Schizophrenia is a chronic mental health disorder characterized by hallucinations, delusions, disorganized thinking and behavior. One of the most common symptoms of schizophrenia is auditory hallucinations, also known as “hearing voices”. About 60-80% of people with schizophrenia experience auditory hallucinations. For schizophrenics, hearing voices can be an incredibly disruptive, frightening and even dangerous experience.
Coping with auditory hallucinations and managing schizophrenia in general requires a combination of medication, therapy, social support and self-help strategies. With proper treatment and support, many schizophrenics are able to achieve stable and fulfilling lives despite the challenges of their illness. In this article, we will explore the various ways schizophrenics can cope with hearing voices and manage their condition.
Understanding Auditory Hallucinations in Schizophrenia
Auditory hallucinations involve hearing voices or other sounds that are not real. The voices may talk directly to the person, carry on conversations with other hallucinated voices or comment on the person’s thoughts or behavior. The voices are often threatening, critical, vulgar or commanding. Two of the most common auditory hallucinations are:
- Hearing voices conversing with each other
- Hearing voices commenting on one’s actions or thoughts
Auditory hallucinations are a key characteristic of schizophrenia. However, hearing voices can also occur in other mental disorders such as bipolar disorder, borderline personality disorder and major depression.
Some key facts about auditory hallucinations in schizophrenia:
- Onset is typically in young adulthood.
- Voices can be male, female, without gender, familiar or unfamiliar.
- Most patients report hearing multiple voices.
- Voices often have distinct personalities and may change over time.
- Voices are perceived as real sensations coming from the external environment.
- Patients usually have insight that voices are not real early in illness.
- Insight can diminish over time for some.
While the exact cause of auditory hallucinations remains unclear, most experts believe they are linked to structural and functional abnormalities in the brain regions involved with language, memory and emotion processing.
Negative Impact of Untreated Hallucinations
Untreated hallucinations in schizophrenia can severely impact patients in multiple ways:
- Increased suicide risk – Hostile and commanding voices can lead to suicidal ideation.
- Social isolation – Patients withdraw due to fear of ridicule or difficulty concentrating.
- Self-care neglect – Voices can interfere with motivation to care for oneself.
- Inability to function – Hallucinations prevent normal daily activities and relationships.
- Violent behavior – A small minority of patients experience voices commanding violence.
- Substance abuse – Patients may use drugs/alcohol to try and silence voices.
Let’s look at some statistics on the impact of untreated psychosis:
| Issue | Statistic |
|---|---|
| Suicide risk | 5% to 6% lifetime risk of suicide with schizophrenia |
| Social isolation | As many as 75% have very limited social interactions outside of family. |
| Unemployment | 80% to 90% unemployed due to symptoms and stigma. |
| Substance abuse | About 50% affected by substance use disorders. |
| Homelessness | 20% to 50% experience periods of homelessness. |
Clearly, untreated psychosis can wreck havoc on a person’s life. The good news is that with proper treatment and coping strategies, schizophrenia patients can better manage symptoms and improve quality of life.
Pharmacologic Treatments
Antipsychotic medications are the first line treatment for schizophrenia. They work by blocking dopamine receptors in the brain regions associated with psychosis. Antipsychotics can treat a broad range of symptoms like hallucinations, delusions, paranoia and disorganized thinking. Patients usually start with traditional or “typical” antipsychotics. Newer “atypical” antipsychotics may be tried if the first medication is not effective.
Common medications:
- Haloperidol (Haldol)
- Chlorpromazine (Thorazine)
- Perphenazine (Trilafon)
- Fluphenazine (Prolixin)
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Aripiprazole (Abilify)
Antipsychotics can reduce hallucinations significantly within days or weeks in many patients. However, up to 30% do not respond adequately to medication alone. Even those who respond well may have residual symptoms or side effects. That is why other interventions are key.
Medication Considerations:
- Can take 6-8 weeks to achieve full therapeutic effect.
- Patients usually require maintenance treatment.
- Non-compliance is an issue due to side effects or lack of insight.
- Clozapine is effective for treatment-resistant schizophrenia.
- Long-acting injectables can improve compliance.
While medications are the foundation of schizophrenia treatment, additional interventions and supports are key to coping with voices.
Psychosocial Interventions
Psychosocial treatments should complement medication management:
- Psychotherapy: Cognitive behavioral therapy helps patients cope with symptoms, address stressors and improve functioning.
- Social skills training: Group classes can teach interpersonal and coping skills to improve community functioning.
- Support groups: Peer-lead groups provide empathy, encouragement and practical guidance.
- Psychiatric rehabilitation: Programs assist with goals like returning to work/school and independent living.
- Case management: Case workers coordinate care, monitor progress and provide access to resources.
A key goal of psychosocial interventions is to reduce the power and omnipresence of voices so they are less disruptive to patients’ lives. This involves learning to identify triggers, managing stress, shifting focus and building healthy activities and relationships. With practice, many patients become adept at managing voices.
Self-Help Coping Strategies
There are also many self-help techniques patients can try to cope with bothersome voices:
- Use headphones and music to drown out or distract from voices
- Increase social contact to feel less alone
- Talk back assertively to hostile or critical voices
- Use relaxation techniques like meditation, yoga and deep breathing
- Engage in activities that require focus like sports, games or hobbies
- Keep a journal detailing when voices occur and possible triggers
- Limit stress and maintain healthy lifestyle habits like diet and sleep
Building a toolbox of different coping methods allows patients to take back a sense of control. Patients can work with therapists to identify strategies that work best for their unique circumstances. Peer support groups are also a great resource for self-help tips.
