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Dr. Keane
Dr. Keane, Therapist
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Experience:  Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
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Are hallucinations heard inside the head different in severity

Customer Question

Are hallucinations heard inside the head different in severity from those heard outside? A colleague insists that those heard inside the head only are not "true hallucinations," I have always contended that those heard outside the head are more serious and evidence projection. Sometimes it has appeared to me that those inside the head may be elaborations of obsessional thoughts.
Sidney Bolter, M. D.
Submitted: 5 years ago.
Category: Mental Health
Expert:  Ralph LMHC replied 5 years ago.
Hello Dr,

As a colleague I am answering this with no intention of fee, but in my experience I do not believe that hallucinations inside the head are the only true hallucinations. I have seen many very psychotic individuals carry on conversations with the voice that was talking to them "outside the head", and see an individual turn to talk to the voice in the absence of a visual hallucination. I would also tend to agree with the statement that those outside the head can be indicative opf a more disturbed individual. I think that another problem is that terms like schizophrenia and hallucinations are constellation type in nature and not a single phenomenom. I would greatly appreciate your feedback making this a learning experience for myself as well.
Sincerely,
Ralph Atlas LMHC, CRC, CGP

Please note I have dealt with the SPMI population for over 35 years going back to the days of the schophrenogenic mother.
Customer: replied 5 years ago.
I am not sure what my colleage means by "true hallucination" but her opinion if followed by the judge may mean that the ruling may be negative and a very ill patient is put to work. I recognize this can be a complex issue but her strong belief implies that hallucinations heard inside head only will result in a decision unhelpful to the patient.
Expert:  Ralph LMHC replied 5 years ago.
That is a legal issue with which I am only remotely familiar. I was sharing a clinical opinion that both are true hallucinations, but in my experience the ones "outside the head" are more disturbed.
Customer: replied 5 years ago.
I agree that those ouitside are more serious but this turns out to be a black or white issue. If inside the head are "true hallucinations" then the atty representing the claimant will likely win his case. Provided there are no issues of malingering.
Expert:  Ralph LMHC replied 5 years ago.
Then that is a miscarriage of justice and strikes me as being irrational. What more can I say. I do not understand why it has to be one or the other. Could you clarify-damn I wanted to go to sleep, but this so interesting and as I said strikes me as a miscarriage of justice. Can I assist in any way?
Customer: replied 5 years ago.
No further help is needed. I think I understand where you are coming from You have essentially aswered my basic question. We can't make a federal case out of this. I usually win the day. Go get some rest. I     accept your answer. Thanks.
Expert:  Ralph LMHC replied 5 years ago.
My pleasure goodnight. I will now have some listen to the voice that tells me to sleep night and be well.
Ralph Atlas LMHC, CRC, CGP

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