Faydra Aldridge: Welcome to Look again, mental illness re-examined, I'm Faydra Aldridge.
S2: Teddy, please, please don't do this. -- A year ago,
S2: I met a man who was down on his luck.
S2: He's got a gift. Thought I might be able to help.
Faydra Aldridge: Are you out of your mind?
S2: She paints, she reads...
Dr. Randall White: Yeah, she paints, she reads, she lights things on fire.
Dr. Randall White: I got a fire extinguisher, just bring her. Help you? Do I look like I
Dr. Randall White: could help you? What are you doing? You threw the goddamn ball into the fence -- you threw the ball into the fence - Christ almighty -- there's nobody there!
Dr. Randall White: John has Schizophrenia. P eople with this disorder are often paranoid... I'm not.
Faydra Aldridge: If Hollywood is to be believed, all people with schizophrenia
Faydra Aldridge: hear voices telling them to do bad things. The truth, though,
Faydra Aldridge: is a little more complex than that. Hearing voices can
Faydra Aldridge: be a symptom of mental illness. Some people do hear
Faydra Aldridge: voices or experience other kinds of hallucinations, of course, but
Faydra Aldridge: others do not. Some hallucinations are actually not negative or violent. Well,
Faydra Aldridge: some cause a person to want to harm themselves or others.
Faydra Aldridge: So what's it really like to hear voices anyway? Why
Faydra Aldridge: is there so much stigma around this? And what can
Faydra Aldridge: we do about it if we do encounter someone who
Faydra Aldridge: seems to be experiencing hallucinations? These are just some of
Faydra Aldridge: the fascinating questions we're going to be looking at on
Faydra Aldridge: today's episode of Look Again. Today, I'm very happy to
Faydra Aldridge: introduce you to Dr. Randall White. Dr. White is the
Faydra Aldridge: medical director of Community Mental Health in Vancouver and the
Faydra Aldridge: clinical director of the BC Psychosis Program at UBC Hospital.
Faydra Aldridge: He is also a clinical professor of psychiatry at UBC
Faydra Aldridge: and on the Medical Advisory Board of the BC Schizophrenia Society.
Faydra Aldridge: And Dr. White has also been awarded the status of
Faydra Aldridge: Distinguished Fellow by the American Psychiatric Association this year. Randall,
Faydra Aldridge: welcome to Look Again.
Dr. Randall White: Thank you, Faydra.
Faydra Aldridge: Now, before we really get into things, I want to
Faydra Aldridge: kick things off by sharing some thoughts from our panel.
Faydra Aldridge: We're going to hear from some people with lived experience
Faydra Aldridge: about what it's actually like to hear voices. So let's
Faydra Aldridge: take a listen now.
S2: I have experienced auditory hallucinations and olfactory hallucinations and physical hallucinations.
S2: I thought I was in labor and that was very interesting,
S2: to say the least. Needless to say, I didn't go
S2: to the hospital. My family was with me and they said, oh,
S2: it's just your imagination, which I accepted. And then I
S2: had olfactory hallucinations where I smell things.
S4: I started hearing audio hallucinations again and they actually were
S4: about hallucinations. And I actually get up on the psych
S4: ward and I don't know if you feel like I
S4: don't have to listen this. So but yeah, I did
S4: have them anyways and it just kind of scared me just
S4: having them. So I went to the psych ward and
S4: I'm doing much better. I was really, really anxious when
S4: I took myself to the psych ward.
Faydra Aldridge: So those were some thoughts from our panel. People living
Faydra Aldridge: with mental illness, pretty powerful. Dr. White, we just heard
Faydra Aldridge: from people living with mental illness and the fact that
Faydra Aldridge: many of them hear voices, but not all people with
Faydra Aldridge: schizophrenia hear voices. In your clinical experience, how prevalent is
Faydra Aldridge: this symptom?
