Invisible intruders – the voices in my head
This 30 minute radio documentary broadcast in Australia in 2013 provides a honest and wide ranging appraisal of people who say they hear “voices in my head”.
The programme is based around interviews with people who say “I hear voices”. It also considers what neuroscience can tell us about the experience of “hearing voices in my head”
Interviewees include well known voice hearers and members of the hearing voices movement: Will Hall from the USA, Indigo Daya from Australia and Rufus May from the UK. They all were able to show that it is possible to say “I hear voices” and be healthy and able to communicate in a coherent way what hearing voices in my head involves.
The programme tackles issues such as the discrimination faced by people who hear voices and the mistaken belief that voices are associated with violent behaviour.
The programme also looks at recent research findings by neuro-scientists. Susan Russell, Professorial Research Fellow at the Swinburne University and Monash Alfred Psychiatry Research Centre referred to the important recent research using brain imaging that show that when people say “I hear voices” the parts of the brain responsible for speech are active. This means that when people say they “I hear voices” they are not experiencing an hallucination.
For someone to say “I hear voices in my head” does not necessarily mean they have a psychotic disorder.
We would recommend this programme.
From the programme notes:
The programme considers how it is possible to deal with voices in your head?
We all have them to some extent – perhaps they’re just thoughts, comforting and easy to live with – but for some, they are menacingly real and reflect past trauma.
We hear what happens in the brain during “auditory hallucinations”, and how engaging with the voices can actually help to heal.
One voice hearer interviewed in the broadcast found relief by giving one of her voices his own Facebook page!
You can read the transcript of the programme here.
Invisible Intruders – “The Voices in my Head” Broadcast, Sunday, on All in My Mind, ABC Radio, 1st December 2013
Transcript of Invisible Intruders in My Head Documentary
Lynne Malcolm: On RN, I’m Lynne Malcolm with All in the Mind, and this is an impression of what some people hear when nobody is there.
Research shows that at least 4% of the population hear voices. We all have the experience to some extent, as thoughts, memories or in dreams, but some people hear voices when they are awake, and they can be menacingly real and frightening.
Today we’ll hear what neuroscience has to tell us about voice-hearing, and some innovative treatments focussed not on getting rid of the voices but changing the relationship with them.
Will Hall: Ever since I was a kid I had very powerful altered states experiences, and eventually that’s what led me to end up in the mental health system. I was locked up in hospitals and had a very difficult time, was on different kinds of medication. And today I still live with altered states experiences, including voices, and I have voices that are both positive and negative in my life.
Lynne Malcolm: Will Hall is a therapist and trainer whose recovery from a schizophrenia diagnosis has brought him to the forefront of innovation in psychosis treatment in the United States. He hears a range of different voices with different characters.
Will Hall: There is a voice that comes to me that’s very comforting, and I’m not sure if it’s the same voice every time. But it’s a voice that if it’s not there then I know I’m in trouble. If I’m suffering, if I’m in a lot of pain, that voice is really there to help me out, so I am very appreciative of that voice being there to protect me.
And I also have a voice that’s very aggressive and puts me down, and sometimes speaks in the voice of my father and sometimes is more of a daemonic voice. And I also hear all kinds of different machine noises and go into different states where I feel like my name is being called to me or that the person that I am with is…what they say is echoing as a voice.
Lynne Malcolm: It sounds like when it’s intense it must be very disturbing, upsetting.
Will Hall: I can go into states where I’m frozen and I can’t really talk, where I get really, really frightened of social interaction. It’s all I can do to just stay in communication with people until I can just get out of there. I can go into very dark places where I can feel suicidal. Sometimes I’ll stop eating. And I’ve learned that these are very difficult places that I go through but they are part of who I am, they are part of my creative process, they are part of being a sensitive person, they are part of my spiritual process. And so I’ve learned to really live with that and to maybe also welcome it in sometimes and be curious about it, because often there’s important information, I can learn things about myself.
