The Voices My Daughter Hears

“In the case of hearing voices, it seems as if there is a
kind of ‘placing outside’ of emotions; and emotions are, in the
beginning, felt to be provoked by the voices. Only in the process
of recovery do emotions become recognized again as one’s own.”

Living with Voices: 50 Stories of Recovery — Marius Romme

I write about my daughter Annie’s voices with her permission. They are her private experience and I can never completely understand what it must be like to live with them, but she has entrusted me to try and “do some good” with them, maybe help shed light on and humanize this very stigmatizing topic or perhaps provide a modicum of succor to other families. She is a young woman now, twenty-two as of this writing, living her life and grappling with many of the same things as others her age; however, the voices have not budged. Objectively, I am fascinated by the way her mind works, why the voices came to be, how they behave, how she lives with them; subjectively, I am inspired by untold sympathy for my daughter and am in awe of her courage and strength.

Hearing voices is a little understood phenomenon, and the statistics belie its apparent uniqueness. Studies have shown that between 4 and 10% of people throughout the world hear voices. At last estimate, 22% of 11-13-year-olds and 8% of older teens hear “distressing voices.” For many children, the voices disappear with time, but for others, like Annie, they become an intrinsic part of their identity. Learning to accept the voices and find meaning in them is the herculean task for this population of voice hearers, and I believe the time is ripe for a more open discussion about them and a more holistic approach to living with and treating them.

* * *

In the early days of Annie’s voice hearing, my husband Mike and I attended a three-hour information session on voices at a behavioral health hospital some distance from our home. After a brief background on auditory hallucinations, the moderator distributed each of us a pair of earphones, along with a small cassette player with a tape of simulated “voices.” Next, everyone was assigned a different list of tasks to carry out as we listened to our tape and navigated our way through the hospital. The purpose of the exercise was to get a true feel for what the experience of hearing voices was like. I set about my route, stubbornly ignoring the voices on my tape, but the forced concentration left me tense and grouchy. When the group debriefed, everyone commented on how difficult it had been to follow their instructions and how scary and demeaning it had felt to be berated by the voices on the tape. Mike and I were the only family members present, the rest mental health workers, and when we mentioned that our daughter was the voice hearer, the group extended their sympathy. By the end of the session, we knew more about what the actual experience was like than when we had started. The simulation had been a commendable effort at consciousness raising, but from everything Annie had told me, and everything I had read about hearing voices, I knew it was a vast trivialization of the real thing. However, despite this inevitable drawback, the activity of the voices on that tape — the fluctuations in tone, character, the number of the voices, the content — had made an impression on me and is still probably the closest I am ever likely to approach the brouhaha in Annie’s mind.

The voices were extraordinary; in a way, they were like ghosts. I could not see them, but only divine them by the turmoil they stirred up in Annie. They were not polite house ghosts who knew when to leave; they were ne’er-do-wells she could not get rid of. Cloak-and-dagger was their stock-in-trade. They were tormentors and torturers, testing the limits of her sanity, blackmailing her into submission. They were rude and obscene, taunting her with insults and foul language. They were nosy, intruding on her private thoughts, and gossipy, prattling on about trifles. They were nasty and mean, loved to sabotage her, trip her up while she was working or socializing or trying to pay attention in class, calling her name from various corners of a room, just to confuse and embarrass her, which made it hard for her to “prioritize” what she heard. They were incorrigible hecklers, mocking her at every turn. They were loafers, murmuring nonsensical chatter, lazy background static. They were boors, sniping at what she or anyone around her was doing, wearing, or saying. They were male, female, genderless, with distinct personalities, whose voices bore no resemblance to her own. They were entertainers and comedians, amusing themselves in comical asides and other mischief, sometimes even joking with her. They were loquacious and spoke gibberish, riffing on everything they heard or saw, from the word “green” someone just spoke to the refrain from a song on the car radio. In addition to these “regular” voices, she also heard other sounds the rest of us did not hear, things like banging doors, shrill whistles, animal sounds, music, maniacal laughter, and screaming. Occasionally I jested with her, “What’s going on with the crew up there?” “Oh, you don’t want to know!” she would say.

