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16 January, 2012

Among the things to be evaluated in a mental status examination where hallucinations are detected are the age of onset, frequency, conditions of occurrence, and the intellectual, affective and behavioral responses to them.  One of the things that set survivors apart from the truly psychotic is their responses to hallucinations.  The affective responses are congruent with the content, of course.  The shadowy figure which appears at the foot of the bed or in the doorway to the bedroom is, to say the least frightening.

Behavior is congruent as well, as in survivors cautiously searching their entire homes in response to the sixth-sense hallucination of a threatening presence in the house. Most significant is the intellectual response of the survivor.  While people with schizophrenia accept their hallucinations, incorporate the content thereof into delusions, and consider the hallucinations to be real experiences not to be questioned as to their origins, survivors often take their hallucinations to mean they are crazy — or are going crazy.  I’ve lost the link at the moment, but one inspired researcher analyzed on-line chat and support groups for single mothers (as a sort of control group), persons with schizophrenia, and for sexual abuse survivors.  In looking for self-references to being ‘crazy’ (he included such terms as nuts, bonkers, etc.), he found that survivors were far more likely to refer to themselves as crazy than the control group of single mothers, and even more than the schizophrenic posters.

That is one of the reasons survivors seldom reveal spontaneously the hallucinations described in this blog and why I’ve taken pains to make an issue of those hallucinations.  Simple, straightforward mental status examination questions as to whether a person has experienced each symptom will suffice to make the reader a believer.  Asked about the symptoms, survivors, will often make a comment about going crazy or otherwise questioning their sanity.

Rationalizations are usually culturally based.  Latinos steeped in traditional culture might suspect having been cursed by el ojo (the evil eye), fundamentalist Christians might suspect an onslaught by Satan, etc.  Almost invariably, survivors will make no connection between the symptoms and childhood experiences.  With a bit of guidance, survivors can come to make an initial connection between those childhood experiences and the symbolic nature of their symptoms.  Once that is done, they can be reassured that the symptoms they have make absolute sense and have nothing to do with being crazy.  That alone offers tremendous relief, not to mention offering the hope that comes from that which was thought to be crazy making sense, and therefor subject to mastery.

  1. Elizabeth permalink

    Could you give me the titles of the other two papers that you wrote and where I could find them? I would like to read those as well.

    • Elizabeth,

      Getting the complete text may take some work. Here are a couple of links with the titles and abstracts:

      Horror, rage, and defenses in the symptoms of female sexual abuse survivors

      Detecting a History of Incest: A Predictive Syndrome

      You may have to sign up for a service that gives access to the papers. The former, above, was the last of three papers, published in 1989, and is heavy on theory. The latter of the two is the first paper, published on the subject in 1985. I hope these leads help you get to them. Both are copyrighted by Family Service America. They were originally published in the journal Social Casework, now called The Family in Society.

      I’m sorry I can’t give you the actual text. When a clinician has a paper published they fall under copyright law and the authors don’t get to keep the copyrights, just the journals. You will likely find that the latter paper, the first of the three, resonates the most with you.

      • Elizabeth permalink

        Thank you so much!

      • You are more than welcome, Elizabeth. I had an aunt by the same name who everyone called Buffy. She was indeed the vampire slayer. I invite you to read the post One Man’s Journey.

        Once again, you’ll find the Detecting a History to be of the most help as it goes into multiple signs and symptoms to which you, no doubt, will relate.

  2. Elizabeth permalink

    I just read your article “Disturbances of Perception In Adult Female Incest Survivors”, and I couldn’t believe it– it was the validation of something that I’ve experienced my whole life, and an answer to what I had been searching desperately for over many years. Thank you so much for writing that article. You have no idea what it means to me.

    • I’m so glad you located the article and found it helpful, Elizabeth. I’m impressed that you were able to read it through as just reading about the symptoms not infrequently triggers flashbacks. More than one person has simply thrown it down. Godspeed in your search for healing.

  3. Annie permalink

    These hallucinations, are they a result of sexual abuse only or can physical, non-sexual, abuse cause them, too?

