Ideas on How to Handle

Hallucinations

Hallucinations

Hallucinations

     As a caregiver, you may need to deal with hallucinations from two different perspectives. How you approach your family member depends on why the hallucination is occurring. Is it the result of a chronic mental illness under treatment that requires management with honesty or an intervention? Is this hallucination related to Alzheimer’s and causing no harm to anyone?

 

Mental Health Hallucinations

     With mental health conditions, the individual often has a chronic health condition requiring counseling and treatment protocols.  They have a designated approach to dealing with the hallucinations.  As a caregiver, they should share that process with you. The person experiencing the hallucination learns to recognize if what they see is real or fake with therapy.

Ideas on How to Handle Hallucinations

   Keep in mind that the hallucination is not real. Since it’s not real, it has no power to hurt you because your mind controls it.  Therefore, you have total power over it. When you feel like it’s trying to harm you, that’s your mind playing tricks on you. 

     Increased stress may bring on hallucinations. Stress seems to be a trigger for hallucinations, and it can be good stress or bad stress.

     Therefore, if you are hallucinating, check your stress level.

  • Are you getting enough sleep?
  • Are you drinking enough water and eating enough food?
  • Have you been ill or ran a fever?
  • Have you taken any medicine or used any drugs that could cause hallucinations?
  • Has there been any emotional family event?

    What better way to dispel fear than to face it head-on? Check the hallucination to see if it’s real.  Here’s how you can do that.

Visual (sight, vision): 

     Test (1) Take a few pictures of what you see.  If it’s not in the picture, it never was there. 

    Test (2) If you wear glasses or contacts, look at the image, then remove them.  If the image doesn’t blur as everything else does, then it’s not real. All the real things should blur the same amount without your glasses or contacts. 

Auditory (Sound, hearing):

     Test (1) If you hear the sound while you are on the phone, hit the record button to capture the sound.  Then ask someone else to listen to the recording to find out if they hear the sound also.

     Test (2) If you hear voices, you can turn the music volume up very loud.  If you can still hear the voices clearly through the music as if the music were not there, it’s not a real voice.

Olfactory (Smell):

     Test (1) Ask another person if they smell what you smell.  If they don’t, it may be a hallucination.  However, you may need to ask a couple of people if the smell is subtle.

Taste:

     Test (1) Ask someone to take a bite of what you are eating and ask them how it tastes to them. You can use this method to confirm that the food is okay to eat; however, recognize that the “taste” is still present.  Therefore, it may still be difficult to force yourself to eat something that may taste nasty to you, even knowing that it’s okay in the real world.

General Rule Test: 

     Notice how others react to what you think you see, hear, feel, smell, or taste.  If others are not having the same reaction as you, the chances are that you may be having a hallucination, especially if most people are behaving the same way.  Learning to read other people’s cues and body language can help these situations provided you validate the read by comparing results on several individuals. 

  • Focusing on activities that you know are real will help keep you grounded and connected to reality.
  • If you have a hobby, enjoy playing with a pet, or playing a favorite game, use them as your “go-to” activities when you are uncertain about what your senses are telling you. Items and activities that are familiar establish a long-term memory imagine in your brain that will give you a sense of comfort and help you figure out what is normal for your world and what is not.
  • If one of your senses participates in a hallucination, use another to engage in an activity that takes concentration. If you see something you know is not real, sing a song using sound to divert your sensory stimulation.
  • On the other hand, sometimes, you can block out the hallucination using the same sense. For example, if you feel like you have ants crawling on your skin, a hot shower or cold compress might soothe the hypersensitive area and stop the sensation.

     If the voices in your head are scaring you, give them a name. Talk to them as if they are friends when you’re alone, and they may seem less scary. If you give them a silly name or character that sounds non-threatening, the voice may take on some of those characteristics too.

Pretend They Are Rude Bullies

     If the voices sound like a bully or tell you to do bad things, think of them as pathetic teenagers who are being rude and want attention. Just ignore them to keep them from getting their way.

Talk To the Voices Out Loud

     If you’re in a private area, you can talk out loud to the voices.  If they insult you, insult them right back. Mock them or be sarcastic.  However, if you’re in public, you might want to talk into a phone to do this, so people don’t look at you oddly.

     Dealing with hallucinations is a scary business. Most people feel very insecure during the episodes since it’s difficult to know what is real and reliable.  Therefore, whatever you use to give you a sense of security should be available to you during this time as well, even if it might seem “silly” to someone else. If it calms you and makes you feel better, then use it.

  • If you have a special comfort place that you feel safe, consider visiting it, or a special chair, you find helps you to feel safe.
  • Use any comfort objects, like a favorite blanket or a book that you like to re-read.
  • Turn on the lights, open or close curtains (whichever you prefer).
  • Play your favorite, most relaxing music.
  • Spend time with people who help you feel safe.