Lynne Malcolm: And at the time when you are hearing the voices, how do people react to you? Because it must be so incredibly distracting that you can’t actually attend to what is going on in outside reality if you are being distracted by this internal dialogue.
Will Hall: It is really distracting, but not as distracting as it was in the past, and I’ve learned how to keep things hidden from other people. And I think a lot of us have a big split between the outer persona that we put out into the world and then our inner reality, and for me that split gets very huge. And for me these are auditory experiences but it is more like a presence or a spirit. And sometimes with the more daemonic voice I can feel grabbed or I can feel held down or have a physical sensation of not being able to move.
Lynne Malcolm: And do you know that yours is related to past trauma?
Will Hall: I think in some ways, yes. When I was in the hospital I had a lot of questions from doctors about my family history, they were trying to establish that it’s all just the cause of your brain, but no one was ever really interested in what it was that I was hearing, nobody ever really asked me about that. It wasn’t until later that I realised that the voice that I was hearing, the voice that had driven me to the Golden Gate Bridge in San Francisco and the voice was telling me that I was worthless and was mocking me and putting me down, it wasn’t until years later that I realised that that voice was my father’s voice.
And I don’t blame my father. I mean, my parents gave me a lot of positive things as well, but I do connect that with some physical and emotional abuse that I experienced from my father. My father is a Korean War veteran, he has been in prisons, he has been in psychiatric hospitals himself, so he carries around a lot of trauma. So I feel like the traumatic family situation that I came out of really played a big role with my voices. But I don’t really see it as something that can be just reduced to that because I also feel like there’s a spiritual dimension to what I’m going through.
I’ve felt very helped by my voices and very challenged by my voices. I feel like even the bullying voice has been something in my life that is pushing me to be more powerful and to be more assertive and to be more confident about myself, so it has a certain teacher quality or mentor quality, like a spirit ally that’s trying to guide me or push me.
And on my mother’s side I am mixed-race American Indian from the Choctaw tribe and I always was given a great pride of that part of my heritage, and that message has always been, you know, the world is much more of a magical place than we often are led to believe and that science believes and medicine believes. So my own framework for understanding is that I am communicating with spirits and I feel like the universe talks to me and guides me, and I often am looking to signs and connections and to the presence of spirits to really show me the way forward.
Lynne Malcolm: Will Hall, who has been in Australia to attend the recent World Hearing Voices Congress.
Indigo Daya has also drawn on her personal experience of mental illness to assist others in their recovery at Voices Vic, part of Prahran Mission in Melbourne.
When I met her she told me she’s ‘proud to be mad’ and jokingly said that she’s privileged enough to have been diagnosed with eight different mental illnesses. Jokes aside though, it’s been tough for her. She’s been in and out of mental institutions, and reached 130 kilograms due to the side effects of antipsychotic medication. She was 30 when she first heard voices.
Indigo Daya: I’ve heard one voice which I’ve called the Judge. For me my voice is internal so I don’t hear it through my ears, like many people do. But I hear the Judge like a thought but not like my own thoughts. It feels like there is an entity called the Judge that is speaking to me but I hear it inside my mind.
Lynne Malcolm: And what’s your understanding of how that started and where it came from?
Indigo Daya: These days, now that I’ve worked a lot more on my recovery, I understand very much that it’s to do with the trauma that I experienced when I was young, and it was my way of responding to that and to making sense of what happened to me, which has been very important because even though I still occasionally hear that voice I’m not frightened of it any more. I certainly don’t see the voice as an illness, I see it as a part of the creativity that we have as human beings to adapt to what happens to us and find ways to make sense of the world.
Lynne Malcolm: So just tell me a little bit more about how that voice relates to the trauma that you experienced.
