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Living With Voices
August 14, 2012 5:19 AM   Subscribe

A new way to deal with disturbing voices offers hope for those with other forms of psychosis.
Hans used to be overwhelmed by the voices. He heard them for hours, yelling at him, cursing him, telling him he should be dragged off into the forest and tortured and left to die. The most difficult things to grasp about the voices people with psychotic illness hear are how loud and insistent they are, and how hard it is to function in a world where no one else can hear them. It’s not like wearing an iPod. It’s like being surrounded by a gang of bullies. You feel horrible, crazy, because the voices are real to no one else, yet also strangely special, and they wrap you like a cocoon. Hans found it impossible to concentrate on everyday things. He sat in his room and hid. But then the voices went away for good.

posted by Joe in Australia (79 comments total) 50 users marked this as a favorite

 
Wow, I love that, before the voices went away, they were providing positive 'self-talk' like "Buck up, you can do it!"
posted by leotrotsky at 5:36 AM on August 14, 2012 [2 favorites]


Awesome.
posted by anotherpanacea at 5:40 AM on August 14, 2012


I saw a talk a while ago by Iris Sommer, another Dutch researcher into hearing voices. The most surprising part of it to me was how prevalent hearing voices is in otherwise normal people. Also, Language Log had a post the other day about Hearing Voices groups.
posted by knile at 5:45 AM on August 14, 2012 [3 favorites]


Sorry, I'd only read the first half. Looking at the connection to dissociation and false recovered memories, I start to worry again. It's great to starts with direct empiricism, "you're hearing something, just not rats" but the difference between finding meaning in the hallucinations and finding fact in the delusions is pretty important. If you're hearing something that's not there, what makes you think you've recovered a memory of something that was there?
posted by anotherpanacea at 5:48 AM on August 14, 2012


Yeah, I had no idea any non-schizophrenics heard voices. %15? Surely they must be feeling like they are crazy, though. It seems odd to me that you could be experiencing something so classically and stereoptically indicative of mental illness and just operating normally throughout the day. Maybe they aren't.
posted by DU at 5:49 AM on August 14, 2012


But, I mean we all hear voices or at least a voice, right? That's what thought is, or a big portion of conscious thought. Seems to me that the only difference is that we recognize the voice in our mind as our own.
posted by empath at 5:55 AM on August 14, 2012 [6 favorites]


This is one of those makes-sense-in-hindsight things to me. It seems like cognitive-behavioral therapy for your delusional voices, which are still irrational thoughts from your own brain. I think David Burns, Feeling Good author, would approve.

(I also think it makes sense to use this method in combination with medication, especially in the case of schizophrenia.)
posted by shortyJBot at 5:56 AM on August 14, 2012 [4 favorites]


empath: But, I mean we all hear voices or at least a voice, right? That's what thought is, or a big portion of conscious thought.

If you hear your thought as a literally audible voice, then no, that's not normal at all. You understand that these people literally (as far as their perception is concerned) hear the voices, right?
posted by gilrain at 6:03 AM on August 14, 2012 [7 favorites]


"You hear a sound, and you interpret the sound as rats." I have an anxiety problem, and while I don't hear sounds except rarely, more often it does cause me to feel creepy-crawlies that aren't there. My nervous system, when keyed up, responds to tiny inputs and makes them feel huge. When I'm having a bad time of it, my brain immediately jumps to ZOMG BUGS.

I do think they make a mistake in assuming it's all about earlier trauma. I think the biological component might be similar to my anxiety: It makes me over-react to things that are real but not that bad. Minor annoyances become total freakouts. That could potentially explain a lot of this without having to resort to "you were abused as a child". Essentially, then, you'd see what seems to be happening here: Progress with a little medication (to settle down the internal thing that reacts disproportionately) and also engagement with the voices in a similar fashion to how one might try to use positive self-talk to counteract worries that ten to be excessive.

I think there's another key in that schizophrenics are often relatively disconnected from their families/communities even before the symptoms start, but they get effectively ostracized once they're dealing with voices regularly. That usually means there's a shortage of connection with the normal world to provide that reminder that everything you hear isn't really what it sounds like. Much like someone with depression, lacking engagement, might lack the outside voice that needs to say, "I know you feel hopeless, but look at these things, aren't they good things?" Meds are often necessary and helpful, but so is that element of outside feedback.
posted by gracedissolved at 6:07 AM on August 14, 2012 [3 favorites]


Empath wrote: But, I mean we all hear voices or at least a voice, right?

Temple Grandin doesn't. I don't either, except when I'm composing something to write down or mentally imagining a conversation. My wife says she hears a voice when she thinks - is that what happens with you? It seems weird to me.
posted by Joe in Australia at 6:12 AM on August 14, 2012 [2 favorites]


Still reading through, but this was such a spot-on description of the obvious go-to reference that it made me smile:
The book, The Origin of Consciousness in the Breakdown of the Bicameral Mind, is one of those gangly, overwritten academic books that is undoubtedly wrong, but wrong in such an interesting way that readers, on finishing it, find that they think about the world quite differently.
posted by Drastic at 6:14 AM on August 14, 2012 [14 favorites]


I think when most people say they hear a voice when they think, they probably mean that they think in fully formed words and sentences, right? For instance, Joe, you mention writing... when I'm writing dialogue, I'm imagining hearing a conversation, but am not literally hearing it.

Am I imagining a confusion which doesn't exist, here, or do people really not understand that the people who "hear voices" actually, literally hear the voices. It's not the same as thinking in a voice or imagining a voice.
posted by gilrain at 6:17 AM on August 14, 2012 [2 favorites]


I emphasize this so much because if the confusion exists, it would effect the empathy one feels for the condition. You can imagine that actually hearing voices, very loud voices, even -- perceptually earsplitting -- would be far, far more disruptive and disturbing than simply imagining them or thinking in words, even if the thoughts are persistent.
posted by gilrain at 6:19 AM on August 14, 2012 [1 favorite]


What a beautiful, moving story.

Growing up in the Pentacostal/Charismatic world, there was an intense belief in Hearing God's Audible Voice Telling You What To Do. I knew lots of people who insisted that "hearing God's voice" wasn't a metaphor, but a literal statement and evidence of faith.

Since leaving the church I've often wondered how many of us were just stretching the figure of speech to fit in and bolster our own brittle beliefs (hello!), and how many were demonstrating classic symptoms of mental illness, but had found a different framework to understand and live with those symptoms. Those individuals weren't hearing horrifying, life-destroying voices: they heard moving, beautiful things, and shared them with others -- but they also understood the voices (or The Voice, rather) in a way that gave them permission to both dialog, and dismiss destructive or "vile" messages as being deceptions of Satan.

