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A call to listen to the inner voice

To help Christians in all our churches to engage more fruitfully with those suffering mental distress, Norfolk Christian magistrate and social psychologist John Myhill draws on his own professional experiences.

As a rebellious student in the 1960s I became part of the anti-psychiatry movement inspired by E. Goffman and R.D. Laing.  In the 1980s as a professional social psychologist I was in charge of a psychiatric rehabilitation unit to enable long-term patients to escape further incarceration.  We all suffered degrees of disillusionment, when we found that successive governments were unwilling to spend on community care, the huge sums they were saving by closing the asylums. 
Money did pass to the pharmacology companies, for what was called at the time “the liquid cosh”.  But it was clear that mental distress was increased by pushing people out of care into isolated flats, with minimal support, surrounded by a fearful, judgmental populace.
One reason I am a Quaker is that I have a very positive inner voice, guiding me through difficult moments.  Escher and Romme showed that such a positive experience of voices could be very helpful to those who experience of voices has led to mental distress.  So in the 1990s I became involved in the ‘Hearing Voices Network’ and got to know some very remarkable individuals, some of the best friends I have had. 
Whilst my professional contacts have given me a huge concern for the suffering of people with a mental illness label, when I became accepted as an equal, as a friend, it was their ability, rather than their distress which impressed me.
I want to give you a flavour of what it may be like to hear voices, and I will do this by presenting points of contact; places where their experience may be similar to yours.  I do this in the hope that you will listen carefully next time you meet a voice hearer, so that you may benefit from the wisdom beneath the pain.

Listening to those whose voices cause them distress

For many voice hearers, voices are a metaphor: there is no desire to identify where the voices come from, nor fear that the speaker will suddenly appear.  There is no wonder about the mechanics, or the appearance of those who are manipulating the sense experiences.  Such questions are beside the point.  The voice hearer is not “credulous”, nor do they exist in some primitive pre-rational state.
They are often strongly detached from what they say, and capable of irony to deflate their own statements.  There may be a mannered, conscious mockery of everything, including themselves. Like Satire it often debunks Establishment perceptions.  Like satire, it has its own internal logic.
Far from “taking everything literally, or losing awareness of the mind’s role in constituting reality”; they are emphasising the significance of the mind’s role, explaining how representation of reality works and what subjectivity really is.  They are living a “form of transcendental idealism” as if the world was not substance but ideas, “an emanation of consciousness itself”. Or as Wittgenstein put it: “the world is the totality of facts not of things.”   But to the person in distress these “facts” form the Truth.  This is sometimes referred to as seeing the world in concrete terms:  even abstractions become solid individual objects.

Metaphoric Explanations

Some voice hearers, when presented with a picture and asked to tell the story, may speak as if the people in the picture really do exist, in two dimensions in that moment in time, unable to escape the permanence of the representation.  The voice hearer may feel trapped, and two-dimensional in their own moment.
Film has had a profound impact upon the way we conceptualise our relationship to a higher power.  It is routine for people to see themselves as if they were in a film; to wonder if they are really living, or just being played back; to believe that those around them are merely projections, animations, holograms, whilst they are directing the production of the movie.  Some people in simple societies when first faced with a camera were afraid that it would steal their soul.  Not an unreasonable belief given the numbers of people who believe (with Morel in “Last Year at Marienbad”) that they have been swallowed into new technology (as in “The Matrix” trilogy). 
A reflection of this may be seen in the obsessive need of some criminals to film their crimes: to enjoy them at a later date? Or to distance themselves from their actions by reducing them to film? Or to present themselves as movie stars to an audience?
They may imagine themselves as watching a film: moving images moving past.  Yet at the same time they feel that there is nothing past which the images float. (The objects are merely film, but the observer is merely camera/ projector; controlled by forces unknown.)
Likewise computers lead us to think in terms of retrieval and processing of memory as mechanical tasks, rather than as thinking.  Such processing is seen as banal in comparison with the transcendental experience of hearing voices.

