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Psychosis and Hearing Voices
Because I work as a Psychiatrist, some people think that a trip to see me is not complete without the archetypal question, “Do you hear voices”. However, though I do usually cover this are at some point, that question itself is next to useless.
Some people will run a mile – especially if they actually suffer from something like OCD [page 24] and just FEAR they are going mad. Others will have voices which for them are quite normal – about 1% of the UK population chronically hear voices and are not ill at all. And the group who you might think I am interested in (those with Schizophrenia) do not all hear voices and (as a diagnostician) I am interested in far more than just hearing a voice.
Causes for Voice Hearing
Normality: Hearing voices or complex noises can be a normal experience and people live otherwise healthy lives. If it gets bad, the Hearing Voices Network (www.hearing-voices.org) have a helpful website with links to books and self-help groups all around the country. This resource can also be useful for some of the people who hear voices for the reasons listed below.
Split-Mind: The literal meaning of the word schizophrenia is ‘split brain’ but this is a misnomer – this is not what is happening in schizophrenia. But there are people whose mind is ‘split’ who hear voices. This may have occurred as a result of awful trauma when young such as sexual abuse – and our natural defence mechanism is to split off that awful memory into a hidden part of the brain. But humans don’t do well with hidden bits, and it tries to get out – some times as flashbacks, but sometimes as the voice of the abuser saying nasty things like “You are dirty/horrible/useless.”
Low self-esteem: When our mood is chronically lowered, not typically due to depression which is episodic, but due to low self-worth; we can begin to hear a voice that resonates with our mood. It is more like an audible conscious stream of negative and critical comments: “You are useless. You are fat. I can see why no-one wants to be your friend…”
Substance Misuse: If you use alcohol heavily, or other street drugs like amphetamines that stimulate dopamine [see below] you will be likely to hear voices. In chronic alcohol use, the voice is similar to in low self-esteem above. In amphetamine intoxication it can be anything from hearing police sirens to thinking you are in space and ‘Ground Control’ is trying to reach you…
Severe mental illness: People with schizophrenia will experience all kinds of voices. General paranoia is common, but psychiatrists are particularly interested in three types of voice: Two or more people talking about you, a voice commentating on your actions, hearing your own thoughts read out aloud. These voices are strongly suggesting of schizophrenia rather than other causes. Voices are also sometimes heard in other severe mental illnesses such as bipolar affective disorder, advanced dementia or very severe depression.
Schizophrenia
Though a fairly uncommon cause of hearing voices, this is worth an extra mention due to the fact that people know almost nothing about it – yet think they know enough to pass judgement. It is a very severe mental illness and needs urgent management by a psychiatrist supported by a well-equipped team. You will probably be offered anti-psychotic medication (see page 32), as an abnormality of brain chemistry [specifically dopamine transmission] in the frontal and temporal lobes is thought to be a key feature. However, it is never just about medication and should ALWAYS be accompanied by some kind of support (according to how much you need), some kind of talking therapy (to reduce the anxiety associated with the symptoms) and a crisis plan (of things to do if symptoms worsen). Some people may need to come into hospital for a while.
However, it is not something to be afraid of. Sadly, people have a negative image of schizophrenia – largely thanks to films like ‘One flew over the cuckoo’s nest’ and ‘Me, myself and Irene’. The first is woefully out of date and even then inaccurate, the second is about multiple personality disorder and psychopathy – things completely unrelated to schizophrenia even if Jim Carey doesn’t know this. Also, Christians can need reminding that Schizophrenia is NOT demon possession – most of the cases of demon possession in the Bible are completely unlike Schizophrenia and even the ‘Gerasene Demoniac’ in Mark 5 is pretty far off the mark. For a more complete discussion on this topic, look at the Mind and Soul website (www.mindandsoul.info) and search for ‘demon’.
Schizophrenia affects 1% of the population at some point in their lives and treatment can last for several years. This means that there are lots of people on treatment and you would never know – anymore that you could tell a person with diabetes was on insulin. People with Schizophrenia (and please lets call them this, not ‘schizophrenics’ or ‘nutters’) are more likely to get hit that hit you – they are not typically violent, especially when well. In fact, in my experience, I have typically found them to be amazing and resourceful people who have to live with a severe illness that affects something very close to their core. Perhaps you or I would do well to meditate on this before we jump to any conclusions.