Dr. Randall White: Hallucinations are one of the five main symptoms listed in
Dr. Randall White: the diagnostic manual we use to diagnose schizophrenia. They're very common,
Dr. Randall White: but as you said, they're not universal. I would say
Dr. Randall White: that probably three quarters or more of people with schizophrenia
Dr. Randall White: experience that at some point it can be episodic. So
Dr. Randall White: at a given time, somebody with this diagnosis might not
Dr. Randall White: be having that, but then we may have relapse or
Dr. Randall White: illness gets worse. It may come back.
Faydra Aldridge: You talk about psychosis and sometimes I've heard people use
Faydra Aldridge: schizophrenia and the term psychosis as the same term they
Faydra Aldridge: use it synonymously. Can we delve into that? Because hearing
Faydra Aldridge: voices is a symptom of psychosis, which is associated with
Faydra Aldridge: many mental illnesses, not just schizophrenia. Can you tell us
Faydra Aldridge: more about that?
Dr. Randall White: Correct. Hallucinations, hearing voices or auditory hallucinations is one symptom
Dr. Randall White: of psychosis, and psychosis refers to an abnormal state of
Dr. Randall White: mind that could be due to any variety of causes.
Dr. Randall White: Schizophrenia is one one of the more common causes of
Dr. Randall White: especially chronic or ongoing hallucinations. When we talk about psychosis
Dr. Randall White: in general, we talk about this abnormal mental state that
Dr. Randall White: lasts for anywhere from usually days to weeks. And in
Dr. Randall White: the case of schizophrenia, it could be years. Another common
Dr. Randall White: form of psychosis is schizoaffective disorder, which is similar to schizophrenia,
Dr. Randall White: but also has elements of depression or mania or mood
Dr. Randall White: problems mixed in as well.
Faydra Aldridge: We all hear voices right now. There's a voice in
Faydra Aldridge: my head saying, sit up, don't talk so fast, remember
Faydra Aldridge: to breathe. So how do we know the difference between
Faydra Aldridge: the voice that's in... or example, my head right now,
Faydra Aldridge: my inner voice and an auditory hallucination?
Dr. Randall White: Well, yeah, we talk about our inner voice. And another
Dr. Randall White: way people describe that is maybe their conscience. That's not
Dr. Randall White: what people with schizophrenia are experiencing when they talk about
Dr. Randall White: hearing voices. They talk about an experience that's very similar
Dr. Randall White: to what our listeners are having right now, where someone
Dr. Randall White: else is talking to them. They don't necessarily call it
Dr. Randall White: their inner voice. They call it often an alien voice
Dr. Randall White: that's coming from outside their head. Sometimes it sounds more
Dr. Randall White: like it's hitting their head, but it can vary. But
Dr. Randall White: frequently it's completely alien. They may or may not give
Dr. Randall White: an identity to it. It may say things that seem
Dr. Randall White: totally uncharacteristic for the thoughts they usually have. It may
Dr. Randall White: tell them to do risky, dangerous things. And so it's
Dr. Randall White: a very compelling experience in many cases that could lead
Dr. Randall White: to irresponsible or dangerous. That's very different from what we
Dr. Randall White: might call our inner voice or our conscience or even
Dr. Randall White: our repetitive thoughts,
Faydra Aldridge: And when we think about auditory hallucinations, there are many
Faydra Aldridge: other kinds, and you alluded to this earlier, including tactile,
Faydra Aldridge: which you don't really hear a lot about. Can we
Faydra Aldridge: talk about those other hallucinations that we may not hear
Faydra Aldridge: a lot about?
Dr. Randall White: Yes. So in psychosis and especially in schizophrenia, the hallucinations
Dr. Randall White: can occur in any sense. We call them sensory modalities.
