Negotiating with hallucinations

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Tanya Marie Luhrmann, "Beyond the Brain", Wilson Quarterly, Summer 2012, writing about a new approach to treating schizophrenia:

In Europe, the Hearing Voices network teaches people who hear distressing voices to negotiate with them. They are taught to treat the voices as if they were people–to talk with them, and make deals with them, as if the voices had the ability to act and decide on their own. This runs completely counter to the simple biomedical model of psychiatric illness, which presumes that voices are meaningless symptoms, ephemeral sequelae of lesions in the brain. Standard psychiatric practice has been to discount the voices, or to ignore them, on the grounds that doing so reminds patients that they are not real and that their commands should not be followed. One might think of the standard approach as calling a spade a spade. When voices are imagined as agents, however, they are imagined as having the ability to choose to stop talking. Members of the Hearing Voices movement report that this is what they do. In 2009, at a gathering in the Dutch city of Maastricht, person after person diagnosed with schizophrenia stood up to tell the story of learning to talk with the voices–and how the voices had then agreed to stop.

As you might imagine, this appears to be a bit misleading, in the sense that the description of how "person after person diagnosed with schizophrenia stood up to tell the story of learning to talk with the voices–and how the voices had then agreed to stop" apparently does not describe a typical experience.

According to Anna Ruddle, Oliver Mason, and Til Tykes ("A review of hearing voices groups: Evidence and mechanisms of change", Clinical Psychology Review 31 2011), "Hearing Voices Groups" are definitely a trend in treatment for people with auditory hallucinations, and not only in Europe:

In recent years, health services have also begun introducing group treatment for voices to try to reduce distress. They are often viewed by service providers as a way of maximizing resources and engaging clients who might not be amenable to individual therapy, especially in inpatient settings (e.g., Davidson, Hammond, & Maguire, 2009). At present, the content, structure, and description of these groups varies hugely between services, with some offering time-limited closed CBT ["cognitive behavioral therapy"] groups (e.g., “Group CBT for Auditory Hallucinations”; Penn et al., 2009) and others offering open, rolling groups akin to the Hearing Voices Network (e.g., “Hearing Voices Support Group”/“Managing Voices Group”; Meddings et al., 2004). Other groups focus on relatively didactic skills-training (e.g., “Behavioral Management of Auditory Hallucinations”; Buccheri et al., 2004; Buffum et al., 2009) and there is now an emergence of mindfulness groups for voicehearers (e.g., Chadwick, Hughes, Russell, Russell, & Dagnan, 2009). The groups are particularly common in the UK, America, Canada, and New Zealand health services and increasingly in early intervention services.

Ruddle et al. did a qualitative and quantitative meta-analysis:

An electronic search of five databases was performed (PsychINFO, Web of Science, Ovid MEDLINE, EMBASE, and CINAHL), including all papers published up to June 2010 and relevant papers from their reference lists.  […]

Any full English language paper that described or evaluated a Hearing Voices Group was included. In order to evaluate all the HVG approaches currently used in services, all types of evidence were considered (e.g., single cohort designs, wait-list control designs, RCTs). […]

The search produced 25 papers which described or evaluated a Hearing Voices Group. Three further papers were included, describing RCTs for group treatment for psychosis which specifically targeted voices, giving a total of 28 papers to be reviewed. […]

Their conclusion:

Summary of evidence for hearing voices groups: To date, the HVG approaches discussed in the literature appear to fall into four categories: unstructured, open-ended support groups; skills-training groups; CBT and mindfulness. At present, there is no reliable evidence to suggest the Hearing Voices Network groups are effective so an RCT ["randomized controlled trial"] is needed. Large single-group studies with follow-ups suggest skills-training groups may be effective but again a controlled evaluation is needed. The one controlled evaluation of mindfulness groups failed to produce positive outcomes. CBT has the largest evidence-base to date, with at least some positive outcomes in most studies. However, the results of the RCTs were less promising than the non-randomized trials, especially comparing CBT to active treatment controls. There were often commonalities however, between the active treatment and CBT, and indeed across the four approaches reviewed here. This suggests that further investigation is warranted into the key ingredients of any HVG and what might predict or mediate change.

