March 25, 2007

"I've learned over time that my voices can't be rejected."

"No matter what I do, they won’t go away. I have to find a way to live with them."

Should there be a new acceptance of auditory hallucinations? Daniel B. Smith writes about the work of Hearing Voices Network, which argues that hearing voices does not always mean that a person is psychotic:
In his 2003 book, “Madness Explained,” [Richard] Bentall draws on the theory that auditory hallucinations may have their roots in what psychologists call “inner speech.” All of us, every day, produce a steady stream of silent, inward-directed speech: plans, thoughts, quotations, memories. People hear voices, Bentall argues, when they make faulty judgments about whether this inner speech is the product of their own consciousness or of something alien to their consciousness. Lapses in what researchers call “source monitoring” may occur for a number of reasons — because an individual is primed to expect a perception to occur, because the level of background noise makes it difficult to separate what is internal from what is external, because he or she is in a state of emotional arousal. But whatever the cause, Bentall writes, there is evidence to suggest that hallucinating “can be explained in terms of the same kinds of mental processes that affect normal perceptual judgments.”

This theory raises the critical question of why making source-monitoring errors results in psychosis: why, when people mistake their private speech for someone else’s, does it cause them to grow so distressed that they seek professional help? The answer Bentall gives echoes Romme’s observation that a fundamental difference between voice-hearers in the community and voice-hearers under psychiatric care is that the latter think negatively about their experience. According to Bentall, how patients perceive auditory hallucinations can have a significant impact on how those hallucinations are experienced.

35 comments:

rightwingprof said...

I thought it wasn't hearing voices that made you nuts, but answering them back.

Patrick said...

Does thinking voice hallucinations are a bad sign make me an audiophobe?

If so, then fine. I'm just never going to support marriage between people and their voices no matter the lobbying.

P. Rich said...

"This theory raises the critical question of why making source-monitoring errors results in psychosis: why, when people mistake their private speech for someone else’s, does it cause them to grow so distressed that they seek professional help?"

Not to put too fine a point on it, but making source-monitoring errors (what a benign phrase) is psychosis - not the seeking of help for the condition. Ask any psychologist. The ones who seek help are the healthy ones. The rest of us bumble along mired in our various disfunctions.

Organizations and attendant behaviors intended primarily to condition people to feel good about their disfunction (or limitations) are generally destructive. You know, like the whole silly self-esteem movement in education.

Rick Lee said...

Apropos of nothing perhaps, but I like that new TV show "Raines" (with Jeff Goldblum) where the police detective sees and hears hallucinations but he recognizes that they are such and does not want psychiatric help.

downtownlad said...

Can't we agree that people who hear God talk to them are nuts as well.

Spiny Norman said...

DTL brings up a really interesting point. Not exactly the point he was trying to make, but an interesting one nonetheless. Among Pentecostal/Charismatic circles people, a rather small number, will talk about hearing the auditory voice of God.

Now, that's a little weird to me. Most of the time "hearing from God" is more of an impression, an emotional moment, the inner speech that most people have. It's generally distinguished in other ways, but it's not really a Voice.

But some people say they hear that Voice. For the most part I tend to dismiss them, because in those circles you're really the coolest and have a lot of authority if you can say that. Maybe they really are hearing a Voice.

Which goes to exactly what Bentall is saying. If the voice is saying "kill your children" then it's a bad thing and the person needs help. But if the voice is saying, "Go to Africa and brings lots and lots of food" then it is likely going to help a lot of lives. It might be nice to encourage that Voice.

And people who say God talks to them are nuts, unless God is really talking then it's the other people who are nuts for not hearing God. It's a tricky issue really.

downtownlad said...

I don't care if people hear voices. As long as they recognize that it is their brain playing tricks on them, and that the voices are not really there. It's when people "believe" that the voice is someone else and then act on those voices - that's when I think we're getting into the realm of psychosis.

Palladian said...

downtownlad wasn't trying to make a point. He was trying to be his normal nasty insulting self.

At least that's what Elijah just told me.

Seneca the Younger said...

This theory raises the critical question of why making source-monitoring errors results in psychosis: why, when people mistake their private speech for someone else’s, does it cause them to grow so distressed that they seek professional help?

I think there are two category errors here. I don't think making source-monitoring errors results in psychosis; I suspect that certain psychoses lead to source-monitoring errors. The voices aren't the psychoses.

Personally, I'm listening to Harry Chapin sing "Taxi" right now, in my head, right down to the little riff he does with first harmonics in the bridge. This doesn't distress me; it's kind of convenient that have that kind of eidetic memory of music.

It's when I can't change the track that it makes me nuts.

downtownlad said...

Let's stop with the attacks Palladian. Ann said she is trying to change the tone.

Peter Palladas said...

