Hallucinations. The 16-year-old teenager suspected of having stabbed his Spanish teacher, Agnès Lassale, in Saint-Jean-de-Luz, “has put forward a little voice that speaks to him (…), which encourages him to do evil and who would have suggested to him the day before to commit an assassination, ”explained Jérôme Bourrier, the Bayonne prosecutor. The first psychiatric examination, carried out during police custody, however, did not reveal “mental illness of the schizophrenia type, manic state, melancholy or mental retardation, nor acute psychiatric decompensation”, specified the magistrate. If this point is a central element of the investigation, David Masson, psychiatrist at the Psychotherapeutic Center of Nancy and departmental head of the University Center for Cognitive Remediation and Recovery of the Grand-Est, wishes to recall that “one can have hallucinations without having mental disorder”.
When we talk about hallucinations, what exactly are we talking about?
Hallucination is the perception of an object that does not exist. We perceive something that we shouldn’t as if it were real. When someone says he hears a voice, he really hears a voice that others do not hear. These hallucinations can affect all of the senses. They can be tactile, with sensations of touch, coenesthetic, with impressions of burning, electric current or sting. They can also affect taste and smell. But the most frequent hallucinations are the acoustico-verbal ones. That is to say the sounds and the voices. It is then very distinct voices, people who say something intelligible.
Is a hallucination necessarily linked to a psychiatric illness?
No way. Hallucinations are common in psychic disorders, such as schizophrenia or psychoses. About 70% of people with schizophrenia have or have had hallucinations. This means that 30% do not have one. They can also be linked to other mental disorders. In the manic phases of bipolar disorder, for example, it is not uncommon to experience grandiose ideas, even hallucinations, in the form of voices telling the person that they have superpowers.
You can also have hallucinations without having a mental disorder. More than 10% of the population has experienced an auditory hallucination at least once. These hallucinations can be due to sleep deprivation or to the intake of substances, drugs or alcohol. Alcohol withdrawal can also cause it. There are also hallucinations that appear when falling asleep or waking up because the state of consciousness is slightly modified. One has the impression of being called, for example. Migraine, temporal epilepsy and certain advanced dementias such as Alzheimer’s disease can also create them.
Are these hallucinations necessarily malevolent?
Not necessarily. In psychiatry, we often meet people with hallucinations emitting a negative judgment towards themselves. A voice that insults, that says “you suck”, “you’re not worth anything”, “you’d better disappear”. So it’s not necessarily turned towards others, with phrases like “you have to hurt such and such a person. It’s something much more personal and intimate.
People say that the voices speak to them of very personal things, of their history, of what is important to them. It is also often at this time that they consult, when they hear a person telling them horrible things because it can generate anxiety and deep discomfort. But other people have sympathetic hallucinations. Some have learned to live with it. It is part of their daily life. I have a patient who once told me: “it’s background noise and if they weren’t there anymore I would feel a great void because they keep me company. »
In the case of the murder in Saint-Jean-de-Luz, the high school student says that a voice incites him to do evil and suggested to him the day before to commit an assassination…
There is a real misconception that voices take control. It’s not true at all. It is not because a voice says “we must attack someone” that it is necessarily accompanied by a passage to the act. It’s a voice. It’s not autopilot. People who have these hallucinations often have impulse phobias. They say to themselves “if the voice says that, it’s because at some point it’s going to take over and it’s going to force me to do things that I don’t want to do”. But that is very, very, very rare. We are more often confronted with the fear of acting out, than with acting out itself. Care should therefore be taken with any generalizations.
Should we necessarily consult when we have hallucinations?
If they are coupled with other symptoms, such as sadness, anxiety, it is worth consulting. Similarly, disorganized thinking, impaired functioning, or even plummeting school results and isolation may be symptoms of psychosis. At least one clinical examination can be carried out with a doctor, such as his general practitioner. When a first psychotic episode, which is often accompanied by hallucinations, arrives, we will ask for a brain scan to check that there is not another physical problem that could explain it. Basically, hallucination is a bit like fever. It is a clue but it does not give us precise information on what is happening.
In the Saint-Jean-de-Luz case, the first psychiatric examination revealed “no mental illness such as schizophrenia, manic state, melancholy or mental retardation, nor acute psychiatric decompensation ».
Yes, and it is very disturbing for people. They think it’s not normal to hear voices. For them, it is incomprehensible because hallucinations = schizophrenia = dangerousness. Which does not help people who suffer from it. They know very well that hearing voices is frowned upon so it’s complicated for them to talk about it.