Imagine Hearing Everything at Once

Imagine sitting in a busy railway station.

Normally, your brain performs an extraordinary task without you even noticing it.

You hear:

• People talking
• Trains arriving
• Footsteps
• Announcements
• Phones ringing
• Fans running
• Traffic outside

But you don’t consciously process every sound.

Your brain automatically prioritizes what matters.

If someone calls your name, your attention shifts.

If a train announcement starts, you listen.

If someone coughs several metres away, you usually ignore it.

This ability to filter, prioritize and organize incoming information is part of how the brain allows us to function in a complicated sensory world.

But what happens when this filtering and interpretation become disrupted?

For some people experiencing psychosis, the world can begin to feel unusually intense, significant, confusing or deeply personal.

A harmless coincidence may feel meaningful.

A background sound may seem important.

A thought may feel as though it came from outside.

And a voice may be experienced as genuinely external.

This is one reason researchers have become interested in sensory gating, salience processing and predictive processing when studying psychosis. (Nature)

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A Story: “Why Does Everything Feel Like a Message?”

Meet Arjun

Arjun is 24.

Over several weeks, he begins sleeping poorly and becomes increasingly withdrawn.

One evening, he is walking home.

A car passes him.

The driver looks in his direction.

Arjun thinks:

“Why did he look at me?”

A few minutes later, he sees two people talking and laughing.

He starts wondering:

“Were they talking about me?”

Then his phone vibrates.

He receives a completely ordinary notification.

But suddenly he thinks:

“Maybe this isn’t a coincidence.”

Over the next few days, ordinary events begin to feel unusually connected.

A song playing in a shop.

A person looking at him.

A television news story.

A particular number appearing repeatedly.

Instead of experiencing these events as unrelated, Arjun begins feeling that they are connected specifically to him.

His family tells him:

“These are ordinary things.”

But to Arjun, they don’t feel ordinary anymore.

They feel significant.

This experience can resemble what clinicians call aberrant salience—when otherwise neutral events are experienced as unusually important or relevant. Abnormal salience processing is one of the mechanisms studied in psychosis, although it is only one part of a much larger and more complex picture. (Nature)

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What Is “Sensory Gating”?

Think of your brain as having a sophisticated information-management system.

It doesn’t simply receive information.

It has to decide:

What should I pay attention to?

and

What can I safely ignore?

This filtering process is often referred to as sensory gating.

Research in schizophrenia has identified sensory-gating abnormalities in a significant proportion of patients, although these findings are not a simple diagnostic test and do not explain every symptom of schizophrenia. (PubMed Central (PMC))

A simple example

Imagine you are working in a café.

Initially you notice the background music.

After a while, you stop paying attention to it.

Your brain has effectively learned:

“This sound is repetitive and not important right now.”

But imagine if every background stimulus continued demanding your attention.

The music.

The fan.

The cups.

The conversations.

The traffic.

The footsteps.

The air conditioner.

Suddenly the environment could feel overwhelming.

Research on sensory gating in schizophrenia has explored precisely this problem of reduced filtering of repetitive or irrelevant sensory information. (PubMed Central (PMC))

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But Psychosis Is More Than a “Broken Filter”

This is important.

It would be misleading to say:

“Psychosis happens because the brain’s sensory filter stops working.”

Psychosis is much more complicated.

Current research explores interactions between:

• Sensory processing
• Attention
• Dopamine signalling
• Prediction and expectation
• Salience processing
• Self-monitoring
• Memory
• Cognitive biases
• Brain-network connectivity
• Environmental and psychological factors

Modern theories increasingly examine psychosis through predictive processing—the idea that the brain continuously generates predictions about the world and compares them with incoming information. (Nature)

So the “sensory glitch” is best understood as a metaphor, not a complete biological explanation.

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Your Brain Is Constantly Predicting Reality

Your brain doesn’t passively record the world like a video camera.

It is constantly making predictions.

For example, if you see a partially hidden object, your brain can often work out what it probably is.

If you hear someone speaking in a noisy room, you use context to understand their words.

If someone you trust enters a room, you don’t need to analyse every movement to recognize them.

The brain combines:

Incoming sensory information

with

Previous expectations and knowledge

to construct our experience of the world.

Predictive-processing models suggest that psychosis may involve alterations in how these expectations and sensory evidence are weighted. Current research considers both situations in which expectations may be overweighted and situations involving unusually noisy or influential sensory signals. (Nature)

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When Ordinary Events Become Unusually Significant

Imagine seeing a red car.

Normally:

Red car = red car.

But if the brain begins assigning excessive significance to neutral information, the experience can become:

“Why is that particular red car here?”

Then:

“Is someone trying to tell me something?”

This is where the concept of aberrant salience becomes useful.

Salience means the importance or relevance we assign to something.

Normally, important things stand out.

A loud alarm deserves attention.

A loved one’s voice deserves attention.

A dangerous situation deserves attention.

But when salience processing becomes disrupted, neutral events may begin to feel unusually important. (Nature)

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From “Something Feels Strange” to a Belief

A person may initially experience something difficult to explain:

“Something feels different.”

