Avoidance of Voices Can Be as Problematic as Listening Too Much

Ron Unger, LCSW
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In the system of mental health “care” which is dominant today, “hearing voices” is conceptualized as an illness, and so the goal is seen to be minimizing such experiences.  Even talking about the voices is usually discouraged.  Mental health practitioners show no interest in the voices other than to find out whether they are still present: if they are, drug dosages are increased or changed in the hopes of dampening or eliminating them.  If the person continues to hear voices despite often massive drugging, then distraction methods are usually the only coping idea that is suggested.  Anything is done to avoid actually listening to, or being curious about, the voices.

It certainly is true that listening too much to voices can cause extreme problems.  Voices can order people to harm themselves or others, or say things which could crush, or conversely cause a grandiose inflation of, self esteem.  If the person obeys the voices or believes them, or even if the person just gets pre-occupied by them or caught up in them enough to be distressed by them, damage can result.

But sometimes the opposite of one mistake is just another kind of mistake:  it is becoming obvious that the avoidance of voices is just as much a mistake as is listening too much to them.

One problem that occurs when people chronically avoid the voice hearing experience is that they never learn how to handle it.  An even more serious problem is that the methods people use to avoid the voice hearing experience actually weaken the person, so that they become less able to handle the voice when they encounter it anyway despite their best efforts at avoidance.

Consider the effect of chronic use of antipsychotic medications.  These drugs do sometimes cause voices to disappear, or at least become less prominent.  But they do so by weakening a person’s ability to care about things:  they are essentially indifference drugs.  They weaken a person’s ability to have strong opinions, a strong personal voice.  They induce a kind of passivity, and it has long been noted that a person under their influence has fewer spontaneous interests, but is still capable of responding to the ideas or suggestions of others.

The problem with the above is that if a person is ever going to face the voices and work things out, the person needs personal strength, or the very thing being dampened by the drugs, in order to do so.  If a voice orders a person to kill themselves, it is very important that the person have strong ideas about the importance of continuing to live, so that the person can reject the suggestion.  A person made passive by a drug is actually less capable of resisting suggestions made by voices that persist despite the drug.  Unfortunately, this passivity is currently usually seen as just an aspect of the person’s “mental illness” and as proof the person cannot handle hearing voices, and the need for even more medication to try and suppress the voice.

(This is not to say that cautious use of medication can never be helpful, for example when a person does not yet have skills needed to face voices and when “listening too much’ would lead to disaster.  But such use should be sparing, and as temporary as possible, if the person is to get a chance to really learn to face the voices and the issues behind them.)

Distraction, when it is overused, has the same problem.  Consider a person who always distracts herself from her worries, rather than face them.  Such a person never learns that there are ways to face the worries effectively, and the worries themselves tend to get worse due to being neglected.  The same problem occurs when distraction is overused when coping with voices.  As one voice hearer I know put it, “voices are personifications of issues you don’t want to deal with.”  Failing to deal with the issues makes the issue seem more pressing which in turn actually strengthens the voice, while the person never learns to feel strong enough to face the voice or to work through the issues the voice talks about.

While always avoiding the voices keeps the voice hearer stuck in being incompetent to deal with voices, the mental health system suffers the same effect when it’s only strategy is encouraging drugging and avoidance.  Mental health professionals fail to learn anything that helps them understand voices:  instead they are taught simply to categorize them as illness, and to suggest drugs and distraction.  Since they never study the experience or what can be done about it, they feel incompetent to suggest anything else, and then their allegiance to the illness model grows even stronger since it is the illness model that says “there is nothing more to know here, the voices are just a result of something “wrong” in this person’s brain…..”

Fortunately, new models of how to cope with voices are emerging, mostly due to the efforts of the Hearing Voices movement, which is an alliance of voice hearers and people who have been really willing to listen to their experiences.

In the new models, changing the relationship with voices, rather than eliminating them, is the aim.  The fact that many people hear voices without problem, or even find that their life is enriched by hearing voices, is highlighted.  People learn to deliberately listen to voices some of the time, and to mostly refuse to listen to them at other times, so that the voices are neither avoided nor experienced as overwhelming.