Indigo Daya: The Judge voice was always extremely critical of me, and still is when I hear him. The Judge would frequently say things about how terrible I was. I’m not sure what sort of language we can use on the program, but if you imagine lots of quite rude words that you would need to edit out, they are the sorts of things the Judge would say to me.
But in terms of relating to the trauma, in essence the Judge represents my shame. It was very difficult for me and I think it is for many people who have experienced sexual abuse and many other types of trauma to understand why it happened and to understand why I had the reactions that I did to that. I think looking back that I felt that it was my fault and that I was somehow corrupted. And so the judge would tell me very frequently that I was evil, that I had to be destroyed. And when I was really struggling I would believe that and think, yes, I am evil, I am disgusting, I should be destroyed.
But I now understand that it was because I felt really disgusting about what happened to me and was blaming myself. And with lots of support, and particularly talking with others who have been through the same experience, I’ve been able to see that that’s quite a normal way to feel and that it wasn’t my fault, it was…you know, somebody did something terrible to me. So the Judge is not scary to me now because he is just pointing out, I guess, that I needed to understand that contradiction and that I needed to forgive myself.
Lynne Malcolm: Indigo Daya is well on the path to recovery, and after going through intense withdrawal effects, she no longer takes antipsychotic medication. She now specialises in trauma informed recovery and is a strong advocate for the growing international hearing voices movement.
Sadly, we’ve all heard stories that link voice-hearing with madness and violence, but Indigo Daya says the stigma around voice-hearing can often stand in the way of recovery.
Indigo Daya: I think that there is a real perception amongst the public that voice hearers are dangerous people. I think there are so many TV shows where the serial killer turns out to be a voice hearer. If you say you hear voices, people will take three steps back. It’s not the kind of thing you’ll bring up at a party and say, ‘Hi, my name is Indigo and I hear voices.’ It’s a great way to lose friends and not influence people! So there’s this real perception that we are dangerous, that we hurt other people.
For me it’s a particularly offensive misconception because the vast majority of people who hear voices have actually been victims of trauma and abuse. There are statistics in the UK that show that people diagnosed with schizophrenia are 14 times more likely to be victims of violence than perpetrators. We experience stigma and discrimination and violence much more than the average person, and yet we are perceived to be violence. So this idea that we’re dangerous is not true, and it’s very harmful because it stops us talking about our experiences, it makes us a hide away and feel really ashamed. And how can we recover if our experience is so misunderstood?
Lynne Malcolm: Many people’s voices though are very aggressive, as you were describing your own voice, the Judge. They can be very aggressive, very violent, they can stimulate people to do violent things to themselves or other people. That must have an effect on the way people behave.
Indigo Daya: Look, certainly voices can say very violent things, but we hear violent things all the time, particularly from our TVs. And I think that the big distinction that’s helpful to understand is just because you hear a voice saying something violent doesn’t mean that you have any intention or desire to do something violent. And even if you had a desire to do something violent, it doesn’t mean that you are going to plan to do it or will actually do it.
So I’ve met many people who have had voices yelling at them for years to kill themselves or to do something violent and they’ll say to me, But I’m not going to do that, of course I wouldn’t do that, I don’t want to do that.
And of course there will be some people who will do what their voices say because they are frightened, of course that does happen as well, but what’s important I think to understand is that that doesn’t happen at any higher rate than the average person without a diagnosis committing violence.
So it’s a struggle. But a part of the work that we do with people is reminding people that we need to listen to our voices so we can make sense of them and get control of the experience. We need to not be afraid of it. But we shouldn’t obey voices, just like we shouldn’t really obey anyone, we need to make our own decisions. Except of course for directions from traffic police, we should obey those generally.
Lynne Malcolm: Indigo Daya. You’re with All in the Mind on RN, Radio Australia and online. I’m Lynne Malcolm, and today: invisible intruders, the voices in your head.
So what are the brain processes that are going on when people hear voices?
