Sunday, December 9, 2018

That Voice in Your Head

Man holding a mask

Recently our group at NAMI East Bay heard a panel of consumers1 discuss their experiences with hearing voices. Two of them were from the Bay Area Hearing Voices Network, an organization that helps people with the “lived experience” of “hearing voices, seeing or sensing things that others don’t, or have extreme or unusual experiences and beliefs” come to understand and explore the meaning of these phenomena.

One of the panel members, who had taken prescribed medications to subdue the voices, found the side effects so distressing and the results so problematic that he preferred instead to live with the voices. A second panel member actively interrogated the voices and tried to understand them, asking whether they were ghosts, or pure energy from another dimension, or extraterrestrials. He would reason and debate with them when they told him to harm himself. A third felt that the voices were an inspiration, and he knew they came from outside his head because he could not feel the resonance in his skull when he himself spoke aloud. This man came to trust their answers when he needed to take an examination or make a business report.

The original Hearing Voices Network in the UK was founded in part by Ron Coleman, a consumer himself who is now in recovery and works to provide “recovery centered treatment” to other consumers. The principle seems to be that these experiences are not the symptoms of an illness but real events—as indicated by two of the panel members above—that the person feels he or she should explore in a positive way and that others—loved ones and family members—should be curious and supportive about rather than judgmental. The basic good that I can see in all this is that, if the phenomenon of hearing voices cannot be treated and eliminated with either medication or psychotherapy, at least it should not become a source of fear and anxiety for the patient. Support from and discussion with others who share the experience perhaps can approach this good result.

But I still don’t believe the voices are real—or anything more than a neurological or perceptual fault in the auditory processing centers of the brain.2

One of the panel members said that hearing voices is a common experience. He is right—in the sense that humans are a verbal species and routinely put our thoughts, however silently inside our heads, into words. We may not convert all of our sense impressions and internal thoughts into words, but we certainly try. For example, if I smell something familiar, I will usually try to identify it with a word: “This is ‘coffee.’ ” Or, “That’s ‘a rose.’ ” If I see an unusual shape, I will try to match it with a familiar shape and give it a name.

Many of the thoughts that pop into our minds are verbally arranged. For example, if I am doing something and sense it’s wrong, the thought may insert itself as a sentence: “This is a bad idea.” In the old Transactional Analysis, which was popular back in the late 1960s, the Freudian personality functions of superego, ego, and id were explained as the internalized voices of your Parent, your own Adult self, and your earlier Child self. The Adult makes rational decisions based on current needs, reason, and experience. The Parent issues decrees and warnings based on remembered authority. And the Child expresses needs and wants based on remembered emotional states. … Or something like that. The point is, these are learned and internalized reflexes that the person remembers from growing up as an immature version of self under the regime of a parent who is more mature and either guiding or punishing. Usually, these reflexes present themselves as verbal statements. When my mind generates the thought “That’s a bad idea,” it is usually in my mother’s voice.

I should note also that when I am writing, as now, the words are coming into my head as if I were speaking them aloud.3 And when I write fiction and generate dialogue, I imagine the two or three characters speaking and supplying their own favorite expressions, diction, preferred sentence structure, and even accents as they speak.

So this “common experience” of hearing voices can be pictured as a spectrum, and this matter of thinking in terms of words would be the “normal” end. It is normal in that most people are not alarmed by it, do not find it troubling, and accept it as the way their brain works. I should note that this end can have its alarming aspects. My mentor at the university, Professor Philip Klass, once told of a time he was driving faster than usual on an elevated freeway. He heard a voice in his ear say distinctly, “Slow down!” The voice was so real that he reacted instantly—and around the next turn was a wreck that, if he had not slowed, he would have plowed into. Was that voice the manifestation of a guardian angel? Or just his own mind cautioning him about driving too fast? Either way, he questioned whether the instance of hearing the voice, followed by the crash up ahead, could be mere coincidence.

Moving toward the less-normal parts of the spectrum, we have Professor’s Klass one-time warning voice, as well as the times when we hear a change of air pressure at a partially cracked window and think it’s a human moan or sigh, or the babble of the crowd in a busy restaurant suddenly resolves into an almost-familiar voice speaking our own name. Or—and I speak from experience here—sometimes a recent widower will hear a noise and imagine it’s the whisper of his dead wife. It may be imagination, but it sounds awfully real and there is a momentary pang of recognition and regret. The point is, in this part of the spectrum we are not at all sure, however briefly, whether the voice was inside our heads or not.

