Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, often experiencing hallucinations, delusions, disorganized thinking and speech, and impaired cognitive ability. One of the most common symptoms of schizophrenia is auditory hallucinations, also known as “hearing voices”. But can schizophrenics actually see their voices too?
What are auditory hallucinations?
Auditory hallucinations, or “hearing voices”, occur when someone hears noises or voices that do not exist. The hallucinated voices are usually perceived as coming from outside the person’s head. The voices may talk to each other, comment on the person’s thoughts or behavior, argue with the person, or give commands. Auditory hallucinations are one of the defining characteristics of schizophrenia, experienced by 60-80% of people with the disorder.
Some key facts about auditory hallucinations in schizophrenia:
- They are experienced as voices coming from outside the person’s head, not their own inner thoughts.
- They are perceived as real sensory experiences, not imagined.
- The voices may be familiar or unfamiliar, but are experienced as distinct from the person’s own voice.
- The content of the voices can be positive, neutral, or negative.
- Multiple voices may be heard that speak to each other or comment on the person.
- The voices are involuntary and cannot be controlled.
Auditory hallucinations can vary widely from person to person in terms of frequency, content, and how distressing they are. But the key feature is that they are perceived as real voices from external sources.
Can schizophrenics see their voices?
While auditory hallucinations are most common in schizophrenia, some people may also experience visual hallucinations related to their voices. So in some cases, yes, schizophrenics may “see” their voices in addition to hearing them. Some examples of this include:
- Seeing disembodied mouths or faces that are speaking the words.
- Seeing shadowy figures that correspond to the voices.
- Seeing the voices emanating from particular objects or locations.
- Seeing images or figures that reflect the content of what the voices are saying.
However, it is much more common for auditory hallucinations to occur alone without corresponding visual hallucinations. One study found that only about 15% of people with schizophrenia experienced concurrent visual and auditory hallucinations related to their voices.
Some key facts about visual hallucinations of voices in schizophrenia:
- They are rare compared to pure auditory hallucinations.
- The visual experiences are often vague shapes or shadows rather than clear images.
- They may fluctuate in sync with the volume of the voices.
- Seeing disembodied mouths is one of the most common visual manifestations.
- They are perceived as external to the person, not imagined.
So in summary, while it is possible for some schizophrenics to have visual experiences related to their voices, pure auditory hallucinations without visual components are far more common.
Differences from imagining or inner thoughts
An important distinction to make is that true hallucinations in schizophrenia are not the same as just imagining something or inner thoughts. Both auditory and visual hallucinations are perceived as truly real sensory stimuli coming from outside the person’s mind. The person has no control over the experience.
In contrast, imagined voices or images are experienced as being generated by one’s own mind. And inner verbal thoughts are recognized as self-generated rather than coming from an external source.
Some key differences:
- Hallucinations are involuntary, while imagined voices/images are deliberately conjured.
- Hallucinations are perceived as real external stimuli, while imagined ones are recognized as not real.
- Inner thoughts experienced as one’s own “inner voice” are not hallucinations.
- Hallucinations persist even if the person tries to ignore them.
So even if a schizophrenic does “see” their voices, they recognize these visual experiences as truly existing external phenomena, not something they are imagining. The hallucinations are self-generated by the brain, but are perceived as real.
Causes
The exact causes of auditory and visual hallucinations in schizophrenia are not fully understood. However, here are some leading theories from brain imaging and neuroscience research:
- Hyperactivity in language processing networks of the brain, causing false perceptions of voices and sounds.
- Abnormal connectivity between sensory processing and language areas in the brain.
- Deficits in being able to monitor and recognize self-generated inner speech.
- Imbalances in neurotransmitter levels, like excess dopamine, altering brain signaling.
- Faulty predictions and signal filtering by cognitive processing regions.
In essence, hallucinations arise from disrupted communication between brain regions involved in processing sounds, language, imagery, and the sense of self. This results in inner thoughts and imaginings being misinterpreted as external, voices and images that appear real but arephysiologically self-generated.
Treatments
While schizophrenia has no cure, hallucinations can often be managed through a combination of antipsychotic medication and psychosocial therapies:
Medication
Antipsychotics like olanzapine, risperidone, and clozapine can reduce frequency and intensity of hallucinations by suppressing excess dopamine activity.
Talk therapy
Cognitive behavioral therapy helps patients identify triggers and develop coping strategies to manage disturbing voices.
Support groups
Peer support provides empathy, advice, and normalization of the experience of hearing voices.
Communication tactics
Negotiating with voices, naming them, and setting boundaries can reduce their negative impact.
Distraction techniques
Focusing attention outward using work, social interaction, or sensory stimulation can divert from voices.
Sound therapy
Soothing music, sound machines, or voices of loved ones played through headphones can mask auditory hallucinations.
With consistency, many patients find they can achieve long-term management of symptoms and reclaim an improved quality of life.
Conclusion
In summary, a subset of schizophrenics may experience visual hallucinations related to their voices, such as seeing threatening figures or disembodied mouths speaking to them. However, it is far more common for the hallucinated voices to be purely auditory with no visual component. Importantly, these hallucinations are perceived as real sensory experiences, not imaginings, and originate from overactive and misfiring brain circuits rather than reflecting literal external sights and sounds. While troubling, hallucinations can often be successfully managed through antipsychotic medications and therapeutic techniques. With proper treatment, many schizophrenics learn to cope with these symptoms and carry on relatively normal lives.