Katy was very ill.
At least that´s what her email told me. And that´s what she believed to be true. And why wouldn´t she?
She had been diagnosed with paranoid schizophrenia in 2009 and was currently hearing multiple voices, some of them critical and wounding in their comments. Their impact on her life was quite profound.
She had a few nicer voices too but these were heard less regularly.
Until she became unwell she had been very active, enjoying yoga, meditation classes, and a keen art student , attending a local college and hoping one day to pursue a career as an artist herself.
She was talented and enthusiastic and looking to to build a bright future, a 23 year old woman living in a large Irish west coast town and with everything to live for and look forward to. But then things changed.
Her life became more difficult as her father died after a long illness and her first real relationship of importance was also taken away by an unhappy accident to her partner. And all within a few months.
Naturally enough she became sad and even quite profoundly depressed. Her studies fell away, she felt worthless and her self esteem sank to rock bottom. She became estranged from her mother, moving out of the family home after a huge argument and taking on her own apartment.
Now she was responsible for paying the rent and, without her supportive father to help her out and support her a little, she gave up her studies and dropped out of college for a part time job.
Yes, she felt anxious and even disappointed. It was a knock to her hopes but, temporarily, it was the way it was and would be.
She felt she had to prioritise keeping a roof over her head as it became clearer that her relationship with her mother didn't look like it was healing any time soon and going back home was no longer any kind of option.
She somehow knew that she needed to push on, regardless of where this path would lead her.
And that was when her voices first began.
In social isolation, in a new town, a new job and arriving home exhausted from a demanding day, she began to drink in order to decompress and relax a little.
The new job had its' built in stresses too, not least a somewhat bullying office manager who'd been there many years and who ran the place as something of a personal fiefdom.
She had a habit of projecting her stresses onto junior staff members and was very critical if they didn't get things right first time, a characteristic and quirk of personality that Angela remembered from her overly critical and emotionally cold mother.
A mother she had tried to foster a loving relationship with, but was too often repaid with sarcasm and cutting comments. Never a great incentive to keep on trying to fix things between them, it took the wind out of her sails and left her feeling worthless and unvalued and, eventually, she learned to withdraw from emotional contact in order to keep herself emotionally safe.
Initially, I knew none of this background story. I simply read an email asking me to help with hearing voices. I was careful to point out that I´m not a therapist and could not heal this young lady but...If she was willing to do some work, I would support her and then? Well, who knew what was possible?
She said she was in a mess, taking extended sick time off work and worrying about losing her job. On a combination of anti depressants and anti psychotic medication, none of which she felt helped very much, she had gained a lot of weight and hated her body, how she looked and how she felt about herself. She told her psychiatrist that her voices were gone in an effort to avoid further increases in medication. This is more common then you might think.
Katy often sat for hours in a darkened apartment, a radio and the tv both turned on in an effort to drown out her voices. The critical voices laughed at her, decried her ability to be a success in life and worse, they told her she was worthless and barely deserved to be alive. And it was at this specific point, considering suicide, with no one she felt she could talk to, that she came by chance across my website. We emailled and then Skyped and I wondered if I could help her to make some sense of her confusing experiences. If she was willing to try, well, so was I.
What Katy did next.
First of all, we kept it simple.
I asked Katy to make a list of her voices and in order of priority, depending on how often they were heard. I asked her to identify if voices had specific characteristics, i.e were they exclusively p.ositive, negative or neutral regarding content and if they gave mixed messages. Were they guiding or cautionary voices, abusive or demanding. Or just plain annoying?
Her email arrived and she realised that we were effectively mapping out her voices and externalising an internal experience. No one had suggested she do this before.
I asked her to identify which voices she cared to keep and which she would like to eradicate, if it was possible to do this. A question she had never been asked, as normal psychiatric orthodoxy discourages voice hearers from engaging with and exploring any possible meaning inherent in the voices that they hear.
She was able to think about her voices in a new way as we did a little analysis of the comments they made. Had she heard these criticisms before in her past? Who made them? Were they in any way related to her feelings about herself?
Katy agreed to keep a voices diary and to write a little at the end of each day of her experiences. What voice came forward and where she was when it happened. How did this voice make her feel and what did she usually do in response.
In this exercise, she was able to identify activities and thoughts and feelings that increased her stress levels so she agreed to look at simple breathing exercises to help reduce stress and decided to go to the stores at a later part of the evening when there was less busy traffic on the road, the buses were quieter and the supermarket only had a few tills open.
