Hallucinations are often depicted in the movies as terrifying experiences. Think Jake Gyllenhaal seeing a monstrous rabbit in Donnie Darko, Leonardo DiCaprio experiencing the torture of Shutter Island, Natalie Portman in Black Swan, or Joaquin Phoenix as the Joker.
Each character experiences some form of psychological distress. Scenes connect to, or even explain, a decline into chaos and violence.
Experiencing hallucinations can be distressing for some people and their loved ones. However, focusing solely on such depictions perpetuates myths and misconceptions about hallucinations. They also potentially perpetuate harmful stereotypes of mental distress.
Movies such as Joker use a broad, arguably incorrect, brush to connect hallucinations, mental health issues and violence. This reinforces the misconception that hallucinations always indicate mental health issues, when this is not necessarily true.
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What are hallucinations?
Hallucinations are perceptions that occur without a corresponding external stimulus. They can involve any of the human senses.
Auditory hallucinations involve hearing things that aren’t there, such as voices or sounds. Visual hallucinations involve seeing things that aren’t there, such as lights, objects or people. Tactile hallucinations involve feeling things that aren’t there, such as a sensation of something crawling on your skin. Gustatory hallucinations involve taste and smell.
People often confuse hallucinations and delusions. The two can be related, but they are not the same thing. Delusions are false beliefs, firmly held by a person despite evidence to the contrary. A person might believe someone is following them (a delusion), and see and hear that figure (a hallucination).
Before the 17th century, hallucinations were commonly thought to be of cultural and religious significance.
However, between the mid-1600s and 1700s, hallucinations began to be understood as medical concerns, related to both mental and physical illnesses. This medical lens of hallucination remains. Now we know which parts of the brain are activated when someone has a hallucination.
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What causes hallucinations?
Hallucinations can be a sign of serious mental health issues. The presence or experience of hallucinations is, for example, one of the criteria used to diagnose schizophrenia (delusions are another).
Hallucinations may also provide insight into mental health issues such as bipolar disorder, post-traumatic stress disorder and depression.
However, hallucinations can also be linked to other medical conditions.
Hallucinations can be caused by fever, as well as disease or damage impacting the brain or optic nerves. Parkinson’s disease causes visual, auditory and tactile hallucinations in up to 75% of people. Epilepsy and migraine headaches are also linked to hallucinations, and can cause perceptual disturbances, sometimes for days. Substance use, particularly of hallucinogenic drugs such as LSD or ketamine, can also cause hallucinations.
Hallucinations can also occur in people without any underlying medical conditions. For example, some people may experience hallucinations during times of extreme distress or grief.
Environmental factors such as sleep deprivation can cause a range of perceptual disturbances, including visual and auditory hallucinations. Sensory deprivation, such as being placed in a soundproof room, can also cause hallucinations.
But still, the common image that hallucinations are connected only to mental health issues persists.
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Hallucinations can be frightening, but not always
Hallucinations can be frightening for people, and their families. And the stigma and misconceptions surrounding hallucinations can have a significant impact on someone who experiences them.
People who have hallucinations may be afraid or embarrassed of being considered “bizarre” or “unsafe”, and therefore may avoid seeking help.
But hallucinations are not always scary or disturbing. Some hallucinations can be neutral or even pleasant. People have been sharing on social media their positive and empowering experience of hallucinations. In the example below, we see one person’s positive experience of hearing voices. Yet we rarely see such depictions of hallucinations in the movies.
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How to support someone having hallucinations
If you are with someone who is having hallucinations, particularly if these are new or distressing for them, here are several ways you can support them:
ask the person if they want to talk about what they are experiencing and listen to them without judgment: “I cannot hear what you are hearing, can you tell me about it?”
listen. Don’t argue or blame. Acknowledge that hallucinations are real to the person, even if they are seemingly unusual and not based in reality: “I cannot see what you see, but I do understand you see it.”
empathise with how the person feels about their experiences. “I cannot feel or taste it, but I can imagine it would be a difficult experience. I can see how much it is concerning you.”
support someone to seek care. Persistent or distressing hallucinations should always be evaluated by a qualified health professional. Establishing potential causes is important: “I cannot hear it like you, but let’s talk to a health professional about it. They can help us understand what might be happening.”
encourage the person to reach out to their peers as well as to hearing voices groups for ongoing support.
We’d like to acknowledge Tim Heffernan, Deputy Commissioner of the Mental Health Commission of New South Wales, who contributed to this article.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. In an emergency dial 000.