Food for thought.
posted by verb at 6:26 AM on August 14, 2012 [5 favorites]


Gilrain: I understand (at least intellectually) that people who "hear voices" feel as though they are literally hearing the voices of people speaking to them. I appreciate that this is not the same sort of thing as the "voice" people tell me that they hear when they think. But I don't think in words except when I'm thinking about words.
posted by Joe in Australia at 6:26 AM on August 14, 2012 [1 favorite]


There is so, so much wrong with this article that I don't even know where to begin. A few things, based on my limited understanding:

1. Heavy drug use can cause psychosis. Sometimes this is just the onset of schizophrenia, sometimes it is just psychosis. In the short term this is easy to misdiagnose.
2. Clozaril is an atypical antipsychotic. If it doesn't work, you try another one. Nothing works for everyone.
3. Schizophrenia is a very wide and deep illness. Furthermore, while sometimes it is classic and easy to diagnose, at other times it can be very difficult to tell what is schizophrenia and what is some other type of major illness.
4. Everyone uses a combination of therapy and pharmaceuticals to treat schizophrenia. This is not new or interesting information.
5. The focus on searching for childhood trauma is, to me, a clear and absolute sign that this is a bullshit method of treatment. What ye seek, so shall ye find. Any method that starts with the assumption of trauma and works backward from there is deeply flawed and, frankly, just plain bad science. Bad medical care too, for that matter.
6. From the article: If it is true that distressing auditory hallucinations are the dissociative consequences of trauma, the implications are enormous. Unfortunately for the author, it is not true, there is strong and widespread evidence to indicate that it is not true, and the implications are not enormous. This is not to say that childhood trauma does not exist or does not contribute to mental illness - it does both. There exists a wide-ranging set of personality disorders very strongly linked to childhood trauma, and treatment of these disorders is WAY different than treatment of schizophrenia.

My time is up. To conclude - this is a flawed piece with dangerous misconceptions about psychiatry, and you shouldn't take anything it says at face value.
posted by NathanBoy at 6:31 AM on August 14, 2012 [32 favorites]


I've often puzzled this one.
Sometimes I hear voices.
Sometimes, they are *almost* audible, but rarely as much as whispers.
I'm pretty sure I am sane.
But this thread has given me a lot to think about.
posted by Mezentian at 6:32 AM on August 14, 2012 [1 favorite]


Disclaimer: I'm a pretty credulous Jaynesian.

I clicked the link, wondering if this new therapy fit into a Jaynesian mold. Lo and behold, it outright mentions bicameralism. My prediction of the seriousness with which The Origin of Consciousness... will be taken in the future is bearing out.
posted by cthuljew at 6:36 AM on August 14, 2012 [2 favorites]


Joe, you are saying that you literally do not have an internal monologue?
posted by empath at 6:39 AM on August 14, 2012


On whether "voices" are auditory or internal:
The organization insists that hearing voices is a normal human experience, which indeed it is, although what is common (and thus “normal”) is hearing a voice as you slip into sleep, perhaps calling your name, perhaps your mother’s voice. About half of a standard subject pool (read: university undergraduates) will say that they have had some experience like that at least once. Many more will say so if the experimenter gives them examples.
I've certainly heard that voice before (it often sounds like a loud, sharp whisper of a single word, sometimes my name). It's definitely different from my internal monologue or daydreamed dialogues, and as far as I know it's almost as common a bedtime experience as the hypnic jerk.
posted by postcommunism at 6:41 AM on August 14, 2012 [9 favorites]


One of the difficulties of diagnosis is highlighted in Where Are the Clinical Tests for Psychiatric Disorders? (via) In Scientific American, a description of hallucinations, specifically Charles Bonnet syndrome. Slate covers how forensic psychologists determine if somene is faking or not. As an example, a first-person account(PDF) of schizophrenia. (via)
I sit at home alone, and I physically hurt from just loneliness. I curl up in the fetal position and hold my head. I stare at the wall and barely breathe. That’s my loneliness. My loneliness is dead silence. It is pitch black. It stretches
on and on endlessly. I am not trying to be poetic. I am not trying to dream up a new and dramatic way to express loneliness.
Darryl Cunningham's experience, in comic form (previously).
posted by the man of twists and turns at 6:42 AM on August 14, 2012 [1 favorite]


Joe, you are saying that you literally do not have an internal monologue?

Yes, and I don't really comprehend what it would be like to have one.
posted by Joe in Australia at 6:53 AM on August 14, 2012


I think this article overstates the success of the method. I've worked with a local Hearing Voices Network group in the past, and the sort of recovery that 'Hans' had is very far from the norm. I think the approach is immensely helpful in a lot of ways; it allows people to acknowlege the voices and deal with them acitvely rather than simply pharmacologically suppressing them, and also the groups build community for people who are often ostracised by society at large. But within that there are people who are commited to the Hearing Voices ethos who are also using psychiatric medication to control their symptoms, and/or who also are spending time as psychiatric inpatients. It's not a panacea.

The group I had contact with also did not have the focus on sexual abuse that this article does. They made the link between voice-hearing and trauma, but not looking for specific childhood trauma. Having only been in contact with one book, and not read any Romme, I don't know if this focus on sexual abuse is from Hearing Voices or the author of the article. There are certainly gene-environment interactions in the development of schizophrenia (for example, if you are brought up in poverty you are more likely to go on to develop schizophrenia), and I don't think that making an association with trauma is as unreasonable as has been suggested upthread.

And to respond to a specifc point made by NathanBoy: Clozaril (Clozapine) is not just any other atypical antipsychotic. It's the end-of-the-line antipsychotic. Its side effects are such that it's only ever used after a number of antipsychotics have been tried and failed, and requires significant monitoring. It's very effective, which is why it's still in use. But if you're on clozapine you almost certainly have tried a number of other medications without success and just switching to another may not be an option.
posted by Coobeastie at 6:54 AM on August 14, 2012 [13 favorites]


You understand that these people literally (as far as their perception is concerned) hear the voices, right?

I dunno. Perception is mushy enough, both in terms of what we experience and especially in our attempts to commit those experiences to language, that I'm willing to believe a difference in degree rather than a difference in kind. There's an example in the article about someone who "hears voices:" "She used 'voice' to refer to the caustically self-critical commentary often running through her head, not to anything she heard with her ears." I don't know why that has to be viewed as categorically different than what others might call an "auditory hallucination." All we've got is what people are telling us about what they experience, and I'm inclined to put the two in the same category.

Because they aren't "literally" hearing the voices. There is no sound wave that causes their ear drums to vibrate which the mechanisms in the ear translate into nervous impulses that the brain interprets as sound. It's all in their head. I can recall music and speech with such clarity that I can totally believe someone who says that they're "hearing things." I can talk that way too. The difference is that I can tell the difference between what I'm imaging and what I'm not.

I have "conversations" in my head all the time. It's a useful way of processing things. The "voices" are all me, and I'm consciously directing them, but yeah. I also know what that self-critical little "voice" can be like. I know that's me too, but sometimes it says things that I don't want to say. Or, rather, that know aren't true but that fear are true. So I talk back to it. Telling myself the truth. Because it's me I'm talking to, only sometimes my gut's got shit for brains.

I think this is pretty normal. Certainly it tracks pretty closely with descriptions of others' experiences. "Why art thou cast down, O my soul? and why art thou disquieted in me?" "You're gonna make me give myself a good talking to."
Am I a coward?
Who calls me villain? breaks my pate across?
Plucks off my beard, and blows it in my face?
Tweaks me by the nose? gives me the lie i' the throat,
As deep as to the lungs? who does me this?
Ha!'swounds, I should take it: for it cannot be
But I am pigeon-liver'd and lack gall
To make oppression bitter, or ere this
I should have fatted all the region kites
With this slave's offal
So yeah, I think this is entirely plausible. The association with childhood trauma is distressing and disappointing, but I think it's an accident, not an inherent feature of the concept. Non-medical ways of dealing with so-called "auditory hallucinations" are to be encouraged, to my lights. Especially since our concept for what schizophrenia actually is is so damned muddy. There are still no physical diagnostics which can definitively diagnose one with a particular mental illness. It's all patient interviews and a classification system. I certainly don't see this as any kind of panacea, but I think it's definitely promising.
posted by valkyryn at 6:56 AM on August 14, 2012 [2 favorites]


> The most surprising part of it to me was how prevalent hearing voices is in otherwise normal
> people. Also, Language Log had a post the other day about Hearing Voices groups.

