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Talking to Someone with Hallucinations and/or Delusions

As we are becoming more aware when it comes to mental illness, we are discussing it more and more. We see a lot more attention paid to diagnoses like depression or anxiety, maybe even bipolar disorder but we still hesitate to talk about psychosis and disorders like schizophrenia without being sensationalistic or perpetuating stigma.

Hallucinations and delusions can be extremely hard to understand and are symptoms that are much more difficult to treat. As a family member or friend, it is normal to feel ill equipped to care for someone experiencing these symptoms but there are ways we can help and ensure our interactions are more effective.

Hallucinations are false perceptions: believing that something is there when it isn’t. They can be visual, auditory, tactile, olfactory and even gustatory, though visual and auditory are most common.

Delusions are false beliefs: believing things to be true or to be happening that are in fact outside of reality.

Here are some tips for communicating with and helping someone experiencing either or both.


· Remain calm and use their name often

· Speak clearly and keep sentences simple

· Check in with how the hallucinations/delusions are making them feel:

- Are you scared?

- Are you confused?

- Do you find it soothing?

- What does it mean to you?

· Empathize with and validate those feelings

· Assure them that it is OK they are experiencing these symptoms (in that it is not their fault)

· Ask for details on what is going on for them:

- When did it start?

- Where is it coming from?

- Can you make it stop?

- What happens if you ignore it?

· Paraphrase and ask clarifying questions to really understand

· Question the logic behind the hallucinations/delusions:

- i.e. If the delusion is that the CIA is after them, ask who is gathering this information on them. This may help them connect a bit more with reality.

· Do not argue or forcefully tell them that it isn’t real

· In the same vein, do not confirm or play into the hallucinations/delusions

· Gently express that you are not perceiving the same thing they are and explain your reality

· Normalize the hallucinations/delusions:

- Ask the person to help you list reasons this might logically be happening, such as sleep deprivation, drugs, stress, fever/illness

· Use diversions and distractions and check in to see if it’s still happening. If they explain it is, try to refocus on the distracting task:

- This could be singing a song, cleaning up the house, counting items, finishing a puzzle, anything really that will require brain power

Hallucinations and delusions can be scary, confusing and overwhelming. When something distressing is happening and you are both dealing with the crisis and experiencing the confusion of partially knowing this is not real, it can escalate the feeling of helplessness and fear. It is important not to rush someone who is experiencing hallucinations and delusions and to be gentle and patient with them.

If you struggle with this, it does not by any means reflect on your value as a caregiver or loved one. Even medical professionals struggle with this. Remember to practice self-care and set boundaries so you can remain healthy and stable, which is the only way you’ll be able to help your loved one.

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