It would be wonderful, in my opinion, if people who hear (hallucinated) voices could reliably learn to negotiate with their voices and get them to stop, or perhaps to behave in a helpful and non-distressing way. Unfortunately, this doesn't seem to be true as a general matter.

The website for the Hearing Voices Network ("for people who hear voices, see visions or have other unusual perceptions") is here.  Hearing Voices Network USA is here ("one of over 20 nationally-based networks around the world").

Update — Tanya Luhrmann has a longer article in The American Scholar, Summer 2012, "Living With Voices: A new way to deal with disturbing voices offer hope for those with other forms of psychosis". It goes further than her Wilson Quarterly article in suggesting that negotiating with voices can be expected to be curative. An early paragraph:

The commonsense understanding that accompanied this wisdom was that nonpharmacological treatments for schizophrenia were useless. But recently a new grassroots movement has emerged. It argues that if patients learn to address their voices directly and appropriately, as if each voice had intention and agency, the voices will become less hostile and eventually go away. From the perspective of modern psychiatry, this assertion is radical, even dangerous. But it is being taken seriously by an increasing number of patients and psychiatrists. [emphasis added]

It would be terrific if this were true. But it seems to go far beyond what the Hearing Voices Network people themselves claim — and it seems straightforwardly at odds with such evidence as there is from outcomes research.


  1. Jay said,

    August 9, 2012 @ 11:33 am

    Thanks for the links. When I worked at a residential treatment center for teenagers, I met one girl who had diagnosed schizophrenia with auditory hallucinations, who had worked out a similar way of coping. According to her, she had been negotiating with her voices since she was a child, and for a time she believed that this was a normal experience and that it was what people meant by "imaginary friends". She still heard the voices but reported that she could ask them to limit their commentary to positive or neutral statements, with significant success.

    I would guess that there are many factors that affect how possible this is for hallucinating patients to achieve. I'm glad to hear that more research is being done in this area.

  2. Amanda said,

    August 9, 2012 @ 12:32 pm

    Isn't the idea of "reasoning" with the voices itself similar to CBT, at its core, where the patient often examines his/her own distorted thought and challenges it?

    Lecomte et al (2008) (cited in the Ruddle et al review you discuss above), write that, "The participants also learn to understand and use CBT techniques such as normalization, the ABC's of CBT (linking events to thoughts and emotional and behavioral consequences), Socratic questioning, checking the facts, finding alternatives, trying new coping strategies, and modifying attributions." The authors also write that the patients are seen as the "experts" on their experience, with the therapists acting as their guides.

    So, could this be taken a step further, such that the patients try to guide their voices in individual CBT exercises of their own (with a therapist's further oversight)? If the idea of HVG is that the voices are treated like they have agency, then maybe they should be treated as being susceptible to cognitive biases – and able to overcome them – as well.

  3. Mona Williams said,

    August 9, 2012 @ 1:43 pm

    Based on my experience, as a layperson, in trying for the past few years to help a schizophrenic family member to talk back to and reason with her voices, I think this is quite a reasonable idea. My relative seems to feel this way as well, and is quite willing to work with me. However, progress is slow, since she has been experiencing these symptoms for 50+ years. I don't know whether the trials control for length of illness, but it would seem important to do so.

  4. Mike said,

    August 9, 2012 @ 3:29 pm

    The article starts with a predictable straw man: "In the 1990s, scientists declared that schizophrenia and other psychiatric illnesses were pure brain disorders that would eventually yield to drugs. Now they are recognizing that social factors are among the causes, and must be part of the cure."