The mind naturally tries to make sense of unusual experiences.

It asks:

“Why is this happening?”

A possible explanation emerges.

Then another event appears to support it.

The explanation becomes stronger.

Eventually, this may contribute to the development of a delusional belief.

This does not mean the person is deliberately inventing a story.

From their perspective, the experience can feel completely real.

Research into predictive processing proposes that hallucinations and delusions may partly reflect altered weighting of sensory evidence, expectations and prediction errors. (Nature)

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What About Hearing Voices?

One of the most recognized symptoms of psychosis is an auditory hallucination.

A person may hear:

• A voice speaking
• Someone calling their name
• Conversations
• Comments about them
• Threatening or insulting voices
• Sounds that seem completely external

The experience can feel as though another person is physically present.

Auditory hallucinations are particularly common in schizophrenia-spectrum disorders, although hallucinations can occur in several psychiatric, neurological and medical conditions. (PubMed Central (PMC))

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“But I Can Actually Hear It”

This is an important point.

When someone experiencing hallucinations says:

“I heard the voice.”

it is not helpful to simply respond:

“That’s not real.”

The person’s experience is real to them, even though there may be no corresponding external sound.

Research has linked hallucinations with changes in sensory and perceptual processing, including activity in auditory brain regions and altered predictive mechanisms. (Nature)

The clinician’s task is not to ridicule the experience.

It is to understand it, assess its causes and help the person regain stability.

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Hindi Story: “हर चीज़ मुझे अपने बारे में क्यों लग रही है?”

अर्जुन 24 साल का है।

कुछ समय से उसकी नींद कम हो गई है और वह लोगों से दूर रहने लगा है।

एक दिन वह सड़क पर जा रहा था।

एक कार उसके पास से गुजरती है।

Driver उसकी तरफ देखता है।

अर्जुन सोचता है:

“उसने मेरी तरफ क्यों देखा?”

कुछ मिनट बाद दो लोग आपस में बात करते हुए हंसते हैं।

अर्जुन सोचता है:

“क्या वे मेरे बारे में बात कर रहे थे?”

फिर उसके फोन पर notification आता है।

वह सोचने लगता है:

“क्या यह सिर्फ coincidence है?”

धीरे-धीरे उसे आसपास की सामान्य घटनाएं भी बहुत meaningful लगने लगती हैं।

TV पर कोई खबर।

किसी व्यक्ति का उसकी तरफ देखना।

एक particular number।

एक song।

उसे लगने लगता है कि ये सब घटनाएं आपस में जुड़ी हुई हैं और शायद विशेष रूप से उसके लिए कोई message हैं।

परिवार कहता है:

“ये सामान्य घटनाएं हैं।”

लेकिन अर्जुन के लिए वे सामान्य नहीं लगतीं।

उसे वे बहुत महत्वपूर्ण और personally connected महसूस होती हैं।

यही वह अनुभव है जिसे समझने में salience processing और psychosis के दूसरे mechanisms मदद कर सकते हैं।

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Psychosis Is Not Simply “Being Crazy”

The word “psychotic” is often used casually and negatively.

But psychosis is a clinical syndrome, not a personality flaw.

It can involve symptoms such as:

Hallucinations

Perception-like experiences without an appropriate external stimulus.

Delusions

Strongly held beliefs that are not adequately explained by available evidence and occur in a broader clinical context.

Disorganized thinking or speech

Difficulty maintaining a coherent flow of thought or communication.

Changes in behaviour

Behaviour may become markedly unusual or difficult to understand.

Psychosis can occur in schizophrenia and other psychiatric conditions, but hallucinations and delusions can also occur in mood disorders and a range of medical, neurological, substance-related and medication-related conditions. (Nature)

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Why Does Dopamine Matter?

Dopamine is one of the neurotransmitters strongly implicated in psychosis.

One influential concept is that abnormal dopamine signalling may contribute to aberrant salience—making certain experiences feel unusually important.

This may contribute to the process through which neutral events become personally meaningful.

However, psychosis cannot be reduced to:

“Too much dopamine = hallucinations.”

The biology is considerably more complex and involves interacting brain networks and multiple neurotransmitter systems. Contemporary research continues to investigate these mechanisms. (Nature)

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The Brain Is Trying to Make Sense of the Glitch

One of the most fascinating aspects of psychosis is that the brain often tries to create meaning and coherence from unusual experiences.

Imagine suddenly experiencing:

• Unexplained sounds
• Unusual sensory experiences
• Strong feelings of significance
• Sleep deprivation
• Anxiety
• Difficulty concentrating

The brain naturally asks:

“What is happening?”

It tries to build an explanation.

Sometimes that explanation can become increasingly fixed and disconnected from shared reality.

This is one reason delusions may develop alongside unusual perceptual experiences.

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Why Sleep Matters

Sleep and psychosis have an important relationship.

Severe sleep disruption can worsen:

• Attention
• Emotional regulation
• Perception
• Cognitive functioning
• Vulnerability to unusual experiences

In someone already vulnerable to psychosis, significant sleep disturbance may be an important warning sign.