Professor Susan Rossell is a neuropsychologist at the Brain and Psychological Sciences Research Centre at Swinburne University. She is also co-director of the Voices Clinic at Alfred Hospital. She’s spent over 20 years looking at the mechanisms of the voice-hearing experience.
Susan Rossell: When I first started in the field there was a massive controversy; this is all in people’s imagination, these aren’t real experiences. And I think one of the really beautiful things that neuro-imaging has been able to show is that when someone is having a voice experience, exactly the same brain regions are active as when you are listening to my voice now.
So there are couple of main brain regions, so there’s Wernicke’s area, an area that is involved in comprehending speech. And there’s Broca’s area, an area of the brain that is involved in producing speech. So it’s not any more different from hearing a voice in the external environment. These brain regions are also active when people are engaged in their own thinking. So there’s something to do with these networks being active that’s producing the experience to the voice hearer.
Lynne Malcolm: So what is it about people who hear voices like this that’s different to the way people who don’t hear voices respond?
Susan Rossell: Yes, that’s kind of the million-dollar question and I actually wish I had the answer. There has been 20 years of research and we are a little bit closer but we certainly don’t have the full answer. There are couple of models that have reached some significance in the voice-hearing literature.
The first one, as Indigo was talking to you about earlier, the effect of trauma on the brain. So one of the models that we are working with is that the voices are reactivating memories, and they are popping into people’s consciousness without their awareness. These can be voices from the past via traumatic experiences and can be events reactivating and re-occurring for people. But that doesn’t seem to explain all the voice-hearing experiences.
So another prominent model that we work with is that these are thoughts, again with the lack of consciousness that they are your own thought and perhaps a problem with monitoring your own thoughts. So there’s not a clear single answer to why these things are happening for people. And I think one of the things that has been interesting is that people come with voice-hearing experiences from very different backgrounds and from very different experiences, and the way I’d like to think about the voice-hearing experience in the brain is in terms of these backgrounds and in terms of the entire life of a person.
Lynne Malcolm: And so from what you know, having examined the brains of people that hear voices, what makes sense in terms of effective treatment?
Susan Rossell: That’s an interesting question and I think it really needs to be individualised. There are many people that come to see us that really do need to work through their trauma, to talk about the events that have happened to them and they need to relate it back to the characters maybe that their voices are in their heads.
There are other people who may not have had such obvious traumas in their life. There are a range of different psychological therapies that can assist people with coping mechanisms. So Dr Neil Thomas who I work with at the Voices Clinic has a number of different approaches that he uses in terms of psychological therapies. There’s mindfulness, there’s acceptance and commitment therapy, which fall under a broad umbrella of cognitive behaviour therapies.
Lynne Malcolm: And there’s antipsychotic medication. Many people such as Indigo Daya choose not to take antipsychotic medication because of unpleasant side effects, but Susan Rossell says there is an important role for pharmaceutical drugs.
Susan Rossell: I know it’s always the elephant in the room, especially when we hear some of the experiences of voice hearers with regards to medication. A lot of them have very negative experiences with their medication. But I think that there is a role often with medication that is certainly sometimes overlooked. And when people are in a great deal of distress on first entering an acute psychotic period, some form of medication to help with relieving some of that stress and calming them down a little bit is certainly something that I think needs not to be overlooked.
Lynne Malcolm: Dr Rufus May has been a clinical psychologist in the UK for 18 years. His interest in holistic approaches to healing from mental illness began as a result of his own psychosis and recovery in his late teens.
Rufus May: My experiences were more around having powerful beliefs, and that partly came from my own experiences of looking for meaning in the environment. So I’d pray to God and then see if I could get a message back and I’d look at advertising hoardings, for example. And so the more I did this meaning-searching, like opening books randomly for messages, the more I found all these coincidences and these omens in the environment. And if I tuned in to the radio randomly I seemed to pick up messages for me, and I started to worry that I might be being controlled. I thought the chest pains might be a gadget inside my chest that had been placed there by Russian spies.