Falling asleep at night was another Sisyphean task. The quieter Annie got, the more likely the voices were to rise in pandemonium. She kept the radio on loud at her bedside, kept the light on beside her, kept her windows wide open even in the dead of winter, any physical sensation to detract from the voices’ commotion. Medications sometimes helped ease her into slumber, but they left her groggy and out of sorts the next morning. During the high school years, she reversed course and took to taking lengthy showers, with the radio on, trying to literally drown them out. She loved music; it was one of the few things she found both a distraction and a tonic. She had a good singing voice and sense of rhythm and could repeat songs almost verbatim, in pitch, with all the subtleties, after hearing them once or twice. Reading, television, and knitting were also calming, but, as she told me once, the struggle not to run out screaming in the streets was never less than exhausting. The focus of her days therefore was modest yet beyond most people’s comprehension — to survive the continual onslaught of the voices without yielding to despair. Despite that dissonance in her head, she was in most other respects a typical teenager, up on the latest music and fashion, concerned about her appearance, and eager to obtain her driver’s license. Her boyfriend at the time was kind and supportive, but she often wondered, “What is he doing with me? I’m crazy!”

* * *

In the fall of 2012, I attended another hearing voices event, this time a NAMI-sponsored presentation by a witty, articulate, and slightly disheveled Scotsman named Ron Coleman. The flyer said he would speak about his own experiences with voice hearing, which keenly interested me, for besides Annie I had never met another person with the “lived experience” of hearing voices. Before the event got underway, I was browsing through the informational books and CDs spread along the side table when I overheard the person next to me conversing with a man I thought must be Ron. I could hear his thick Scottish accent, and when the opportunity arose, I worked up my nerve to strike up a conversation with him. I asked if it was true that he heard voices, and he casually nodded. I asked if he still heard voices, and he nodded again, adding, “But I only listen to them for a short while in the evenings.” I told him that my daughter was also a voice hearer and he was interested to learn more about her, but he was called to the stage as the presentation was about to get started. It still shames me to say it, but I was not expecting someone so completely rational, someone so friendly and approachable, who also happened to hear voices, and I realized I was not immune to the stereotypes about voice hearers.

The purpose of Ron’s visit was to raise awareness of the phenomenon of voice hearing as part of the “diversity of the human experience.” Ron explained that hearing voices most often occurs in a person’s life after experiencing some type of trauma. In this light, he said, whether the trauma is emotional, physical or sexual in nature, voices are a normal human reaction to the overwhelming psychological stress induced by that trauma. Voices, he emphasized, are not a sign of “madness,” but rather a meaningful way human beings cope with their extreme feelings of powerlessness and helplessness. Voices thus do not come out of nowhere; they arise within a social and emotional context. As any victims of trauma will attest, they did not choose the terrible thing that happened to them. Their world was somehow radically transformed, often destroyed, and voices are like shrapnel after the explosion. Voices can also be likened to slivers of a broken mirror, reflecting a kaleidoscope of distorted images to the voice hearer. According to Ron Coleman, those pieces need to be put back together. Voices, he said, hold special meaning which the voice hearer cannot afford to ignore.

Ron made a distinction between the traumatic event — what happened to the voice hearer — and the voices, which are the consequence of what happened. While the trauma was no doubt a horrendous event, he maintained that it is not necessarily the main problem for the voice hearer. Emotions are what fuel the voices, and when human beings cut themselves off from the emotions that naturally flow from the traumatic events, they profoundly disrupt the healthy processing of the trauma. For Ron, it all starts with one question, “What happened to you?”

I first heard mention of a “Hearing Voices Movement” in 2011, when I read an article in The Sun Magazine entitled “The Voices Inside their Heads,” an interview with Gail Hornstein, Mount Holyoke College Professor of Psychology, by Tracy Frisch. Hornstein has been studying firsthand accounts of people with ‘mental illness’ for decades and considers these individuals “experts of their own experience.” In her book, Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness, she explores the topic of hearing voices in great depth. Like Ron Coleman, she believes that no person is beyond hope and rejects the alienating medical language of the psychiatric community, mostly because it does nothing to help the patient.

Hornstein explains that voices are not the “inner speech” or internal monologue that most of us are familiar with, where we tell ourselves to do something or admonish ourselves. True voice hearing is different. She asserts that voice hearers “hear those voices through their ears, the way you are hearing my voice. Most people find it highly distressing. The experience often becomes overwhelming, especially if they don’t tell anyone, which is common. Imagine if I started screaming obscenities at you and accusing you of things that only you would know you were potentially guilty of. It would be terrifying.” Hornstein states that the voices heard by voice hearers are as diverse as the people who hear them and describes the heterogeneous makeup of the voices themselves: While some sound like human voices, others more resemble mumbling or static or animals or a machine or the maniacal laughter Annie so often hears.

