"You'd better get away from there!  Get away from there!  Leave!"

It's 3am and I wake to the sound of my mother screaming at her apartment door.  Outside there are people–her neighbors and their friends–plotting to hurt her.  She's heard their voices, taunts, and threats for hours.  She simply can't take it any more.

I ask her if I can open the door.  I want to show her that no one is there.  No one is there. 

But this will not help.  My mother hears voices.  But to her they are not voices: they are real.  One of the most frustrating and disempowering aspects of her auditory hallucinations is that she does not recognize them as hallucinations (in psychiatry this is called a lack of "insight").  Opening the door and facing an empty hallway will not bring her any peace and will not stop the voices from plotting against her.  Paranoid thinking has a terrible, inescapable logic.  If the hallway is empty, then that's because the bad people heard us walking toward the door and ran back into their apartments.  After all, she can still hear them murmuring behind their closed doors.

Daniel B. Smith is also a child of a person who heard voices, and his book, Muses, Madmen, and Prophets: Rethinking the History, Science, and Meaning of Auditory Hallucination, is in part an effort to understand his family's experience with voice hearing.  Smith first became aware of his father's voices when he and his brother were helping their grandfather put together a self-published memoir.  In a short piece called "Voices," his grandfather described hearing voices that helped him make decisions, take exams, and even play cards.  For Smith's grandfather, the voices he heard were helpful and non-threatening, required attention and patience to hear, and were seemingly never a cause for anxiety or shame.  For Smith's father, however, the voices he heard, although similarly non-threatening, were commanding and intrusive, difficult to ignore, and a source of deep shame and concern.  Smith's father felt betrayed by his own father's silence regarding these voices: he "felt that he had been denied his salvation" (5).  Had Smith's father known earlier that it was possible to live comfortably with voices, perhaps his life would have been easier.  Perhaps he would have avoided a brief hospitalization for a nervous breakdown (which caused him to lose his job) and a lifetime of fear and anxiety regarding his sanity.  If Smith's father had an understanding of voice hearing that was not dominated by the stigma surrounding mental illness and by a medical model of auditory hallucination that pathologizes the experience, would he have lived a better life?

This is a compelling question, and one that Smith answers with a tentative "yes."  In one of the most interesting sections of the book, Smith describes the Hearing Voices Network, an advocacy group based in Great Britain.  (Smith's recent article, "Can You Live with the Voices in Your Head?," published in The New York Times on 25 March 2007, is an adaptation of this section.)  Building in part on the work of Marius Romme and Sandra Escher's Accepting Voices (1993) and Ivan Leuder and Philip Thomas's Voices of Reason, Voices of Insanity (2000), books that critique traditional psychiatric responses to voices, the Hearing Voices Network (HVN) offers support groups where people who hear voices can talk openly about their experiences and exchange strategies for living and coping with their voices.  HVN is a radical departure from most modern psychiatric approaches, which generally view auditory hallucinations as mere symptoms of mental illness best treated with psychiatric pharmaceuticals.  While some HVN members do use medications to help deal with their voices, others do not and adamantly reject any models that medicalize or diminish the significance of the experience.  It is this loosening of voice hearing from the "biomedical framework" that most interests Smith (81).  According to Smith, as psychiatry developed and public culture in general became more secularized in the 18^th century, attitudes toward voice hearing changed: "What was piety and poetry became science and sanity.  In public discourse, voice-hearing became a force of harm and an experience to eradicate" (14).  Smith's book, and groups like HVN, offer an alternative way of conceptualizing and dealing with the phenomenon of voice hearing.

The strength of Smith's book is his ability to synthesize and render in laymen's terms scientific research that is pertinent to understanding voice hearing, such as the physiological process of hearing itself (16-20) and the psychological "White Christmas test," which illustrates how easily auditory images may be created without the presence of actual sounds (102).  In addition to this contemporary material, several chapters in the book examine an eclectic selection of famous historical voice hearers: Socrates, Joan of Arc, and Daniel Paul Schreber.  While this material is interesting, these chapters are a separate thread which is thematically, but not altogether substantively, connected to the contemporary context and to Smith's personal story.  For example, Smith's father's voices were, like my mother's, mundane and persecutory.  Unlike Moses, unlike Joan of Arc, some people's voices are not the voice of God.  An unresolved paradox of the book is Smith's emphasis on the spiritual experiences of voice hearers which contrast vividly with the mundane and banal nature of his father's and his grandfather's voices.

In a chapter which is at turns poignant and comic, Smith attempts to conjure up his own auditory hallucinations or voices.  Such attempts by outsiders to access the heightened psychic states and altered perceptions often associated with mental illness have a well-established history of course, and LSD and other hallucinogenic drugs have been used by both psychiatrists and by the general public for this purpose.  While these attempts are often forms of experimentation and recreation, Smith's attempt is an altogether different exercise in empathy.  Rather than seeking hallucinogenic drugs, he opts for a less mediated method: floating in the silence of a sensory-deprivation chamber.  (It is perhaps ironic that Janssen, a major pharmaceutical company, has recently embarked on a somewhat similar project.  Janssen's virtual reality device, Mindstorm, is a multimedia theatre that simulates the voices and other hallucinations that people diagnosed with schizophrenia experience in order to foster empathy in non-patients and to simultaneously promote the use of medications for treating these symptoms [Janssen].) 

Despite his efforts and intentions, Smith's floatation tank experiment ultimately fails to produce auditory hallucinations.  This failure, however, causes him to rethink his original purpose: "I had paid for silence so that I could hear a voice, but what I really wanted was to hear my father's voice" (139).  More than that, perhaps, he wants his father to hear his voice, to have a dialogue.  He ends the book by returning to the multiple, enigmatic voices of his father: our "modest" duty is "to listen" when voice hearers speak, "no matter what they say" (217).

Listening, however, is not a passive activity, as Smith's book testifies.  Moreover, responding to voice hearers in a way that is respectful, not dismissive, can be a difficult task, especially when those voices are destructive, not divine.  As an observer, I have often wished to wrest away the power of a voice by denying its reality.  However, this is rarely effective.  In the mental health field, one well-used strategy for communicating with someone who is experiencing psychosis or delusional thinking is to respond to the emotional content of the experience, rather than the material content of the delusion.  But perhaps this is a strategy that also might be productively practiced in reverse: observers can acknowledge their own emotional response to an experience that occurs beyond their purview and that is not amenable to rational explanation.

And so, after listening to my mother's long explanation of her voices and what they have said, in that brief moment when she pauses for a breath, I say, "I wish there were something I could do to make things better."  And she responds, "I wish so too."  Smith's book is a special type of listening: it is a response to his father and a dialogue with his father's voices that might have made things better, if only he had a chance to hear it before he died.

Works Cited

Janssen.  "Janssen's A Virtual Hallucination: MINDSTORM." 1 December 2007.  24 August 2007.  http://www.janssen.com/janssen/news_mindstorm.html.

Smith, Daniel B.  "Can You Live with the Voices in Your Head?" The New York Times. 25 March 2007.  http://www.nytimes.com/2007/03/25/magazine/25voices.t.html.

—.  Muses, Madmen, and Prophets: Rethinking the History, Science, and Meaning of Auditory Hallucination.  New York: Penguin, 2007.

© 2007 Elizabeth Donaldon

Elizabeth Donaldson, Ph.D., Interdisciplinary Studies, New York Institute of Technology

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Categories: Psychology, MentalHealth