    In reality, the fraction of scientists and clinicians who saw schizophrenia as purely biological and yielding only to drugs has always been a minority. True, they often got more attention, in particular the attention of anti-psychiatry activists, but were always few. There have always been clinicians who supported the notion of bringing talk-therapy and interpersonal elements (what she calls "social factors") to bear in treatment. I trained in a psychiatric hospital in the 90s, and we ran talk therapy groups for schizophrenics.

    Why does this have to be ignored so often? What's Luhrmann's basis for saying that there is/was "the simple biomedical model of psychiatric illness, which presumes that voices are meaningless symptoms"? Where is this great declaration of scientism from the 1990s? I agree that anything that helps is good, if it really works. But the meta-analyses you reviewed and nicely summarized are hardly a secret.

  5. anon said,

    August 9, 2012 @ 3:57 pm

    The most effective approach to psychotic illness at present seems to be one called Open Dialogue, with the related approach often called Soteria not far behind. They both rely on managed social contexts to promote shared meaning, and neither has a narrow focus on voices.

  6. jaypatrick said,

    August 9, 2012 @ 10:26 pm

    "What about the world of a schizophrenic? Maybe it's as real as our world. Maybe we cannot say that we are in touch with reality and he is not, but should instead say, His reality is so different from ours that he can't explain his to us, and we can't explain ours to him. The problem, then, is that if subjective worlds are experienced too differently, there occurs a breakdown of communication…and there is the real difference.

    From "How to Build a Universe that Doesn't Fall Apart Two Days Later" in The Shifting Realities of Phillip K. Dick

  7. Adrienne Giacon said,

    August 10, 2012 @ 1:16 am

    I must point out here, that Hearing Voices Network support groups are not set up as therapy centers. They are set up to provide support for voice hearers. Somewhre they can come and talk about their experiences without stigma, or judgement. To create friendships and receive understanding.

    We are of the opinion that hearng voices is a variation or human experience, not an illness. So do not aim to get rid of the voices, but to understand what part they play in our lives, and how to live them without distress.
    Sharing ideas with people who live with the experience seems to be helpful, rather than being tested with drugs, or have therapeutic techniques (ECT???) applied by people who have never experienced it and so can only guess what it may be like. As they dont experience they consider it an "illness" that must be subdued, driven out, or hidden. Which is what many people do. Hide their experiences, which causes isolation, stigmatisation and feelings of shame.

  8. Gabriel Curio said,

    August 10, 2012 @ 5:11 am

    Before caller ID, my parents would screen their phone calls by letting the caller start to leave a message on the answering machine. This meant letting the phone ring and ring without answering. It really irritated our guests. They couldn't understand how we could have a phone ring and not answer it. It was like having an itch and not scratching it.

    "Hearing" voices and not responding might be similar. When someone says something to us, especially when it's negative, we want to respond. Ignoring bullies makes them go away, but is hard to do.

    The voices a schizophrenic hears are not rational and cannot be negotiated with. Nevertheless, telling someone to ignore a voice can be very stressful. It also might make it difficult to maintain social skills, and reinforces that the person is "crazy". Even if negotiation doesn't work, is there any harm in encouraging people to respond to hullinactions in a rational way?

  9. Plegmund said,

    August 10, 2012 @ 7:17 am

    One wouldn't encourage patients with visual hallucinations to behave as if the illusions were real – it might be dangerous to do so . If the strategy is confined to telling the voices to go away it may do no harm, but a negotiation implies the possibility of concessions on both sides. which must surely be a bad idea?

  10. Pflaumbaum said,

    August 10, 2012 @ 7:22 am

    I was talking recently to a psychologist who'd designed a very promising experiment in this area.

    He worked with the patients to create a computer avatar for the dominant hallucinated voice, looking as they imagined its owner to look, and electronically adjusted his own voice to sound as close as possible to the hallucinogenic one. Then, on another day, the patient came in and sat in a room with a computer and talked to the avatar – whose voice was in fact controlled by the psychologist in another room. He started off imitating the character of the voice as the patient had described it – usually bullying and abusing the patient. Then, over a series of six sessions or so, he allowed the patient to turn the tables on the voice, eventually dominating it until it 'left' entirely.