A form of Consciousness like Fantasy

Voice hearers are not contradicting biological reality: but giving an unconstrained expression to their passing fancies, the imaginary realm where such strange transformations can occur, though only as thoughts.
Thus “the prime minister is preventing me from getting a wife” makes no reference to a person out there, but to an internal experience of being prevented from imagining a successful outcome by the cultural constraints of early childhood, symbolised by the concept of a political leader.  Similarly “MI5 have chosen me to direct great changes in the world” does not relate to a real organisation, but to a symbol of power and control, which in the internal mind produces a grandiose fantasy that is not taken as literally true.  Facts are nothing: truth is all that matters.  Doubt, distance and deconstruction are seen as essential roads to this truth.  Rational arguments are seen as attempts to suppress mysticism and sensuality, as well as the inner voice.  Such fantasies might be compared with sexual fantasies, which excite because of the threat of total disaster.  Just as sexual fantasies are addictive, so that the fantasist quite often feels controlled by the fantasy, so the voice hearer feels controlled by the ideas: the victim of thoughts rather than the thinker.  As with all fantasies, they are generally preventive of action, rather than productive of action.
The inability of the historian to “keep Charles the First’s head out of his book” in “David Copperfield” was not an expression of a mad obsession, certainly not an indicator that the writer would try to chop off someone’s head or revenge the death of Charles II.  But it did show that he felt controlled by an idea, which Freud might interpret as a castration fear, whilst others might see illusions of grandeur.  Somehow the fantasy allows the individual to live out experiences impossible to him or her in the real world.  The computer game is an example of capitalism cashing in on this need.

A form of Consciousness like Dreaming

This is my explanation for the voice hearer’s “enhanced ability to see non obvious similarities”. The interesting thing is why one fantasy rather than another?  How do some people become totally drawn into their fantasy and controlled by it, whilst others enjoy but remain detached?  Why would anyone allow a negative fantasy (in which they always lose, or suffer, are evil or stupid) to dominate their consciousness?
OpenMind“I felt trapped, caught in a story, absorbed by a device for recording my thoughts, watched in everything I did, everything I saw was being recorded elsewhere. It thinks therefore I am not.”  These epistemological delusions, are symbols for the subjective, for the isolation of individual consciousness from real understanding by any other individual consciousness.  Such symbols are evidence that the person is developing a theory of being, not that they are ineffective at testing reality.
Imagine that your waking life seemed like a dream, where you are involved and see everything, but the weird and impossible happen all the time and you have no sense of control.  In dreaming, our thoughts and perceptions do not pass through the usual filters that limit imagination in waking life. Imagine it is like a nightmare and your only desire is to wake up.
You can see huge distances yet touch objects on the horizon, yet you cannot move to avoid an approaching bus.  You can make a steep hill become a slow descent, by wishing it would be so, yet you cannot control who takes centre stage, or what they say, or even who you are.  You remember people and places you know you have never seen before.  Even your most intimate thoughts and desires appear to come from outside, from someone else.
This is like “the solipsist whose acute awareness of his experience-as-such, feels and declares that the world is his own idea, existing only because he is conscious of it. This is not a reversion to the infant’s ignorance of ego boundaries, but the consequence of exaggerated awareness or sense of the role of consciousness in constituting its world”.

A form of Consciousness that determines brain function?

Measurements of brain function are usually thought to cause strange thoughts, but what if the thoughts could produce changes in the brain.  For example a person spending all their time in listening to an inner voice and reflecting on inner thoughts might clearly impact upon his muscle to fat ratio because of inactivity.  Why should it surprise us if certain parts of the brain: (eg those controlling physical activity), should atrophy in the same way as the muscles.  People suffering from organic brain changes sometimes recover of their own accord, suggesting that brain changes are reversible, by changing mental activity.  People coming off anti-psychotic drugs will suffer the same symptoms as those to whom the drugs are usually given.

A form of Religious Belief?

