Hearing voices

Those who don't hear voices might consider the experience frightening, or as evidence of madness. Some people associate it with religious zealotry or even criminality. However, my experience of hearing voices ranges from being ordinary and everyday, to being something of an ordeal.

The author Jeanette Winterson reminds us that in the past, voices were seen as respectable and desired. In her book 'Why be happy when you could be normal?,' she describes voice hearing as a phenomenon experienced by "the visionary, the prophet, the shaman and the wise-woman. And the poet, obviously." Others see voice hearing as a creative and ingenious survival strategy, a meaningful experience to be explored.

Long before I started hearing voices, I heard my own thoughts in audible form. I was shocked as a child when I discovered that not everybody hears their own thoughts. I wonder to this day what it might be like to have a quiet mind, since mine is often chaotic and messy, with thoughts being so simultaneous that I'm assaulted by a cacophony of noise. That's why regular peace and quiet is so important to me.

My experience of voice hearing is different to my audible thoughts. "Voices" sound as though somebody is standing by my side, speaking to me. I know that if I can't see anybody there, the voice is coming from inside my head. I can then choose to ignore the voice or take notice of it if it's telling me something useful! Voice hearing isn't always unpleasant you see; sometimes the voices are helpful, for example, reminding me of important things I need to do or think about. Occasionally my voices are humorous.

I recognise a range of different voices, but every so often an unfamiliar one joins the crowd. I usually hear the voices one at a time, but during periods of extreme stress, I hear multiple voices, sometimes talking between themselves or competing with one another for attention.

Sometimes, the tone of the voices changes from neutral to negative and they become hostile and critical. Occasionally the voices take on a sinister tone, urging me to take action which would be harmful. Music through headphones helps, as does distraction, but in rare cases, when the voices are commanding, I'm at risk of acting upon what they tell me to do. This is when I choose to take medication. The medication quietens things down but it does so at a significant cost. My intellect is dulled. I lose my sparkle, I'm sleepy and I gain weight. Life seems to slow right down; I sleep, eat and move only when necessary. Life simply becomes a long, slow pause and there are times when even breathing becomes a conscious task. Thankfully, for most of the time, the voices and I coexist peacefully and I've managed without the need for medication.

Overall, I don't consider voice hearing and hearing my own thoughts as a blessing, nor do I see it as a curse. It simply is. It's part of who I am; as much a part of me as breathing in and out. 

 

A to Z?

I thought I was doing pretty well, recovery wise. Actually, I take that back, I WAS doing well with my recovery. And then...

I started feeling as though someone was following me. There was a dark shadow at my shoulder, which disappeared whenever I turned around. Then the voices started. Sometimes a mundane kind of commentary, "she's making a cup of tea," sometimes hostile "fat bitch, you need to lose some weight." Or worse.

I started seeing the world through a kaleidoscope of colour. Shifting shapes before my eyes, changing shade rapidly. Then I noticed a smell. A bad smell, rotting, like bins left out in the hot sun. It followed me around, so I reasoned I myself must be the source of the smell. I started bathing and showering multiple times during the day, changing my clothes. Nothing would shift the stench. I had butterflies in my stomach almost permanently. I began to believe I was host to a colony of parasitic worms and that I was rotting from the inside. I could feel them shifting around under the skin of my abdomen -  that was the source of the butterflies in my stomach. I borrowed my husband's electric drill and told him I was going to drill a hole in my stomach to get the worms out. Luckily for me, he relieved me of the drill, put it in the shed and hid the key. I was quickly taken on  by the home treatment team.

I began to believe that if I took all my medication at once, I'd be well again. I had quite a stash - anti psychotics, anti depressants, mood stabilisers, diazepam and zopiclone. A cocktail of almost- certain demise if taken all at once. I casually mentioned my plan to the CPN from the home treatment team. I had no reservations about sharing my plan because I thought it the most logical solution in the world. He made arrangements for my medication to be dispensed daily, so I didn't have so many meds at my disposal.

The psychiatrist changed the dose of my anti psychotic and recommended I continue to be seen by the home treatment team. And that's where I am right now, battling with the interface between reality and unreality and trying to challenge unusual beliefs with logic and 'common sense.'

I realise that recovery isn't a linear process, A to Z in simple steps. The way I see this is I've wandered down a blind alley by mistake and have to work out how to get out of it. A diversion, if you like. I'm really looking forward to getting back onto the road.

Post Christmas blues

It's been a while since I updated my blog and I thought it was about time I wrote something.

Things haven't been good for me recently. On the positive side, I enjoyed a family holiday to Cumbria over Christmas. On the negative, it was whilst I was away that my mental health collapsed again. I'm attending day hospital at the moment because I'm not well enough to be alone at home. It's more manageable than being a psychiatric inpatient but it's still pretty intense and has caused some disruption to family life and our usual routine. We're coping with help from family, mainly in relation to the boys. I'm grateful to them for stepping in, even though I feel guilty that I'm not well enough to do much parenting.

Life isn't much fun for me at the moment but I'm hoping things will improve as we head towards the spring. Going back to work is a long way off, both in terms of time (I'm not due back until September) but also in relation to how well I am. I'm looking forward to being well enough to think again though.

It's a funny thing, mental health. When you're in a good place with it, you sort of take it for granted and expect it to continue serving you well. When you're in a bad place with it, you'd give anything to feel as 'good' as you felt on your bad days when you were well!