One of the trickier issues is to learn to discover the issues the voices are about, and to reconnect with parts of the person’s psyche and experience that the voice represents.  The problem is that voices are often best understood an integrated by not taking them literally.  That is, a voice that says “kill your mother” may eventually best be understood as meaning something like “you need to find a way to reduce your mother’s dominance in your life.”

While none of this is easy, more and more people are taking this journey, and many are writing about it quite eloquently.  One example is Rachel Waddingham.  Rachel hid from her voices, using drugs and distraction, for 9 years before hearing the stories of others in the Hearing Voices Network convinced her to try another approach that led to her recovery.  As she puts it,

Through a combination of luck, the kindness of others and my own, not inconsequential, stubborn streak, I have finally ditched the psychiatric labels and see myself as a survivor. I manage a London-wide mental health project, am an independent trainer, speak at conferences, take part in committees and live a life that I truly love. I no longer take neuroleptic medication, and choose to live with alongside my experiences.

Rachel has her own blog, and she has also shared her experiences recently on a new website run by the Hearing Voices Network of the UK.  Rachel writes very clearly about how to be curious about and communicate with even voices that seem stubbornly uninterested in communication and dialogue.  For example she writes that:

When I finally felt ready to open up the lines of communication with The Three, The Three weren’t so eager to reciprocate. I remember talking internally with them, asking them who they were, why they were with me and what they were trying to tell me. I tried to be as respectful and open as the Voice Dialogue method suggested, but still The Three carried on talking as if I wasn’t there.

 

Initially this lack of response discouraged me. I felt a bit like a failure – even my own voices didn’t think I was important enough to talk to. Still, I persevered and tried to reassure myself that it takes time to change a relationship that has been running in the same way for over a decade.

 

The Three still haven’t talked directly to me, but I am now much more skilled in the art of the one sided conversation. For the first six months or so, I tried to ask them direct questions with no luck. Recognising I needed to change tack, I instead responded to what they were saying. I reasoned that some people, especially those who have a point to press, are more engaged when you talk with them about things they are interested in than your own agenda.

 

When The Three talked of there being gas on the tube and that I was being poisoned, I simply stated (as calmly as possible) ‘Thank you for reminding me I don’t feel safe. There have been lots of times in the past where I haven’t been safe, but I’m ok here at the moment. The other people on here don’t smell gas, and they are not afraid. There’s nothing here to be scared of’. This wasn’t a magic trick, and The Three didn’t suddenly skip off into the sunset. They carried on talking over me. I felt safer, though, and – in time – The Three started to respond to this approach and became quieter and less insistent.

Rachel’s full post is very much worth reading, I suggest you check it out.

With more articles like hers, and with the leadership of the Hearing Voices Network, and of groups like the International Society for Psychological and Social Approaches to Psychosis (ISPS) of which she and I are both members, I’m hoping that we can shift to a mental health system that supports a balanced approach to voices rather than the current mode of drugging and running away from them.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

15 COMMENTS

  1. A good post Ron:))

    One wonders what we are “running away from,”or standing in denial of, in our need to judge & drug in our “intellectual” observations of mental illness & hearing voices.

    Hearing voices is a disease process in brain like any other physical illness, apparently? One wonders why we shy away from any research or scholarship which points towards natural cause & particularly the body’s role in states of profound dis-ease?

    Its interesting note the role Julian Jaynes book about the Greek voices of the God’s played in the formation of the “Hearing Voices Network,” through the work of Marius Romme?

    In Jaynes book about a bicameral mind he investigates the “Mind of Iliad,” and discusses its language, suggesting the epic is written with nothing like the conscious mind we have today. He says;

    “The word for psyche is in most instances life-substances, such as blood or breathe; a dying warrior bleeds out his psyche onto the ground or breathes it out in his last gasp. The “thumos, “which later comes to mean something like “emotional soul,” is simply motion or agitation. The “thumos” can tell a man to eat, drink or fight. Diomedes says in one place that Achilles will fight, “when the “thumos” is in his chest tells him to and a god rouses him.”