Like the solipsist, the voice hearer does not seek converts.  In contrast the convert to a new religion may appear to be playing a role, imitating the behaviour of the leader of the cult to such an extent that their speech is almost a parody of the voice hearer.  (Erving Goffman in “Asylums” described copying behaviour in psychiatric hospitals in just these terms.) The ideas are of tremendous importance to the person having them, and they are happy to talk about the ideas, but they do not expect to be understood, as they are expressing an inner experience, which cannot be explained by language.  “I have to use words when I speak to you” TS Eliot  and “Of what we cannot speak we must remain silent” Wittgenstein.  The internal experience is not an image, fantasy or delusion of the mind.
Yet there is a very thin line between the believer’s statement that he listens to the voice of God, discerns Truth through the guidance of the Spirit, speaks directly to God” etc, and the schizophrenic’s idea that he is dealing directly with God.  The voice hearer  is excited by the ideas but does not expect others to take him literally.  “The shadows, reflections and phantasms” (Derrida) have taken over from a world out there.  The problem of the voice hearer is how to separate delusions from a whole new mode of thinking (categories, concepts and mode of logic are all new).
It appears that the voice often speaks tersely, using cryptic words and not expecting to be understood; but careful analysis will reveal deep and interesting meaning (as in Lucky’s speech in Samuel Becket’s “Waiting for Godot”).
As with religious language, the voice emphasises what is not said, the transitory, the fugitive and the contingent; where obscure references are felt to be more authentic, than ordinary language used by other people.
Everyday life is seen as the weak exploiting the strong, greed destroying both rich and poor, regulations preventing love.  In simple societies the voice hearer is often seen as someone too close to God:  they may need healing to recover, or they may be guides for the people bringing gifts from a spiritual world.   If the distress gets no worse, how can it be illness?  If the voices start suddenly and leave just as suddenly it makes more sense to talk about a “message” rather than an “illness”. The lack of pragmatism, refusal to be bribed, and general unworldliness of voices, inevitably reminds us of the teachings of the great religious leaders.   
“Embodiment” is a central idea in Christianity and some other religions.  How does the consciousness, the voice, the God, become embodied within bone and muscle; and is this a limitation or a gift of grace.  This is not to be confused with the young child who is focused on its physical needs and lacks self-awareness.  The voice hearer is much closer to the existential philosopher, fascinated by Being, Mind and Language. Everything is more real than non-voice hearers are used to. (The doorknob in Sartre’s “Nausea”).  But, what the voice says may sometimes be banal, with pompous phrases providing formality, calling attention to ambiguities in language in an ironic rather than a meaningful way.  It may just be filibuster to throw others off the scent of what is really being thought.
Is inner reflection in an ideal for you? Would you call it meditation, or seeking the way, being in touch with the spiritual or following the path of the mystics?  Is a chosen objective to be reached through silence, through clearing the mind, through asceticism or through chanting? Is it an attempt to shut out the external world?  It is our human condition that any attempt to overthrow conditioning, culture, upbringing, genetic determinism, habits and obedience; may lead to “a paralysing ambivalence, an anxious self-awareness, an endless deliberation, self-criticism and doubt.” This loss of self, has been compared to the surrender of self in Buddhism, leading to enlightenment.
Successful meditation can blank out all reality and memory, and this may be as frightening as the experience of a flotation tank where all physical stimuli is removed, or a long period of solitary confinement.  There can be a loss of all sense of reality, of being alive.  The same experience can be produced by a traumatic experience, when the person becomes catatonic.  An escape from such catatonia is sometimes to imitate what other people are doing, but more extreme actions involving self-harm are common.  Where does the boundary lie between meditation and mental distress; or between enlightenment and madness?  Why are religious people “persecuted”; whilst other voice hearers are “treated/ medicated”, or dismissed as mad.