    The success rate in making the voice vanish – at least so far – was 20 out of 26, as I recall. He's now got funding for a far larger study, I think through Imperial College in London.

  11. Dan Hemmens said,

    August 10, 2012 @ 7:39 am

    If the strategy is confined to telling the voices to go away it may do no harm, but a negotiation implies the possibility of concessions on both sides. which must surely be a bad idea?

    I suspect that a lot of this has been garbled in the reporting, but judging by what Adrienne says above, a lot of the point of Hearing Voices groups is just to put people into contact with other people who have similar experiences.

    My experience of this kind of thing is only secondary, but I *think* the point is not to propose a specific strategy to "cure" people who hear voices, but to provide people who hear voices with an environment in which they will not feel the constant pressure to be "normal" which, I understand, is a tremendous source of distress for many people with psychiatric illnesses.

    I'm not sure, but I suspect that "negotiate with the voices" is just a (regrettably attention-grabbing) example of the kind of coping strategy some people might find helpful. I don't think anybody is actually suggesting that it's a magic bullet.

    More generally, my experience of this is only secondary, but it often seems like the prevailing social consensus (amongst, I should stress, laypeople – I'm not trying to make generalisations about the psychiatric profession) is that the correct way to deal with any psychiatric illness is to act like you don't have it. I understand that this is often a significant source of distress for people with psychiatric illnesses.

    There doesn't seem to be any evidence that "negotiate with the voices" is an effective way to reduce the symptoms of auditory hallucinations, but I strongly suspect that a lot of people with auditory hallucinations would benefit greatly simply from having access to an environment in which they do not have to pretend that they don't hear voices.

  12. Jay said,

    August 10, 2012 @ 10:02 am

    "The voices a schizophrenic hears are not rational and cannot be negotiated with."

    Baldly asserting this doesn't make it so.

  13. Nev Jones said,

    August 10, 2012 @ 2:23 pm

    A few additional thoughts:
    (1) Undeniably, HVGs are neither a magic bullet nor panacea–nor is any other existing intervention or form of treatment (including pharmacotherapy). This doesn't mean that a subset of individuals aren't profoundly helped by these groups, however. And, of course, it's totally unsurprising that TL would have encountered only enthusiastic supporters at the Congress. (As one almost certainly would at, e.g., a big AA conference.)
    (2) The Ruddle et al. review needs to be interpreted with caution. Traditional designs (pre-post as well as RCTs) are notoriously problematic in the context of interventions that almost certainly help some but may have no (or even a negative) impact on others–primarily because researchers are almost always focus on (whole) group effects. (And even when you find these, e.g. in successful clinical trials, the effect sizes are often very very small.) IMHO, far more energy needs to go into longitudinal evaluations that make use of growth curve and growth mixture modeling with latent class trajectories (i.e. "person centered" instead of "variable centered" approaches).
    (3) In addition, there are myriad other reasons why evaluation research may fail to detect a significant impact. For instance (this is something I often hear in my own research), the full force of a particular intervention may only sink in months or even years later. Or an initially unsuccessful foray to a self-help group may nevertheless prompt sustained engagement two years down the road… Or some external catalytic event may be necessary. (And so on.)

    All in all, then, I don't see much in the Ruddle article that actually refutes TL's essay…. Rather it serves as a reminder of the difficulties of evaluation and the extreme heterogeneity of treatment response in psychosis.

  14. Gabriel Curio said,

    August 10, 2012 @ 3:38 pm

    '"The voices a schizophrenic hears are not rational and cannot be negotiated with."
    Baldly [sic] asserting this doesn't make it so.'

