Tag Archives: Hearing Voices

A Psychiatrist Discusses Hearing Voices

By Dr David Laing Dawson

In the winter of 1968 I finished a 24-hour shift in the emergency department of a major Toronto Hospital, changed quickly, and walked out into the still dark morning to catch the trolley on Bathurst St. I heard my name called, over and over. I looked for the source. It seemed to come from the electrical wires strung high above the street. I got on the uptown trolley. I looked at my fellow passengers. They were each oblivious, each locked in their own private early morning thoughts within their heavy winter coats.

Sleep deprivation and stress.

I don’t remember the particular stress of that 7 AM to 7 AM shift, but in 24 hours it must have included some bleeding, screaming, and dying, some vomit and rage and insanity, some crying and bewilderment, some failure.

I have no doubt that it is a simple slippage in our brains that can take our thoughts, our inner dialogue, our inner fears and our self-reassurance, and have us hear them, hear them as if either coming from outside our heads, or from an ‘other’ in our heads. In fact, when you think about it, it seems quite remarkable that usually our brains can make a clear distinction between the inner and the outer. So I am not surprised the boundary can be so easily broken in times of high anxiety, fear, stress, sleep-deprivation, psychosis, brain impairment, and trauma.

I am also not surprised that these voices often carry one of two kinds of meaning: accusations, fears, nasty directives or calming, reassuring, comforting messages. The phenomena that might be more difficult to understand are the hearing of conversations, undecipherable mutterings, even crowds shouting at one another. But then again, if our thoughts are often conflicted, unclear, inarticulate, there is no reason to assume thoughts that become voices would be otherwise.

In the many years since 1968 I have talked to hundreds of people who hear or have heard “voices”.

The most common of these is the hypnagogic experience, occurring in the moments between wakefulness and falling asleep, and the hypnopompic experience during the process of wakening.  I’m sure we have all experienced, at times, the overlapping of dream states and wakefulness, with sounds and images from from each world colliding. As a psychiatrist though, I usually hear about it from a parent or patient worried that it is a harbinger of something serious. It is not. Though this overlap can be increased by drugs that alter the rhythms of sleep, and by anxiety and stress and sleep deprivation.

Then we have the shy, anxious, overly-selfconscious teenagers who imagine, and then feel, and then think they hear their peers speak about them in the crowded hallways and cafeterias of school. For the boys it is usually an accusation of failure, of stupidity, of weakness, of failed or unwelcome sexuality. For the girls it can have more to do with dress, complexion, blemishes, size, being alien, as well as stupid, a loser. If it is the product of anxiety, social anxiety, in this age group, the teen usually, once away from the experience, understands he or she probably imagined it.

But it is often the reason they refuse to go to school, isolate themselves, become depressed. It is painful for them. And it is alleviated by good counsel and medication.

(Of course there are also instances of groups of teenagers actually systematically taunting and commenting on a schoolmate’s shortcomings)

The next most common cause of hallucinations may be brain impairment, from injury,  disease, toxic substances, withdrawal from alcohol, or dementia. And these experiences of imaginary people, imaginary events, fearful reactions, and conversations with visual and auditory hallucinations are scattered, disjointed, intermittent, chaotic, changeable. They also may overwhelm reality, replace it. And if the brain impairment can be treated they go away.

And then the psychotic illnesses: In the exalted state of mania with its feelings of power, of influence, of supreme importance (often accompanied by sleep deprivation), the thought that becomes a voice often belongs, as one might anticipate, to God. And the messages are prophetic and instructive. Usually instructions to share one’s new found wisdom. But sometimes they draw on the Old Testament and include fire, flood, pestilence and vengeful punishment.

Fortunately we now have medicines that quell acute mania in short order, and prevent, if taken regularly, relapses.

In the past it was not uncommon for a manic person to die of exhaustion, pneumonia, exposure, or to wreak some havoc, before coming back to earthbound reality.

And then we have a psychotic depression. Again if the boundary between thought and auditory experience is broken, the thought-voices align with the person’s mood. They are dark, hopeless, foreboding. They speak of death and disease. Usually the sufferer’s death and disease, but sometimes, with some men and women, the death of their family as well.

Undiagnosed and untreated a psychotic depression often leads to tragedy. Again, fortunately, our modern treatments, including ECT, are very effective.

And then we have  the schizophrenias. In my experience the hearing of voices is just one part of schizophrenia, a small part, though often very distressing to the sufferer. Many don’t admit to voices until years later. (For over a year it had remained a puzzle why one young man jumped off a school roof. Until he was well enough and he trusted me enough to tell me about the instructions he was receiving at the time.)

And the voices, the transformation of thoughts to an auditory experience, again follow the pattern of the sufferer’s feelings, ideas, distorted interpretations. They are often accusatory in nature, exacerbating guilt and self-loathing. They are sometimes instructive. That is, they might propose an action that will stop the pain and suffering of others. Such as jumping off a roof.