Constant self-analysis

The  voice hearer  does not choose to be hyper-reflexive: this intense state is irresistible to them, and much of what they say is an attempt to express what it feels like to be constantly in this inner world: “The splitting of egos which inspect each other”  “the self monitoring, so that in a discussion, I am the other person, and I am  saying things, but I am unable to stop myself, because by the time I have heard what I say and analysed it, it is too late and I am alone again.”  
Every culture, discipline, tribe, organisation, social group; has boundaries laying down what cannot be thought.  Those who test those boundaries may become the new leaders of the group: but those who go well over the boundaries and become fascinated with what lies beyond; may be expelled from the group or suffer its control.  Consider how this is done within the communities to which you belong.
People who hear voices are usually amongst those who are expelled, and rarely belong to a group.  Their isolation makes them vulnerable.  To live entirely within the subjective experience is to understand the impossibility of conveying to others what it feels like to be you.
Let me try to express what voice hearers have told me it feels like.  They want to be in control, and cannot allow the ongoing flow of practical activity.  It is the fear of missing the opportunity to make a free choice that ultimately prevents them from choosing.  They are concerned with choice at a high metaphysical level: the choice between self-abnegation and self-deification, between self as object and self as subject, between the finite and the infinite.       
To the outsider, the voice hearer  (or the religious mystic, artist, theoretical scientist, poet or philosopher) may appear to be in a vegetative state, whilst in fact their inner consciousness is working overtime, often producing thoughts of great lucidity and importance, so interesting that the person cannot leave them alone.  “I felt myself capable of thinking myself to death – I felt an incredible sense of calm come over me.”
Modern western society places huge emphasis on self-organisation and personal responsibility, so anyone who is hyper-reflexive tends to be seen as sick. We lack traditional values and fear mystical experience, so the individual is left to flounder until they are labelled as mad or bad.  The emphasis on individual privacy and rationality positively encourage self-analysis, but provides no support for coping with hyper reflexivity which it often produces. 
Society expects such reflection to produce nonsense, so those who express their experience are labelled as “demented”, “depressed” “schizophrenic”, “manic”, suffering a “neurological disorder”; when the real problem is one of poor translation.  These labels themselves isolate the reflective person from normal interaction.  It has been my argument throughout this essay that voices are never nonsense, but often very demanding, like reading James Joyce or Proust rather than Harry Potter.  I have attempted to suggest some starting points, but translation will always be unique to the individual.

Escape through Obedience

A command hallucination, is a way out of this dithering: it externalises authority and relieves the individual of all the inner heart searching and weight of responsibility.  Voice hearers often feel that they are unable to make decisions, because they are too busy observing their thoughts.  Many people would call this: being open to the Light, or to God or to Logic; following conscience, or the religious way, or Truth.   Immediacy of response is able to replace the impossibility of choosing and the frozen state of self-blame. 
Another alternative is to return to routine mundane tasks, like shoemaking for Mr Mannet in “A Tale of Two Cities”, but this is an escape used by all kinds of people trying to forget a traumatic event. Where the alcoholic hears voices relating to his senses, these voices are conceptual or cognitive.  Where the rational person obeys established authority or a crazy idea, all the way to genocide; most command hallucinations demand that the individual sacrifices themselves for the needs of the least fortunate and this rarely involves the suffering of other individuals.

Escape through a self-fulfilling Prophecy of Doom

Finally consider a fanatical religious follower or the voice hearer who feels persecuted: there is a tendency towards catastrophe.  The Jeremiah element found in many religions, can contain an element of self-fulfilling prophecy: the prophet deliberately bringing about the disaster.  We see this in Capitalism where bankers engineer a recession by over-investment in certain commodities, selling at far more than the commodities are worth, and reinvesting the capital in undervalued goods.  The voice hearer may also attempt to deny responsibility, for any catastrophe caused, on the grounds that his/her actions were controlled from an external source.  Not that he was just obeying orders, but that he was totally controlled like a puppet or animation.  What can we do to enable others to feel free?  It is not enough to tolerate religious diversity, or mental distress, or say that bankers cannot be reached in their gated condominiums: we need to engage with any individual who appears to be engulfed by a fantasy, a dream or self-obsession.
{The direct quotations, unless otherwise referenced are taken from “Madness and Modernism” by Louis A. Sass -  Harvard University Press 1992}


If you would like to contact John about this article, please e-mail him at John.Myhill@homegroup.org.uk



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