Cannabis and Schizophrenia
It is well known that smoking too much grass can make you a bit edgy – even paranoid. But this typically settles. Opinion is divided as to whether heavy use will actually CAUSE schizophrenia. Statistically, there is a dose-related correlation between use and later Schizophrenia. However, it could be that it just brought to the fore something that was going to develop anyway. Cannabis is also used by some people to take the edge of voices in the short-term. However, unfortunately it tends to make voices worse in the long term. It can also be a ‘gateway’ to other more serious drugs like amphetamines and heroin.
Students and first episodes of psychosis
The peak age of onset for Schizophrenia is in the early twenties so it may well develop at University. It is triggered (though not caused) by stress, so can particularly emerge in Freshers’ Week – most Universities will see several new cases each September. It may also emerge more slowly as a person struggles to adapt to the new environment.
A ‘typical’ person developing Schizophrenia (and this is only typical) may have given some warning signs early on such as being uncharacteristically rigid in their thinking or having a few ‘BLIPS’ (brief limited intermittent psychotic symptoms) of voices or paranoia that last for a few days then back to normal. There may well be a close family member with the illness. They may be using drugs, not as a cause for the problem, but to help them cope with symptoms. They will most likely be self-isolating and you will see their life begin to deteriorate on a number of levels (appearance, work, hygiene) not just in what they say and think.
This is one of the situations where you should encourage the person to seek help themselves but, if they will not, you may want to go over their head as early treatment is more effective and can help prevent a severe breakdown later.
More information
Hearing Voices Network – www.hearing-voices.org, 0845 122 8641
NHS info and video - www.nhs.uk/conditions/psychosis |
Rob Waller, 07/05/2010 |
10 Comments
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| | | Libby (Guest) | 11/05/2010 22:28 | My brother has been having a breakdown for the last 4 years he's 41 and it's getting worse he has been in and out of mental hospital this year, but will not accept any help from anyone including our pastor and the church, friends, family, noone, he's says he's beening attacked by demons and they trying to eat his flesh, however it started off 4 years ago that he had wasted his life as an actor and let good people go and now he's all alone and has nothing. He found Jesus and became born again 9 years ago and was on fire for the Lord hoping God would send him a wife, however he stayed in a friend ship basis relationship with a married woman who became a christian with him and her husband is a none believer. They were very close and his church told him the relationship was not right, as my pastor also said so, they went to the gym together and meals etc, her marriage is for conviencence only however he said it has stayed platonic. He's back up here living with mum and dad after selling his flat which he pulled out of 4 times and took 3 years to sell he wasn't working so dad paid the mortgage but could keep it up. He's making mum and dad miserable we have all tried to make him see sense and get help, he makes no effort he's scruffy and angry, what is happening can you advise us what to do, we pray to the Lord he is healed and rests in the Lord, but he won't, how can someone love Jesus but be so selfish and unloving.
| | | | Sally (Guest) (Guest) | 12/05/2010 17:57 | Hi Libby,
This must be so difficult for all of you, and exhausting as well having this illness for four years. You are doing the right thing, praying to the Lord for his healing. I would also like to pray for his healing and for strength for you and your parents to support him but also that you will be refreshed. The good news to hang on to is that when he was well he was saved and God loves him just the same now, even though his behaviour has changed. Unfortunately many Christians appear selfish and unloving - we just don't know why that should be, but it is. In practical terms - does your brother have a mental health worker that you could speak to about your concerns for his mental heath and the effect his behaviour is having on your parents? Failing that, perhaps a chat with your GP or practice nurse for some advice on what you can do to help him and get some support yourself. Sorry I can't make this better.
| | | | margaret (Guest) | 15/05/2010 10:26 | i am surprised that as a Christian you seem to have decided that hearing voices is only due to mental illness or a chemical imbalance in the brain.
Moses when on a mountain saw a burning bush = flames without damaging it's structure. He heard GOD speaking as if from a bush. By your definition, moses would have been deemed to be having auditory and visual hallucinations and would have been diagnosed as mentally ill.
There have been many ocassions cited in the Old Testament whereby GOD has spoken to people either through His own voice or through the actions and speech of angels. People are cited in the Old Testament as having witnessed miracles and no doubt would be labelled as psychotic or having psychosis.
GOD is unchanging, he is the same GOD of the Old and New Testaments - are Christians now saying that any interraction is a result of mental illness eg psychosis or hallucinations?
I beleive that in some cases GOD still has direct interractions with people as do angels and it cannot be eddifying to dismiss signs given from Him to a person as hallucinatory in origin.
| | | | S (Guest) | 17/05/2010 19:59 | The text above gives several reasons for hearing voices - one of which is under the heading of 'normality' - so I do not think he is attributing all experiences of voice hearing to mental illness. There may be a cultural component in how we experience contact with Spiritual powers (good or evil) as there is with mental illness, which influences the exact form of our experiences.
