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Articles    H4'ed 12/19/10

Hearing Voices and Seeing Visions: What to do?

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So we need stories about how to manage voices and visions in order to manage them.   These stories create a normalizing context for voices and visions within which their messages and meanings can be interpreted and understood.  

Telling people that their voices are not real is not a good story.   It doesn't work.   Patients tell me over and over how very real the voices are -" as clear as mine.   They don't accept the story that their voices are hallucinations.   They sound too real, too genuine.   While we can speculate about the realms from which these voices originate, the key concept in helping people to manage voices is the understanding that, wherever these voices originate, they have no physical power in ordinary reality.   They can't kill you.   They can't harm you.   They can't harm anyone else.   They actually can't do anything at all.   Their only power is to convince you to do harmful things to yourself or others. They are like the Lakota Iktomi character who is the evil spirit of that culture, and who has no direct power to intervene in human affairs, only the power of trickery and flattery.   Voices are like that, and this realization is of major importance in helping people to reduce the suffering related to their voices.   It's easier to ignore negative voices once we know that they don't actually have any power in this dimension, no matter how real they sound.

Another group of clients, however, acknowledge a tonal difference between my voice and their voices, a qualitative difference.     They know the difference between the voices of ordinary reality and these other voices.   They may still suffer enormously from these other voices, but can distinguish them as different.   In some ways, they are easier to help.   The awareness of difference can more quickly lead to the awareness of the impotence of the voices.

In some respects, I do envy the position of my clients as being more solidly in other realities than our consensual one.   I have to work much harder to hear voices.   I have to use mindfulness meditation techniques to empty my mind so that I can detect others in the stillness.   I have to work at turning off my own chatter.   I usually feel   moderately confident that I hear the voice of an "Other" when what the voice says is startling or novel, something unexpected that I hadn't previously considered.   Another clue to the presence of an "Other" for me is when I have deep physiological responses to the voice -" a sense of deep inner peace, a sense of compassionate wisdom, a deep feeling of relaxation.   Unfortunately, my patients don't have these marvelous feelings or wise communications.   Most of their voices are negative and only productive of suffering.   Their voices are intrusive.

Like everyone, I have what could be called intrusive thoughts at times.   Standing on a balcony, I have had the thought to jump.   Who hasn't?   Unlike my clients, however, I have techniques to stop these thoughts and to turn my awareness elsewhere.   The balcony is an interesting example.   I suspect we have these thoughts because we can fly in our dreams.   We can jump off tall buildings and survive.   Part of being "sane" is being able to maintain an awareness of which coordinate system currently constrains us and to act accordingly.   I know better than to jump off a building when I'm awake (and I know when I'm awake and when I'm not).   I have a client who didn't have this awareness and who fell five stories.   Luckily he survived, but not without some permanent disability.   People who get diagnosed with schizophrenia and other psychotic disorders have minimally good means of managing intrusive thoughts or intrusive voices.   They have to learn, and rarely does anyone want to teach them.   The conventional biomedical position is that medications will solve this, but, rarely does this happen.   Patients continue to suffer from their voices but learn to tell their doctors that they're fine lest the dosages be raised high enough to turn them into zombies.

The intrusive thoughts or voices that some people hear can be disabling, often commanding them to do disturbing acts.   The Voices say, "Take off all your clothes," or

"Masturbate right here, right now, in public view," or

"Jump off this balcony," or

"Slit your wrist," or

"Burn yourself with a cigarette."   The list is endless, and anyone who has done the Buddhist meditation exercise of sitting back and watching the content of consciousness knows that some of the content is bizarre.   The difference between meditators and patients is the awareness that bizarre ideas come and go and the refusal to fix upon them.    When we monitor, in the sense of a freely floating meditative awareness, we discover that these thoughts are universal.   Some just ignore them, suppress them, or dismiss them. Those who come to be diagnosed with mental illness, augment them, dwell upon them, and amplify their frequency of presence.    For this to change, they have to learn a different strategy.

In a similar vein, people who eventually came to be diagnosed with PTSD, make the story of the trauma every time they tell it, a bit more severe; while people with equivalent trauma, who do not come to be diagnosed, make their trauma a bit less severe each time they tell it.

How do we help people who suffer from hearing voices or seeing visions?   Good advice is available in the publications and websites of the Irish Advocacy Network.   Additionally, there is a world-wide hearing voices network that began in England in Leeds and has spread rapidly.   I will end with a brief summary of some of these techniques.   Of first importance, however, is to help the person discover their own successful strategies that they're already using to subdue voices.   These can include playing music, singing, talking back to the voices, exercising, walking, jumping up and down, shaking, and more.   The strategies are simple -" to recognize that the voices have no actual power.   To track down the sources of the voices, when possible.   To find counter-voices.  

To accomplish this, we use a variety of techniques.   We use mindfulness meditation, progressive muscular relaxation, puppets, drama therapy, and more.   In Hearing Voices Group, we help people to enact their voices in order to learn new ways to stop them or reduce their volume.   We put bodies to voices and make those bodies look ridiculous.   It's harder to take a voice seriously when it's coming from a ridiculous source.   The list for how to triumph over voices is as endless as the number of people who have objectionable voices.   Sometimes, we can even help people connect with the positive beings/voices who can enlighten and comfort them.   We can do the loving kindness exercise for practicing compassion toward the beings who are the sources of the voices.   On patient told me about looking into the mirror and tearing away the monster who is looking back.

The bottom line is that people can be assisted to manage their voices and visions and to reduce their suffering.   It is through the compassionate involvement with others who appreciate voices and visions but do not suffer from them that transformation can occur.

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Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and (more...)
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