Anything we can sense or feel when appropriate physical stimuli are present we can also sense or feel (much less intensely, usually) when the stimuli aren't there. This is perfectly normal, not pathological. Both my parents have been dead for years but still I occasionally hear one of them calling out to me from a distance, in the tone that used to be followed by "Where are you, we're leaving the store" or "Come on, supper's ready." It's never really distinct, it's something I hear out of the corner of the mind's ear, so to speak, but it makes me jump just as if I were about to be told to do something. Then after I had kids of my own I started hearing them calling me in the tone that might be followed by "Help, I need you" or "I'm lost, I can't find you". Always in their small-child voices, though all of them are quite grown up now. These imaginary calls also make me jump with the same must-do-something-now impulse, and the jump impulse comes way before any conscious awareness that no it can't be them, mom and dad are gone and the kids haven't been 5 for a good long time. It's the kind of thing that bypasses the rational mind completely, like jerking your hand back when you touch something hot even before it hurts.

There's bound to be a range of variation among individuals on the hearing-voices continuum. I expect some people have never had the experience at all, and others hear disembodied voices more often and more vividly than I do. But it's a skewed distribution. There's nothing impossible about hearing many voices speaking at once, distinctly and intelligibly. Doesn't seem to be much of a limit in that direction. But there is a hard limit in the other direction--can't hear fewer than zero voices.

If it happens to you so much it becomes troubling, that would be the time for medication or shrinkage. Otherwise hearing voices is just something than people can do and consequently do do, like catching glimpses of a polevik or leprechaun in a dark field.
posted by jfuller at 6:59 AM on August 14, 2012 [3 favorites]


I forwarded this to a social worker friend of mine; he works primarily with the homeless, not of few of whom are schizophrenic. Interested to hear his take.
posted by smirkette at 6:59 AM on August 14, 2012


Richard Feynman was classified 4F for draft/reenlistment (can't remember, been a while since I read his book) for Vietnam by telling one of the officers that he regularly talked to his dead wife and occasionally heard back from her.

This sentence troubled me: "The Faustian bargain made by the hearing voices approach is that the risk of recalling false trauma is less dangerous than ignoring the potential healing power of its method." The author acknowledges the Satanic Ritual Panic that swept the country in 80's, ignoring the smaller panics in the UK.

The author seems to come to the conclusion, although I cannot find the argument for this, that if a psychiatric condition can be alleviated by talk therapy, the condition cannot be biological in origin. This is like saying that if a chronic painful condition can be alleviated by exercise then the pain must be psychosomatic and not due to a dysfunction in the body.

The cause could be trauma or idiopathic. Either way, the treatment needs to be tailored to the individual, and the blanket dismissal of biological treatment strikes me as worrysome.
posted by Hactar at 7:03 AM on August 14, 2012 [2 favorites]


The article mentions the interesting thing where you hear voices as you go to sleep. Anyone else get this? It doesn't happen to me every night, but when I've had a particularly stressful day I'll often hear a garble of nonsense as I settle down, often in a voice of a person I've been around all day. If I've had a taxing workday, for example, it might be my boss's voice, sometimes on its own and sometimes against a background of other muttering voices. What's said is usually a mishmash of sentence fragments and other words arranged so that the rhythm mimics actual speech but the content is negligible. I have other MH issues but I've always assumed this isn't an issue, and the article confirms it's very common.
posted by Acheman at 7:04 AM on August 14, 2012 [1 favorite]


valkyryn: Because they aren't "literally" hearing the voices. There is no sound wave that causes their ear drums to vibrate which the mechanisms in the ear translate into nervous impulses that the brain interprets as sound. It's all in their head.

No, their eardrums aren't being vibrated -- but their brain is sending them information which is the same as if they were. In practice, to those experiencing true auditory hallucinations, the sensation is functionally identical to hearing real sounds.

Also, no it's not just in their heads, at least not in the way that phrase is usually meant. It's physically different from just imagining a voice. I have a lot of other cites, but this addresses it directly.
posted by gilrain at 7:06 AM on August 14, 2012 [3 favorites]


their brain is sending them information which is the same as if they were

Who says mine isn't?

I have a lot of other cites, but this addresses it directly.

See, that doesn't actually do it for me. It doesn't prove what you want it to prove. All it does is show that certain parts of the brain light up when people experience an auditory hallucination. But we have no idea what the f*ck that means. We don't know why it's lighting up, or even what the fact that it does light up imports. And if you look at the article, the authors basically admit that. The interaction between the mind and the brain is very poorly understood. We don't even know if that activity is the cause or effect of the phenomenon we're talking about!

Just generally speaking, the idea that we can tell all that much about stuff from fMRI scans is pretty shaky. I just don't think we're in a position to make as dramatic a claim as you seem to want to make.
posted by valkyryn at 7:18 AM on August 14, 2012


I'm not sure what you're arguing, valkyryn.
posted by shakespeherian at 7:20 AM on August 14, 2012


I have, on very rare occasions, heard voices. Or specifically, my dad's voice, mostly yelling at me when I was procrastinating or otherwise being lazy. This didn't provoke anything negative from me; my dad was always able to get me motivated, and his yelling was never really angry. And I missed hearing his voice anyway (I started hearing him - again, very rarely - after he died), so it was kind of welcome for him to "come back" and kick me into gear when I needed it.

It happened maybe once a year, or occasionally once every couple weeks for a few-month span. After I went to a new school, and then college, and started making friends again (I isolated myself pretty thoroughly from the age of 12-16), it stopped entirely.

I never thought I was going crazy. I figured it was just my brain's way of giving me the motivation I needed to get done whatever I needed to get done.

Long story short: Yeah, I can see how a good number of people might periodically hear voices and not think much of it - or if they do think anything of it, not report it and in the long run not suffer from it.
posted by Urban Winter at 7:24 AM on August 14, 2012 [1 favorite]


I'm not sure what you're arguing, valkyryn.

Here? That we aren't really able to interpret brain scans all that well beyond "Yep, there's activity there." We can kind of tell what the brain is, but we're only just starting to figure out what it does and how. Certainly not why.
posted by valkyryn at 7:34 AM on August 14, 2012


Growing up I was quite surprised to learn that not everybody heard voices. It was such a prevalent aspect of my childhood that I figured it was one of those things that everybody must deal with but nobody likes to talk about.

Valkryn, hearing is definitely not simply sound hitting your eardrums. This sort of reductionist passive model of perception has been discredited. That said, when I hear voices I can usually determine that they're not ”real” and if I can't a moments reflection will always settle it.

I've also always trusted the voices I hear, they've really virtually always proved to be very helpful and relevant. (I can remember many a test where, after a few minutes of panic, somebody would just start calmly explaining everything.) I find it quite plausible that such voices are shaped by life experience though I'd be wary of trying to pin everything on a single trauma.
posted by nixerman at 7:36 AM on August 14, 2012 [4 favorites]


There are a number of audio illusions that will allow you to hear voices that aren't there. If you take a 10 second snippet of random speech and play it as a loop, and listen attentively to it for over twenty minutes, it will blossom out into various sentences and phrases that are not in the content. The only way you can know that this is in your mind, is to assure yourself that the tape loop has not been tampered with.

