December 19, 2010
Hearing Voices and Seeing Visions: What to do?
By Lewis Mehl-Madrona
Once upon a time, in most of the world's societies, hearing voices and seeing visions was honored and desired. In contemporary, modern culture it has become the one symptom that allows an immediate diagnosis of a psychotic disorder. In this essay, I write about the downside of pathologizing voices, while still acknowledging that many people suffer enormously from voices and negative visions. I describe how to be healing.
In our contemporary world of North America, hearing voices is the only "symptom" that immediately and single-handedly qualifies one for the DSM (Diagnostical and Statistical Manual of the American Psychiatric Association) diagnosis of psychosis. We could qualify this as more correctly referring to the acknowledgement of hearing voices to a professional empowered by the State to make diagnoses in a context in which diagnosing occurs. Thus, Moses could not have been psychotic, for no psychologists or relevant State laws existed to diagnose him. A famous quote says, "When we talk to God, it's called prayer; when God talks to us, it's called hallucinations."
Throughout recorded history, people have seen visions and have heard the voices of Angels, Gods, or others. Only recently have these experiences (or the reporting of them) become pathological. With the emergency of modern science and the ascendency of materialism, anything smacking of spirits or of the supernatural is suspicious or pathological. In Arizona, a recent archbishop for the Roman Catholic Church definitively declared that the Virgin Mary is no longer seen. Hundreds of Mexicans didn't read enough English to disagree with him. Divine communication and contact was sought, cultivated, and treasured until very recently, and is still desired within many indigenous communities.
However, today, many people live on the shadow side of hearing voices and having visions. These people constantly hear berating, deprecatory voices, who won't leave them alone. These people suffer tremendously. They become unable to function, so much so that relatives or well-meaning friends take them to the emergency department or to the mental health center for help. In another time and place, a traditional healer might be asked to cast out a demon or remove a curse or retrieve the soul that has wandered away, causing the soul to be stuck in spirit world and the body to express its urgent cries for help. Today, the contemporary interpretation centers around people with defective brains that need medication.
In his book, Crazy Like Us: The Americanization of Mental Health," Ethan Watters writes about the damage to people in Zimbabwe when hearing voices and having visions became medicalized. Prior to that, people were taken to healers who had a consistent explanatory story about spirit contact. Participation of all parties in this story and its prescriptions for enactment often resulted in resolution of the problem, with greater honor coming to the hearer of voices and the deliverer of visions. With the replacement of this idea by the defective brain story, the quality of people's lives deteriorated and recovery became much less possible. The traditional Zimbabwean explanations included the possibility of recovery and wellness. They also included dignity and respect for the person brought to the healer. The new biomedical stories did not include recovery from defective brain conditions; nor did they fail to stigmatize those whom they described. People were not better off following the Americanization of mind and mental health in Zimbabwe.
The voices that my diagnosed clients hear are not kind, for the most part. They are not uplifting or transformative. They convey no positive messages. What do they say? One client related some of the continual litany chanted by her voices:
"You're going to hell."
"I'm not going to stop tormenting you until you're a corpse."
"You're fat and ugly."
"You should kill yourself so you can stop taking up space."
"You don't even deserve the air that you breathe."
"Why don't you just hold your breath until you die."
The list goes on and on. Her voices were always female (Later, over weeks, we would discover that they were the voices of her female relatives which she had internalized.)
What differentiates my "patient" population from the rest of us who hear voices? Is it the uniform inclusion of negative, mean, unkind voices? The exception to this occurs with people who are diagnosed as manic, some of whom only hear joyful, celebratory, elated voices. That would be fine, except that they often lose judgment about how to report their elation and what to do about. A well known movie shows a man in a state of elation, going to a symphony concern, and getting up onto the stage to take over conducting, because he was guided to do so to produce more spiritual music. Admirable, but not condoned.
I suspect that the people who are diagnosed begin with the gift to tune into other dimensions and to be extra sensitive to other states of consciousness, but that trauma causes their reception to get stuck on the negative. One of my clients hears the voices of racism. These voices are social stories that she has internalized due to her great sensitivity, but it would be better for her if she were to leave combating racism to those who are stronger than she is. The stories overburden her and cause her to collapse. She ends up believing that everyone is making negative, racist comments about her, which is actually not happening, at least as far as I can determine. Nevertheless, if we bracket for the moment the materialist paradigm in which their voices are the product of deranged brains, we arrive upon some very interesting ontological questions about the dimensions from which these voices arrive and the ontological status of the beings behind these voices. These questions become practical when we begin the work of reducing the influence of the voices upon people or the suffering that they experience from these voices.
Elders have told me that the suffering of modern people from voices and visions exist because modern people have lost the stories needed to manage such experiences. Two Huichol elders told me they would not give a modern person peyote for at least a year and only after that person had learned all the stories and songs deemed necessary by the elders to manage the visions that might be offered by the Spirit of Peyote.
Stories work that way. They tell us how to interpret experience. Without such stories, we could be overcome by the power and intensity of the peyote experience. Then we could really get into trouble if we fell back into our own American cultural stories of heaven and hell, angels and demons, and we might either require extensive babysitting until we came out of it, or we might get noticed by the authorities and taken to hospital or jail.
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.
Authors Website: www.mehl-madrona.com
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 Narrative Medicine.