Dr. Randall White: So touch, smell, vision and hearing, of course, so people
Dr. Randall White: can have visual hallucinations, they can see other people, they
Dr. Randall White: can see animals or other things that aren't present. They
Dr. Randall White: can have odors, they can smell strange things, even their
Dr. Randall White: taste can be distorted. And then they can feel things
Dr. Randall White: on their skin like someone is touching them. That may
Dr. Randall White: be very complex. They may feel as though they're being
Dr. Randall White: sexually assaulted, which is obviously very distressing. These can occur
Dr. Randall White: in different combinations. So they might hear the voice and
Dr. Randall White: then they feel something and they think someone is trying
Dr. Randall White: to harm them or possess them. And that can lead
Dr. Randall White: into another symptom, very common in psychosis, which is delusions.
Dr. Randall White: Delusions are false beliefs. So somebody who's having a hallucination
Dr. Randall White: where they feel like they're being sexually assaulted may then
Dr. Randall White: develop a delusion that an unseen person or their neighbor
Dr. Randall White: or whoever is repeatedly assaulting them.
Faydra Aldridge: Now, if somebody does experience hallucinations, what are some treatment
Faydra Aldridge: options with schizophrenia?
Dr. Randall White: The cause is not completely understood. Therefore, we only have
Dr. Randall White: treatments that can sometimes partially, sometimes fully suppress that symptom,
Dr. Randall White: but not necessarily cure it. And it comes down to medications,
Dr. Randall White: antipsychotic medications. At the same time, I should mention, we
Dr. Randall White: have some psychological and behavioral interventions that can help as well.
Dr. Randall White: They won't necessarily eliminate it, but it can help people
Dr. Randall White: to manage the distress that goes along with the experience
Faydra Aldridge: You're listening to. Look Again, Mental Illness Re-Examined, a podcast
Faydra Aldridge: brought to you by the BC Schizophrenia Society and B.C.
Faydra Aldridge: partner organizations. I'm your host, Faydra Aldridge . This podcast would
Faydra Aldridge: not be possible without the support of the entire community.
Faydra Aldridge: From the bottom of our hearts, we want to thank
Faydra Aldridge: you for caring about mental illness together. We truly can
Faydra Aldridge: make a difference. So we're speaking with Dr. White about hallucinations, earlier,
Faydra Aldridge: we heard from people with lived experience and what it's
Faydra Aldridge: like to experience these hallucinations, and now we're going to
Faydra Aldridge: hear from family members and what it's like for them
Faydra Aldridge: to see a loved one experiencing them.
S5: I remember one day coming home, it still upsets me
S5: to this day. He was walking around my living room
S5: and then just kneeling, staring, and then slowly get up
S5: and take a few steps to the left or the
S5: right and he'd kneel down on one knee again. And
S5: he did that -- just in a circle in my living room.
S5: And I just couldn't reach him in that moment, just
S5: watching his body move so slowly in response to something
S5: that I couldn't see or hear. It's quite it's very terrifying.
S5: I mean, I remember those those years. And I'm just
S5: so grateful that we're past those.
S4: The feeling of helplessness, not not so much fear, but
S4: you just see the torment that these folks are going through.
S4: It's just distressing to see them. Sometimes it's his paranoia
S4: how it bothers him. And it's there. It's really unfortunate.
S4: There are places where people have tried to reproduce auditory
S4: hallucinations on YouTube. And if some of those are true,
S4: it is scary if if in fact those renditions are
S4: even close to what people are hearing in their heads.
S4: And I just feel so, so sad for the torture
S4: that this symptom gives to gives to these folks, to
S4: my sons.
S5: You can just see the torment that they're going through
S5: and how how badly he felt about himself because of
S5: what the voices were telling him about how awful he was.
S5: And he's going to go to hell. You know, he
S5: didn't want to live anymore. You wanted to be put
S5: out of his misery when he was so afraid they
S5: were right that he's going to go to hell.
S2: I can see my son's eyes. They go flat when
S2: he's somewhere else. They were a comfort to him and
S2: they told him he was really smart. But they also
S2: warned him that people were after him all the time
S2: and stuff, too. So that's been stolen, the candle is blown out, feeling pretty awful
S2: to witness in your child.