Also one useful point that Sim (Christian psychopathologist) makes is that, typically the people who are spoken to directly by God or who have a religious, quasi-psychotic experience are built up and positively influenced by it. The kind of destructive, persecutory voices that some with schizophrenia suffer are not edifying or positive and are clearly a symptom of impaired mental health. I suppose the 3rd camp would consist of the people who hear voices and are usually neither distressed or greatly energised by them - they are just part of the person's psychological make up.
The more time you spend with people with hallucinations combined with a reasonable biblical knowledge and the gift of discernment, the more the differences becomes easier to spot (usually).
| | | | "" (Guest) | 19/05/2010 20:41 | Don't get schizophrenia mixed up with Bipolar type 1 the symptoms are quiet similar, if you research the medications you will see that they treat Bipolar type1 and schizophrenia its very complex the mind and only professionals can properly diagnose. I only know because I'm still not properly diagnosed they first thought I was schizophrenic then they said bipolar now they say schizoaffective and its been 2 years since i first got hospitalised. my tablets now treat both schizophrenia and type 1 bipolar
| | | | suzie w. (Guest) | 02/06/2011 13:53 | I havent been properly diagnosed either, and have just started on meds to help with symptoms, i have been scared out of my mind for years thinking that symptoms have been reality, i guess i just need reassurance that im not alone, and that im not beyond healing, or being loved and accepted...
| | | | Ann | 02/06/2011 21:33 | I suffer from chronic dysthymia/depression and also chronic pain. There have only been two experiences of what I would call real 'voice hearing', in that the voices seemed to come from outside my mind. The first, over 30 years ago, was while my medication was being changed, and I had a weird hypomanic-type reaction for three days. The second was a couple of weeks ago, for a day, when I had a cacophany of voices in my head. I realised that this was an interaction between two different types of pain medication, and on investigating on a pharmacology site, I discovered that one type of medication raised the blood levels of the other (which can cause 'thinking disorders') by almost 50%. At least from my nursing experience I suspected the cause and knew where to look, but I wonder how many other people are 'freaked out' because the interaction is not on the enclosed Patient Information Leaflet, but only on the SPC on pharmacology websites. It's hard enough putting up with the 'visual disturbances' - a great understatement - if I only use it sporadically, without the voices as well!
| | | | janine (Guest) | 09/08/2011 11:48 | I was in an accident on mothersday of 2008 where a little girl was killed. I have epilepsy and had a siezure behind the wheel. I went to jail for this for 8 months.I started hearing"hings" in jail.I got very bad and was left untreated while I was there.It is basically untreated now, but I am working on it now. I thought I was possesed,haunted,schiphrenic,the whols nine yards.i am now of the mind set of a phsycisis diagnisis. I had spoken to a docotr and am on zyprexa.They have started to fade, but are still there every second.They put me down, they regurgitate my every thought in a diferent voice, a {monster} voice -I call it.I would never have thought this would happen to me.
| | | | WhateverTheySay | 14/08/2011 21:03 | @Margaret - I know it is a long time since your comment, but you inspired me to reply. As a teenager I would regularly call 'religious experiences', much of which involved God either talking to me or altering my thoughts.
Then later I would have the same experiences (but negatively impacting on my life this time, and not from God) a few years ago until the present day. I was eventually diagnosed with psychosis and I now take medication. For a long time, I thought that what was happening to me was demon possession but I am glad to say that this is no longer the case.
The 2 kinds of experiences, to me, are very different (even if they so happened to involve the same processes).
| | | | Richard (Guest) | 22/10/2011 21:34 | I've also just read this text and it's helpful to hear all your comments. My experiences have been of God talking and evil voices and seeing lots of psychiatrists over 22 years since I was 12. I became a Christian when I was 13 but I'm not from a Christian family and I'm still being supported by my parents. I get disparaging attitudes: from my family and professionals that my faith is part of my illness; from other Christians that my faith is less real than theirs, but others who go the other way and think I'm really lucky to hear the Lord and that it's not an illnes.
For me it's hard to separate the mental health and spiritual voices because they all are part of the same thing somehow. I now have a diagnosis of schizphnrenia. Once in hospital I was begging the docs to give me this diagnosis, but they wouldn't. It's now hard to live with the diagnosis since January 2011 but good that they're not treating me for bipolar I (moodwings side)any more.
I sympathise with Libby and her brother, as it's impossible to accept you are ill when you're ill. My voices and paranaoia are milder now I'm on a a depot injection but I've lost the certainty I used to have in my Christian faith. It's a weird journey.
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