Therefore, changes such as:

“I haven’t slept properly for several nights and things are starting to feel strange.”

should not simply be ignored.

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Is Every Unusual Experience Psychosis?

No.

People can occasionally:

• Mishear something
• Misinterpret someone’s expression
• Feel unusually suspicious
• Experience vivid dreams
• Have intrusive thoughts
• Feel detached or unreal
• Notice coincidences

These experiences alone do not establish psychosis.

A psychiatrist considers:

• Frequency
• Duration
• Intensity
• Level of conviction
• Distress
• Functional impairment
• Associated symptoms
• Substance use
• Medications
• Medical and neurological causes
• Overall mental state

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When Should You Seek Help?

Early assessment is particularly important when someone develops:

• Hearing voices while awake
• Strong beliefs that others are monitoring or targeting them
• Increasing suspiciousness
• Feeling that ordinary events contain special messages
• Severe social withdrawal
• Marked behavioural changes
• Confused or disorganized speech
• Major sleep disruption
• Rapid deterioration in functioning
• Self-harm or suicidal thoughts

Early psychiatric assessment can help identify the cause and guide appropriate treatment.

If there is immediate danger to the person or someone else, seek urgent emergency medical care.

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Can Psychosis Be Treated?

Yes.

Treatment depends on the underlying cause.

It may include:

Psychiatric assessment

The first step is understanding what is causing the symptoms.

Medication

Antipsychotic medication is commonly used for psychotic disorders and may help reduce hallucinations, delusions and other psychotic symptoms.

Psychological interventions

Psychological approaches can support recovery, coping, insight and functioning.

Family intervention

Education and support for family members can be extremely valuable.

Sleep and substance-use management

Sleep disruption and substances such as cannabis and stimulants can be important clinical factors and should be assessed carefully.

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A Better Way to Understand Psychosis

Instead of thinking:

“The person is imagining everything.”

a more useful question may be:

“What has changed in the way their brain is processing and interpreting information?”

This perspective doesn’t mean accepting every belief as factual.

It means approaching the person with curiosity rather than ridicule.

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The “Sensory Glitch” Analogy

Think of ordinary perception as:

SENSORY INPUT
↓
FILTERING
↓
ATTENTION
↓
INTERPRETATION
↓
MEANING
↓
EXPERIENCE OF REALITY

Psychosis may involve disruptions at multiple points in this process.

There may be altered sensory filtering, changes in attention and salience, differences in predictive processing, and difficulties distinguishing internally generated experiences from external events.

It is not one single broken switch.

It is a complex interaction between multiple systems. (Nature)

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Final Takeaway

Psychosis isn’t simply “seeing things that aren’t there.”

It can involve profound changes in the way the brain filters information, assigns significance, generates predictions and constructs a sense of reality.

For someone experiencing psychosis, an ordinary world can suddenly feel:

louder.

more connected.

more threatening.

more meaningful.

more personal.

And sometimes, almost like a parallel reality.

Understanding the neuroscience does not make the experience less serious.

Instead, it reminds us that behind the unusual behaviour is a person experiencing a genuine alteration in how their mind is processing the world.

When reality begins to feel different, the answer is not ridicule. It is assessment, understanding and appropriate treatment.

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Frequently Asked Questions

What is sensory gating?

Sensory gating refers to the brain’s ability to reduce attention or neural responses to repetitive or irrelevant sensory information. Abnormalities in sensory gating have been studied extensively in schizophrenia. (PubMed Central (PMC))

Can sensory gating problems cause psychosis?

Sensory-gating abnormalities may contribute to difficulties in filtering information, but they are not considered a complete explanation for psychosis. Psychosis involves multiple interacting biological and psychological mechanisms.

Why do people with psychosis hear voices?

Auditory hallucinations may involve alterations in sensory processing, brain activity, self-monitoring and predictive processing. There is no single mechanism that explains every person’s experience. (Nature)

What is aberrant salience?

Aberrant salience refers to situations in which normally neutral stimuli are assigned unusual importance or relevance. It is an influential concept in understanding some psychotic experiences. (Nature)

Is psychosis the same as schizophrenia?

No. Psychosis is a syndrome or group of symptoms, while schizophrenia is one psychiatric disorder in which psychosis can occur.

Can psychosis be treated?

Yes. Treatment depends on the underlying cause and may involve medication, psychological interventions, family support and management of contributing factors.

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About Dr. Rameez Shaikh

Dr. Rameez Shaikh is a Psychiatrist & Counsellor at Mind & Mood Clinic, Nagpur, providing psychiatric assessment, counselling and treatment for a range of mental-health conditions.

📞 +91-8208823738
🌐 www.hellomind.in

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Medical Disclaimer

This article is for mental-health education and does not replace a psychiatric evaluation. Psychotic symptoms can have psychiatric, neurological, medical, medication-related or substance-related causes. Anyone experiencing hallucinations, delusions, severe confusion, significant behavioural changes or safety concerns should receive appropriate professional assessment.