There is too much emphasis in this discussion on whether the voices are inside or outside of one's head. The nature of the voice and the content it conveys are more important. If I heard a voice inside my head saying, "You are a lazy boy, you didn't clean the dishes," and I hadn't, I could accept that as some kind of illusory self-chastisement.

But if I heard a forceful voice, speaking in a consistent foreign accent that I myself could not imitate, using unfamiliar vocabulary, laced with credible technical jargon, selling me true facts that I myself was unaware of, predicting and parodying things that had not yet been said on the radio, then it wouldn't matter much if that voice was inside or outside of my head.

Once the voice meets a certain level of credible autonomy, it would be more logical and likely, more sane, to think that it was being beamed into my head than to accept that such a complete and autonomous entity could exist inside my head without my control.
posted by StickyCarpet at 7:38 AM on August 14, 2012 [6 favorites]


> my dad was always able to get me motivated, and his yelling was never really angry. And I missed hearing
> his voice anyway (I started hearing him - again, very rarely - after he died), so it was kind of welcome for him
> to "come back" and kick me into gear when I needed it.

While Herschel Walker (Heisman Trophy 1982) was at UGa, his sister was also there as a scholarship track athlete. I once saw an interview with her in which she talked about all the ways their mother (who was no longer alive) had contributed to their drive and success. She said she had once asked Herschel "Bo, do you ever hear mamma talking to you" and he replied "All the time. All the time."
posted by jfuller at 7:39 AM on August 14, 2012 [1 favorite]


valkyryn, you're contending that people who hear voices -- that is, have auditory hallucinations -- have them in the same way that others can conceptualize, or imagine, conversations and sounds, but that it just bothers them more than normal?

I agree that fMRI studies aren't conclusive, but you seem to be taking the opposite extreme and dismissing the testimony of many, many people who have this condition.
posted by gilrain at 7:41 AM on August 14, 2012


This most recent Sunday morning I worked the 12am to 8am shift, by the end of which I'd been up for approximately 26 hours. Near the end of the shift, while I knew for certain that I was the only human inside the entire office building, I knocked a metal railing, and the ptannnnng sound it made was grabbed and twisted by my brain. I very distinctly heard a man's voice angrily shout "what are you doing up there!?" at me.

I just about jumped directly out of my skin - by which I mean I did in fact jump. Twirled in the air too and came down in a slight crouch, ready for fightin'.

Having regular and hostile auditory hallucinations would be awful.
posted by kavasa at 7:42 AM on August 14, 2012 [2 favorites]


No.
posted by cashman at 7:43 AM on August 14, 2012


Also, valkyryn, perhaps this study showing that there are statistically significant physical differences in the brains of people who have auditory hallucinations is more convincing to you?
posted by gilrain at 7:43 AM on August 14, 2012


No, that colloquial "hearing that voice" inside is not the same thing.
posted by cashman at 7:44 AM on August 14, 2012


My son has Schizophrenia. When he was sixteen he had a severe head injury (one week of coma, coming out with impaired balance, thinking, speech) and his recovery was very slow but continuous until he was 26. At that time he started hearing voices. It took us about three months to admit to ourselves how bizarre his behavior really was but we finally sought help for him. After a round of medications that was not working (of course according to us, since we were expecting complete recovery at the time) we changed psychiatrist. The new one (six years ago) told him to deal with the voices and John has been dealing with them since.

His voices are rather benign, telling him that good things will come. He has actual conversations with them, one voice at a time. The voices have been changing through the years, also the number of voices. A couple of times he has believed the voices, maxed his credit cards, pawned his tools, gone on a spending spree. Like most Schizophrenics, he does not believe in medication, (we do) but takes Seroquel having convinced himself that it helps him sleep. His father and I believe that Seroquel mutes the voices somewhat.

About early trauma and Schizophrenia. There is a study on males who hear voices that has determined a strong connection between head trauma and hearing voices. According to this study 60% of males who have suffered head injury develop auditory allucinations. I have not been able to find more studies.
posted by francesca too at 7:53 AM on August 14, 2012 [7 favorites]




dismissing the testimony of many, many people who have this condition.

I'm not dismissing anything. I'm suggesting that there may be more going on here than we realize, not all of which may be a direct product of brain chemistry. I'm suggesting that brain chemistry affects the mind, but that the mind can affect brain chemistry too. People who find these experiences debilitating have my sympathy, but I'm also sympathetic to the argument that writing this all off as the immutable product of anatomy is too reductionistic.

perhaps this study showing that there are statistically significant physical differences in the brains of people who have auditory hallucinations is more convincing to you?

A little, but it's still basically groping around in the dark. We don't have any idea what these "distributed structural abnormalities" are or do. "Hey, we think there's some kind of physical difference here" does not to me say "We have this thing figured out, and here's what's going on." I would not at all surprise me if our current exploration of brain structure winds up sharing the fate of physiognomy in another century or two.
posted by valkyryn at 7:59 AM on August 14, 2012 [2 favorites]


francesca too, are you familiar with the two-hit hypothesis?
posted by cashman at 8:08 AM on August 14, 2012 [1 favorite]


the mind can affect brain chemistry too

Wait what? What is a 'mind' in this sense?
posted by shakespeherian at 8:13 AM on August 14, 2012


It may be worth keeping in mind that one doesn't have to believe in any sort of mind/brain dualism to recognize that MRI and other neural activity peekings are in a very nascent state. (For one thing, resolution of scans, while getting better, is still pretty fuzzy. Areas of the brain as opposed to specific cellular activity within it, etc.) While my quatloos are comfortably in the "the mind (and the comparatively small subset of it that is conscious experience) is the brain in motion" bank, things are still very much in the rough-correlation stage of being able to point at bits of brain structure and behavior type X and say consciousness therefore will be Y. So I still take all pop-sci cognitive neuroscience with lots of grains of salt. (Fascinated salt, though.)
posted by Drastic at 8:15 AM on August 14, 2012


Even if you're a strict materialist, you can recognize that there is at least something in the mind that exists as a medium-agnostic pattern. Let's just look at the common case of working out a decision logically, perhaps using pencil and paper to work out all the ramifications and choosing the correct course of action. The decision that is made has to work its way out to the brain someway, which means that some abstract pattern of thought which arose through the action of the brain manages to cause a physical change in the opposite direction.

I probably didn't explain that well, because I haven't entirely got my head wrapped around the concepts.
posted by empath at 8:26 AM on August 14, 2012 [1 favorite]


when I've had a particularly stressful day I'll often hear a garble of nonsense as I settle down, often in a voice of a person I've been around all day.

Yup, this happens to me, although I haven't noticed it being a function of stress. It's also not usually a recognizable voice. Just little snippets of random things, and then I fall asleep. I always assumed it was a sort of waking dream, as I also have dreams that are overlayed upon my wakefulness when I'm about to fall asleep (especially when I am going back to sleep for the second time in the same day; when I'm working evenings I wake up to hang out with my baby and then go back to sleep for a few hours).

I also do not think in words unless I am very stressed and constantly reminding myself of what I need to be doing next.
posted by the young rope-rider at 8:29 AM on August 14, 2012 [2 favorites]


That "garble" thing right before bed happens to me too - usually just a fragmentary syllable or two. It usually happens when I'm extremely tired. (Just as a footnote, I do have friends who have heard entire illusory sentences in broad daylight, and they are, at least as far as I can tell, completely and totally sane.)