Gail Hornstein’s description of voices was remarkably close to Annie’s day-to-day experience, and I was moved by her devotion to this unconventional cause. I immediately ordered her book and sent a copy of the Sun article to our support team at Child and Family Focus, the mental health agency Annie was working with at the time. The serendipitous discovery of Hornstein’s article was my first step away from the hush-hush atmosphere of voice hearing within the psychiatric community into the light of the “World Hearing Voices Movement.”

For both Ron Coleman and Gail Hornstein, disregarding the voices is not the answer. Voices, they say, are more likely to get louder when ignored, and talking about what the voices say is one of the few things likely to diminish their intensity. Hornstein also attests that the reason people hear voices is that they have “experienced some kind of trauma that is too unbearable to remember directly.” The victim is afraid to talk about the trauma and is therefore unable to integrate it into the rest of his or her personality. As a result, the psychological processing of the trauma breaks down and the most harrowing, emotionally charged memories of the trauma go underground, splitting off from the rest of the mind. Unwittingly, and tragically for the voice hearer, the processing of the traumatic episode is relegated to the unconscious, where it operates autonomously, “the way digestion does: we don’t have control over it.” For some individuals, the trauma eventually returns in the form of “voices.”

I was fascinated by Hornstein’s characterization of an automatic, independent mechanism at the root of voices and began to apprehend a world where they made a malicious kind of sense. Like other defense mechanisms, they are mostly unconscious attempts to reduce anxiety by pushing back uncomfortable or unacceptable emotions, impulses, and thoughts. Most defense mechanisms are “primitive,” the garden-variety type that originate in childhood such as denial, regression, and projection. While defense mechanisms may help someone deflect anxiety in the short term, the goal for human beings is to learn more mature ways to confront emotions and cope with stress as they get older.

Voice hearing is considered one of the more sophisticated “dissociative” defense mechanisms. This category of defenses usually does not become activated until some time past the early childhood years. Psychological dissociation is defined as “the splitting off of a group of mental processes from the main body of consciousness.” These defense mechanisms manifest on a continuum, ranging from the mild detachment of daydreaming or “spacing out” from one’s immediate surroundings to the more extreme states of amnesia, depersonalization (feeling detached from one’s body and thoughts), and psychosis. While we can learn to become aware of the point at which we begin to use the simpler, more primitive defenses, the dissociative defense mechanisms are harder to pin down and hatch from a more mysterious realm. Dissociative defense mechanisms separate individuals from their troubling memories and emotions in the real world. In cases of extreme trauma, they can be the most effective means of completely blocking out psychic pain; however, the achievement is attained at the steep price of severe psychological disturbance.

* * *

Unlike Gail Hornstein, Charles Fernyhough, psychology professor at Durham University in England, in his book The Voices Within, sees a vital similarity between voice hearing and “inner speech.” He posits that the inner dialogues we have, which are a kind of splitting of the self and helpful in reasoning, can also be a safety mechanism in that they help channel inarticulate painful emotions into more comprehensible and digestible language. This can be akin to cognitive behavioral therapy, where thoughts are intentionally formulated and used to challenge fears and the mental habits of anxiety disorders. Fernyhough believes that voice hearing bears some relationship to inner speech. When people endure horrific ordeals they frequently recall having automatically “dissociated” during the episode in order to survive the overwhelming stress. “Splitting itself into separate parts is one of the most powerful of the mind’s defense mechanisms,” states Fernyhough. These dissociated states can later take the form of voices with a similar point-counterpoint tone.

On a personal level, I could understand the value of the inner dialogue and the power of the mind’s dissociative capacity; I could also imagine voices somehow emerging from the dissociated states, but if the job of these split-off voices was to ward off traumatic memories, it seemed a grotesque transaction. The voices go hideously overboard in their diversionary tactics. They manifest in almost lifelike proportions, sundering voice hearers so completely from their everyday reality, their sense of belonging in the world, that they become strangers to themselves and the environment around them. If the voices once emerged within a social and emotional context, when they become lodged within the psyche most vestiges of that context disappear and remain imperceptible to the disoriented voice hearer.

