Coping with Auditory or Visual Hallucinations
A hallucination is the experience of seeing something that is not really there, or hearing something that is not really being said or occurring. Hallucinations happen when our loved ones are awake, and they can be very convincing to them—with the result that our loved ones have a false understanding of what they are seeing or hearing.
Hallucinations can be caused by diseases like Alzheimer's or other dementias that change the way the brain interprets what is seen or heard. For example, your loved one may see the face of a former friend in the folds of a curtain, or they may see insects crawling on their hand. They may hear children talking in the next room, or think they hear people speaking directly to them.
How you respond to these situations depends on how severely the hallucinations affect your loved one. In some cases, a hallucination will not bother your loved one at all, so it may be better to ignore it and not make a big deal about it.
Other hallucinations may be frightening or otherwise upsetting to your loved one. Some hallucinations may even lead your loved one to do something dangerous such as lashing out physically, or getting up in the middle of the night and leaving the house, putting themselves in danger.
Assess the situation
If your loved one is experiencing a hallucination, first determine whether or not the hallucination is a problem for you or for your loved one. That is, is the hallucination upsetting? Is the hallucination potentially leading your loved one to do something dangerous?
If the hallucination isn’t causing problems:
If your loved one’s hallucination doesn’t cause problems for you, for them, or for anyone else, then it’s best to simply ignore it until it subsides. Don’t argue with your loved one about what they see or hear. Unless the behavior becomes dangerous, you might not need to intervene at all.
If the hallucination is upsetting or dangerous:
If the hallucination is upsetting or is leading your loved one to do something dangerous, you need to immediately address the situation.
First, calm down your loved one to help get them through their fright or upset. Think about what emotion your loved one is expressing. That emotion, not necessarily the content of the hallucination, is what you want to react to. Are they afraid of what they are seeing? Then reassure them you are there and will help protect them. For example, you might want to say: “I know this is frightening for you. Don’t worry. I’m here. I’ll protect you. I’ll take care of you,” or “I know you’re worried. Would you like me to hold your hand and walk with you for a while?” A gentle patting on the arm or shoulder may turn your loved one’s attention toward you and help reduce the hallucination. Or, if your loved one is angry because of their hallucination – "people are making noise" – you might commiserate with them. In both cases, you should focus on your loved one’s emotional needs, and try to distract them by engaging them with activities and thoughts unrelated to the hallucination.
Respond to how your loved one is feeling, NOT to the details of the hallucination itself. Do not try to convince your loved one that they are wrong about what they are seeing or hearing. It’s better to divert their attention and get it focused elsewhere, and then help them feel safe, loved, and protected. That is better than trying to change their mind about what they are hearing or seeing.
Use distraction—Think FAST! Use the “Think FAST” technique to turn your loved one’s attention to a favorite food or snack, or an activity such as listening to music, drawing, looking at a photo album, or counting coins. You can suggest that your loved one come with you on a walk, or come sit next to you in another room of the house that has better lighting or where people are gathered. Frightening hallucinations often subside in well-lit areas, or where other people are present.
Respond honestly. Avoid trying to explain to your loved one that they are hallucinating. For example, if they ask “Do you see him?” you may want to answer: “I know that you see something, but I don’t see it.” In this way, you’re not denying what your loved one sees or hears or getting involved in an argument.
How to reduce hallucinations in the future
The next step is to explore how to prevent this kind of hallucination from happening again in the future. If hallucinations are a new development for your loved one, and especially if they are upsetting or potentially dangerous, you should contact your doctor and seek advice. This may require an examination.
Schedule a doctor visit
When you visit the doctor, ask:
Is there a physical reason for the hallucinations? The physician can look for physical problems, such as kidney or bladder infections, dehydration, intense pain, or other conditions that may be a contributing factor. If nothing is found, and the hallucinations are upsetting to your loved one, the physician may decide to use a medication. If that happens, watch for resolution of the hallucinations, but also be on alert for possible side effects such as oversedation, increased confusion, tremors, or tics.
Could a medication be creating the hallucinations? Your doctor can help advise you on whether a medication might be causing an adverse side effect, as there are some medications that can contribute to generating hallucinations.
Could some other physical problem be causing these hallucinations? If there are no other clear causes, you may want to have your loved one’s eyesight or hearing checked. But be prepared for the conclusion that these may in fact not be related to your loved one’s hallucinations. Still, it is a good idea to do what you can to ensure your loved one wears their glasses or hearing aids on a regular basis.
Modify the environment
If something in the environment appears to be a trigger for hallucinations, change the surroundings. If your loved one sees a face in the kitchen curtains, for example, consider removing, changing, or closing the curtains. During a hallucination, ask your loved one to point to the area where they see or hear something. A bright glare from a window may look like snow to your loved one, or dark squares on tiled floor may appear to your loved one to be dangerous holes.
Check your loved one’s surroundings for noises that might be misinterpreted, and for lighting that casts shadows, or glare, and look for reflections or distortions from the surfaces of floors, walls, and furniture. If your loved one insists that he or she sees a strange person in the mirror, cover up the mirror or remove it. It’s also possible that your loved one can’t recognize their reflection as their own. Increase the lighting in the house to reduce shadows that could look frightening to your loved one.
Hallucinations can be a challenge for you and your loved one. But by ignoring episodes that cause no harm, seeking triggers in the environment or medical reasons that might cause hallucinations, and modifying your loved one’s surroundings, you can meet this challenge.
Please talk with your own/loved one’s healthcare provider before using any of this information.