This meant fewer shoppers and less loud announcements on the store loudspeakers. In other words, it was a quiter experience and didn't trigger anxiety. It can be hard hearing voices and trying to focus and concentrate on tasks, so making some alterations to schedules and avoiding "hot spots" is very helpful.
We looked at dietary improvements, less sugary drinks and artificial additives in food, more fruits and vegetables. She had fallen into poor habits which she agreed to address. We all are beginning to learn that food affects our mood and we saw this as a part of building a toolkit for better health.
I recommended Gloria Steinem and her inspiring book on self esteem "Revolution from Within", so that she might work a little on self perception and increasing self love and acceptance. And that , if possible, she could choose an ally among her small circle of friends who might be willing and able to offer a little support and be trusted to hear a little of her challenges and efforts to recover some quality of life.
We agreed to skype once a week and that emails could be used as and when she needed to share further realisations or ask any questions. I sent her the rather brilliant "Coping with Voices" guide from the Hearing Voices Network and asked her to take a look. It's filled with insightful tips and hints on managing challenging voices that have proved useful for other voice hearers. She could read it and choose which strategies and ideas she would care to try.
This is also very liberating when a person can see that others have had these challenging experiences and that sometimes, something might be done about resolving them.
MAKING THE LEAP
It was time for action and Katy had made some decisions. After looking through the coping with voices guide, she chose a selction of tactics to manage her experiences more effectively. She said that she knew one thing for sure, she didn't want to go on as she was.
So here was her "battle plan", reviewable with me at the end of each week. Her cousin had agreed to be her ally locally and to check in with her on progress, challenges and feelings about how she was doing via phone calls at agreed times and a weekly visit. I sent cousin some basic info on hearing voices so that she felt prepared a little and not too out of her depth.
Week 1 : Asking the voices to go away.
Week 2 : Instructing the voices to go away
week 3 : Ordering voices away.
We thought she sould set some boundaries and try selective listening, telling herself to focus on listening more to the voices she preferred and ignoring the others. We would try to alter the pattern of voice hearing in this way and break up the total wall of voices that had become predominant. It would be a process and there would likely be resistance from the negative voices but, what did she have to lose in trying?
Also, she agreed certain times of the day where she would tell the voices to go away and come back later at a more "convenient" time where she was willing to pay attention. If they spoke during the times she wished to be voice free, she was to remind them of the allocated time and then use the requesting, instructing and ordering model of persuading them to be quiet and to go away. ( This started to become more effective in week three)
Slowly, and with determination, persistence and patience with herself and with her voices, Angela realised that she was starting to taking back control of her experiences and exercise her personal autonomy more effectively. That she had a tool kit of possibilities to dip into and utilise. And some allies to support her journey. This, in itself boosted her self confidence and she began to grow.
She tidied her flat, cleaned up and bought fresh fruit and vegeatables as well as a smoothie maker, She reduced her sugar intake slowly, drinking lemon water and mint teas. She began to think about wanting to get healty and get back to work so started looking to job vacancies as well as college courses. She started to do breathing relaxation exercises.
She ordered a brilliant and inspiring book by Marius Romme, "Living with Voices" (50 stories of recovery) and began to read of other individuals who had made a success of overcoming negative voice hearing experiences.
And of the annoying voices refused to go away? Well, she visualised a ray gun and "zapped" them out of existence.
Now, all this meant that she did talk to and engage with her voices at times. She decided also to keep two voices and wished to eliminate or reduce the presence of the two critical and cynical voices. We had drawn up a table or profile of her voices, the names they had and their general content and after some deliberation she made her decisions. One nice voice was her dead grandmother, who had often looked after her as a child when mom and dad were busy fighting with one another. This was a consoling and protecting voice and caused Angela no distress at all.
The other was an unnamed young girls voice and Angela felt on reflection that this was somehow an aspect of her younger self that spoke of her need to grow and flourish, even though it was sometimes critical and told her she was hopeless too.Maybe even this voice would diminish if she could get her life back on the tracks and feel more positive about herself? So, this one too was a "keeper", at least for now.
It meant that we were going to deal with managing the two hugely horrible and critical voices, both male and both related to real people she had known in her past. The work of recovery had begun!
Part two to follow...
Activist/ Health worker/ 20 years. Specific interests : wellness/ voice hearing/ coping/ exploring/ sharing/ stigma reduction.