Simon McCarthy-Jones, professor of clinical psychology and neuropsychology at Trinity College, Dublin, proposes in his book, Can’t You Hear Them? The Science and Significance of Hearing Voices, that voice hearing may “be driven by prior expectations” or “prior knowledge.” Where science has traditionally viewed the brain as “passively drinking in signals from the external world” and then translating those signals into perceptual experiences, an alternative approach to understanding perception offers the “predictive processing framework.” This theory contends that the brain automatically weighs any current actual sensory stimuli in its field against phenomena it has experienced in the past and calculates a “prediction error” for how accurately it will perceive the current stimuli. In other words, the brain “peeps at the past to predict the present,” and then chooses, or predicts, the best hypothesis of reality based on the lowest prediction error. To some extent, then, the perceptions that register in the brain are more reflective of the brain’s prediction of the experience than of the “actual thing ‘out there.’” This process enables the brain to allocate a relatively small portion of its resources to dealing with the prediction error factor, rather than wasting time and effort assessing every new sensory experience.

The therapeutic implication for voice hearers who hear distressing voices, according to McCarthy-Jones, is that to rid themselves of the voices, their brains “need to be persuaded that what [they are] experiencing is not best predicted as being a voice, but rather as being inner speech or a memory.” One way to re-train the brain involves modifying the cues it takes in from the external world, which in turn color its predictions of our perceptions. During and just prior to voice hearing, individuals often experience muscle tension, fear and anxiety, and if the body can be physically relaxed, through deep breathing, improved sleep or medication, for example, it might be possible to alter the cues which can trigger the dissociative mechanism of voices.

This, too, made sense to me, and I could see where physiological adjustments might affect the environmental cues the brain relies upon. In times of greater stress, for instance, Annie’s voices were usually at their worst, but if the brain was in the business of choosing the most apt perceptions, it seemed unfair that voice hearers, most of whom had traumatic backgrounds, had prediction errors unfairly weighted toward anguish and shame.

Voices lend themselves more to the language of metaphor than science, eluding and transcending scientific explanation. As Daniel B. Smith writes in Muses, Madmen and Prophets, with voice hearing “all preliminary steps are bypassed. There is no breath, manipulation of air, no movement of bones or cochlea, not even a stimulation of the auditory nerve. With voice hearing the brain, working alone in its watery chamber, creates a voice out of nothing but its own duplicitous silence. And it does so with such reality and finesse that the individual whose brain is engaging in such operations experiences the voice as if it were external. How is this possible? How can the brain create a voice in the absence of an external stimulus?” In other words, the modern psychiatric community is at a loss to explain voice hearing in any cause-and-effect, materialistic kind of way.

The neuroscientist Gerald Edelman compares the human brain to a jungle, with its countless tangled masses of neuronal networks. Spectacular feats of cooperation occur among these jumbled neurons at every instant, enabling us to perform advanced neurological functions, but for the brain to operate optimally, he claims, it must deal with emotion. Its gears must be lubricated and anointed with the springs of joy, sorrow, fear, hate, love. Edelman’s vivid conception of the brain reminded me that the emotional fallout from Annie’s second grade trauma still lay buried in that dense jungle, its fountains of emotion desiccated, obstructing the natural flow of neuronal activity. The jungle metaphor also suggests the savage potential of emotions gone astray. It was not hard to conceive of voices materializing like vapors from the embers of some unknown brutality left smoldering in that jungle and then to imagine how lost and imperiled someone like Annie might feel trapped there.

* * *

However best we grasp the concept of voice hearing, according to people like Ron Coleman and Gail Hornstein the only way voice hearers can come to grips with their voices is by venturing into the jungle itself. This means voice hearers must work at uncovering, exploring, possibly even reliving events that might have engendered the voices. As they begin to reconstruct some of these distressing life experiences, voice hearers may find their voices contain logic, form a coherent narrative structure. Voices can be instructive, indicating what voice hearers are afraid of, what they cannot cope with, and what it would best behoove them to work on. And, as Simon McCarthy-Jones discussed, if voice hearers can learn to retrain their brains by identifying the conditions, the bodily sensations, the thoughts and feelings that trigger an increase or change in tone of their voices, they might find a way to manage their emotions, and thereby their voices. Since we cannot tap directly into the brain’s unconscious to figure out the mechanism that creates voices, we can at least approach it by re-creating the developmental steps that led up to their formation.