    Even if you say hallucinations are as rational as a mentally healthy adult, you're not saying much. My wife and I have been having the same argument for years. We keep going in circles. We're both rational, well educated adults, but every time the topic gets brought up, its like its the first time we talked about it.

    Relationships require trust. My wife is wrong, but she still loves me. Can someone say the same thing of a hallucination?

  15. Jerry Friedman said,

    August 10, 2012 @ 3:57 pm

    What happened to the idea that there was a simple cure for hearing voices (in many cases), namely opening the mouth or humming to prevent subvocalization?

    [(myl) The main source for that idea is P.A. Bick and M. Kinsbourne, "Auditory hallucinations and subvocal speech in schizophrenic patients", American Journal of Psychiatry 1987. They reported that

    Fourteen of 18 hallucinating schizophrenic patients reported that the voices they heard went away when they undertook a maneuver that precluded subvocalization. The same applied to 18 of 21 normal subjects who hallucinated under the influence of hypnotic suggestion. Control maneuvers had no such effect. The authors suggest that auditory hallucinations may be projections of schizophrenic patients' verbal thoughts, subvocalized due to deficient cerebral cortical inhibition.

    Then there's E.E. Levitt and T.G. Waldo, "Hypnotically induced auditory hallucinations and the mouth-opening maneuver: a failure to duplicate findings", American Journal of Psychiatry 1991.

    The authors sought to replicate the part of a study by Bick and Kinsbourne in which hypnotically induced auditory hallucinations in normal volunteer subjects were abolished by requiring the subjects to open their mouths.
    Sixty-four normal volunteer subjects were hypnotized, and an attempt was made to induce auditory hallucinations. The subjects in whom hallucinations were successfully induced were then asked to perform the mouth-opening maneuver and the control maneuvers of putting their fingers in their ears or squeezing their eyes shut in an effort to end the hallucinations.
    Sixteen subjects reported having hallucinations. None of them reported that a hallucination was abolished by opening the mouth or closing the eye; four reported ending hallucinations by putting their fingers in their ears.
    Opening the mouth does not affect auditory hallucinations induced by hypnosis in normal persons. The most likely reason for the discrepancy between the results of this experiment and those of the Bick and Kinsbourne study is that the design of the latter study was faulty because it permitted demand characteristics to influence the results.

    In case you're not familiar with the jargon, the term "demand characteristics" (according to Wikipedia) "refers to an experimental artifact where participants form an interpretation of the experiment's purpose and unconsciously change their behavior to fit that interpretation".

    There's a 1989 paper by Green and Kinsbourne ("Auditory hallucinations in schizophrenia: does humming help?", Biol. Psychiatry 25) which tested five mechanisms on 17 schizophrenic patients (opening the mouth, biting the tip of the tongue, softly humming a single note, raising the eyebrows, and making a fist), and found that only humming helped.

    There's a 1998 review article (S.S. Shergill et al., "Auditory hallucinations: a review of psychological treatments", Schizophrenia Research 32(3)). Executive summary: It's complicated.]

  16. cam said,

    August 10, 2012 @ 4:20 pm

    Remember Joanne Greenberg's 1964 book I Never Promised You a Rose Garden? It's an account of her teenage experience of schizophrenia, including the powerfully tormenting voices she hallucinated that 'punished' her when she talked about them. Her treatment wasn't medication, but talk therapy in an institutional setting (which included taking the voices seriously and discussing them by name). She also suffered from being different, and found comfort among fellow patients and some staff members. Institutional practices weren't great, and her recovery took 3 years, but the outcome was excellent. This one carefully documented case would seem to support recent developments in treatment. I realize it's not data, but surely there's value in a lucid account of a psychotic illness.

    [(myl) Her story is certainly an inspiring one. But according to Dava Sobel, "Schizophrenia in Popular Books: A Study Finds Too Much Hope", NYT 2/17/2981:

    Supporters of this new precision in diagnosis are concerned about the persistent public misunderstanding of madness, particularly as it is spread by popular books such as "I Never Promised You A Rose Garden."