    The characters of the Iliad do not sit down and think out what to do. They have no conscious minds such as we say we have, and certainly no introspection. It is impossible for us with our subjectivity to appreciate what it was like. When Agamemnon, king of men, robs Achilles of his mistress, it is a god that grasps Achilles by his yellow hair and warns him not to strike. In fact, the gods take the place of consciousness.

    When Achilles reminds Agamemnon of how he robbed him of his mistress, the king declares, “Not I was the cause of this act, but Zues, and my portion, and the Erinyes who walk in darkness; they it was in the assembly put wild “ate” upon me on that day when I arbitrarily took Achilles prize from him, so what could I do? Gods always have their way.”

    Jaynes points out that this excuse for bad behavior was fully accepted by Achilles, for he too, had his gods who must be obeyed. He then says;

    “If we erase all our preconceptions about poetry and act toward the poem as if we had never heard poetry before, the abnormal quality of speech would arrest us. We call it meter nowadays. The function of meter in poetry is to drive the electrical activity of the brain, and to relax the normal emotional inhibitions of both chanter and listener. A similar thing occurs when the voices of schizophrenics speak in scanning rhythms or rhyme.

    Who then were these gods that pushed men about like robots and sang epics through their lips? They were voices whose speech and directions could be as distinctly heard by the Iliadic heroes as voices are heard by certain epileptic and schizophrenic patients, just as Joan of Arc heard her voices.

    The gods were organizations of the central nervous system and can be regarded as personae in the sense of poignant consistencies through time, amalgams of parental or admonitory images. The god is part of the man, and consistent with this conception is the fact that the gods never step outside of natural laws. Greek gods cannot create anything out of nothing, unlike the Hebrew god of Genesis.” _Julian Jaynes.

    One wonders why we shy away from any research or scholarship which points towards natural cause & particularly the body’s role in states of profound dis-ease? Perhaps its something to do with “cognitive dissonance?”

  2. Hearing voices is a very interesting phenomenon, especially since all «normal» people can do it. I am a psychologist from Norway, and I have worked with patients who hear voices in a new way, based on principles of cognitive therapy.
    First of all, the phenomenon of hearing voices can be thought of as a normal human experience. Around 30% hear a clear voice at least once in their lifetime, 2% hear voices regularly, but only 1% have problems with them. 100% can hear voices right before they fall asleep, wake up during the night or right after they wake up. Lack of sleep for a few days makes almost everyone hear voices.
    And we all hear approximately 60 000 sentences spoken in our heads daily. It’s just that for for most of us the voices don’t sound like actual sounds. They are what we call thoughts. I once had a patient who was very bothered about a so-called commanding auditive hallucination. She heard a voice saying,” hang yourself you swine”. It was a male voice and very threatening. She couldn’t say who it was but she was very afraid of the voice and told me: “Maybe I should just do it. Maybe I should just obey the voice”. She was at the time taking 4 different antipsychotics and they were not able to take away the voice or reduce stress about the voice.
    I used principles from Cognitive behavioral therapy to see if I could create a link between the voice and positive self talk and at the same time use the principles of exposure training to limit the anxiety associated with the voice. I told her to imitate the voice: “Hang yourself yourself, you swine” and then say ”No! I’m going to live” in a positive voice inside her head in her own voice, very quickly and forcefully. I told her to take a break between each time she practiced this combination.
    In other words, I told her to expose herself for exactly what she was afraid of and to attach this negative voice to a positive sentence in an automatic way, through classical conditioning by repeating the combination over and over. She did at least hundred pairings of the negative and positive phrases, and within two days the voice had disappeared.
    There was was no change in the antipsychotic medication and she was very happy that she had made this on her own. The reason why this method works, is probably that she habituated to the voice, got used to it. She got used to the negative voice, and by actively imitating it, could take away that feeling of loss of control. She took control herself by attaching it to “No! I’m going to live”. So there were two processes at play. First the exposure training: she actively took control and exposed herself to the feared voice, and then took even more control by attaching it through repetition and classical conditioning to the positive voice. It would be very interesting to hear from other people who try this method on scary voices to see if the success is as rapid as it was with my patient. You can contact me at the following e-mail address [email protected]. All contributions will help furthering the work with voices.