    • You would have to be more specific for me to go out on a limb. Are you referring to all of the posts about hallucinations (your question arose under the post I Must Be Going Crazy)? I noted a huge spike in visitors to this blog reading that poem but less than 10% actually reading the posts about hallucinations.

      “These hallucinations” isn’t narrow enough, so I’ll leave a general answer: I suppose it’s possible for some survivors of purely physical abuse to have some of the specific symptoms I describe, but I never encountered that. If you have not done so, read all of the posts about the specific hallucinations of survivors. You might also want to Google the phrase “Ellenson hallucinations” to see the multitude of studies confirming the predictive power of the syndrome.

      Affect is a big clue as well. If you aren’t tweaking at least a bit, reading about the hallucinations, the answer to your question may be yes. Physical abuse, however horrid the experience and sequelae, doesn’t seem to elicit lingering (literal) horror.

      Godspeed in your recovery.

      • Annie permalink

        Firstly, thanks for replying so quickly and sorry for the multiple post. Didn’t seem to submit, and then when I posted it again this morning they suddenly were all there.
        Ok, so lets say I’m referring to the shadowy figures thing, seeing them from the corner of my eyes, or feeling like something is moving around (in the house or outside the window/door). I also get parts of this bedroom intruder thing, again shadowy figure in door, side of bed etc. But for me it’s a lot more on the sensual side than on the visual. You know, I’m feeling some frightening presence more than seeing it. There’s the occasional glimpse, but it’s split seconds and could be shrugged off as all sorts of optical illusion. The sensations on the other hand are really strong. It includes smell sometimes, but that might be related to different traumatic events (I was in a burning car once and sometimes wake up smelling smoke even though there is non, for example. Or if I’m really, really low, I can smell my granddad. Stuff like that.) I also get the feeling of someone touching my lower back when I’m in bed. But I got a lot more of this one when I was a kid. I was convinced my room was haunted.
        What I get an awful lot (when I’m alone in the house or when my boyfriend is upstairs in his study) is the feeling of someone being there watching me. For instance, when it’s dark and I go to my downstairs bathroom (which is just off the entrance hall), I am almost convinced if I were to turn on the light outside, I’d see someone standing there looking at me through the glass door. I’m pretty sure there’s not actually someone standing there. But the sensation is incredibly strong. Whenever this occurs (which is fairly frequent) I get the same feeling as soon as I enter the bathroom. I am convinced, if I were to look at the mirror, I’d see a figure behind me. Same goes for the mirror in the bathroom upstairs (but only if I’m alone in the house).
        Now, I’m very aware of physical abuse, but I don’t recall anything sexual (at least not in my childhood). But there is a good chunk of my very early childhood that I can’t account for (living with birth mom for a year, than orphanage until being adopted). All sorts of crazy shit could have happened then. So I don’t know how to figure this one out.

      • It sounds like true, visual hallucinations are out as a symptom since those experiences, for you, are not solidly visual experiences. What you describe regarding an evil presence does come close to what I call sixth sense hallucinations, but could be intrusive obsession phenomena. In so-called neurotic OCD, one is plagued by intrusive thoughts that elicit anxiety. You haven’t mentioned, and so I assume you do not have, the tell-tale nightmares. The single, suspicious symptoms are the olfactory hallucinations and touch on the back but the combined experiences fall short of the typical syndrome. If you have sisters, there is one other possibility. Girls who grow up in a home where sexual abuse is going on but are not themselves victims of same can have limited symptoms of sexual abuse themselves.

        I’m tempted to say that the symptoms are related solely to the physical abuse as you lack a sufficient constellation of symptoms to suggest sexual abuse. To me, that’s still PTSD, particularly if the physical attacks were somewhat unpredictable. If you have the resources, or can locate one, I’d suggest therapy or counseling.

        Godspeed in your quest for healing.

      • Annie permalink

        Thank you, that’s somewhat a relief. I do have nightmares, but that’s a rather recent phenomenon. I believe it’s linked to a traumatic event occurring later in my life, which just weeks ago came back into my conscious memory.

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