Working with the Voices of Schizophrenics (and the Rest of Us)

When I was at the Psychotherapy Networker conference last month, Loius Cozolino mentioned that when schizophrenics have a good relationship with the voices in their heads, they often no longer need medications to manage the "psychosis" and can be functional members of society.

Only a few days later I came across this article in the Guardian UK, written by a schizophrenic who had learned to talk back to his voices and have dialogues with them rather than be bullied by them or afraid of them.

Schizophrenia and dissociative identity disorder are extreme versions of the subpersonalities we all have in our heads, the competing selves who live in our heads.

I talk back to the voices in my head

• Dean Smith
• The Guardian, Saturday 4 April 2009
• Article history

Dean Smith of Stockport who has suffered from schizophrenia. Photograph: Fabio De Paola

I was working as a holiday rep in Brittany 15 years ago when I started hearing voices. I was in my mid-20s and thought it was my mates mucking about. I looked inside and outside the flat to see where they were. It felt really scary, because the voices were saying stuff like, "Right, you're having it" and, "We'll get you in the end."

Over the next four days, the voices taunted me more and more, and I became depressed and paranoid. I had a strong desire to be with my family - I had no money, but I got back to my mum and dad's house in Stockport by hitchhiking and dodging fares. The train journey was particularly harrowing: the voices convinced me everyone was talking about me.

My family were brilliant. My mum used to care for my auntie, who had mental health issues, so she had some insight, and my dad was very patient with me. My visits to the GP were less successful - I was put on antidepressants and, when they didn't work, antipsychotics. They didn't work either, and by now I was regularly hearing three, one laughing in a wicked kind of way, the other two using abusive and threatening language.

The voices got me down so much that I started self-harming. I wound up getting sectioned several times. I was put on heavy medication and encouraged to spend my days playing games with the other patients - anything to distract the voices. Each time, I'd come out being a fantastic Scrabble or blackjack player, but none the wiser about the voices.

Ten years ago, at 29, I was told I had paranoid schizophrenia. Friends - well, people I thought were friends - immediately associated the diagnosis with knife-wielding murderers. A lot of them stopped having anything to do with me. I realised I'd been given a label that comes with a huge stigma and a prescription of potent, but in my case useless, medication.

I remained keen to find out about innovative treatments, and finally, at a mental health seminar, I heard a speaker talk about an approach advocated by growing numbers of mental health professionals that involves people engaging with the voices inside their head. He was from the Hearing Voices Network and I agreed to visit him. He said I should be frank and uncompromising with the voices. If they told me to self-harm, I should just say no. "If anyone else told you to put your finger in the fire, you wouldn't, so why act on what they say?" he said. He added that if I wanted to know why they were there, I should ask them, and if I wanted them to go away, I should tell them. It was so simple, but it made so much sense.

I took his advice, questioning them, challenging them and even cutting them off if I didn't have time to talk to them. I'd say things like, "I'm watching TV now, I'll talk to you later" or "Why exactly do you think I deserve it when bad things happen to me? You can't answer that, can you?" Sometimes I'd do it in my head; other times out loud. I began to recognise the voices as representing the negative feelings I had about myself, and that alone helped me feel less frightened of them. It's not that they aren't real, but they ceased to have the power over me they did. I began to realise they couldn't carry out their threats.

Now they bother me a lot less and, when they do, I'm in control of the conversations. I'll still talk out loud to them if I feel like it, even if I'm on the bus or in the street. I get some funny looks, but I don't mind.

Recently another voice appeared, but this one is positive and happy, sounding like me as a young teenager. He's mischievous, but funny, and I quite enjoy chatting with him.

I'm off medication now and have been discharged from mental health services. I've got my own place and have a girlfriend, and I train nurses and mental health staff in helping others to engage with their voices. The fact that I can speak with genuine understanding means I usually have a captive audience. I also work with people who hear voices, getting them to understand the benefits of talking back.

I've learned that my voices themselves are not a problem. It's my relationship with them that's important. Facing them and working with them has changed my life and made me feel optimistic about it instead of scared.

This is the extreme version - this little article from The Daily Om talks about how to integrate the smaller voices we all have in our heads, the little selves we often confuse for one BIG self. The most important thing to know is that we cannot disown or suppress these selves, any more than Dean Smith could in the article above - we must befriend them, talk to them, find out what they need.

Putting Your Selves Together
Integrating Our Many Selves

Human beings are multidimensional creatures. Our identity is made up of the sum total of our many traits and values and our character. Each of us possesses within us many different selves. There is the adult part of ourselves and the childlike spirit that resides in each one of us. There is our masculine side and our feminine side. There is the hard worker in us, the artist, the parent, and the caretaker. All of these selves combined form a well-rounded, complex person. Not all of these different aspects of who we are blend easily with each other, however, and some of them may even conflict with or oppose one another. When a person’s different parts clash, such as the self that is our childlike aspect and the self that is our responsible adult, we often end up compartmentalizing or suppressing one of these aspects to ease the conflict. While this may make us feel better in the short run, we would be better off finding a way for these two selves to coexist peacefully inside us.

Though some of our selves may be dominant while others rarely assert themselves, attempts to suppress one or more of these different aspects can leave us feeling that our identity has been splintered. Being able to successfully integrate our various selves can be as simple as accepting and embracing each one. It may also be necessary to reframe the way you see them. The immature self that you ridicule can become a valued and accepted part of you when redefined as your more playful aspect. Journaling can help you acknowledge and understand the different parts that make up your identity.

When your many selves blend together to form an integrated individual, you will feel changed. You will no longer feel pulled in multiple directions, and you will never again have to deny any part of yourself. You become a complete person—familiar and comfortable with the many selves that make up the person you are.

Tags: Psychology, brain, therapy, personal growth, consciousness, schizophrenia, subpersonalities, parts, selves, voices, psychosis