Faydra Aldridge: So those were just a few thoughts from some family members,
Faydra Aldridge: from our family panel made up of families of people
Faydra Aldridge: with schizophrenia. And we asked them to share what it's
Faydra Aldridge: like to witness someone who is experiencing active hallucinations from
Faydra Aldridge: the outside. We're back with Dr. Randall White, clinical professor
Faydra Aldridge: in the U.S. Department of Psychiatry and distinguished fellow in
Faydra Aldridge: the American Psychiatric Association. Randall, that was tough to hear
Faydra Aldridge: families express. Obviously, a lot of concern about seeing their
Faydra Aldridge: loved one going through psychosis. And it's not easy to see.
Faydra Aldridge: It certainly wasn't easy to to listen to, that's for sure.
Faydra Aldridge: So in your experience, what does it look like from
Faydra Aldridge: the outside for someone to witness that?
Dr. Randall White: Well, I know that this is a really mystifying disease
Dr. Randall White: for families or for anyone who is observing. And it
Dr. Randall White: can look different, obviously, because everyone is unique. But I
Dr. Randall White: think one of the family members was describing somebody probably
Dr. Randall White: in the midst of of hearing intense voices who was
Dr. Randall White: kind of overwhelmed by it, showing a lot of disorganized
Dr. Randall White: or amped up behavior, doing repetitive movement. And that's something
Dr. Randall White: that I observed. And the patients that I treat commonly,
Dr. Randall White: they have gestures or pacing, grimacing, talking to themselves, laughing,
Dr. Randall White: all those things. And it's the hallmark of what I
Dr. Randall White: guess historically was called madness. Sometimes it's clear that the
Dr. Randall White: patients are in anguish. Other times they might smile and
Dr. Randall White: laugh and it might look like they're enjoying themselves. But
Dr. Randall White: at the same time, we know they're cut off from
Dr. Randall White: others around them when they're in this experience and it
Dr. Randall White: takes them away from meaningful relationships. And that's what hurts
Dr. Randall White: the family so much.
Faydra Aldridge: So I'd like to talk about the danger part of it.
Faydra Aldridge: How much of a danger to others is someone in
Faydra Aldridge: the state likely to be? Because I think there's a
Faydra Aldridge: lot of misconceptions around this.
Dr. Randall White: People with schizophrenia are more likely to be harmed or
Dr. Randall White: assaulted than they are to commit an assault or to
Dr. Randall White: commit murder. And they're actually quite vulnerable when they're in
Dr. Randall White: that state. They're vulnerable to being exploited because they're not
Dr. Randall White: as aware of their surroundings to getting, let's say, hit
Dr. Randall White: by a car. At the same time, it's important to
Dr. Randall White: be truthful and honest about the fact that certain kinds
Dr. Randall White: of psychosis do elevate the risk for assault or harming
Dr. Randall White: other people, because people who are very paranoid and fearful
Dr. Randall White: may react unpredictably. In some cases, people with psychosis can
Dr. Randall White: develop a very intense, specific delusion about maybe someone in
Dr. Randall White: their environment. It's rare, but it does happen. But I
Dr. Randall White: still need to emphasize that the average person with schizophrenia
Dr. Randall White: who is not adequately cared for and treated wandering on
Dr. Randall White: the street is really not dangerous to the public at large.
Faydra Aldridge: I've been hearing this term a lot lately, psychotic breaks.
Faydra Aldridge: So I'd love to get your professional opinion on the
Faydra Aldridge: difference between hearing voices and an actual psychotic break. What
Faydra Aldridge: is a difference between those two?
Dr. Randall White: Well, psychotic break is it's not actually a diagnosis. It's
Dr. Randall White: it's a term that we use a bit casually. The
Dr. Randall White: word break refers to a break with reality that sometimes
Dr. Randall White: our psychosis is characterized because in the psychotic state of mind,
Dr. Randall White: the person is preoccupied with these internal things that don't
Dr. Randall White: reflect reality. A psychotic break means the person becomes psychotic,
Dr. Randall White: and it often refers to the first episode of psychosis.