    For according to the new diagnostic criteria, Deborah Blau [the fictionalized heroine of Greenberg's story] was not schizophrenic to begin with. Nor was Mark Vonnegut, author of "The Eden Express," who recently became a doctor himself, nor Marguerite Sechehaye, who wrote "The Autobiography of a Schizophrenic Girl," Jane Rittmayer of "Life/Time" or Sister Terra Ford, the central character in "Schizophrenia Cured."

    If any of these authors had been truly schizophrenic, Dr. Remi Cadoret and Carol North write in the February issue of the Archives of General Psychiatry, their chances of recovery would have been slight. Most of them, according to the researchers, appear to have had depressive disorders, which are much less debilitating, far more responsive to therapy and sometimes go into spontaneous remission. […]

    Deborah Blau, according to Dr. Cadoret and Miss North, suffered from somatization disorder, formerly known as hysteria or Briquet's syndrome. In other words, she had many recurrent physical complaints that were not related to any physical disorder. Readers may recall that Deborah had a mysterious "tumor" that made her gasp and double over in pain. She would try to counteract her internal pain by burning her arms with cigarettes until she raised oozing wounds.

    The elaborate fantasy world of Yr that Deborah created and retreated to, as well as the hallucinated voices in Yri language that told her "Bird-one, you are not of them," did have the appearance of schizophrenic delusion, Dr. Cadoret and Miss North concede, "but their dramatic nature hand in hand with her many somatic complaints is more suggestive of a different diagnosis."

    I have no expertise in this area, but here again, it appears that Greenberg's story is not typical of what we can expect for people diagnosed with schizophrenia post DSM-III (1980).]

  17. John Swindle said,

    August 10, 2012 @ 7:01 pm

    Back in the 1970s Wilson Van Dusen, a psychologist and author of strong Swedenborgian bent, wrote about interviewing the hallucinated voices of patients in the California mental hospital where he worked. I imagine the key to the thing was taking his patients and their experiences seriously. As I recall, he was irritated with fellow professionals who thought he was saying he was hearing the hallucinated voices directly.

  18. cam said,

    August 10, 2012 @ 9:16 pm

    Well at least people are questioning Joanne's diagnosis now instead of her recovery. At least one prominent psychoanalyst asked for a meeting in which he tried to undermine her peace of mind in order to prove that schizophrenia really couldn't be cured with therapy.

  19. [links] Link salad’s gonna make momos | said,

    August 11, 2012 @ 9:08 am

    […] Negotiating with hallucinations […]

  20. cam said,

    August 11, 2012 @ 9:32 am

    @myl, If I may expand on my cryptic comment above, and bring it back to the topic of your post:

    Like many students and faculty at CU and Mines, I knew Joanne Greenberg years ago when I lived in Boulder – she taught writing at (the Colorado School of) Mines, published widely and locally, spoke often, and participated in community (e.g. she was a fearless volunteer firefighter when she was in her 50s, and wrote about that experience in a magazine for retirees). Her 1964 novel is largely autobiographical, as she has discussed publicly on many, many occasions.

    I think it’s important not to lose sight of the fact that she did have a very serious psychotic illness, no matter how the boundaries of diagnostic categories are set, and hallucinated voices were definitely involved. (Incidentally it strikes me as odd that she’s being re-diagnosed in the pages of the NYT when she’s still living and presumably available for comment…? Although I certainly wouldn’t blame her if she chose to ignore the ongoing public discussion.)

