Hearing Voices

Feel free to play Chris Young's I Hear Voices as you read along.

If you want to get a feeling for what had to listen, click on this link before you start reading. 

As a part of the curriculum we are required to participate in two PSYC SIMMs (live simulations) which are supposed to give another dimension to out clinical experience  The down side is that today was a 13 hour day.

For the first eight week PSYC term, I am working on a combination inpatient, locked unit which houses patients with Schizophrenia and dual diagnosis substance abuse.  (Subconsciously I probably chose this unit because most of the adults I saw in clinic last year had one or both of these diagnoses.)  Tonight after our regular clinical day, we participated in a Hearing Voices exercise.  While it is easy to place a person in a wheelchair for 24 hours to understand what a paraplegic might experience, it is recreate a mental illness experience like hallucinations.  Over the years a simulation has been created which allows students to listen to "voices" as they participate in a variety of exercises. 

For the first hour we watched a video which helped us to understand what a patient who hears voices might experience on a daily basis.  One of the examples she gave was to imagine a scenario where 15 minutes before the work day ends your boss comes in and explains everything you have been doing wrong.  Instead of being able to voice your opinion/say what is really on your mind, you leave work, head to your car and start up an internal conversation with yourself.  You might mutter under your breath or yell, have worked up facial expressions and maybe hit the steering wheel a time or two.  To an outsider you might look "crazy" talking to yourself and being completely wrapped up in your own world, but in reality you are by all definitions sane.  If a ball was to all of a sudden come into your lane, you would be able to snap yourself out of your conversation and back to reality.  Unfortunately, for many who hear voices that is not an option; all day, everyday they hear someone/something in their minds, coming from various parts of their body and/or environment. 

Another great example was to imagine that you have a song stuck in your head.  Of course it is only a phrase (not the entire thing) and the harder you try to forget the song or figure out the rest of the words, the more it becomes lodged in your head.  Over the years this professor has polled the audience to see what they do to help escape the song.  One of the best examples was a person who would sing Happy Birthday to themselves 54 times (no more ... no less).  Now if none of us knew the person had a song stuck in their head and this was their coping strategy for getting the song out of their head, we would think that something was not right with this person.  For many who hear voices they go through the same thing.  Some have various coping mechanisms like responding to the voices/reciting mantras and to an outsider these actions seem unnatural.

Unfortunately for most of the patients I have worked with the voices do not have good ideas.  Instead they encourage suicidal and homicidal ideations, as well as self-harm and self-esteem issues.

Once the video wrapped up, we were split up into our clinical groups, told to hit play and we were off.  As we traveled from classroom to classroom for the next three hours, not only did we constantly have the voices on repeat, but we also had to participate in a wide variety of activities.  Things like playing board games and origami were fairly easy compared to reading comprehension and a simulated Mini Mental exam in an ED.  Most of the students commented that when we were participating in activities which did not require much active thinking, like the tactile experiences, it was much easier to block the voices out.

Researchers are still trying to determine what causes people to experience hallucinations (visual, auditory, olfactory, gustatory, tactile, proprioceptive, equilibrioceptive, nociceptive, thermoceptive and chronoceptive with the first five being the most common).  One successful study has taken PET scans of those who are hearing voices/noises and those who experience no hallucinations/are listening to music.  Interestingly enough, the same areas of the brain light up in both groups.  Unfortunately this also means that the brain is not able to differentiate between voices/noises which are real and those which are caused by the disease.  As a result it takes some time and experience before people are able to get a sense of what is real and what is not.