The resource for this section came from “Coping Strategies for Hallucinations” https://www.wikihow.com/Handle-Hallucinations.

Caregiver Training: Hallucinations 

The above video link connects to the UCLA Alzheimer’s and Dementia Care Video series which provides practical tools in a variety of settings to create a safe, comfortable environment both for the person with dementia and the caregiver. They have several other videos you might find useful on that site in addition to this one.

Seeing someone who is telling her what to do.
Seeing someone who is telling her what to do.

Am I Having a Hallucination?

Hallucinations Seem Real

     Hallucinations are a common symptom of many mental health conditions. They emerge using the senses – sight, hearing, smell, or touch – seemingly real though they are not. It’s difficult for anyone who has not experienced hallucinations to understand how real the encounter feels. There is no difference between the real tree and the hallucination tree; both are the same.  They look, smell, sound, and feel the same.  The hallucination tree is real to them, and if it’s about to fall on them, they feel the terror they would feel if a real tree is about to fall. Therefore, it is important not to dismiss their hallucination as a dream.  Dreams are not real to them, but hallucinations are.

Can’t Tell the Difference

     If they experience hallucinations but can’t always tell when they are having one, they must get very frustrated. Furthermore, they may be afraid to move with not knowing if they can trust what they see.

If your family member is new to having hallucinations and you’re trying to help them learn to copy, here are some pointers you can give them on how they can recognize if it’s a hallucination and some ways to help reduce their occurrence.

Ideas on How to Handle Hallucinations con't.

     Don’t forget to take your medicine every day. If you need to set the alarm on your phone, or write a reminder, do it.  Also, ask your doctor or pharmacist what you should do if you forget to take a dose.  Should you skip it, take it when you remember, or double the next time.

Let Your Pet Help

     Get your pet in on helping you remember to take your medication. If you have a pet, give your pet a treat every time you take your meds. You may forget when it’s time to take your meds, but your pet won’t.

Use a Pill Organizer Tray

     If you forget if you have taken your medication, keep your medicine in a schedule tray.  I’m referring to one of those trays marked with the days of the week and four boxes at least under each day. At the beginning of the week, organize your medication for the week.  As you take medicine, the slot for that dose empties, which serves as a reminder that you took it. It’s a good way to help prevent taking the medication twice.

     After you have a few episodes, you may notice a pattern of events leading to hallucinations.  The pattern can serve as your warning sign that hallucinations may be coming. If you can recognize what causes them, sometimes you can prevent them from occurring.  Other times, you can just be prepared for them when they happen.  Some common warning signs include, but are not limited to, the following:

  • Changes in sleep routines
  • Wanting to be alone, isolating yourself away from others
  • Feeling annoyed more easily.
  • Wondering if it’s time to stop taking your meds

     If you keep a diary of your hallucinations, it can help you notice the patterns as they develop and make it easier for you to determine what might be a trigger for hallucinations. A diary is also a helpful tool to show to your doctor or therapist when discussing your hallucinations’ impact on your life.  

     A lower-stress lifestyle can help reduce hallucinations. Doing something relaxing or enjoyable helps to reduce your exposure to stress. Below are some stress-reduction strategies you can try if you need some ideas.

  • Spend time with people you enjoy.
  • Participate in sports or exercises you enjoy.
  • Spend time with hobbies you find relaxing.
  • Give your pets a little extra love and attention.
  • Get advice on how to tackle the most stressful areas of your life.
  • Turn off all news, talk shows, commentaries, and social media—anything with controversy.
  • Cut out (or at least reduce exposure to) toxic people, places, and habits.
  • Use caller ID to avoid talking to persons who will share negative viewpoints only.

     Some people find it helpful to focus on their breathing when trying to manage a hallucination. It’s like meditation in that you concentrate on thinking about how you breathe as you’re doing it.  You focus all your attention on your lungs and chest wall as you breathe in and hold your breath for four seconds.  Then you concentrate on a slow controlled exhale through your lips.  You repeat this over and over so that you focus only on breathing in and out. The purpose is to take your mind away from the hallucination until it’s gone. 

     Your family wants to help you when you are distressed, but they don’t always know what to do.  You know best what you need. Tell them. They want to understand and help.  If they say the wrong thing now, it’s just because they don’t understand, and they’re worried.  By telling them what you want and how you want it, you can make life better for you and them. Here are some examples of things you can say:

  • “Sometimes I forget what to do when I hallucinate because I’m so scared that I forget how to help myself. It would be helpful for you to gently remind me of the strategies I can use.”
  • “There’s not much you can do when I hallucinate. But if you stay with me and listen and validate my feelings, it helps me feel better.”
  • “Please don’t argue with my hallucinations. It doesn’t help me. What I need is someone to listen to me and acknowledge my feelings, even if the hallucinations aren’t real.”
Avoid self-isolation

     Being alone with your hallucinations can make them worse.  Try to spend time seeing friends or family.