    Joanne’s therapist was Frieda Fromm-Reichmann. It may be that the most important tool Fromm-Reichmann had in her toolbox was patience, and the time to use it. That contrasts with the time strictures of our modern era, in which medication, if it works, fits best. Thanks to the discussion here, I’ve come across some fascinating reading on the topic — _To Redeem One Person is to Redeem the World_ by Gail Hornstein:

    which brought me back to the Hearing Voices Network:

  21. Banana101 said,

    August 15, 2012 @ 12:32 pm

    In response to anon's comment:

    anon said,
    August 9, 2012 @ 3:57 pm

    "The most effective approach to psychotic illness at present seems to be one called Open Dialogue, with the related approach often called Soteria not far behind. They both rely on managed social contexts to promote shared meaning, and neither has a narrow focus on voices."

    Keep in mind that Hearing Voices/Soteria House/Madness Radio, etc. are all within the Anti-Psychiatry Movement. Loren Mosher, who founded Soteria House, was fired/dismissed by the National Institute of Mental Health for his anti-medication beliefs. He felt that the APA was "in bed with Big Pharma" and actually called the APA the "American Psychopharmacological Association" in his resignation letter to the APA. Mosher (et al.) deny that mental illnesses exist, and believe they were "invented" by the APA to make money.

    They also think that the APA and psychiatric institutions are like they were in the early 1900s-1960s. There is no such thing as "forced ECT" therapy. If you're being violent and can hurt yourself or others, I don't think a "forced" sedative is taking away anyone's "rights". It's protecting others (and the violent person).

    Despite the fact that schizophrenia has been linked to abnormal brain patterns in a variety of ways via CT scans, PET scans, fMRI scans, etc., the Anti-Psych people do not believe that there is any biochemical connection for mental illnesses, and sadly, they're gaining strength, despite science-based medicine.

    I think it's great that people can live with a severe mental illness and not suffer. Sure, anti-psychotic medications have side effects. But so does Tylenol, which kills more people each year than all "psych drugs" combined. Which tells me that their motive is not all about helping people– they are staging a strange war against science and psychiatry.If I were wrong, all of their quack books, vitamins, and alternative therapies would be free, or my insurance company would gladly pay for them if they worked.

    It's abysmal when "non-profit" groups are pushing this quackery in the mainstream media, and possibly hurting people via neglect and/or fraud by selling such snake oils. I'll take my APA recommend and FDA VERY rigorously tested meds over such nonsense any day.

    Just a heads-up to Mr. Liberman and the other readers if they did not realize this was some sort of combat against science-based medicine.

  22. Banana101 said,

    August 15, 2012 @ 1:14 pm

    @ jaypatrick said,
    August 9, 2012 @ 10:26 pm

    " 'What about the world of a schizophrenic? Maybe it's as real as our world. Maybe we cannot say that we are in touch with reality and he is not, but should instead say, His reality is so different from ours that he can't explain his to us, and we can't explain ours to him. The problem, then, is that if subjective worlds are experienced too differently, there occurs a breakdown of communication…and there is the real difference.

    From "How to Build a Universe that Doesn't Fall Apart Two Days Later" in The Shifting Realities of Phillip K. Dick' "

    Phillip K. Dick was a great author. He "appeared" to have schizophrenia or was within the spectrum, due to his somewhat illogical books (while very good!) and interests in ex-schizophrenics. We all don't see Jesus, have clairvoyance and see our "other life" as being a persecuted Christian in the 1st Century, after all. I'm not sure if you know this, but he also abused amphetamines and LSD, which he would regret years later. I'm not anti-drug, but amphetamine tends to cause paranoia when it's abused, and LSD causes hallucinations. Probably not the best combination for one to take if he had schizophrenia. He didn't find "freedom" in these hallucinations and paranoia, as he regretted it much later.

  23. jaypatrick said,

    August 15, 2012 @ 6:05 pm


    A lot has been written about amphetamines as a cognitive enhancer. See, for example, a Slate explainer that involves table tennis. Much more has probably been written about amphetamines as a cause of paranoia, though. Still, the word "cause" might stand further elaboration. Causal chains get complicated. E.g., is it the drugs, the lack of sleep, or some combination of these and other factors? He supposedly received strange insights while on amp confirmed in external reality. Speaking a language he never learned (to his wife, who did know the language). Saving his sons life by insisting to doctors had a life threatening inguinal hernia (revealed to him by VALIS, I believe). And much else.

