Leaning against the kitchen counter, I wait for the microwave to finish while overwhelmed with a million deadlines. It’s almost the end of the semester, but because of the pandemic, I’m back at home, trying to juggle classes and learning how to use Zoom. Then, I feel my dad’s hand around my shoulder, squeezing it twice. He knows I’m stressed, but how is this possible? My dad passed away two months ago from colon cancer.
Hallucinations exist in non-clinical populations and can be a side effect of grief or bereavement. Hallucinations come in many forms: visual, auditory, tactile, or a feeling of presence. Many people associate hallucinations with schizophrenia and psychosis; however, this is not always the case. It is estimated that between 5 and 28% of the general population has had an auditory hallucination in their lifetime. Hallucinations are linked to imbalances in neurotransmitters, such as dopamine and serotonin. Excessive dopamine and serotonin have been linked to reliance on prior expectations versus sensory input, which can cause a hallucination. Trauma, like losing a loved one, can also bring on hallucinations. For example, my prior expectations tell me that around 6:30am, my dad walks down the hallway to the kitchen and turns on the coffee pot. In the absence of any actual cues, I can still hear his footsteps in the early hours of the morning, and the hum of the percolator which was given away months ago.
Around 30-50% of bereaved spouses have hallucinations. Most people find these sensory experiences reassuring, but sometimes, these hallucinations can be distressing in people with underlying conditions or people who feel that they have unfinished business with the deceased. Grief is a complicated emotion. It often comes with unexpected feelings, especially when you’ve experienced an impactful loss for the first time. Everyone experiences grief differently; there is no “normal” grieving process. Reactions to grief include depression, anxiety, guilt, hostility, social withdrawal, rumination, memory difficulties, sleep disturbances, and exhaustion. Coupled with hallucinations of a deceased loved one, these experiences can be distressing.
Human brains are composed of cells called neurons that receive information from the environment and communicate that information to processing centers. After the sensory input is summarized, like hearing a loud noise and seeing a bright flash, your brain integrates everything and tells you what’s going on. But the brain doesn’t just use sensory input to create your perceptions. It also uses predictions, based on what you’ve previously learned and experienced. These predictions are heavily influenced by your culture: religious views, concepts of the mind, and sense of spirituality. We see the world as we are, not as it is. Even reality is a controlled hallucination because what we experience with our senses is modified by our expectations and beliefs. It is hypothesized that people with hallucinations have a decreased importance of the external stimuli, which puts more weight on the internal predictions. This has been supported by neuroimaging data which shows decreased connections to control centers of the brain and altered connections between auditory centers and language processing centers in people who hear voices. Similarly, visual hallucinations are correlated with dysfunctional wiring in the brain, but much less research has been done on the topic.
The serotonin receptor, 5-HT2A, is on the receiving end of neurons, which transfers the electrical signal from neurons into a chemical signal that has downstream effects. It is related to learning and memory, as well as anxiety and depression; activating this receptor presumably leads to increased adaptability of neuronal circuitry in the brain, which can alleviate depression. The 5-HT2A receptor is not only activated by serotonin existing in the brain, but also by psychedelic drugs, like psilocybin. Activating this receptor causes delays in spatial memory in mice, which might reflect visual hallucinations.
Now that it’s been over a year since my dad’s death, the symptoms of my grief are less prevalent. I do experience hallucinations from time to time, which seem to be more prevalent upon waking up. Opening up about my experiences and being honest with medical professionals has definitely improved my mental health while grieving during the pandemic. Even though social connections are difficult to maintain, the increased use of Zoom, Discord, and messaging has helped me stay in contact with friends and family I can’t see in person.
Grief is especially prevalent during a pandemic, where isolation and stress exacerbate the problem. If you are struggling to cope with grief or stress during the pandemic, you are not alone! Please reach out to the numbers and links below.
SAMHSA’s National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service) or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications and other information.