Avoid drugs and alcohol.

      You may be on prescription medication for hallucinations or your medical condition.  If so, prescription medicines and non-prescription medication may clash and make you sick if they are not compatible with one another. Do not mix alcohol and drugs without consulting a doctor. Marijuana might calm you down at the moment, but it makes symptoms worse and increases the risk of a relapse.

Stick with your self-care habits.

     Sleep well, get outdoors to exercise and eat healthy food. Good self-care habits can help you feel healthier and stronger, so you’re better able to cope with difficult situations.

Don’t punish yourself f you have a bad day and cannot take good care of yourself. Tomorrow is a new day. Just keep doing your best.

Hallucinations associated with Memory Disorders

     Whether hallucinations stem from a mental health condition, result as a side effect of a medication, or show up as a warning of a urinary tract infection, the impact is the same for the person having them. They seem real. The individual sees, hears, feels, smells something that is not there, but it’s as real as the earth beneath their feet.  To tell them it’s not going to cause conflict because either you’re lying to them, you’re trying to play a trick on them, or you’re going to hurt them.  Any way you look at it, you become someone they can’t trust. Unless the person with the hallucination is aware that they are hallucinating and that you are trying to help them, they will not believe what you say. Why?  Because the hallucination is so real.

 

What May Be the Cause?

     When individuals with memory disorders hallucinate, the cause is often something other than the underlying medical condition. Therefore, it is important to attempt to determine why they have hallucinations. (Refer to the section under mental health hallucination about possible causes.) Elderly patients often have dementia hallucinations when they have an infection or become dehydrated. Caregivers consider hallucinations a warning sign that a more serious problem may be developing, and they should contact the doctor just in case.

Wants to play with the children in the backyard. Husband trying to explain no one is there.
Wants to play with the children in the backyard. Husband trying to explain no one is there.

How to Help Family Members Cope with Memory Loss and Hallucinations

Your Approach   

     Between the forgetfulness, confusion, and hallucinations, your family member may be living in a very scary world at times. Keep in mind as you approach that she may not recognize you. Depending on the nature of the hallucination, you may even pose a threat to her. If you become argumentative, condescending, or dismissive, she might become defensive, argumentative, and possibly combative. To avoid those situations from developing, keep in mind that the hallucination or delusion she is experiencing is real to her.

Offer Reassurance
  • Speak calmly and with a caring voice. Show support with your words first before you attempt to touch your family member (remember you may be a stranger to her).
  • Tell her who you are-“Hi, Mom, it’s Donna.”
  • Let her know you are there to help her—”Are you okay? I heard you call out, and I came to see if I could help.”
  • If she recognizes you or seems to welcome your presence, you can pat her shoulder or touch her hand reassuringly to provide comfort.
  • Acknowledge that she seems upset and try to describe how you think she feels. Ask her to validate that you are correct in your interpretation of her feelings. “It sounds like you are afraid. Did something scare you?”
Use Distractions
  • Suggest a walk somewhere.
  • Play a game.
  • Increase the lighting in the room.
  • Turn on music or encourage them to play an instrument if they know how to play one.
  • Look through old photo albums.
Respond Honestly

     If your family member asks you if what they are seeing is real, be honest but sensitive to the fact that they believe it’s real.  For example.  If they ask you if you see the man sitting on the sofa and no one is there, say, “Do you mean the green sofa? I’m sorry, but I don’t see anyone there, although I believe you see something when you look over there.”   

Make Changes in the Environment

     Sometimes the trigger for the hallucination is something in the environment that can be corrected, such as noise or flashing light.  Ask your family member to tell you about what they are experiencing.  Based on the details they provide, look for anything that might mimic that description in the environment.  If you find it, try to remove or alter it somehow and see if it makes a difference.  You might find that you can “cure” the hallucination yourself. 

  • Check for (1) sounds from radios left on stations that are not coming in clearly or that someone forgot to turn off, (2) equipment hums or noises that are confusing, (3) building or street noises that regularly occur that might also come across as a whisper or voice.
  • Change burned-out light bulbs to remove shadows and brighten up the room. Check the light fixtures’ position related to mirrors or windows to determine if reflections or distortions occur at certain times from the sun or moon bouncing off their surface.
  • Remove clutter from rooms that could appear as shapes representing scary forms such as intruders.
  • Cover or remove mirrors that may appear to be someone watching when the person passes by them.
  • If using agency attendants, ask if the same individuals can be assigned to provide consistency and familiarity.
  • Place familiar personal belongings around the room from several years ago. Long-term memory is stronger than short-term memory, and they may be able to recall memories better.

The resource for the ideas above primarily came from:

https://alz.org/help-support/caregiving/stages-behaviors/hallucinations

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