I'm feeling optimistic today. Being at hospital is definitely helping. The nurses are lovely and I'm impressed by the way the mental health team have put together a package of support for me. They phone me when I'm at home to check that I'm ok and coping. I think I'll be there another fortnight or so, then discharged to the community team. I haven't been around much on social media so I'll take this opportunity to wish you all a happy new year! Xxxxx

Research website

If you are 18+ with lived experience of the NHS mental health system, please consider taking part in my research. Further details and instructions about taking part can be found here
audiblethoughts.org.uk

Institutional Anxiety

As some of you will know, my PhD involves applying psychoanalytic insights to the way NHS psychiatry works. Previous research tells us that in the UK, the NHS "contains" social anxiety that we might become ill, elderly or frail. Similarly, in mental health, we know that psychiatry and the mental health system operate as something of a 'psychic shield' against anxiety that we too might become mad. We also know that faced with the emotional burden of caring for patients, healthcare staff employ a variety of psychological defence mechanisms, including denial and projection, to offset what's been termed 'institutional anxiety.'

Personally, I reject a too-narrow focus on the biological when it comes to mental health and would point to the wealth of research evidence that highlights the role of abuse, trauma and social adversity in its development. This has now been largely accepted within mental health practice but all too often, it gets lost in the talk of dysfunctional brains. My argument is that this happens not only because of well-documented professional pride and big pharma profits, but because in many areas, there aren’t acceptable alternatives - they exist, but they aren’t where you tend to be referred by your GP. More importantly (for me as a researcher) I also believe that medicalised narratives serve another purpose. 

At the level of the subconscious, I believe that medicalised ways of thinking about mental ill health function as a way of containing another form of social anxiety. This comes from the fact that if we were to fully accept the contribution of abuse and trauma to mental health problems, we would be forced to accept that these unpleasant realities are more prevalent within our culture than we'd like to think. And who really wants to believe that so many lives are blighted in such ways? 

Previous academic work suggests that even those who encounter such stories every day; psychiatrists and mental health nurses, can feel uncomfortable dealing with disclosures of past abuse - in the face of such topics, they report feeling de-skilled and tend to want to refer such cases to psychotherapists; often involving a considerable wait. Previous research also shows that mental health staff can feel helpless in the face of huge social problems, knowing they have only medical responses at their disposal. They know they can't go back in time and magically erase people's pasts, nor can they intervene directly in peoples' social circumstances. As such, these feelings of hopelessness are sometimes directed towards the patient; someone who has already been abused, neglected and not heard. Redeploying the problem as residing within the person may feel emotionally 'safer' for health care staff but it comes at the cost of attacking the wrong target - the patient. Sometimes it’s expressed as frustration - believing that people “aren't trying hard enough to get well,” or aren't getting better in the right kind of way. This adds to the patient’s existing depressive burden and often, low self worth. Ironically, we know that engaging in these defensive processes is unhelpful to staff too - it inhibits the creation of working relationships that would help to offset the anxiety and encourages burn-out. 

I’d argue that similar processes occur at a societal level too. The abused, the mad and the traumatised tend to occupy a binary position - either pitied as ‘victims’ (particularly if they are children) but in adolescence or adulthood,the anger that might be rightly directed towards the perpetrators of abuse, the victims end up being on the receiving end of projected frustration, anger and upset about what's happened to them. In mental health, we hear a lot of comments along the lines of "surely he/she could take more personal responsibility for their own wellbeing?" And "This person is taking the piss ' playing the system."   

Our unwillingness to accept the uncomfortable realities of some people’s lives is partly, I think, due to our understandable reluctance to ‘blame’ families and wider social circumstances. It's a big deal to accuse families of failing to provide the conditions in which people thrive. It's a big deal to say we live in an abusagenic culture where we fail to adequately value human life. It’s not always about deliberate neglect and abuse, as awful as those things are. Sometimes, the adversities families face are things like poverty, isolation, bereavement and bullying. These things have become so normalised that they are reinforced at the level of government policy to 
only muted unease. 

Sometimes the patient is equally reluctant to frame their experiences in this way. The counsellor's consulting room is full of people who had 'happy childhoods.' Given such a murky picture, it’s hardly surprising that we tend to frame experiences in terms of brain disorders; it's a highly convenient euphemism. I don't deny that the brain is involved, there's no question that it is. I just happen to favour explanations that locate brains inside the heads of actual human beings; people existing in dysfunctional circumstances and their brains responding accordingly, by fundamentally altering stress responses. (The HPA Axis, if you're keen to find out more). Given the evidence, I find brain-based explanations much harder to believe than ones which say the family and society are often sources of conflict, adversity and harm, as well as providing us with a great many good things. For the purposes of my research though, we know that these things are way beyond the remit of the NHS.

If we are to find any answers to mental ill health, we should be looking way beyond the role of the individual - as instrumental as individuals are in managing their own recovery - and to the way we organise our wider society. I think if we were to accept the role of abuse and adversity in causing mental ill health, we would justifiably become angry, start to kick up a fuss and demand that changes are made, perhaps forgetting that these changes start with the personal. My belief is there'd be some loss in abandoning euphemistic medicalised explanations, but potentially enormous social gain.

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