“My own journey to illness, far from being a series
of biological or chemical events, was in simple words
the culmination of personal life events that I had never
dealt with.”

Recovery: An Alien Concept? — Ron Coleman

In the spring of 2012, Ron Coleman, along with his wife and professional partner Karen Taylor, travelled from their home on the remote Isle of Lewis, off the coast of Scotland, to Montgomery County, Pennsylvania to give a two-day conference on voice hearing. Excited by the prospect of their visit, I insisted that Annie accompany me at least for the first of the two days. She was a freshman in high school at that point, weaned off antipsychotic medication and holding her own in the Emotional Support program in high school. Her psychiatric diagnosis had changed to “recurrent clinical depression and OCD, with psychotic features.” Since the sixth grade, Annie’s voices had shown no signs of abating, and she still disliked talking about them or even acknowledging them. Annie had told me many times that she was embarrassed to have voices and did not want to advertise the fact. She also had no interest in learning anything about voices and was extremely reluctant to attend the conference. The main reason she finally agreed to go was that it would be a day off from school.

As much as I wanted Annie with me at the conference, I was nervous about it, as well. I was not sure how receptive she would be to Ron’s presentation, to his fresh-air views on a topic she preferred to keep tightly under wraps. It was mostly against Annie’s wishes, then, that we and approximately forty other voice hearers, support workers, mental health advocates and family members, assembled on a rainy spring day to hear what this engaging Scotsman had to say.

Wearing a “Psychottish and Proud” T-shirt, Ron immediately captivated the audience with his disarming honesty and humor. “How many voice hearers do we have in the room today?” he asked. Ten to fifteen hands quickly shot up in the air. Annie’s hand went up slowly, hesitantly. “How many of you voice hearers right now hear your voices telling you to run out of this room as fast as you can?” This time Annie raised her hand more swiftly and we exchanged a knowing look. Several times in the past she had explained to me how threatened her voices felt by any direct confrontation, and I thought for the first time of how stressed the voices themselves must be, held captive at that conference. With that one question, I could sense Annie slightly relax and start to wonder whether Ron might be a person who could truly understand her. “How many of you voice-hearers were ever asked by your psychiatrist what the voices actually say to you, besides ‘are they commanding voices?’” The same hands rose in the air, and so it went as Ron demolished one longstanding taboo after another around voice hearing. It was clear there would be no talk of “auditory hallucinations” or “psychosis” that day, only invigoratingly frank discussion about life and the realities of hearing voices.

Ron admired voice hearers, respected the pathos of their lives, the strength of the human instinct that allowed them to survive trauma at any cost. He shared his own painful history of trauma, which included sexual abuse by a Catholic priest and the early suicide of his first love. He had spent a decade in and out of institutionalized care for schizophrenia, but ultimately, as he said, he “gave up being schizophrenic,” deciding instead to work full-on toward recovery. He still hears voices, but has learned to manage them, learns from them and even thrives with them. He spoke of the many illustrious figures throughout history who have also heard voices and kept returning to the fact that hearing voices is, and always has been, part of the normal range of human experience. As a mental health trainer, consultant, advocate, and author, his mission is to educate the public about voice hearing and to empower voice hearers to live full and meaningful lives. I hoped Annie would take comfort not only from the passion of his encouraging message, but from the knowledge that she was in good company with legions of others throughout the ages.

For Ron, recovery means the ability “to hold onto the self,” both personally and in society. He believes that when the self is invalidated through destructive relationships, it struggles for composure and, if invalidated long enough and severely enough, it collapses, fragments and becomes alienated from itself and from society. Another criterion of recovery for Ron is “wholeness,” which for him means listening to all parts of ourselves. When we censor our emotions, suppress the strong feelings induced by trauma for too long, we lose the capacity to function well as human beings and members of society. We are missing actual pieces of our self and, as a result, the internal structures break down. Ron traces the development of his voices in his book, Recovery: An Alien Concept?