  3. The experience of hearing voices during madness or during our “normal” constant inner conversation that never stops, shows that we use words to express our underlying emotional state- which is ever shifting.
    We first and foremost are emotional beings, primate mammals that have evolved to have the ability to use speech to express our unbridled, pre-verbal emotions with words in the first 2 years of life. Our thoughts which are made up of speech/words and symbolic visual imagery express our second by second emotional state. Our dream images and dream speech also are expressing our emotional states.

    The emotional states of fear, rage, self hatred and grief will always create inner words, voices and conversation that reflects those underlying emotional ststes. Every other emotion also creates words to express it.

    An interesting experiment to try is to hold an arm up off your bed as you are entering sleep. As you fall asleep you will start to hear inner converstaions and see inagery. Ask yourself- “What emotion is being expressed right now by the words and imagery?” If your arm drops as you fall asleep, it will wake you up and you can again ask yourself, what emotion was present that created the totally spontaneous words and imagery in that hypnogogic state?

    I think this experimaent will show that there always is an emotion present that underlies the creation of every word or voice or image.

    As a therapist, I first and formeost want to welcome whatever emotional truth is trying to express itself through voices, imagery and speech/thought.

    In the medication free madness sanctuaries I served at, that inner procees of freely living the emotional truth that was erupting from deep in the core psyche and somatic body during madness, was seen as the powerful transformative experience that people needed us to support happening.

    • Hi Michael:))

      Curious synchronicity? I just finished typing this exert from Jaak Panksepp’s “Affective Neuroscience – The Foundations of Human and Animal Emotions,” into my laptop.

      “Sleep, Arousal, and Mythmaking in the Brain:

      Shakespeare proposed one possible function of sleep when he suggested that it “knits up the raveled sleeve of care.” Each day our lives cycle through the master routines of sleeping, dreaming, and waking.

      Although we do not know for sure what the various sleep stages do for us, aside from alleviating tiredness, we do know about the brain mechanisms that generate these states.

      All of the executive structures are quite deep in the brain, some in the lower brain stem. To the best of our knowledge, however, the most influential mechanisms for slow wave sleep (SWS) are higher in the brain than the active waking mechanisms, while the executive mechanisms for REM sleep are the lowest of the three.

      Thus, we are forced to contemplate the strange possibility that the basic dream generators are more ancient in brain evolution that are the generators of our waking consciousness.

      The brain goes through various “state shifts” during both waking and sleep. Surprisingly, it has been more difficult for scientists to agree on the types of discrete states of waking consciousness than on those that occur during sleep. EEG clearly discriminates three global vigilance states of the nervous system–waking, SWS, and dreaming or REM sleep.

      Some people have also thought that dreaming is the crucible of madness. Many have suggested that schizophrenia reflects the release of dreaming processes into the waking state. Schizophrenics do not exhibit any more REM than normal folks, except during the evening before a “schizophrenic break,” when REM is in fact elevated.

      There seem to be two distinct worlds within our minds, like matter and antimatter, worlds that are often 180 degrees out of phase with each other.

      The electrical activity in the brain stem during dreaming is the mirror image of waking–the ability of certain brain areas to modulate the activity of others during waking changes from excitation to inhibition during REM.

      In other words, areas of the brain that facilitate behaviors in waking now inhibit those same behaviors.

      Many believe that if we understand this topsy-turvy reversal of the ruling potentials in the brain, we will better understand the nature of everyday mental realities, as well as the nature of minds that are overcome by madness.

      Perhaps what is now the REM state was the original form of waking consciousness in early brain evolution, when “emotionality” was more important than reason in the competition for resources.”

      When I go through a spontaneous shift into the early phase of mania, it builds to that common experience of a dream like state, although while awake.

