Hallucinations or Visions? Joanne’s 4 Diagnostic Questions

Of the many wise nuggets bestowed by Joanne Greenberg this afternoon in her Keynote Address, I will tell you first about the Four Questions she uses to distinguish visions from hallucinations.

Ms. Greenberg recalled a woman telling her that she was seeing  her dead mother and other deceased family members sitting at the edge of her bed, and feared she had gone mad. She used these Four Questions to determine the correct diagnosis, to determine if the woman was having visions or hallucinations.

If the answer to all Four Questions is YES, then the person has hallucinations.

If the answer to all Four Questions is NO, then the person has had a vision.

Ms. Greenberg asked the woman, when you see these dead people…

1. Does they look ugly? (No! the woman replied)

2. Are they angry? (No! the woman replied)

3. Does they demand something that you cannot provide? (No! the woman replied.)

4. Do they make you feel guilty? (No! the woman replied)

Ms. Greenberg explains that this woman has had a vision.

Visions illuminate; they unify and exalt.

But hallucinations do not, because they are metaphors for the unbelievable loneliness and alienation of mental illness.

These Four Questions are wonderful rules of thumb to help us understand not only the links between spirituality and madness, but the crucial difference. I think this also applies to the overlap between creativity and madness, because art should also illuminate and reach toward connections with others, rather than whittle away or foreclose relatedness.


Jessica Arenella

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