Toward the middle of this spectrum are the voice hearers, like the members of the panel, who hear voices that they know or believe are not their own and not coming from inside their heads. They can have it explained to them that their brains are malfunctioning and they are listening and responding to tricks of their own imaginations, but they will not believe it. The voices are too real. One of the panel members insisted that the different voices each had their own way of speaking and accents, and that was proof to him that the voice came from outside. Also, the voices often suggest something that the person would not normally do, such as inviting him or her to commit suicide. Whether the person is following the voice or resisting, he or she acts as if dealing with an alien entity.

And finally—or so I believe—the manifestation of a supposedly external voice with its own character, diction, and other qualities might become so embedded in the mind of the hearer that it develops an entirely separate personality or, in psychologists’ terms, a “dissociative identity.”4 While the causes of a brain or mind creating more than one personality or dissociating itself from the one it was born with are debatable, the condition often occurs in someone who experienced extreme trauma as a child. So, presumably, the second and other personalities develop in order to envelop and protect the tender ego. The fact that the core personality is usually not aware of these other personalities, their actions, and their intentions is where the dissociation comes into play. It appears that an alternate personality takes control of the brain and body at various times.

Normally, I would not think of putting dissociative personalities on the spectrum of hearing voices, except one of the panel members mentioned his own childhood trauma and being treated for post-traumatic stress disorder, or PTSD. So it is possible that stress and trauma play a part in the voice hearing as well as the dissociation of a personality.

On top of all this, we must remember that human beings, with our huge and vastly interconnected brains, are the “dream animal.” We live not just in the moment and inside our surroundings, as my dog does, but also in our imaginations, in our speculations, in the what-ifs and if-thens of our subjunctive language, and in the twilight realm of our dreams, where the wildest fantasies seem real and even plausible for a short period of time. Is it any surprise that this delicately balanced and incredibly complex mechanism occasionally slips a few gears and feeds us false information?

That’s just the nature of human existence.

1. “Consumer” is the new, more polite term to refer to people with a diagnosis of severe mental illness and is preferred by people in this situation to the earlier term “patient,” which implies that they have an illness. These people are consumers of mental health services.

2. One of the panel members at the meeting, who tried for a scientific understanding of the phenomenon, stated that functional MRI scans of people when they were experiencing voices showed activity in these processing centers.

3. The generation of this word stream is complex. Some of it comes from my front-of-brain thinking and deciding: here is how the article, argument, or story must go. And some of it comes from my subconscious and its intuitive sense of what the story or article might become. For more on the role of the subconscious in my writing, see Working With the Subconscious from September 30, 2012.

4. The old diagnosis of Multiple Personality Disorder has now become Dissociative Identity Disorder. Po-tay-to, po-tah-to.

Sunday, December 2, 2018

A Classic Liberal

Balloon rising

I’ve been examining my own political stance these days—especially since anyone who believes in personal freedom, personal responsibility, and free-market capitalism while being opposed to big government, statist solutions, and socialism is now considered by some to be a “racist, misogynist, homophobic Nazi.”1 I have decided that what I am, other than a stick-in-the-mud, Eisenhower-era Republican, is a classic liberal.

What are the principles of this kind of liberal, as opposed to the more modern kind?

First, I believe in your personal freedom as much as mine. Your rights to free expression, physical movement, occupation of space, and use of time are yours to exercise and govern, as mine are my own. The province of your right to these actions extends up to about an inch from the tip of my nose, or whatever else defines personal space in our culture. If you violate my space and my time, there will be consequences—and I’m prepared to initiate them. But other than that definition of pre-existing physical and temporal limits, I am not going to prejudge you or prescribe the limits to be placed on your speech, actions, and intentions. Go your way and don’t interfere with me, and we can be trading partners, potential allies, and perhaps even friends.