    Given Dick's prodigious output, I would say overabundant communication was a more notable effect on him than paranoia. I realize he's an outlier to some extent, since diarrhea of the mouth is not listed as a classic virtue, though some variant of "learn to shut your mouth" is probably something people who are not PKD will often learn has value.

  24. Christy Mason said,

    August 16, 2012 @ 2:32 pm

    Complete layman here – but I have learned to speak to characters in my dreams, particularly nightmares, and have the nature of the dream completely change from the moment I interact. Could this be similar?

  25. Banana101 said,

    August 21, 2012 @ 7:19 pm

    @ Jay Patrick: Amphetamines do not make you have insights… Unless you're taking them to the point of amphetamine psychosis. Sure, they're stimulants; they would make most people feel "cognitively enhanced". But not to the point of leaving reality (except as defined above). I assume the hallucinogens made him be able to speak a different "language".

    When PKD claimed to have saved his son could be attributed to the "fallacy of the single cause". Or, he's simply a parent and knew when something was wrong with his child. Occam's razor?

  26. Adrienne Giacon said,

    August 31, 2012 @ 1:34 am

    The Hearing Voices Movement is not an "Anti Psychiatry movement" It is a movement of voice hearers and professionals who use the experiences and advice of voice hearers that are living good loves and managing their voices, with people who are distressed with them. So many organisations tell voice hearers what to do, and ignore any input they give regarding the effectiveness of the treatment. For many people medication simply does not work, and side effects can shorten the life span by up to 15 years, cause diabetes, heart failure, tardive Dyskinesia, loss of sex drive, drooling, incontinence and obesity, lessen concentration. Perhaps that is why people dont like taking them? Do you think?? Voice hearers in care soon learn to lie about the effectiveness of the medication to their care providers, as if they dont doses are often upped to levels that ruin their enjoyment of their lives. This unfortunately does nothing for anyone. The effectiveness from attending support groups is visibly seen as the confidence a person has in themselves increase, as they come out of their withdrawn persona, caused by the stigma of the label schizophrenia, and meet other people that hear voices just like them, and yet have jobs, and friends and are living their lives. Many people report the link between their emotions and the content of the voices, similar to dreams. Like dreaming awake. Voices are often a reflection of a persons environment. So often when they have supportive listening friends, their voices also change a little. See Intervoices site . I must say it is a bit ridiculous that for years people have been trying to treat people who hear voices, by studying them,researching them, observing them like bugs in jar. When they could have just asked them..

  27. Stella said,

    December 9, 2012 @ 2:48 pm

    As I understand it, the "negotiations" with voices tend to be along the lines of agreeing to be quiet for a while, and come under coping skills rather than cures.

    Also would like to point out that there is a good deal of recent scientific interest in methods similar to those used at Soteria House. Good results in (?) Sweden. This type of research/treatment was stopped for a long time because there was a belief that leaving psychosis unmedicated caused brain damage, which is now proven unfounded.

    There is a movement at the moment for "recovery" from Schizophrenia, which means FUNCTIONAL recovery. A person is usually counted as recovered if they can stay out of hospital, although some studies try to measure quality of life instead.

    It is NOT the same as being anti-psychiatry or just quackery. Studies in Manchester have shown that brain activity can be returned to normal with cognitive exercises, and perhaps "damage" reflects understimulation in some cases.

    Don't dismiss training in coping techniques as rubbish, please.

  28. Erith said,

    November 19, 2013 @ 9:23 pm

    I agree – ASK people who hear voices, don't study them. The hopeful "negotiate with the voices" is commendable in its hope but doesn't work, knowing you are not alone helps but little. Making voices softer, quiter gives some respite, time to gather or re-gather strength for next onslaught.

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