Attitude Towards Hallucinations in Schizophrenia (2002)

Abstract Objective: To study attitudes towards hallucinations in patients with schizophrenia and to determine the sociodemographic and clinical correlates. Methods: Seventy five patients with chronic stable schizophrenia having hallucinations (of any form) were assessed with regard to sociodemographic profile, clinical variables, phenomenology of hallucinations, and attitudes towards hallucinations. Results: More negative than positive attitudes were reported. Negative attitudes were elicited in the following areas: 'financial', 'reaction of others', 'sexual', 'general', and 'relationships', while positive attitudes were seen in the following areas: 'companionship', 'control', 'sexual', 'self-concept', and 'defensive'. Attitude scores did not significantly differ among groups defined by sociodemographic or clinical variables. Conclusions: Indian patients with schizophrenia had variable attitudes towards their hallucinations. There were no significant correlations between attitude and sociodemographic or clinical variables. Key words: Hallucination, Schizophrenia Introduction Psychotic patients are known to respond to their illness in different ways during the illness and after recovery. The resultant attitude affects recovery and subsequent outcome. (1) In 1969, Soskis and Bowers found that patients who had a positive integrating attitude (inclusion of illness into a continuous set of life values) towards their illness had better outcomes. (2) Auditory hallucinations, like other symptoms, have a powerful impact on the lives of those who experience them. (3) Different investigators have reported that hallucinations made patients feel privileged, praised, or amused. relieved the patients of their boredom, amused them, acted as a guide, helped in integrating trauma, and strengthened and stimulated them. (3-8) In 1981, Falloon and Talbot reported that patients with chronic hallucinations did not want to reject their hallucinations. (9) Carter et al reported that 36% of their series of hallucinating patients (60% with schizophrenia) said that they would miss their voices. (10) Voices were liked by many patients irrespective of their content. (6) Nevertheless, in other investigations, voices are perceived as being threatening, accusing, reproving, instructing (usually obscenely), hurting, criticising, disgracing, and intruding. (11) Romme et al found that 93% of their sample of hallucinating patients described a negative impact of hallucinating voices on their lives. (12) These authors reported that 24% of hallucinating patients felt that their hallucinations evoked negative responses from others. An equal number of patients felt others' responses to be positive. The content of hallucinations and attitudes towards hallucinations have often been discussed without adequate discrimination. Lowe included the following example of content of hallucinations: They wanted to protect me/they were just passing by. (11) Similarly, Larkin defined the 'content' of hallucinations as a patient's perception of the subject matter of hallucinations, such as loneliness, hopelessness, and anger. (13) These would reflect the attitudes of patients rather than real content. Miller et al developed a questionnaire on attitudes towards hallucination based on their analysis of the descriptive literature, which provided a systematic approach to the study of attitudes. (4) On applying the questionnaire to a group of 50 patients of different diagnostic categories, the authors found that 52% of the sample valued their hallucinations in one way or another. Twelve percent of patients wanted their hallucinations to continue as they were perceived to be helpful. Olfactory hallucinations were the most liked of all the hallucinations. Patients who were able to predict the occurrence of their hallucinations by internal antecedents were also more likely to value these hallucinations. …