Yet most of the members spoke of their voices in the way that comedians speak of mothers-in-law: burdensome and irritating, but an inescapable part of life that you might as well learn to deal with.

Ain't that the truth. Though to date mine [mother-in-law not voices] has never 'instructed' me to cause significant harm to another human being.

I did 'hear a voice' once as I was drifting off to sleep - but most certainly not asleep - starkly informing me that my father would die on such and such a date.

The day of the week, the month and the year were near enough bellowed into my - inner? - ear. No introductory apology a la "You'd better sit down Sir, I'm afraid we've some real bad news for you", just a bald exchange of information.

It was, indeed, an entirely plausible statement given that my father was terminally ill and did in time die, but as it turned out factually incorrect.

I checked the calendar and found that my voice had omitted to consider that year X was a leap year, so therefore 'it' had the wrong day of the week.

I've never taken notice of voices since then - too pedantic to be dealing with sloppy info.

Reminds me of the pervert who leaned over the stalls at the Liverpool Station loos to tell me "My that's a big one." Well I was nine at the time and knew full well that my penis was totally and properly boy not man sized. Have never believed a word a pervert has told me since.

BTW: Totally, effing typical though - given the deathly underfunding of mental health services in the UK - that a 'student' social worker should have been named as a 'facilitator'.

Facilitator of what other than her total ignorance of experiential living or lack of due professional skill and competence?

HaloJonesFan said...

downtownlad: Are you really that humorless?

As for the voices, there's also the Japanese comic book "MPD Psycho", where a detective with multiple-personality disorder solves crimes. He's a one-man CSI!

dave™© said...

I could have sworn I had the first comment on this thread.

What ever could have happened to it?

Maybe I should call the Blogger Police!

ron st.amant said...

I think I lean to the idea that it's a short-circuit in the brain.
The part I found most interesting was the idea, at least as 'Angelo' expressed it, that answering the voices was almost an overwhelming complusion.
In my family we've been dealing with this issue, somewhat, because my father has developed Alzheimers and has had an incident recently with hallucinations.
I'm a little hesitant with the idea of 'accepting' the voice-hearing in the way it was described in the article because it seems to normalize something is a move away from correcting it.

AJD said...

Dave, really?! Censorship at the Althouse Corral? Please, be nice and don't talk about it!

Otherwise, someone might cry.

Bill R said...

There is an interesting book: The Origin of Consciousness in the Breakdown of the Bicameral Mind by Julian Jaynes that posits that conscience as we know it did not exit 3000 years ago. Instead behavior was controlled by "voices" that dictated responses to situations. In other words there was no "ego."

Daryl Herbert said...

I'm already down with this. The real question is, when is everyone else going to learn to obey the voices in my head?

Or were you waiting for someone to make an analogy between voices that can't be silenced and troll commenters?

Eli Blake said...
This comment has been removed by the author.
Eli Blake said...

When I hear voices coming into my head:

I stick my head out the window and yell at my neighbor to turn down the volume on Howard Stern.

Galvanized said...

Hearing voices seemed to be accepted for a time in the case of Joan of Arc, even though it did not bode well for her in the end. The French seemed to support her "auditory hallucinations" while doing so worked in France's best interests.

So maybe, if the hallucinee (?) knows that she functions in the best interests of society, then an apparent psychosis is tolerable and even rewarded for a time. But I can't see how anyone who claims to actually outwardly hear voices would not be tormented in some way and question his sanity. However, to believe that the source of the voices is morally good, and the aims of the voices are noble, and to know that one's judgment remains intact would make the voices more positively perceived by himself. These people would most probably keep the experience to themselves and function. Who's to say that it isn't how God works?

Bruce Hayden said...

DTL does have a point, and it is hard to make without offending anyone. So, I appologize in advance if I do - I don't intend to.

If we go back through the Bible, a lot of esp. the Old Testiment prophesy does appear to be God talking in people's heads. And that seemed to end some 2500 years ago (a Biblical scholor will inevitably come up with a better estimate there), which might fit with the previous poster's comments about 3000 years ago, hearing voices in our heads was considered normal. On the other hand, Mohhammed and Joseph Smith seem to have heard voices since then...

In other words, a sceptic might ask whether this might be an explanation of all the instances where God talked to people, ultimately resulting in our present organized relgions, as well as some/many of the ancient ones.

Bruce Hayden said...

I do find myself talking to myself a lot. Indeed, writing this post has me talking it just a bit before I type it. All in my head (thankfully for everyone else who might be around me). And then, in conversations, I often find my inner voice saying stuff a bit before my external one does. Sometimes it gets far enough in advance that I can delete a sentence and resay it before I say it out loud. Rehearsal for what I am about to say out loud.

I guess though the reason that I am, I think, considered sane, and not prophetic, is that I know that that is my own voice.