And that made other people really worried and think ‘we need to sort him out’, so I was put into hospital and given strong drugs and fairly quickly given a diagnosis of schizophrenia. I was told I’d have to take medication for the rest of my life. And I found the drugs really strong and over-sedating, and so yes, I guess that was the beginning of my interest in perhaps a more holistic approach that uses drugs a bit more lightly.
Lynne Malcolm: The international hearing voices movement is placing more and more emphasis on the importance of listening to the voices. They believe that what the voices actually say can give helpful clues to recovery.
How significant does neuropsychologist Susan Rossell believe the content of the voices is?
Susan Rossell: Yes, I often face this question, and I think it’s a very big challenge for neuroscientists to work out why people have the exact experience that they have. And clearly the content has a great deal to do with the experiences of the person. Everyone is unique, everyone has had individual experiences, and this is where the nature and nurture argument comes into play, you know, that everyone comes at their voice-hearing experience from different backgrounds, different family settings, different cultures and different societal norms. So we do need to take that into consideration when we’re thinking about the content of the voices.
Lynne Malcolm: So what was the content of your voices and your beliefs telling you about what was going on for you?
Rufus May: Well, I’d come out of a relationship with a woman from a different background to me, she was from a Jamaican background, and my parents hadn’t been that keen on the relationship and her parents hadn’t been either. So there was this cultural divide I was aware of. And then in my beliefs or delusions I was thinking that I was involved in a battle between capitalists and communists, and I thought my girlfriend was a spy for the Russians and that we would be reunited in a safe house, a bit like The Spy Who Loved Me. And so I kind of see that…partly there was this real sense of these cultural tensions and me looking at that through those beliefs.
Lynne Malcolm: And how did that help you to notice that association between the reality and what you were experiencing?
Rufus May: I think it makes you less afraid of your mind when you find a meaning to what you’re going through, whether it’s a bullying voice that you actually make a link to—do you know what, I was bullied by a guy really viciously when I was 12 or 13—that demystifies that voice and you realise if you can get counselling about the bullying you went through and start to believe in yourself again, then the voice is not going to be a problem. That’s what I think is really helpful. If we look at the actual meaning of the distress and learn from it, we can actually become more whole in the future.
Lynne Malcolm: Rufus May is passionate about using different approaches to help people deal with their voice-hearing if it’s disturbing to them. He runs therapy groups where the goal is not to get rid of the voices, but to establish a new relationship with them. One approach is to engage with the voices, and even to engage one voice with another.
Rufus May: It’s come from actually couple counselling, and the idea was that we all have different parts of ourselves that we need to manage and negotiate with, and we can do that with voices too. So I can ask somebody who hears voices if I can speak to the voice and ask it some questions and say, ‘How long have you been in John’s life, and what do you want for John, and what differences would you like to see in John’s life?’ Or if the voice is really angry say, ‘If John want to take up martial arts, would you like that?’ Or, ‘If John was to speak his truth more, would you like that?’ And to see if there is some common ground that you can establish, so you kind of mediate.
With one person I was working with I couldn’t see her very often so I said to her voice in one session, ‘I know you’re starting to change, you’re starting to become more helpful to Sophie, but if I’m not around, how about you send me a Facebook message.’ And this voice said, ‘I want my own account.’ So she ended up giving him a Facebook account, and then he went on a forum for other people who hear voices and say, ‘Hey you lot, I’m a voice, is anybody else out there a voice and they want to share ideas with me?’
And so you have this Facebook group now that’s mainly for people’s voices where they talk to each other from around the world. So that’s quite advanced, that’s where people have come to terms with the fact they hear voices and they’ve found ways to feel safe and they’ve found ways to share their life with the voice and they’ve given them…it’s a collaborative thing where they give their voices Facebook accounts. But it’s a really interesting development. I think it shows this approach is really a very different way of relating to our minds, where we embrace the diverse voices within us.
