September 22, 2021

I, Science

The science magazine of Imperial College

What is it like to hear voices in your head? Is it even possible to understand such an affliction?
Words can be hurtful things, whether in your head, or whispered through a rolled up paper…

I recall being a small child sitting opposite an old dishevelled man on a train. His clothes had turned from emerald to russet with all the accumulated dirt. He was laughing hysterically, pointing at me with one hand and holding his stomach with the other as if I had said something mind-blazingly hilarious to him. He was muttering so incoherently amidst his roars of laughter that I could barely comprehend a word.

My instant reaction was to giggle along with him. I sat, transfixed and smiling every time he did. How could this man possibly be talking and laughing so much when there was no one within sight talking to him? He exuded jubilance; and every word he muttered was accompanied by a smile.

I didn’t know what ‘psychosis’ meant back then, let alone ‘auditory hallucinations’. I just knew he was dissimilar to the usual types of people I had encountered so far. He reminded me a little of the Mad Hatter from ‘Alice’s Adventures in Wonderland’. At any given moment I was expecting him to boldly ask me why a raven is like a writing desk or offer me a very curious cup of tea. He didn’t. Rather, he vacated the train at the next stop, laughing at something uproarious yet illusory. Rather rude not to have shared the joke, I had thought. I treasured how happy he looked; something was funny and I was intrigued to know what. Why, though, did everyone around him look so frightened and sad?

In my first year at Nursing College, the lecturer got us to participate in one of those ‘interactive group exercises’. Whilst assigning us to groups of four she told us to roll two pieces of A4 paper and have two people placed either side of a ‘patient’ whilst they whisper obscenities and derogatory remarks through the rolled up bits of paper. All the while the ‘patient’ was set the task of answering five simple questions by the ‘Nurse’ in front of them. Easy, I thought to myself.

“If you don’t stand up right now I’m going to kill you”.

“Argghh” I wasn’t expecting that, and I instantly stood up.

My friends and I burst into laughter together. My friend to the left continued with threats of violence and aggression whilst my friend to the right began with the derogatory ones.

“You’re so ugly, no wonder no one likes you.”

I looked at her and smirked, but tried to not take it to heart as I knew this was merely an exercise. All the while my third friend (the Nurse, in our exercisse), was asking what I had bought during my last visit to the supermarket; at least I think that’s what she was asking. This was a nightmare! I couldn’t concentrate on anything; I couldn’t even decipher my own voice. My eyes had been opened. It was such a simple exercise, yet so enlightening.

We can’t contemplate how it must feel to hear voices until we experience it first hand, but even then it’s nowhere near the real experience. Perhaps we’re not all as distantly related to auditory hallucinations as we might have thought. Have you ever been in that funny period of time between wakefulness to sleep and been alerted by a sudden unexpected jerk or loud bang? Well, a term first described by Dutch physician, Isbrand Van Diermerbroeck in 1664, hypnogogic and hypnopompic hallucinations explain any brief hallucinations that are auditory, visual or tactile that happen during the process of falling to sleep (hypnogogic) or when waking from sleep (hypnopompic). Thought to be more common than people will admit to, this process is experienced by the majority of the population but why then don’t people ever talk about this amongst friends or at the breakfast table? Fear of the unknown perhaps? A worry of being deemed ‘insane’? These experiences can be terrifying, I know as I definitely experienced the above in my half-asleep condition right around the time of writing my undergraduate dissertation. But can any of us really envisage these experiences 24/7, awake or asleep? It’s unimaginable, right?

Through my Nursing career so far I have worked with hundreds of people who experience auditory hallucinations. Each person tells a different tale and holds different emotional attachments towards them. What fascinates me the most is the way people deal with them outside of the hospital setting and how they avoid provoking fear in children on buses, or becoming a public display of entertainment on the commute to work. One boy I met along my journey explained that he keeps his phone in his hand at all times and if he is finding things particularly difficult he’ll pretend he’s talking on his phone. Other people have told me they pretend to rap or hide their mouths in their hands.

I have endured conversations with people whilst they are laughing at unseen stimulus. I have had tea with patients who are experiencing auditory hallucinations telling them I’m trying to harm them and unexpectedly have become violent or aggressive towards me without warning. I have also worked with patients who describe ‘good voices’, those that keep them company in their darkest times. People tell me that voices can be anywhere: in their head; in their bodies; sometimes they can hear their own voices; someone else’s; and occasionally three or more voices all at the same time. I could write forever about all the people I have met and the experiences they have enlightened me with but for now I am more interested in the reaction of the rest of the world. Mental illness is often termed the ‘silent illness’, but it is not as silent as we think.

Many people I speak to who don’t work in psychiatry and who don’t know anyone  affected by psychosis often state they simply can’t comprehend it. The ‘fear of the unknown’ seems to have a brawny hold over the public and their reactions to people who hear voices. A bit more education of the public could go a long way. We all acknowledge that stigma is reducing but should more emphasis be placed on the educational side of things? My suggestion? Perhaps more people need to roll up bits of paper and try it for themselves.

I now make it my aim to sit by the man talking to himself on the bus or the chap laughing loudly on the tube. I make a point to smile as I would at anyone else but create an extra effort to ensure everyone else is watching me while I am doing it.

IMAGES: Nadia Szopinska, flickr.