mental health treatment stuff - it basically works like -

pick a drug - any drug - ok - educated guess as to best one
Start out on the lowest dose
Oops these things take a while - come back in four weeks
Didn’t work - oh don’t worry - we will increase the dose
[go through several cycles of this until you reach FDA limit or side effects are too much]
Oh sorry that didn’t work - everyone’s brain works differently - we will put you on a new drug
[rinse]
[repeat]
Add in therapy and maybe some ECT

That whole process is extremely draining - for many people who have kinda hit rock bottom and finally made the choice to seek help - then to find out sometimes there is no magic pill to help them - or that it can take years to find the right one

I personally think it is easier on someone to go to a medical doctor first - and then have the medical doctor send them to the psychiatrist. Oh and yes - psychiatrists are MDs - but you know what I mean.

14

You might also want to have your friend evaluated about that gender identity disorder. :wink:

15

Generally, if something isn’t interfering with a person’s ability to function in the real world, that is, work, pay bills, fulfill responsibilities it’s not a problem. Given that this has been, apparently, present since childhood makes me think it’s not something like a “slow growing tumor” or some other potentially debilitating problem but simply the way your friend is wired, so to speak, although the usual disclaimer that I am not a doctor applies.

It’s different, but so is something like synesthesia.

If your friend is clear on the difference between hallucination and reality and functions well in the real world I don’t see a real problem here.

16

Does your friend have any other associated symptoms? As a Narcoleptic I sometimes drift into a “Twilight Zone” where things aren’t quite as they seem, have hallucinations, auditory and visual. I know now it’s all part of that “falling asleep” process, and I’m dreaming whilst awake.

My body just muddles up the process, so I may be between full wakefulness and sleep for half an hour or so, and not seem any different to anyone with me. I may then either start to drop further into sleep and start slurring and have glazed eyes (followed, usually, by full-on Zzzzzz), and it will be obvious that I’m about to crash. However, sometimes I’ll come round and be back to fully awake without anyone with me even noticing that I’ve been “away” for a while.

That first stage in the paragraph above may be brief, may last a while, but that’s when the strange things happen - the people I know CAN’T be there, smiling in greeting to me before disappearing into a crowd; or “seeing” things in front of me (which might be prompted by, say, a radio news report of a pile-up on the motorway). As I get older and more experienced, the easier it is to recognise those things as being products of my mind, not real, not spooks or anything else! Stress definitely intensifies the dreams (and that is all they are), both the content and frequency, I’m just bobbing on the surface of sleep.

These days I know it’s all part of a cycle, so I bale out of what I’m doing and head for somewhere to get my head down, I know I’m going to be going to sleep one way or another soon, even though others can’t see the obvious signs of me about to crash. It’s a bit like knowing it’s going to rain before the clouds roll up! Other days, I’ll suddenly glaze over, start making not-much-sense and my colleagues will spot it at the same time I do. (Who knows, I might have been through that first stage and the associated sights and not recognised it…)

For years before diagnosis though, as a kid, I’d fight it and always managed to stave off the actual “Lights Out” stage. The things I saw, of course, I never mentioned to anyone, but they sometimes scared the crap out of me…