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‘What do the voices tell you?’

Vol. 8, No. 7 / July 2009

I would like to thank Dr. Nasrallah for his wonderful editorial about assessing auditory hallucinations (“The hallucination portrait of psychosis: Probing the voices within,” From the Editor, Current Psychiatry, May 2009). He has eloquently addressed many of the concerns I have had regarding how psychiatrists respond when a patient says “I am hearing voices.” In my experience many psychiatrists simply leave it at that and don’t even attempt the briefest characterization of these hallucinations, let alone the rigorous elucidation that Dr. Nasrallah suggests.

We are doing a disservice to our patients by not performing a thorough evaluation of what a patient means when he says “I am hearing voices.” How can we really understand what our patient is experiencing if we don’t attempt to grasp the specifics of something as remarkable as a hallucination?

Unfortunately, there are patients who use statements such as “I am hearing voices telling me to kill myself and others” in order to be admitted to hospitals or for secondary gain. Getting or attempting to get details about these “voices” and documenting what we are told can be an invaluable part of a patient’s records. Inconsistencies arise that can be taken into consideration during subsequent encounters.

Bennett Cohen, MD
New York, NY

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