For most people with schizophrenia who do suffer auditory hallucinations the voices are tormenting. They would like them gone. A few get used to them, learn to ignore them. A very few, eventually, allow them to become a comforting background buzz within their otherwise socially isolated lives.

And an equally common symptom of schizophrenia is the reverse: the discomforting conviction that others in your proximity can hear every thought you have. Your thoughts are being broadcast as it were. (The treatment of schizophrenia is addressed in many other blogs on this site.)

Trauma. Abuse. It is again not really surprising that during acute trauma, during the experience of pain, fear and the threat of death and of absolute powerlessness to change this, our brains can take us elsewhere, that they have mechanisms at hand in these dire circumstances to transport us to kinder experiences in our imagination. For a child this may include being a different child with reassuring caregivers, better parents, a much more benevolent world. The more prolonged the abuse the more complex and real the imagined world may become. It could include multiple thought/voices that reassure and comfort. And others that threaten and punish.

The adult who survives this may carry with him or her both a hypersensitivity to threat, to the faces, noises, smells and symbols of threat, quick and exaggerated fear reactions, as well as an ability to call up, to return to, to run to, the other worlds of reassurance and comfort.

This is not schizophrenia. It is PTSD. We don’t have pills that fix this. Though we do have some that may improve sleep, alleviate some anxiety, and quell the most extreme reactions. And to focus on strength, to find a way to deny the memories, thoughts and voices that threaten, punish, and degrade, and to lean on the thoughts and voices that support, comfort and empower, is a good and courageous survival mechanism.

If the voice is comforting and supporting, and not interfering with one’s ability to live and survive and function in our tangible world, I would not want to try to quell it.

Am I A Reductionist? Part I

By Marvin Ross

I must confess that I’m not really sure what that means other than that it has been an accusation leveled at  me. One of my advocacy colleagues told me recently of a conversation she had with a member of the mental health bureaucracy and my name came up. The bureaucrat said he read me and that I was a controversial writer (I try) but that I was a reductionist. I wasn’t sure if that was a complement or an insult.

Then, just recently, someone who did not like Susan Inman’s latest Huffington Post blog critical of the Hearing Voices Movement, accused her of also being a reductionist. I guess it is an insult. Ms Inman is the author of After Her Brain Broke: Helping My Daughter Recover Her Sanity which my company publishes. 

What does our being accused of being reductionists mean? Richard Dawkins, in The Blind Watchmaker (1996) said Reductionism is one of those things, like sin, that is only mentioned by people who are against it.” This was quoted in Reductionistic and Holistic Science by Ferric C Fang, the editor in chief of the journal Infection and Immunity.

The abstract for this paper states:

A reductionistic approach to science, epitomized by molecular biology, is often contrasted with the holistic approach of systems biology. However, molecular biology and systems biology are actually interdependent and complementary ways in which to study and make sense of complex phenomena.”

And then the paper goes on to say:

Few scientists will voluntarily characterize their work as reductionistic. Yet, reductionism is at the philosophical heart of the molecular biology revolution. Holistic science, the opposite of reductionistic science, has also acquired a bad name, perhaps due to an unfortunate association of the word “holistic” with new age pseudoscience.”

The author substitutes system biology for holistic biology because it lacks the pejorative nature of holistic. And I don’t want to try to give a precis of this paper but simply to say that molecular biology is an example of the triumph of reductionism. But holism goes back to Aristotle and the two are not mutually exclusive. Again, the author states that:

Each approach has its limitations. Reductionism may prevent scientists from recognizing important relationships……..Holism, on the other hand, is inherently more challenging due to the complexity of living organisms in their environment.” And, “When fecklessly performed, systems biology may merely describe phenomena without providing explanation or mechanistic insight or create virtual models that lack biological relevance”.

Furthermore, “It is difficult to imagine how a number of important scientific discoveries could have been made by any method other than a reductionistic approach.” However, the author points out that the “reductionistic and holistic methodological approaches have been coexisting and thriving for centuries. One can argue that Darwin’s theory of evolution represents an early example in which many reductionist observations on finches and domesticated pigeons were synthesized into a system that unified all of biology……….Nevertheless, there is no denying the revolutionary impact of holistic thinking on the field, both in calling attention to situations in which reductionistic approaches have been deficient and in the generation of new experimental approaches for the analysis of complex systems .”

There are many other sources on the reductionist/holistic dichotomy and you can peruse them if you wish. It is only through reductionistic scientific enquiry that we may find a specific and necessary cause  of a problem  though many other factors contribute. But, it is also wise to have a holistic perspective.

There is no either/or in our search for answers and explanations and to abide by one methodology while ignoring others, is stupid and narrow minded. So, thinking, as some seem to do, that they can dismiss my views or those of Ms Inman as reductionist serves absolutely no purpose whatsoever. It says far more of them than it does of us.

Anyone who is honestly seeking truth needs to be open to reasoned arguments and to the unbiased evaluation of fact.

Next On Models, Concepts, Power, and Politics – Part II by Dr David Laing Dawson