“Suppressing one’s feelings is a normal coping strategy that many people employ to protect themselves from adverse life events. I suppressed my feelings for many years before I was forced to face them, and I now believe that the reason I heard voices was my refusal to explore and deal with my own distress. Though I was not prepared to examine what had happened in my life on a conscious level, this did not mean that my unconscious mind was doing the same. Indeed, much of the thinking around my voices is based on my belief that they appeared in order to alert me to the fact that my life was not whole. What I mean by that is that when we endure a major trauma (and refuse to deal with it) we cannot successfully suppress our emotions forever: there comes a point when they must be dealt with. Continual refusal to acknowledge even the existence of a problem brings with it the need to adopt ever more extreme coping mechanisms (in my case, self-isolation and playing sport in a violent manner that went beyond the norm of the game). Indeed, the fact that my voices started after an injury that ended my rugby career is indicative of the short-term usefulness of distraction-type coping strategies. Stripped of my means for dealing with my past forced my inner self into the position of reliving my experiences. However, my continual refusal to acknowledge the past traumas left my inner self with no option but to externalize them through the introduction of voices. I believe that it was my refusal to use the opportunity presented to me to explore the voices when they first started that caused me to be hospitalized. This refusal (like that of many others) is partly based on the societal belief that voices equate with insanity. This was the belief I held myself at the time, and the reality for me at that point was a simple one: I was mad. My secure self had vanished, to be replaced by a helpless and frightened self that felt controlled by the voices I heard.”

* * *

I returned for the second day of the hearing voices conference without Annie. Ron and Karen planned to devote this day to “working” with the voice hearers, which I was eager to observe. On day one, Ron had selected a voice hearer from the audience, “Brian,” who agreed to participate in a “voices profiling” exercise. Brian had been taking antipsychotic medication for several years, with negligible improvement in his voices. Ron and Karen had asked him a handful of simple questions, which helped identify the number of voices Brian heard, their gender, age, tone and other general characteristics, all the while sketching out his answers in graph form on a large easel. On day two, they engaged Brian and his voices in a type of psychodrama. Seated in a semicircle, with one chair left vacant for the voices, Ron and Karen gently delved into the heart of Brian’s “story,” delicately commenting on events and posing questions to both Brian and his voices. Remarkably, Brian related what his voices said to him, in the moment, word for word.

As his traumatic past unfolded, Brian became overwhelmed with emotion. Ron and Karen unearthed layer upon layer of guilt Brian carried and then deftly attempted to relieve him of that burden. Brian had been betrayed and abused by his father in various ways since he was a child, and through Ron and Karen’s subtle intervention, he accessed his original innocence, the vulnerable youngster who had been taken advantage of, the teenager who never had the chance to model himself after a respectable authority figure. It was breathtaking, authentic, heartrending theater, and at its conclusion, Brian’s harshest voice, who represented his father, agreed to “go away” for two months, the amount of time Ron had suggested. Brian himself perceived a relationship between his voices and the traumas he had suffered, which seemed to him an astounding, energizing discovery.

Ron and Karen offered to further support Brian by helping him develop coping strategies, and they invited him to stay at their Recovery House farm in Scotland. Voice hearers at Recovery House were given free accommodations and mental health support in exchange for doing chores around the farm. Ron declared that the most important job any voice hearer at the Recovery House farm had was to work on a recovery plan and to get well, however long that took. Brian was not able at that time to travel to Recovery House, but Ron and Karen planned to keep in touch with him through Skype to sustain the momentum of his recovery.

Watching Brian face down his demons had provoked considerable pain in me. I found it extremely moving to witness his deepest emotions laid so completely bare. I felt terribly sorry for him, for the misfortune of his early life, for the harshness of his voices, and the bleakness of the internal landscape he confronted each day. It was a short vicarious jump to grieve for Annie, and I was grateful she was not there to see my tearful outpouring or catch my gloomy sense of despair. I knew that I myself would not have the strength to endure the voices, but I wanted to project hope for her. Instead I told her how awe-inspiring the day had been, which it was, and how brave Brian had been, which was true. Annie, too, had emotional grit and was tougher and more resilient than I often gave her credit for, but I knew she would probably never dredge up the voices or expose her traumas as fully as Brian had. I had pretty much dragged her to that first day of the hearing voices conference, and there was no guarantee she would ever step into the lion’s den again.

The following October, though, Ron and Karen returned, and to my great satisfaction Annie attended both days of the conference. Ron went out of his way this time to take her aside and chat with her in private about her struggles. She confided fragments of her torturous second grade experience with Sister Maria, and since his own trauma of abuse had been at the hands of a respected Catholic priest he was able to relate to her in a specific and deep way. Later, as the three of us sat together, he asked Annie what she would ideally like to see happen with her voices, and she replied, “At this point, I think I’ll be living with them for the rest of my life, but I would like to not just exist with them. I’d like to have a really good life.”