Auditory Hallucinations: Do I Lack Insight into My Condition?

Q: Auditory Hallucinations: Do I Lack Insight into My Condition?

Hello： Schizophrenia is a disorder characterized by disruptions in the brain's information processing system, affecting thought and perception. <br>The symptoms you described are more akin to thought broadcasting and auditory hallucinations. <br>It is advisable to discuss these s

Do I lack insight into my illness? Will the auditory hallucinations get better?

When I was in the third and fourth grades of elementary school, I thought I had telepathy and could communicate with my classmates mentally.
One day during class, a girl in my class had her skirt zipper down, and I thought to myself: "I am [name], your zipper is down." Later, that girl actually looked at her skirt, talked to the classmate next to her, and then zipped it up.
After that, I thought to myself: "Stop the telepathy." I believed everything was fine, but I later tried to send telepathic messages to others, managing to connect with up to five people.
In my senior year of high school, I attempted to communicate telepathically with my civics teacher.
After we talked for a while, I said: "Stop the telepathy." Yet, I could still hear him speaking; he said the telepathy hadn't stopped.
I started to feel like I was sending telepathic messages to many people, and that everyone knew what I was thinking, doing, or saying.
Once, while I was showering, someone said: "Why do you keep showing me your breasts?" and I was indeed looking at my breasts at that moment.
From then on, I felt that everything I saw, everyone else could see too.
At night, I would hear someone say: "I can't sleep because of you." I have difficulty falling asleep, and before I do, I often hum songs or think about things, but they would say: "If you’re not asleep, we can't sleep." This caused me a lot of stress.
So, when I turned 18, I went to see a psychiatrist, who diagnosed me with delusional disorder and prescribed medication.
However, now at 37 years old, I still feel like I’m not sleeping and that my racing thoughts or humming before bed disturb others, preventing them from sleeping.
I believe everyone knows what I’m thinking, what I hear, what I say, and what I see.
My mother says I lack insight into my illness, but I truly feel that everyone knows what I’m thinking.
Do I really lack insight? I have been troubled by this for a long time.
If those voices are hallucinations, I genuinely feel that I have experienced things that prove others know what I’m thinking.
And if they are hallucinations, why haven't I improved despite taking medication? I sought help and started medication quite early.
Will the hallucinations get better?

He Yun, 30~39 year old female. Ask Date: 2022/12/02

Dr. Cai Qijin reply Psychiatry

Hello: Schizophrenia is a disorder characterized by disruptions in the brain's information processing system, affecting thought and perception.
The symptoms you described are more akin to thought broadcasting and auditory hallucinations.
It is advisable to discuss these symptoms with a physician, and you may also want to clarify with family members whether they are aware of your thoughts.
Regarding medication, it needs to be taken regularly for several months to be effective; approximately two-thirds of cases will see an improvement in symptoms.
Typically, this should be combined with rehabilitation therapy to enhance disease adaptation and restore occupational and social functioning.

Reply Date: 2022/12/02

More Info

It sounds like you are experiencing a complex and distressing situation regarding your auditory experiences and perceptions of reality. From what you’ve described, it seems you have been diagnosed with a type of schizophrenia known as "paranoid schizophrenia," which can involve delusions and auditory hallucinations. These experiences can be incredibly challenging to navigate, especially when they impact your daily life and relationships.

Firstly, it’s important to understand that auditory hallucinations—hearing voices or sounds that are not present—are a common symptom of schizophrenia and other mental health disorders. They can manifest in various ways, such as hearing people comment on your actions or thoughts, as you've described. This can lead to significant distress and confusion, particularly when you feel that your thoughts are being shared or known by others.

The concept of "insight" in mental health refers to a person's awareness and understanding of their condition. Many individuals with schizophrenia may struggle with insight, meaning they might not fully recognize that their experiences are symptoms of a mental health disorder. Your mother’s comment about your lack of insight suggests that she believes you may not fully grasp the nature of your condition. However, it’s crucial to acknowledge that insight can vary greatly among individuals and can change over time.
Regarding your question about whether you truly lack insight, it’s essential to consider how you perceive your experiences. You mentioned feeling that others know your thoughts and experiences, which can be a common delusion in schizophrenia. This belief can be very real and convincing to you, even if it does not align with the reality of the situation. It’s also understandable to feel frustrated when your auditory experiences persist despite medication.
Antipsychotic medications can be effective in managing symptoms of schizophrenia, including hallucinations and delusions, but they do not work the same way for everyone. Some individuals may find relief from their symptoms, while others may continue to experience them despite treatment. This variability can be due to several factors, including the specific type of medication, dosage, individual brain chemistry, and the presence of other mental health conditions.

If you feel that your current treatment is not adequately addressing your symptoms, it may be beneficial to discuss this with your psychiatrist. They can evaluate your medication regimen and consider adjustments or alternative treatments. Additionally, therapy, particularly cognitive-behavioral therapy (CBT), can be helpful in managing symptoms and improving insight. CBT can provide strategies to cope with hallucinations and challenge delusional thoughts, potentially leading to a better understanding of your experiences.

Lastly, it’s important to prioritize self-care and seek support from trusted friends, family, or support groups. Engaging in activities that promote relaxation and reduce stress can also be beneficial. Remember, you are not alone in this journey, and there are resources and professionals available to help you navigate these challenges.

In summary, your experiences are valid, and it’s essential to continue seeking support and treatment. Understanding your condition and finding effective coping strategies can take time, but with the right support, improvement is possible.

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