Example Coping Strategy Table
| Strategy | Description | Benefits |
|---|---|---|
| Play music | Use headphones and upbeat music to distract from voices | Provides an auditory barrier and improved mood |
| Exercise | Go for a walk, run, swim or bike ride | Boosts endorphins, reduces stress and distracts mind |
| Talk back | Assertively tell voices to stop or that you won’t engage | May help reduce power of voices |
| Mindfulness | Practice meditation and yoga. Stay focused on the present. | Promotes relaxation and internal focus |
| Journaling | Record when voices occur and anything that triggers them. | Identifies patterns and manages symptoms |
Social Support Networks
For schizophrenia patients, having strong social connections is linked to better outcomes. Support from family, friends, treatment providers and peer communities helps reduce isolation and improve coping.
Some ways social support helps:
- Provides comfort and encouragement during difficult times
- Motivates patients to stay on treatment
- Helps identify warning signs and prevent relapse
- Offers feedback on how well coping methods are working
- Promotes accountability and daily functioning
Peer support groups allow patients to connect with others facing similar challenges. This mutual understanding and shared tips can be very empowering. Support groups can be found through mental health agencies, recovery centers, NAMI and online forums.
For family members, support groups provide education on schizophrenia and a forum to discuss their own coping strategies and self-care. With proper support, many schizophrenics are able to manage symptoms successfully long-term and achieve life goals.
Creating a Relapse Prevention Plan
A relapse prevention plan helps schizophrenics minimize symptom flare ups and stay on track with treatment. This written action plan typically covers:
- List of current medications and dosing
- Outline of early warning signs of relapse
- Steps patient will take if symptoms worsen
- Crisis numbers for providers, facilities and family
- Preferred interventions in event of hospitalization
Patients create plans with help from their mental health providers and family members. Having an advance roadmap empowers patients and their support system to act quickly when needed. Early intervention improves outcomes and may prevent the need for hospitalization.
Sample Relapse Prevention Plan
Early warning signs for John:
- Having trouble sleeping
- Isolating self from family and friends
- Feeling more disorganized
- Hearing more frequent or louder voices
If symptoms increase, John will:
- Tell case manager at weekly appointment
- Increase time spent at support group
- Ask sister to visit him more often
- Follow crisis plan if severe symptoms persist
John’s crisis plan:
- Take risperidone 6 mg daily and lorazepam 2 mg twice daily if needed
- Call Dr. Bell at 123-456-7890 to schedule med adjustment
- Go to Hope Psychiatric Facility if voices won’t stop
- Call mom at 123-456-0987 so she can pick up John
Relapse prevention plans should be updated regularly to adapt to a patient’s changing needs and resources over time.
Advance Health Directives
Many patients with chronic or severe mental illness complete advance health directives. These legal documents allow them to state their preferences for future treatment if they are unable to make decisions. Types of advance directives include:
- Psychiatric advance directives – Provide instructions for medications, hospitalization, restraints, etc. if in crisis.
- Medical power of attorney – Names person to make medical decisions if patient is incapacitated.
- Living will – Outlines end-of-life wishes.
These directives put patients in control and provide peace of mind. Documents can be updated at any time if preferences change. All members of the treatment team should have copies.
Hospitalization
Despite best efforts, some schizophrenics require psychiatric hospitalization during acute psychotic episodes. Reasons include:
- Risk of harming self or others
- Unable to care for self due to symptoms
- Psychosis unresponsive to outpatient treatment
- Medication adjustments needed under observation
- Respite needed from stressors exacerbating symptoms
The hospital environment is aimed at stabilizing the patient with close monitoring, medication changes and a calm routine. The average hospital stay is 7-10 days.
Goals of admission may include:
- Ensure safety of patient and community
- Better treat agitation, hallucinations and delusions
- Adjust medications under medical supervision
- Provide respite from daily stressors
- Determine long-term treatment/placement needs
Hospitals also provide patient and family education and develop discharge/safety plans. With support, many patients only require hospitalization a few times in their life.
Dealing with Stigma and Finding Empowerment
False stereotypes about schizophrenia involving violence and inability to function are pervasive. This stigma results in prejudice, fear and discrimination against those with schizophrenia.
Some examples of stigma include:
- Media portrayals of schizophrenia linking it to crime and instability
- Assumption that schizophrenics are dangerous and unpredictable
- Belief that schizophrenia is untreatable and hopeless
- Discrimination by employers, landlords and even healthcare providers
In reality, those with schizophrenia are much more likely to be victims of violence than perpetrators. Schizophrenia does not define a person or their full potential. But stigma causes significant barriers to recovery.
Anti-stigma campaigns, advocacy work and public education seek to dispel myths and discrimination surrounding schizophrenia. Patients must also find inner strength and resilience. Key empowerment strategies include:
- Get involved with mental health advocacy and education efforts
- Identify personal gifts and dreams beyond the illness
- Engage in fulfilling work or creative activities
- Build confidence through achievements and mastery
- Find peer communities for mutual support
- Be the expert on your own treatment and needs
Living meaningfully with schizophrenia involves taking charge of care, actively managing symptoms and rejecting external assumptions. There are as many schizophrenic stories as there are people. With proper support and empowerment strategies, recovery is absolutely possible.
Conclusion
Schizophrenia is a challenging condition that exerts a heavy toll when untreated. Hallucinations like hearing voices can severely disrupt life functioning. However, there are many effective treatments and self-help strategies that allow patients to better cope with and manage symptoms. With medication, psychosocial interventions, family/peer support and empowerment techniques, many schizophrenics are able to lead productive and satisfying lives in the community. While schizophrenia is a lifelong condition, recovery is an ongoing process that is absolutely attainable with the right supports and coping skills.