The article is interesting, though as others have already pointed out, the connection with early trauma (particularly sexual trauma) sets off major red flags. Also, to quote the Language Log article linked upthread:
Summary of evidence for hearing voices groups: ... At present, there is no reliable evidence to suggest the Hearing Voices Network groups are effective so an RCT ["randomized controlled trial"] is needed. Large single-group studies with follow-ups suggest skills-training groups may be effective but again a controlled evaluation is needed. The one controlled evaluation of mindfulness groups failed to produce positive outcomes. CBT has the largest evidence-base to date, with at least some positive outcomes in most studies. However, the results of the RCTs were less promising than the non-randomized trials, especially comparing CBT to active treatment controls. There were often commonalities however, between the active treatment and CBT, and indeed across the four approaches reviewed here.
So this kind of therapy seems potentially helpful but definitely not as much of a breakthrough as the article makes it sound. Probably it depends on a lot of other factors (existing insight is the big one that comes to mind, of course).
posted by en forme de poire at 8:48 AM on August 14, 2012 [1 favorite]


When I think I don't explicitly experience it as a sequence of words unless I channel it into that form. A lot of my thinking takes place on a wordless level, I've noticed, and sometimes it's actually difficult to formalize it into language. This has bitten me more than once, but thinking for me seems to be a lot more efficient if I don't have to compose it in the form of an internal narrative. This sometimes has the drawback of making my thoughts less examined and vulnerable to error.
posted by JHarris at 8:59 AM on August 14, 2012 [1 favorite]


There was a pretty interesting interview with Gail Hornstein, about Hearing Voices and the medicalization of mental illness, in the Sun last year.
posted by RogerB at 9:01 AM on August 14, 2012


"Yes, and I don't really comprehend what it would be like to have one."

2nd. I've never seen it put better than the Temple Grandin link above - "I use language to narrate the photo-realistic pictures that pop up in my imagination."

Interesting article. thanks.
posted by anti social order at 9:07 AM on August 14, 2012


Muses, Madmen, and Prophets: Hearing Voices and the Borders of Sanity
See also Strange Brains and Genius: The Secret Lives of Eccentric Scientists and Madmen.
posted by knile at 9:21 AM on August 14, 2012


It’s a little odd that some people think auditory hallucinations are the same as thoughts, however “auditory” in quality, however persistent, or negative, or uncontrolled. We don’t think the same of visual hallucinations vs. imagined images, do we?

When I’m very tired – typically on less than four hours’ sleep, my mind can become a cacophony of unwanted sounds, conversations, noise. But I never, not ever, mistake it for sounds originating in the outside world. I have also experienced the sensation of extreme *loudness* of this internal noise – shouting level. It’s disturbing in a literal sense but again not at all like the quality of someone standing next to me shouting. On the other hand, when I hear a voice as I start to fall asleep, the key difference for me is that I suddenly cannot tell that it did not originate in the environment. The only way I know is to think about whether or not what I heard makes sense, and rationalize it away as something imagined (which means that if I hear a window being cracked or the like I’m liable to go check). My understanding of auditory (and visual, and other sensory) hallucinations is that the person experiencing them perceives them as external stimuli as any other and faces an uphill battle trying to rationalize them away.

Someone suffering from terrible, persistent, critical internal dialogue may have a problem, but I don’t think it would be called auditory hallucinations, whether the sufferer cares to make the distinction or not.

Oh, and on the subject of having/not having an internal monologue, I discovered one day to my shock that the girl I was dating (some time ago) had, according to her, no ability to mentally reproduce sounds. This coincided with her being absolutely tone-deaf, and I wondered if there was a connection, but I have to think such an inability rather rare (but who knows – how often do we talk about this stuff?). At the very least, I was sad that she seemed to be missing one hell of an internal entertainment system.
posted by Durn Bronzefist at 9:38 AM on August 14, 2012 [2 favorites]


Check out this second-life virtual schizophrenia walkthrough.

Some of the comment on it on /r/truereddit sounded hellish:

For me I found the voices to be more persistent and unrelenting, never a pause, never a chance to breath in a process. I personally had a male and female voice at the same time; they'd scream so loudly at me about how horrible a person I was. I couldn't hear my own thoughts so after a while I'd start screaming as loud as I could just to be able to hear my voice again, something I thought to be grounded in reality. It felt like drowning in the sounds of it with them overwhelming my senses. It was horrifying to me as a child and though mostly controlled and gone in my adult life I can still sometimes feel it in the back of my head whispering at me.
posted by Ad hominem at 9:54 AM on August 14, 2012


It’s a little odd that some people think auditory hallucinations are the same as thoughts, however “auditory” in quality, however persistent, or negative, or uncontrolled. We don’t think the same of visual hallucinations vs. imagined images, do we?

Are visual hallucinations not imagined? It seems to me that if there is a part of the brain that is responsible for generating streams of words and images, it would make sense that it's the culprit whenever it happens. It seems unlikely that some other part of the brain is going to develop what is a rather complex ability.
posted by empath at 9:56 AM on August 14, 2012


empath: Are visual hallucinations not imagined?

These definitions are tripping us up a lot, in this thread. Yes, they're imagined in the sense that they are not real. However, they are also fundamentally different from normal imagination is that the victim experiences them as real, not as imagined.

Thus, comparing them to normal imagination, where the reality of even a vivid imaginary scene is never in question, is of questionable use.
posted by gilrain at 10:03 AM on August 14, 2012 [1 favorite]


CNN & TED: My life with schizophrenia
posted by the man of twists and turns at 10:04 AM on August 14, 2012


empath: Are visual hallucinations not imagined?

I just caught a documentary on Albert Hoffman (Mr. LSD). Very early on, he makes a very firm point that hallucinations ARE NOT REAL, but that which you experience on psychedelic drugs is not hallucination. It is in fact a deepening of your grasp of so-called reality.

If you hear your thought as a literally audible voice, then no, that's not normal at all. You understand that these people literally (as far as their perception is concerned) hear the voices, right?

There's voices and there's voices. Or more to the point, there's always voices but sometimes they're much louder in the mix. This nugget of insight took me a few dozen acid trips to sort out (does this count as science?), but it was one trip in particular that forever flipped my grasp of life-the-universe-EVERYTHING inside out, backwards, etc.

I won't go into deep detail. The key thing is that at some point, fairly early in the trip, I became aware of how efficiently, how effectively my brain/mind seemed to be functioning. HOW SMART I WAS. How witty. It didn't matter what people were talking about, I had a kickass insight. I was on a roll, a fucking genius.

But then it turned.

Suddenly, I wasn't just easily plucking the right nugget of insight from my consciousness anymore. Suddenly, the nuggets were out of control, overwhelming me -- a storm of them, a hurricane. And the thing is, they were presenting themselves as voices. Note the plural. It wasn't one voice saying something, then another. It was dozens-hundreds-thousands-millions of voices murmuring around a point, an insight, an argument, a TRUTH ... and I was drowning in them. And no, they weren't saying nice things. They were trying to destroy me. It was fucking horrifying.

And so on. The acid eventually wore off. I eventually stopped hearing the voices. Sort of.

A better way of putting it is that my experience shifted from acute to chronic. That is, the voices weren't shouting me down anymore, a million strong. Now it was more a whisper that I generally didn't notice until I was alone, in a quiet environment, like the end of the day when I was trying to get to sleep. I was having a hard time getting to sleep.

Very long story made shorter:

I never sought help for this, never mentioned it to a friend or family member, I just sort of endured, never really grokking the fact that I might have a mental health issue. Though I did bring it up with the odd stranger. I drove cab in those days so there were lots of interesting strangers to talk to. One night, I drove an aging hippie type (it was the early 80s) to the airport. He was bound for San Francisco. I quickly put two and two together and said, "You were there, weren't you? The Summer of Love."

