Hearing Voices and Paranoid Delusions: Inside a Schizophrenic Brain

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Many of us often have the experience of thinking
we heard someone calling our name and then realizing that wasn’t really the case, and
we just move on, and we forget about it. Sometimes we notice coincidences, like, “Oh, there were
a couple of cars on the street,” and again, we pay no attention to it. But for someone
with schizophrenia these experiences take on a vastly different kind of feeling. So
you might notice, “Oh, there were three red cars on the street,” and instead of just forgetting
about it, you start thinking, “Well, why were there three red cars on the street? Maybe
it has something to do with me. Maybe these people are actually coming to monitor me or
do something that would harm me,” and you start working through some kind of plot or
conspiracy related to that coincidence you noticed. The symptoms that people are most familiar
with in schizophrenia are often hearing voices or having paranoid delusions and paranoid
thoughts. We now know that, in addition to those kinds of symptoms, many people with
schizophrenia have trouble focusing, paying attention, and remembering things. Many people
talk about hearing voices and mean different things. Sometimes people will say, “Oh, yeah,
when I’m thinking about what to do, I hear a voice in my head that tells me this would
be the right thing to do, or this would be the wrong thing to do, or that gives me an
idea.” And when individuals with schizophrenia talk about hearing voices, they describe it
very, very differently. It’s really a voice, that they can’t tell the difference between
that voice and a voice coming from a person sitting right next to them in a room. And
it sounds absolutely real. It sounds loud. Sometimes it’s so loud that they can’t stop
paying attention to it. And sometimes the voices are just calling their name, but sometimes
the voices are saying much more complicated things. Sometimes they’re giving them commands,
telling them what to do. Sometimes they’re commenting on what they’re doing, often in
a negative or derogatory way. It comes as no surprise that the brain is
a complicated place. There’s information flying all over the brain, and the brain has to get
that information to the right place and decide what to do with it. We think that, perhaps,
in schizophrenia some of the problems come because information isn’t getting to the right
place, or, sometimes when information does get to the right place, the brain doesn’t
know what it should pay attention to and what it should ignore. This is really important.
In our everyday lives we might hear a car alarm in the background, and we have to know
not to pay attention to that, but we might also hear a baby crying in the background,
and that probably is something that we need to pay attention to. And so, if your brain’s
not able to act as an executive and say, “This is what’s important and this is what’s not
important,” it becomes very difficult to sort through those everyday situations in ways
that are really important for living and holding down a job or managing your life. Seeing things – visual hallucinations, are
more uncommon in schizophrenia. They do sometimes happen, and sometimes they take the form of
people seeing ghosts or seeing people who aren’t really in the room. Sometimes they
look at a picture and they see something more than what the picture shows, often something
with nefarious intent. Those are the kinds of experiences that individuals with schizophrenia
will sometimes describe. Some people have them; some people don’t. Even for people who
have them, they can come and go at times. But these other symptoms that we now understand
better and are starting to recognize more, they’re much more fundamental to the disease,
and they’re much harder to deal with. And those are the symptoms like having trouble
paying attention, having trouble remembering information, and having trouble being able
to organize your activities and switch from one activity to another activity. These are
things which individuals with schizophrenia start to find are harder than they were before
they became ill. So, all of a sudden, they have trouble paying attention in class. They
have trouble focusing on what they’re reading. They have trouble doing jobs that require
them to switch between one kind of thing and another kind of thing quickly. And that obviously
stands in the way of people being able to live their lives to the fullest, being able
to work, being able to manage their household, being able to manage their families and family
relationships. Those symptoms we often call ‘cognitive’ symptoms, symptoms related to
attention, and memory, and concentration, and focus. They’re really one of our biggest
challenges right now in schizophrenia.


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