Dr. Randall White: Sometimes we call it the first break episode. Sometimes it
Dr. Randall White: occurs abruptly, sometimes and more often it's rather gradual. And
Dr. Randall White: it typically would involve hearing voices...
Faydra Aldridge: If we ignore the fact that one out of a
Faydra Aldridge: hundred people have schizophrenia and even more experience psychosis. So
Faydra Aldridge: if we as a society choose to either ignore or
Faydra Aldridge: keep it hidden that these illnesses exist, where will that
Faydra Aldridge: take us?
Dr. Randall White: I think the fear, the stigma result in the people
Dr. Randall White: affected in the patients, so to speak, not getting the
Dr. Randall White: care they need. So it just prolongs, I think, suffering
Dr. Randall White: when there's ignorance and stigma attached to an illness.
Faydra Aldridge: I'd like to talk about stigma. And I think stigma
Faydra Aldridge: is a huge part of this, which is why I'm
Faydra Aldridge: so happy we're doing this podcast. Randall, what do you think?
Faydra Aldridge: As a frontline clinician, what do you think we can
Faydra Aldridge: do as a society? To start to break down those
Faydra Aldridge: silos and to really address the stigma associated with serious
Faydra Aldridge: mental illness,
Dr. Randall White: Although it's still substantial that stigma, I think there is
Dr. Randall White: some improvement. But, you know, there are plenty of books,
Dr. Randall White: you know, memoirs people have written about their experiences. So
Dr. Randall White: I think, you know, when we have people who can
Dr. Randall White: talk about their experience, that helps a lot more than
Dr. Randall White: some doctor preaching to the public. I think I think
Dr. Randall White: things like what the Schizophrenia Society does like this, a
Dr. Randall White: podcast to try to demystify, I think, getting family members,
Dr. Randall White: if they're able to write into newspapers, op ed, you know,
Dr. Randall White: talking about how important it is to to stop stigmatizing
Dr. Randall White: and to be honest about mental illness. And I know
Dr. Randall White: that families and schizophrenia society are very active in their communities.
Dr. Randall White: So basically, it's a team effort.
Faydra Aldridge: Well Randall, thank you so much for joining me today.
Faydra Aldridge: So that was Dr. Randall White. And we will be
Faydra Aldridge: sure one hundred percent to post all our relevant links and
Faydra Aldridge: items we talked about today from our conversation on our website.
Faydra Aldridge: That website, again, w w w dot BCSS dot org. Dr. White. Thank
Faydra Aldridge: you so much for joining us today.
Dr. Randall White: It was a pleasure.
Faydra Aldridge: And now it's time to thank my incredible guests today
Faydra Aldridge: on Look Again, Mental Illness Re-Examined. And I want to thank
Faydra Aldridge: you for listening. Your support means absolutely everything. Mental illness
Faydra Aldridge: literacy is so important. It's important to you, to me
Faydra Aldridge: and to us as an entire society. We have to
Faydra Aldridge: talk about this. And together, I know we can do
Faydra Aldridge: a better job of taking action. Talk to you soon.
Faydra Aldridge: This podcast is brought to you by the B.C. Schizophrenia
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Faydra Aldridge: Use Information, where a group of non-profit agencies providing good
Faydra Aldridge: quality information to help individuals and families maintain or improve
Faydra Aldridge: their mental well-being. The B.C. Partners Members are Anxiety. Canada,
Faydra Aldridge: BC Schizophrenia Society, Canadian Institute for Substance Use Research. Canadian
Faydra Aldridge: Mental Health Associations, B.C. Division, Family Smart, Jessie's Legacy, the
Faydra Aldridge: North Shore Family Services Program and Mood Disorders Association of B.C.,
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