      What I think it enables is a “container” for the deeply unconscious “fear – horror” of a birth trauma, which had conditioned my nervous system, with a default activity of avoidance.

      Interestingly, although the brain & nervous systems continue to mature with environmental experience, over the first three years of life. The amygdala, which is the “smoke alarm,” for fear & danger, is online at birth.

      During my periods of euphoric psychosis, I dream while awake? The Siren does in indeed sing, during these heightened states of “powerful transformative experience.” Mind you, if all words are metaphors for our “hidden” processes, she has been doing it all along, in the arts and some amazing song lyrics.

      Maybe its a right-brain to left-brain thing? Or as this brilliant paper suggests, maybe its a whole body/brain thing;

      “A discernible communication between the “Self” and the “I” is only possible during the dreaming and hallucinatory states, whether drug-induced or “natural.”

      During the ”I”-state of daily routine, the outside world is experienced as separate from oneself, and this may be a reflection of the greater freedom (that is, separateness or independence) of cortical interpretation from subcortical activity.

      With increasing ergotropic (sympathetic nervous system) and trophotropic (parasympathetic nervous system) arousal, however, this separateness gradually disappears, apparently because in the “Self”-state of ecstasy and samadhi, cortical and subcortical activity are indistinguishably integrated.

      This unity is reflected in the experience of Oneness with everything, a Oneness with the universe that is oneself.”

      _Roland Fischer, “A Cartography of the Ecstatic and Meditative States,” http://wisebrain.org/papers/MapofMedEcstaticStates.pdf

  4. One interesting thought about voices: maybe they have a function. Could it be that voices are just thoughts that become extra clear to us because they are important or because we are not able to get through to ourselves with only normal level thoughts?

    Often if you ask a person hearing voices what the voices are saying, they will tell you that the voices are saying things like:” you are stupid.” “you shouldn’t do that”, “you are fat”, “you are ugly”, “you can’t do anything right”. In other words, thoughts very similar to what we all have: negative automatic thoughts. Anorexic patients will constantly think “you are too fat, your bellie is bulging, you shouldn’t eat that” but usually they will identify these as thoughts. The self-critical person would say “I can’t to anything right “and identify this as a thought.

    But what if the voices that we hear are just extra strong thoughts:Thoughts that we need to notice. What if this is a survival mechanism to get our attention. Imagine you are in the Stone Age. If you are walking on a path and intuitively feel that there is a bear coming up behind you. Imaginge that that this is an unconscious processing based on many cues in the environment. If you just start thinking, among many other thoughts: “Maybe there is a bear somewhere. Maybe I should try to get away”, you might not get your own attention because there are too many other thoughts.

    There would be a definite advantage to having a way to ramp up the volume of the thought so that you would have to react to it. The brain may be doing this by giving the thought the sound of the human voice. So there might be a survival advantage of having voices that can get your attention. So maybe the phenomenon of voices is not so strange after all. Maybe voices actually give us survival advantage.

    If voices made people very dysfunctional in the Stone Age,the trait would probably not survive, evolutionarily speaking.

  5. The following happened to me at the age of 18. I was working towards my final exams. I was rebelling a lot at home and at school. I overheard my father telling my mother that he thought that I was going to fail my exams which upset me a lot and I decided to prove him wrong. So I started to work furiously to catch up, sleeping little and drinking a lot of coffee to keep myself going. I had never heard about people hearing voices in their head or a thing called schizophrenia. One day in a natural science lesson the teacher asked us to draw a buttercup. Then something unusual happened which I thought rather strange and funny.” Look at her, said a gruff, mocking voice in my head, she is rubbish, she can’t even draw a buttercup” A little voice started defending me. I was aware that my thoughts had aquired a voice somehow. I was standing back and listening to these two voices: the loud one putting me down and the little one standing up for me.Both were commenting about what I was doing.I never told anyone about it. I passed my exams, made peace with my father after physically collapsing probably because I had pushed myself too far. I have never heard voices in my head since but then I have never abused my body again in that irresponsible manner and I taught myself not to get stressed out about life’s rich pageant. A bad conscience might have something to do with it as well.

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