"Oh yeah, I was there."

Which got us to the topic of epic doses of psychedelics, ego death, and inevitably my particular drama. He chuckled when I told him about it. "You lost your virginity. The gods had their way with you." And then he went on to relate his own story.

Fourteen year old kid in 1966, his big brother a serious hippie type hanging with Grateful Dead etc. He eventually gobbled way too much acid and, just like I had, went way too far inside himself. But unlike me, when he re-entered the everyday, he found himself in a community of folks who'd had very similar experiences, so he wasn't so alone. He could talk it out.

And one key conclusion he came to was that the voices we both heard were very real. Maybe not in a flesh and blood record-them-with-a-microphone manner, but definitely in an I-HEARD-THEM-SO-THEY'RE-FUCKING-REAL manner. So you can't just ignore them. You can't just shrug them off and go shopping. No, you've got to engage. And step one of this engagement is accept that just because a voice is coming from inside your mind doesn't mean it wants what's best for you. Far from it, a lot of these voices (because they do often present themselves as voices) are hostile. They want to harm you, maybe destroy you. So you've got to learn to tell them to shut up. Or more to the point (and I remember this precisely), "You've got to learn to call them on their bullshit, literally."

And so on. We got to the airport. He paid his fair. It's more than thirty years later and I still occasionally find myself calling bullshit on the voices.

Good article.
posted by philip-random at 10:11 AM on August 14, 2012 [11 favorites]


Nathanboy, I'm really frustrated by your conclusions. There's flaws in the article, granted; but your response falls to its own misconceptions, and you make some pretty big claims that aren't well-substantiated, and (I think) misunderstand the article completely.

Here's the thing: schizophrenia is an amorphous disease with multiple subtypes (5 "true schizophrenias," and several schizophren-ish disorders, last time I checked) and within those subtypes, rather heterogeneous courses between patients. And while there are symptoms that strongly suggest schizophrenia, by and large it's a diagnosis of exclusion: that is, we tried other diagnoses on for size, but none of them fit.

Moreover, childhood trauma's been linked to a significantly (with a super low p value and everything) increased risk of future schizophrenia -- even linking specific types of trauma to specific symptom patterns (Article at Schizophrenia Bulletin - paywall alert). While this doesn't at all imply that trauma inexorably leads to schizophrenia, it does strongly suggest that trauma can be one of the multiple hits that leads to mental illness.

With all that said, I think the article's main thesis is at its end:

But the search for hidden memory is not intrinsic to the movement’s central insight, which is that the way we understand our mental experiences has the potential to alter them fundamentally. The Hearing Voices proponents believe that if you do not envision schizophrenia as a life sentence, you increase the chance that patients will be able to discover their own resilience.

Hear, hear. One of my main research interests is in stigma and mental illness. I think it's arguable that divorcing mental illness from its historical "life sentencing" may, to some degree, deny its stigmatization. I'd love to see some actual trials of this as a therapeutic modality. Group therapy is cheap, and unlike antipsychotics, generally doesn't lead to dyslipidemia (unless the group leader provides donuts). If this could work for some schizophrenic patients, hurray!

...

Oh, and one more thing: what you said about treatment for schizophrenia is categorically untrue.

4. Everyone uses a combination of therapy and pharmaceuticals to treat schizophrenia. This is not new or interesting information.

No. First-line is antipsychotics for an actively psychotic person; psychosocial interventions are adjunct therapies, saved for the "stable" phase, and focused on family interventions (here's what to expect, here's how to support them); symptom-focused cognitive-based therapy (training folks to evaluate their delusions for plausibility, for instance); or occupational therapy-like interventions (social skills training; practical skills training). (the gummint's guidelines) Moreover, treatment of actively psychotic people is focused on drugs and palliative psychotherapy (reducing stress) - while the approach in the article might be a way we could integrate a useful form of therapy into longitudinal treatment.

What really sticks in my craw is that your remark ignores the biggest problem facing health care: a lack of resources to meet increasing demand. I'm entering psychiatry, and the demand for psych docs is asininely high. Great for me, when I'm job hunting in a few years; terrible for patients. In the end, this lack of resources represents a particularly hard hit to folks with severe mental illness, who have staggering rates of unemployment and disproportionately low incomes.

tl;dr: The care guidelines prescribe is drugs first; hugs second - and many schizophrenics can't even get drugs.
posted by johnnypollen at 10:19 AM on August 14, 2012 [12 favorites]


Great post, thank you. I have done some work with homeless people and still know several, I know this knowledge Will help them.
In my own life, my grandmother had a tendency to go about muttering and sort of singing, even when she wasn't actually there. In other words, my grandfather and I clearly heard her outside of our heads, even if she was 200 miles away.
She recently died, and stopped muttering/singing. I miss her. And neither of us felt it was strange when she was alive. She was a strong woman
posted by mumimor at 10:27 AM on August 14, 2012


People with dissociative disorders often say that they hear voices, although usually those voices are perceived not as externally heard auditions but as strong, alien thoughts. These internal voices are understood as the marks of the alters, these strange, split-off pieces of the psyche.

I had a brief experience with this after the birth of my son. In addition to my own history of Bipolar II, the doctors were concerned about my mother's history of Post-Partum Psychosis and put me back on meds 24 hours after giving birth.

Mostly I was fine, but I had thoughts that felt like I was somehow tuned in to the internal dialogue of a child abuser, based on stories I had read in the news. I knew that I had no intention of harming my child but to experience what seemed to be alien psychopathic thoughts in my head was distressing.

I talked to my doctor and my best friend about the thoughts which helped me feel less "crazy". Thankfully, the "alien thoughts" eventually went away. I feel for anyone who has to live with this day in and day out.
posted by echolalia67 at 10:36 AM on August 14, 2012


Are visual hallucinations not imagined? It seems to me that if there is a part of the brain that is responsible for generating streams of words and images, it would make sense that it's the culprit whenever it happens. It seems unlikely that some other part of the brain is going to develop what is a rather complex ability.

The brain is producing sensations for everything you experience, whether triggered internally or in your environment. The visual cortex is implicated both in memory recall and in dreaming. I don't see how this is a question of capacity.

The experience of imagining a rainbow vs. seeing one are pretty different, and people don't tend to confuse the two or suggest they only differ in degree. People do seem more amenable to confusing imagined sounds with those heard, and I wonder why that is. (I've long wondered whether fidelity of imagination reaches a point where survival is diminished rather than enhanced, and so gets weeded out of the gene pool. But hey, maybe audio fidelity is less dangerous and has persisted -- in 15% of the population)

Again, this is not to diminish the suffering of someone who experiences persistent, unwanted negative thoughts.
posted by Durn Bronzefist at 10:42 AM on August 14, 2012


For those pondering the question of whether hearing voices varies from an internal monologue only in degree, there's a great discussion and some clips from a tape made by voice hearers designed to simulate the experience for mental health workers in this radio program. As someone who's never known a voice-hearer or studied the subject, I found it fascinating.

Interesting article, although it's hard not to wince at phrases such as, "European psychiatrists do not know about the strange collusion between some therapists and some patients, when patients seemed to deliver one after after another. . ." There's a lot about the technique described that seems problematic, and it's probably true that Dutch psychiatrists have been less burned by repressed memory scandals; however, there must be a less obnoxious way to present that story.

