Source : FISH ’S Clinical psychopathology

The patient’s attitude to hallucinations

In organic hallucinations the patient is usually terrified by the visual hallucinations and may try desperately to get away from them. Most delirious patients feel threatened and are generally suspicious. The combination of the persecuted attitude and the visual hallucinations may lead to resistance to all nursing care and to impulsive attempts to escape from the threatening situation, so that they may jump out of windows and jeopardise their lives.

The exception is Lilliputian hallucinations, which are usually regarded with amusement by the patient and may be watched with delight.

Patients with depression often hear disjointed voices abusing them or telling them to kill themselves. They are not terrified by the voices, as they believe they are wicked and deserve to hear what is being said of them. The instructions to kill themselves are not frightening since they may have thought of this for some time anyway.

The onset of voices in acute schizophrenia is often very frightening and the patient at times may attack the person he believes to be their source.

Those with chronic schizophrenia on the other hand are often not troubled by the voices and may treat them as old friends, but a few patients complain bitterly about them. Those patients who are knowledgeable about their illness or who have insight into it may deny hallucinations, since they know this is an abnormal feature. Sometimes it is obvious that a patient is hallucinating if they stop talking and appear to be listening to something else or if they attempt to reply to the voices