Pleasurable auditory hallucinations
Sanjuan J, Gonzalez JC, Aguilar EJ, Leal C and Os J;
Commented by , 29 Oct 2004
Aim of the study
We usually consider auditory hallucinations to be negative experiences that substantially contribute to the suffering of patients with schizophrenia. However, in clinical routine we sometimes also have the impression that some patients seem to benefit from their psychotic experiences and occasionally this may even contribute to non-compliance.
There are virtually no studies as to whether auditory hallucinations can be perceived as pleasurable and how often this is the case. The authors of the present publication tried to fill this gap by assessing the frequency of voices being a pleasurable experience in psychotic patients treated in Spanish hospitals.
Methods
The authors recruited a total of 160 in- or outpatients with auditory hallucinations (89 had schizophrenia and 17 had other psychotic disorders) in three psychiatric hospitals in Valencia, Spain. Auditory hallucinations were evaluated with the psychotic symptom rating scale (PSYRATS).
The PSYRATS is a five point scale that covers frequency, duration, location, loudness, beliefs about the origin of voices, amount of negative content, amount of distress, intensity of distress, disruption of life and controllability of voices. The PSYRATS was supplemented by an item on whether the hallucinations were perceived as pleasurable or not.
Results
26% of the patients (n=28) reported voices as a pleasurable experience and for 10 of them this was frequently so. There was a statistically significant negative association between pleasurable hallucinations and intensity and amount of distress, degree of negative content of the hallucinations and their loudness. Overall those with pleasurable hallucinations had lower PSYRATS scores than the whole group. Chronicity of hallucinations and the feeling of control over the voices were positively correlated with pleasurable perception.
Discussion
The most important finding of this study was that auditory hallucinations are not necessarily perceived negatively by patients with psychotic disorders. Pleasurable hallucinations were found in a substantial proportion of the patients (26%). This finding challenges our understanding of auditory hallucinations as a per se negative experience.
The fact that pleasurable perception was associated with chronicity and perceived control of the hallucinations can reflect a positive adjustment to hallucination via habituation and reappraisal processes.
This is in accordance with recent studies that showed that cognitive behaviour therapy may be an effective intervention to alleviate treatment resistant hallucinations.
The authors, however, speculate that treating hallucinations with cognitive behaviour therapy should take into account whether the hallucinations are positively perceived by the patients and that sometimes treatment my even be counter indicated.