At the risk of a further derail into the subject of internal monologues, I wonder if people who think in words or experience an internal monologue are more likely to hear voices rather than experience other hallucinations. Measuring such a thing seems difficult, but not impossible. As someone at the extreme end of the "thinks in words only when thinking about words" range, I used to assume the whole idea of an internal monologue was just a literary convention. After talking to words-people in depth, it sure does seem like there really are a range of ways in which humans process information, and that those differences extend further than just variation in the way we describe processing information. It doesn't seem crazy to imagine those difference also extend into the way in which the mind simulates reality.
posted by eotvos at 10:43 AM on August 14, 2012 [1 favorite]


Psychology, as a discipline, is tragically (and rather ironically... or perhaps just symptomatically) inept at sustaining a sense of institutional memory: Its discoveries get forgotten, rediscovered, and relabeled over and over and over again.

You can find more precise, richer versions of the same method in NLP books from thirty years ago; no doubt countless shamans from countless forgotten cultures would have proffered similar advice, and with some random, colorful, and efficacious belief-building ritual added on, such as rubbing a feather or scaling a mountain and eating a toad.

>You understand that these people literally (as far as their perception is concerned) hear the voices, right?

>>I dunno. Perception is mushy enough, both in terms of what we experience and especially in our attempts to commit those experiences to language, that I'm willing to believe a difference in degree rather than a difference in kind.

When it comes to shaping human behavior, threshold effects are common: A profound change in amplitude-- particularly if it's sudden-- is readily perceived as a change in kind.
posted by darth_tedious at 11:12 AM on August 14, 2012 [2 favorites]


francesca too, are you familiar with the two-hit hypothesis?

Yes, I was aware of the paper. My last job before retirement was as a Molecular Genetics tech for ten years and before that I was a Cytogenetic Technologist for 15 years or so. In a genetic laboratory every new test introduced has to have a large number of "normal" controls and my family and the other techs families routinely donated their blood as control. None of us have the 22q11 deletion or the Notch4.

The objections I have to that paper are the following:
1. the frequency of 22q11 deletion in the normal population is 13 for 100,000 live births, much lower than the frequency of Schizophrenia (1%)
2. the same goes for Notch4
3. lacks randomized studies of any kind as yet

While the hypothesis is interesting, it is still in its infancy, as yet lacking any kind of decent proof. I have been keeping an eye on the literature, trying to see if it moves from Psychiatric Journals to Science Journals (no offense meant to any psychiatrists on Metafilter).
posted by francesca too at 11:36 AM on August 14, 2012 [3 favorites]


Now I'm wondering what would happen if all the people in this thread who claim not to have an internal monologue suddenly developed one - would they recognize it as their own thoughts or feel it as an alien intrusion.

I have an internal monologue that's pretty much non stop, and the only way I can get out of it listening to music or dancing or playing video games or something that similarly engages the brain. If I don't, I'm constantly spinning out fictions in my head, snippets of songs, remembering, rehearsing conversations with people, and so on. I swim in words as thick as the air I breathe. If my mind were ever silent, rather than silenced by distraction, I think I'd be worried.
posted by empath at 12:01 PM on August 14, 2012 [4 favorites]


empath - yeah, that describes me as well. Given 30 seconds of silence I'll be knee-deep in imagined monologues and dialogues, outlines of essays I'll never write, sentence fragments from stories I'll never finish, and so on.

It can make getting to sleep a real pain in the ass.
posted by kavasa at 12:18 PM on August 14, 2012 [2 favorites]


empath: or playing video games

HEY!

LISTEN!

DO A BARREL ROLL (PRESS Z OR R TWICE)!
posted by gilrain at 12:18 PM on August 14, 2012 [2 favorites]


In Scientific American, a description of hallucinations, specifically Charles Bonnet syndrome.

Hallucinating body flowers
posted by homunculus at 12:39 PM on August 14, 2012


If my mind were ever silent, rather than silenced by distraction, I think I'd be worried.

I remember a friend praising meditation, who was amazed that he could be taught to go whole minutes “without a single thought”, which I take to mean, “without an internal monologue”. To do so, he had to overcome a fear which seemed to associate lack of internal narration with death (!). I don’t think he believed that for some people the monologue is optional. (for me it’s just a useful habit, like talking through a problem aloud, without the social repercussions)

Given 30 seconds of silence I'll be knee-deep in imagined monologues and dialogues, outlines of essays I'll never write, sentence fragments from stories I'll never finish, and so on.

Not that this is something that needs to be “fixed”, but if you feel like experiencing a lack of this state, I recommend a week-long camping/hiking trip completely solo and with no noise-making tech. After a few hours you’ll find yourself humming, singing, whatever to make noise. Then just internal monologue. Finally, just long, long stretches of silence; only awareness. At some point (admittedly probably related to losing the stink of civilization) even the animals cease to seem bothered by you.
posted by Durn Bronzefist at 1:09 PM on August 14, 2012 [2 favorites]


empath, in addition to hearing voices, many schizophrenics experience "inserted thoughts": thoughts that they claim are not their own, but that are placed in their mind by an external agent. They do not experience their internal monologue as their own. It sounds like you want to reduce hallucinatory voices to a type of inserted thought, but schizophrenics can distinguish the two and they experience them as different. There are behavioral differences too: schizophrenics hear voices as coming from a direction outside of them and will turn their heads to look for the source, but inserted thoughts are "locationless", or located in their heads, just as we experience our internal monologues.

Explaining the auditory phenomenology of hallucinatory voices is a really difficult challenge, and while I don't know any of the most recent literature, I think this is still an unsolved problem. One of the more neat theories is the "whisper hypothesis": schizophrenics are actually hearing themselves subvocalize. There are some studies that show that getting a schizophrenic to open their mouth wide or to clamp down on their tongue with a tongue depressor at the onset of a hallucinatory episode will cause the voices to subside.
posted by painquale at 6:26 PM on August 14, 2012 [1 favorite]


I remember once someone asking me why was I so quiet and I replied, "I don't have anything to say." So they said, "Well, what are you thinking?" and I got very embarrassed because, as usual, I actually wasn't thinking about anything; I was just experiencing the moment, being there in that place, on that day, with that person. I don't remember what I came up with to respond to him. I was afraid that I had to be thinking something all the time, or else it meant I was very stupid. (I was young at the time.)
posted by serena15221 at 7:10 PM on August 14, 2012 [2 favorites]


I have an internal monologue.

When I was a child, on a few occasions when I'd be awake in the middle of the night I found that with the right combination of absolute quiet and complete concentration, I could force myself to hear music. That sensation was what I imagine auditory hallucination to be like; it was different from my internal monologue. It sounded like real, though faint, music.

I think that once I grew up and went to a few concerts I lost whatever it was; I think the tinnitus drowns it out.
posted by no relation at 8:06 PM on August 14, 2012


Clozaril is an atypical antipsychotic. If it doesn't work, you try another one. Nothing works for everyone.

Clozaril is kind of the go-to drug for "we have tried everything else and nothing WORKS!" It owuld have to be, since it's one of the few drugs that has serious physical side effects that require monthly blood tests (and let me tell you, trying to stay on the right side of the regs with that is a pain in the ass; I cry when my clients take Clozaril and can't get to the lab alone).

Everyone uses a combination of therapy and pharmaceuticals to treat schizophrenia. This is not new or interesting information.