Another thought - some scientists believe that they have solved the phenomenon of "déjà vu". It supposedly involves the fact that both sides of the brain process the same image. Normally, they do it at the same time. But occasionally, half of our brains idle or almost sleep, with the other half being in charge during that time. The theory here is that déjà vu happens when you are in a fugue state where one half of your brain is idling, and then something happens to bring you out of it. That even is first processed by the half the brain that is fully operational, and then by the half that is just spooling up. And that time lag is what gives us that "been there, done that" feeling.

Might something somewhat akin to this be happening here - one half the brain is talking, and the other is listening, and usually it recognizes the side talking. But, somewhat akin to déjà vu, sometimes this recognition is faulty.

Pogo said...

This concept is not a new one, but a narrative that rises and falls, and here is characterized by the shopworn but somewhat cuddly self esteem approach. ("Everything is fine!")

In the 1960s, Mark Vonnegut led a group of 1969 Swarthmore College graduates to a commune, Eden, the Promised Land, in British Columbia. Initially their visionary, Vonnegut became increasingly bizarre and was placed in a psych hospital, diagnosed with schizophrenia, but his voices were surely assisted by ample psychedelic drug use and malnutrition. Psychologist R.D. Laing disagreed, and told him that his insanity was a sane response to an insane society (or more quotably, schizophrenia is "a special strategy that the patient invents in order to live an unlivable situation.".

In April 1974, after being successfully treated with medicines and vitamins, he wrote an article in Harper's Magazine called Why I Want to Bite R. D. Laing with this excerpt:

"He's said ...our insights are profound and right on, we're prophetic, courageous explorers of inner space, and so forth... But what I felt when I found myself staring out of the little hole in the padded cell was betrayal. I did everything just like you said, and look where I am now, you bastard."

Now a prediatrician, he describes his mechanism of dealing with it most remarkably here:
"This disease is never your friend. ...You can’t look a the paintings of Van Gogh, and other achievements of manic depressives without concluding that there are positive capacities associated with this illness. But those positives are AS A RESULT OF FIGHTING THE ILLNESS RATHER THAN GIVING IN TO IT."
and elsewhere has said, "Drugs will get rid of the voices in people’s heads, but you have to leave them at least a little bit of their zip."

Jacques Albert said...

Might be an opportunity to open the question of whether mental illness (not suffering, mind you) is simply a reified metaphor (like a "sick" joke or a "sick" economy). I'm with Thomas Szasz on this question--"mental illness" is simply a Fraudian myth that has resulted in the ruination of thousands of lives. And psychologists? Well, I'm with Agatha Christie's terre a terre Inspector Japp on this one: "Psychologists? Most of 'em are balmy themselves!"

Pogo said...

Ah, the anti-psychiatrist approach.

Read the Eden Express to see how helpful that is. Better, talk to the unlabelled "homeless" in NYC and Chicago about how great it has been for them, saved from that Freudian myth, ruiner of lives; how much happier they are being free to defecate in parks, scavenge in dumpster bins, and scream to no one in the streets.

Patrick said...

Why stop at mental illness? Those paid quacks doctors have made a killing at convincing people of all sorts of maladies. Cancer? Bah! Like the body would ever actually attack itself and go haywire. There's no evolutionary purpose for that. The flu? Stupid! Weak willed people who want a day off of work.

Viruses aren't real. They are scam told to us, knowing we don't have microscopes and whatnot. All so we can be bilked out of money every year so as to assuage the real problem -- our utter lack of inner fortitude.

Galvanized said...

Also, mental norms in society are supported to keep people from being a danger to others and themselves, so mental illness has to be defined and classified. If not, we can never be sure what a person's voices are telling him to do or how tormented one may come to be with them.
Diagnosis and treatment are seen as necessary as a preventive measure. One rarely hears of a person experiencing auditory hallucinations that are benign and comforting. It seems to most always be a negative experience for the individual, with or without others' involvement.

mikeyes said...

That's interesting reading, but absolutely no science to back it up. On the other hand there are plenty of scientific papers looking at brain function and hallucinations and even several case reports of brain surgery resulting in unwanted scary auditory hallucinations while certain parts of the brain are stimulated.

Anyone who has dealt with psychotic people will tell you that auditory hallucinations are not inner conversations the way most of us view self talk. The author is just indulging in wishful thinking the way psychiatrists and psychologists did when they blamed every mental illness on the poor mothering and were able to get away with obvious errors of logic because no one wanted to challenge the way they were thinking. (If you did, they threw you out of the fraternity.)

When I was taking my psychiatry boards, I examined a patient and determined him to have schizophrenia. In the ensuing question and answer session afterwards an older examiner asked me about the "schizophrenogenic mother" as the origin of the patient's illness. I told him that I thought that idea was unfounded speculation that did not fit any of the scientific facts available at the time and that there was no reason to think that his mother caused his illness by being cold and uncaring. I speculated that she may have carried the gene and/or contributed to the environment that triggered it off.