Lynne Malcolm: Will Hall, a therapist from the United States, also uses an approach of engaging with inner voices, it’s called voice dialogue.
Will Hall: Well, one of the things that I have used a lot with people is interesting because it is really helpful for people who are hearing voices, and also it’s helpful for everyone because I think all of us have an inner critic, we all have a doubting or menacing or negative part of ourselves that kind of puts us down, and we don’t experience that as an outside entity or an outside voice but it’s also very similar to the experience that people who hear voices have.
And so there’s a method called voice dialogue where you can talk back to parts of yourself or talk back to a voice, and I coach people and we role-play. The challenge is really to stand up and be assertive and say, ‘No, stop being mean to me, I’m not going to accept you being mean to me,’ and I might encourage people to have a really powerful stance and to maybe even shout.
But the challenge is at the same time to tell the voice or to tell the part of yourself, ‘Don’t be mean to me, but I am open to listening if you have a message, if you have something you want to tell me,’ because often the meanness is wrapped around something that might be valuable for the person. And this is something that listeners can try, even if they are not voice hearers, that if you maybe have a message that comes in or a doubt or something that is putting you down on the inside, try talking back to it as if it was a different part of you or a different person inside, a different personality inside of you, and really stand up for yourself, and I think this can be really, really helpful for people.
Lynne Malcolm: Will Hall acknowledges that many people who hear voices take antipsychotic medication, but it doesn’t suit everyone, and there are dangers in going off the medication without guidance and support. He’s written a harm reduction guide to coming off psychiatric drugs. It’s available free on the internet, and I’ll put a link to it on the All in the Mind website.
Before we go, what’s important in the area of future research of voice-hearing? Susan Rossell:
Susan Rossell: One of the ways that we think that it’s important to look at voice-hearing in the brain is to look at what we refer to as the temporal dynamics, so how things happen in time in the brain. All the research that’s been done to date has been looking at single episodes of voice-hearing. So what tends to happen is we will compare a voice-hearing experience in a person that hears the voice during a period of time and then compare that to a period of time when they don’t hear a voice.
Until recently we’ve not had the technology to look at this temporal sequence and exactly what’s happening just before the voice-hearing experience, so up to 10 seconds before and then 10 seconds after. And the reason why we think this is important is because brain regions don’t work in isolation, they work as a network, so trying to work out how that network is producing the voice.
There are a couple of reasons why I think that this is important. So if we can work out how the network is working in time, we might be able to then use other technologies, say for example some of the brain stimulation technologies to stop voice-hearing experience in people that are very distressed about their voice-hearing. I know not everybody is and some people might not want to have that kind of stimulation technology but there are a lot of people out there that do.
The other reason why it is important to find out this information is, again, to work with the psychological therapies to try and work out which psychological therapies are most effective in terms of people’s recovery. So we have a research program at the moment looking at mindfulness and voice hearing, and we’re asking people to have brain scans before and after mindfulness training, to work out how this has had a positive effect on the brain and also a positive effect in terms of people’s recovery. So making sure that we integrate our neuroscience with our treatments and our psychological interventions is going to be very important in the future.
Lynne Malcolm: Professor Susan Rossell from the Brain and Psychological Sciences Research Centre at Swinburne University.
That’s all for today. If you’ve been disturbed by anything you’ve heard in the program, call Lifeline on 13 11 14, or get in touch with the Hearing Voices Network. Links to that and other information connected with today’s show will be on the All in the Mind website via abc.net.au/radionational. Leave a comment and catch up with past programs from there too.
Thanks for your company, catch you again next week.
- Indigo Daya
- Voices Victoria Program Manager and voice hearer
- Rufus May
- Clinical psychologist
- Will Hall
- Therapist, trainer, community development worker and voice hearer
- Prof Susan Rossell
- Professorial Research Fellow; Swinburne University and Monash Alfred Psychiatry research centre