I work with a lot of people who have schizophrenia. In my office, I'm the go-to woman for florid psychotics, meaning people whose explanations for their lives and experiences are wildly outside of the norm. One of the examples I use is an explanation that the tardive disconesia a client was experiencing could be explained by bugs moving his legs. Luckily, he is med compliant, though he believes they cure AIDS. I'm good with that, honestly; sometimes you just have to focus on results and let the reasons fall by the wayside.

In my experience, there are some clients who might benefit from talking back to and making deals with the voices (I can think of two off of the top of my head), but others already do that because to them the voices are real (some clients don't have that delusional aspect and those tend to have fewer delusions but still have voices) and it doesn't seem to affect the voices at all. I would hazard a guess that the delusional aspect of some of the schizophrenias leads to a different set of circumstances; I've found that education on terms and basic b-mod (largely the substitutions side of b-mod with the usual healthy dose of positive reinforcement - never punishment or negative reinforcement) helps more when there are delusions in the picture because part of the process is linking the person up with something closer to the share reality we have so that they can connect with other people more successfully (I'm still stoked I finally, three years on, figured out what a vague comment (think something like cheezit crackers) means to her so that I can start linking it up with things other people will understand).

I do some therapy with my clients, but I can never, ever call it that because then the government won't pay us. What we do, and largely what is paid for, is rehabilitation - which is skill based. No thoughts or emotions, just skills. Of course, some of the skills can be in managing thoughts and emotions, but still - skills! The all important skills. If I never have to type the word skills again, it will be too soon. Therapy is contra-indicated right now because everybody knows that brains are properly treated with medication, and then people like me are paid too much by the government to do unnecessary things with clients that will theoretically keep them stable but really it must be the medications.

Oh, and a chunk of treatment for people with severe mental illnesses is at the hands of people with only undergraduate degrees, who thus have minimal to no therapeutic training. They're cheaper, you see.

The focus on searching for childhood trauma is, to me, a clear and absolute sign that this is a bullshit method of treatment.

Not searching for, but it often shows up unexpectedly. Of course, it also often shows up in other places (I find severe, debilitating depression is more likely to have childhood trauma - by which I mean childhood being terrorized, humiliated, and sometimes tortured; the stories can get pretty horrific). Since we can't assign people mental illnesses to test out our theories of causes, most clinicians end up with vague correlations which slowly resolve themselves into more concrete theories. I'm currently running with the "at least five, maybe ten or fifteen, types of schizophrenia with different features and causes", but I'm relatively new in my field (only seven or eight years experience, and two of them undergrad).

From the article: "If it is true that distressing auditory hallucinations are the dissociative consequences of trauma, the implications are enormous." Unfortunately for the author, it is not true, there is strong and widespread evidence to indicate that it is not true

I'd really like to see this strong and widespread evidence. If it's in restricted journals, I can probably still get access through my graduate library, so I'd love journals references even if they aren't publicly available.
posted by Deoridhe at 1:49 AM on August 15, 2012 [2 favorites]


I had always thought of myself as a visual-kinesthetic person, as I am easily able to see things in my head, preference sight much higher than hearing, often miss or misunderstand things that are told to me, and prefer to see a task done and then do it myself in order to learn it.

I had thought that visual, auditory and kinesthetic learning styles were all that really mattered (although gustatory and olfactory exist). However I recently learned of a fourth learning style, the somewhat confusingly named "auditory digital", the learning style of the internal monologue, and this describes me precisely. Prior to reading Eckhardt Tolle's "The Power of Now" it had never even occurred to me, that what I think of as "I" might be a separate thing other than my internal monologue; the listener within, rather than the speaker.

I don't really have conclusions to draw from this yet, other than to offer it as a potential view of the internal monologue. I've never "heard voices" except that were clearly not "real"; I can have my internal monologue "speak" in funny accents, but not in languages that I do not understand, and what it "says" always seems to be largely under my control.
posted by aeschenkarnos at 5:45 PM on August 15, 2012


Durn Bronzefist: Nope.

I have spent a lot of time on my own in nature. 10 days on a no-talking, 12+ hours sitting a day meditation retreat. I am genuinely uncertain whether I've ever gone 10 seconds with total attention on only one thing, or without internal thought tracks.

I don't have a mono-logue, in that, it's never been 'mono'.
I have at least 3 verbal channels in my head at all times, 1 musical, usually 1 (imagined) visual, at least one non-verbal thinking, and a dreamlike channel.
After a few days at the meditation retreat, I was aware of say, multiple visual and musical 'channels', all playing at the same time, just some I pay more or less attention too. I have no idea how many there are, really.
When I was nearly hit by a car, and everything slowed right doooowwwwnn, I was still clearly thinking of about three things at once, in order to not die.

I really, really keep assuming that someone is going to tell me, oh no, that's not what that means, of course we all have all those different channels in our heads at once, but, apparently some people don't? I still have, essentially, no idea what I'm supposed to be doing when meditating, but I get the feeling that if it's something I have such a complete inability to do, maybe it'd be useful to get the basics down. Somehow.


Also, audio hallucinations are the worst. Visual imagination is somehow distinctly not-real, but, auditory imagination is either so strong, or doesn't have the not-real distinction, that it is much harder to distinguish. The only problems I've ever had there, is one point where I was frequently hallucinating/imagining my phone ringing, muffled in the depths of my bag, and having to check it. I think I was often just hearing a couple of notes in sounds like car traffic, that I was pattern-matching into my ring tone.
Changing the ring tone helped. So does being less stressed/depressed.
posted by Elysum at 7:03 AM on August 21, 2012


I really, really keep assuming that someone is going to tell me, oh no, that's not what that means, of course we all have all those different channels in our heads at once, but, apparently some people don't?

We don't really have an easy way right now describe and then compare and contrast non-shared experiences, like the process of thinking. Early on in psych, around the time of Freud but in a different country, a researcher ran with the idea there were "primal ideas" which existed in the minds of all humans. Intra-center reliability - incredibly high; all the people in the center ended up using the same descriptions. Inter-center reliability - crap; so wildly divergent that there was no ultimate use. Freud stepped into that context, and that type of viewing the mind (which is much more similar to to cognitive behavioral modification, where there is considered to be a "right" and a "wrong" way of thinking) went underground for a long time.

I think in images - but not visual images, or I should say not visual the way Temple Grandin describes, where she can examine and move her images to view them from different angles. Mine are much more conceptual, often with a physical component.

To give an example, about halfway through school with my peers we were walking and talking, and I was trying to express how I was feeling in regards to work and school and home, and I said, "It's like I'm in the middle of the sea just floating, and I can't see anything in any direction." There were audible gasps around me, and my friends' responses led me to believe this was a very tangible and immediately accurate sensation for them, too, but they had never thought of it that way.

When I'm with my clients, I often have sensory-conceptual explanations for how I track them; for a long time I had a client who felt like a bump in the skin that you initially think is nothing, and then it starts to get dark and bruised, and suddenly an abscess surfaces and life really sucks for a while, and then it "heals" a little, but the abscess is always underneath, waiting. I have another where I know there's trouble because when I'm with her I feel like I'm standing on rotten boards in a house. Sometimes very visual images that have no clear meaning to me emerge as well, and I spend a few years wrestling with them to figure them out - often the "answer" is somewhere outside of words, though I can hint at it in various ways; the image is vastly more complicated than the words.

These mental tendencies of mine - for which I have no explanation - probably are part of why i do so well with people who have florid psychosis; once I settle on an image or two for them, I can see the way forward and react accordingly, and it makes sense to me though explaining it to others can be a challenge.
posted by Deoridhe at 11:48 PM on August 22, 2012 [1 favorite]


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