It was only when he was hustled out of the room in an apoplectic fit that I realized that he was one of the authors of the idea. The ironic part was that this was well after the introduction of Thorazine (1954) and well into the scientific inquiry concerning the causes and effects of the disease.

While unfounded theories such as these are easily refuted (just ask "show me the proof") they tend to have legs and there are still papers that discuss aspects of the schizophrenigenic mother trying to shoehorn it into some isolated scientific finding without making the connection nor showing any scientific method being used to verify the thesis.

TMink said...

I posted this earlier, but the voices took it away I guess.

Auditory and visual hallucinations are not sufficient to meet the diagnostic criteria for schizophrenia. They may not even be necessary.

Schizophrenia is a complicated and multi-facted illness, and sadly LOTS goes wrong besides just hearing voices.

And hearing voices as you go to sleep is called a hypnogogic hallucination. It does not count.

Trey

Jacques Albert said...

Yes, Pogo, I forgot the test of any challenge to any theory is: "What's its effect on the homeless?" (might as well try String Theory here). And Patrick, perhaps the no pathology-no illness view of Professor Szasz is unfamiliar to you.

Jacques Albert said...

I'd be obliged to defenders of the theory of "mental illness" to tell us whether they agree with the plebiscite held a generation ago by the APA, where members VOTED on whether homosexuality is a "mental disease". And what about racism? Gambling? Smoking? Promiscuity? Is the mind simply what the brain does? How do you vote on these issues?

mikeyes said...

Jacques,

You are certainly entitled to your opinion, but the word "theory" implies an idea with no proof. There are thousands of scientific papers looking at brain function, abnormal chemicals, behaviors, the effects of medication and the effects of various somatic therapies on a host of mental illnesses while there are exactly zero scientific papers supporting the idea that mental illness does not exist.


Before you go and say that it is impossible to prove a negative, you have to account for the overwhelming amount of evidence that the pantheon of mental illnesses do exist. If you prefer to ignore the science, then you have to ignore the science behind all other diseases. No need to ever see a physician.

As for the vote on homosexuality, that occurred in 1973 and was a hot political issue. I don't know of any organization that has no political flavor to it, and the vote was not binding, rather a plebisite. And it was 34 years ago in May. For some reason nothing has changed and the science that confirms homosexuality as a disease is not present.

Again, if is an article of faith that mental illness does not exist, you can believe what you want. But when I was a resident I asked RD Laing what his institute did with dangerously psychotic people. He said, "give them Thorazine."

Jacques Albert said...

Nevertheless, "milkeyes":

When you assert that a "theory" is merely an idea without proof, do you mean to include some of the most commonly referred-to theories here? Should we henceforth refer to natural selection as a "fancy", relativity a "whim" and probability a "superstition"?

Naturich I don't deny psychotropic drugs influence behaviour, but that doesn't constitute evidence of a preexistent pathology. And sometimes, better scotch than Thorazine?

I should've expected more logical rigour from a scientist than to argue the petitio principii or lame claim that if one denies mental illness one denies all illness or pathology and that medical treatment of any kind is futile. MENTAL illness is at issue here, not illness in general.

The claim that psychology, psychiatry and psychoanalysis have moved on light-years away from their philosophically questionable origins in their "treatments" for "mental illnesses" can also be known as the "exact science just-round-the-corner, so trust us cognoscenti!" plea that mental health practitioners have been milking for generations now.

And aren't psychiatrists uniquely privileged among medical practitioners in our relatively free and consensual society in that they can force "treatments" upon their "patients", AKA "involuntary psychiatric interventions"?

Perhaps I'll go halfway with you in ending in a paradox: Anyone who goes to see a psychiatrist oughtta have his head examined.

TMink said...

Ever been to a state mental ward? These poor folks are fucked up bad. It is not pretty, and it is not subtle. Their behaviors and senses are wacked and they are miserable. To deny this is close to denying gravity.

Those brain disorders are different than behavioral disorders in the way that current science understands them. We used to have theories about ADD, now we have pictures of the brain dysfunction. Perhaps it will be the same with addictive behavioral disorders some day as well.

But most of us in mental health treat the person, not the diagnosis. People come to me asking for help with something and I work to give it to them. Even the kids, I do not fix anyone, but I usually help.

People that hear voices and do not like them have a problem and come to people like me for help. People who hear voices and make good choices are left alone. And that is how it should be.

Now good choices means not hurting themselves or others, not whether they go to church or not or who they are attracted to.

Trey

Jacques Albert said...

Actually, I worked in a general hospital mental ward (admittedly, now decades ago) for several years and received my first information on Thomas Szasz's works from a psychiatric nurse friend. Sufferers can be treated with kindness and charity, but perhaps not for metaphorical illnesses.