Visual hallucinations in psychosis: What do people actually see?

Among people with psychosis, visions most often depict people who behave and appear real, making them indistinguishable from actual perception. In interviews with twelve participants, three key features emerged: the content of visions is typically people; these people act coherently, often speaking or touching the observer; and the visions possess a compelling authenticity. This combination explains why visions are so absorbing and distressing, and the framework of Content, Coherence, and Quality offers clinicians a practical way to explore these experiences.

Study at a glance

Abstract

One in three people with psychosis experience visions. However, little is known about what people see, and current treatments have limited benefits. To improve the understanding and treatment of visions, this study explored the phenomenology of visions in people with psychosis. Twelve people with psychosis participated in semi-structured interviews. Reflective thematic analysis was used. Three main themes were generated covering important aspects of phenomenology: 'Content', 'Coherence' and 'Quality'. The first theme 'Content: People see people', demonstrated that the most distressing visions were of people. The second theme 'Coherence: Visions of people who behave like people', captured how visions were coherent with real human behaviour, often by being multimodal experiences that spoke to and touched the observer. The third theme, 'Quality: They look too real' highlighted the compelling sense of authenticity of the visions, making them indistinguishable from reality. Visions represent what we expect to see in everyday life: people, who act and look real. This powerful combination provides insight into the absorbing and all-encompassing nature of visions and their impact on participant's lives. The framework of 'Content', 'Coherence' and 'Quality' provides guidance to support clinicians and researchers to better explore the phenomenology of visions in psychosis.