Hello again and thanks for your query,

I'm glad that my guidance has been helpful to you and will continue to try my best to help you through this medium.

In order to understand what a pseudo-hallucination is, it is first essential to understand what a hallucination is. A hallucination is a totally unreal experience - involving seeing, hearing, feeling or experiencing non-existent things. In other words, it refers to a false perception, in the absence of a sensory stimulus. Typically, a hallucination is percieved as arising from an external space and is not under the voluntary control of the patient. Also, in most cases, the person is unaware that this false perception is unreal, that is he / she completely loses touch with reality. Hallucinations are a symptom of a severe mental illness, namely a psychotic disorder.

Now, pseudo-hallucinations ("pseudo" = false) are similar to hallucinations, where a person sees, hears, feels or experiences unreal things, but the differences are that
- this false perception is not from the external space (that is, it is arises internally from the person's own mind)
- it is partly under voluntary control of the person, and
- the person does not completely lose touch with reality
- it is not indicative of severe mental illness / psychotic disorders

Common examples of pseudo-hallucinations are hearing XXXXXXX mind voices, having imaginary conversations with someone, etc.

Now, though repetitive mental images can be one of the presentations of an obsession, yet, the symptom of having imaginary conversations is unlikely to be due to OCD. It is a symptom which is associated with borderline features.

Basically, it is a form of 'psychological defense mechanism' (though not a healthy one), which your mind deploys subconsciously during times when you are having difficulty in coping up with stress. Now, generally whenever we go through stress, all of us have some sort of 'defense mechanisms' which help us deal with the conflict and cope up with the stressful situation. Often, these defense mechanisms are conscious, adaptive and healthy. However, when it becomes difficult to 'get to terms' with the conflict or if the person has difficulty in coping up with the stress, then sometimes he / she may deploy such defense machanisms which are subconscious, immature and rather, unhealthy. Having imaginary conversations with someone, without insight into the process is a form of "dissociation". In simple terms, what this means is that, when you are finding it difficult to "accept" the reality of the stressful situation / psychological conflict, you subconsciously "dissociate" or detach yourself from reality, into an unreal world where things are relatively easy to handle. The fact that these imaginary conversations have been with a doctor or a psychiatrist, indicates that your mind was desparately looking for help at a subconscious level.

Though this type of a defense mechanism may have helped you feel less stressed out temporarily, yet this is not a healthy way to deal with stress. The reason is that rather than accepting the reality of the situation, you are in a way trying to avoid or hide away from it, and though this may decrease you anxiety due to the stress, it doesn't help in a healthy resolution of the conflict or stress.

Ways to deal with this and prevent furure episodes is:
- Not to repress your XXXXXXX conflicts or external stress, but learn to accept it and then try to deal with it. So, ventillating your feelings and problems to someone close or maybe, even a psychiatrist or counsellor, will avoid 'bottling-up' of emotions and frustrations.
- To learn coping skills and stress management techniques. Like I have told you in the last communication, it doesnt matter what diagnostic "label" you are given. The basic point is that when we are 'lacking' in some areas, we should take eforts to:
- firstly, understand our weaknessess and accept them
secondly, take steps to rectify them and improve ourselves in those areas.

It's good that you have now been able to realize that there are some areas which you need to work on. Now, you should put in all your efforts to work on those areas to improve yourself and become emotionally stronger.

Wish you all the best.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist

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Hello again,

Well, regarding the talking in your mind, some people do have a habit of talking to themselves in the mind, especially when they are pondering over a particular issue or when they are trying to decide on something. This is normal, provided you don't become too pre-occupied with these thoughts and as long as you don't lose touch with reality. So, if you are, actually becoming too preoccupied with these thoughts / conversations, then it may be unheathy for you. Moreover, if you frequently keep engaging in these type of conversations to your self, there is also a risk that you may start having the pseudo-hallucinations again.

If you are finding it difficult to control these, you can try distraction techniques. For example, the moment you start realising that you are getting too pre-occupied with this, you can try snapping out of it by immediately distracting yourself - say for example, by turning on loud music or making a phone call to a friend or going out for a walk. You should also try to completely avoid idle time. Keep your schedule packed - take up a new hobby or sport, XXXXXXX people more frequently, learn a new skill, etc. Don't think it's too late for all this; throughout our lives, we are in a constant learning process, and we should aim to better ourselves at any stage in life. Though it appear difficult to change long-time habits, still with persistent effort and practice, you can succeed.

Best regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist

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