Second, I grant you provisional respect and allow for your personal dignity. In my heart, I want the world to be populated by—in that old phrase—“men (and women) of good will.” I want to live in a society where people can be—and do become—productive and self-sufficient in their lives, caring about their own and their families’ and their friends’ futures, and confident and comfortable in their own skins and with their current situations. This is not always possible—sometimes through personal frailty and failure, sometimes through societal lapses—but I want people to have this chance at personal happiness and dignity. And so, if I want the world to be like this, I must grant in my own mind that such people exist and that you may be one of them. I must refrain from prejudging you as a person of gnawing envy, grasping ambition, bad habits, faulty decision making, and other personal failings that can lead to chronic unhappiness. I leave it up to you to prove me wrong in this. Please don’t disappoint me.

Third, I grant your personal agency and responsibility for your current state of being. Unless I can see and detect some congenital or acquired disability in you, such as blindness, deafness, missing and frozen limbs, or—after five minutes of casual conversation—some deficit of wits, emotional stability, or active and inquiring mentation, I will presume that you are a fully functioning human being with two legs to stand on, two hands to shape the world around you, and a capable brain to guide them both. As with your right to freedom, I believe in your ability to live as you want and operate in the world. I would hope you will grant me the same and not wish to place barriers to my developing and exercising my full human potential.

You will note that these attitudes apply personally rather than to any group. I prefer to deal with people as individuals, unique beings, and not as indiscriminate members of a race, class, gender, or other aggregate. Economists and Marxists may prefer to deal with large groups—economists by their profession, and Marxists by their obsession—but I would rather follow the rule of Sergeant Buster Kilrain: “Any man who judges by the group is a pea-wit.”2 Marxists will find this attitude hopelessly bourgeois, and so be it. I was born to the middle class and raised to be private, diligent, industrious, and resilient—not a bad way to operate and view the world, in my opinion.3

Being a rabid individualist, jealous of my rights and expectations, dealing with other people as individuals, and granting them the freedom to do and become what they want, I tend to despise one-size-fits-all prescriptions and social engineering. I understand that proponents of big government and statist solutions must, as a matter of logic and fairness, strive to treat everyone equally. And socialism by design must treat all citizens as economic cogs in the great machinery of their proposed social organization—except perhaps for those enlightened experts who are doing the designing and taking control of the command-and-control economy. While I grant that some effort must be made at social cohesion if a village, a state, or a nation is going to function, I want to see the choice to join and function—and of who will be doing the deciding—made individually and democratically. Treating people as mere numbers or as “meat robots” devalues their thinking capability and their human potential.

While I believe we should all work together as a society and function in an open economic system, I take the position that I am not responsible for your health, wealth, happiness, or well-being. That is your responsibility and not mine. If you approach me as an individual and ask for help—whether you have your hand out with a cardboard sign at a street corner, or you are wandering dazed and confused after a disaster, or you are a friend or family member in need of support—it is my choice and not my responsibility to respond positively. I am the sovereign of my time, my effort, and my purse, as you are over yours. How I choose to spend them is a matter between me and my conscience or my god—if I have either one.

Note also that these are my personal and individual guidelines, attitudes, and approaches. They are not rules prescribed for me by someone else. They are subject to revision and revocation, and I can change my mind as I see fit.4 I can be flexible without worrying about my own inconsistency, based on my previous experience with similar situations and my new experience with each person. You can’t shame me by pointing a finger and exclaiming, “Aha!”

I am not a big proponent or follower of rules and regulations, policy statements, and firm positions. I deal best with people who have and practice a personal religion but who don’t make an issue of it or expect me to believe in and follow its rules myself. I am humble enough to know that I might be wrong, and not ashamed of admitting a mistake and moving along. I trust others to have the grace to do likewise. After all, life is a still-unfolding mystery. The universe is huge beyond our wildest imagining. No one has all the answers. And we are all just finding our way.

1. And the people who believe that really ought to examine their historical referents.

2. Kilrain was a fictional character in the book The Killer Angels, later made into the movie Gettysburg.

3. As opposed, I image, to being a member of the aristocracy, expecting undue deference, and looking down on everybody else. Or a member of the proletariat, or underclass, or whatever the opposite of an aristo is, and looking upward with hatred and envy at anyone better situated, more industrious, or better educated. The middle is not a bad place to be.

4. I live by the dictum that no rule is universal; there are always exceptions; and no one rule can be tailored to fit all situations. Our minds were given flexibility for a reason.