Hearing Voices: Internal versus External

Something people who don’t hear voices misunderstand about hearing voices is that it’s not like sitting next to a party of five in a restaurant where you can generally tune out all the giggles and unrelated conversation and focus on the person in front of you. It’s more like that party of five arranged their chairs around you and take turns commenting on your posture, your date’s violent sexual thoughts, your wants you didn’t know you had, while also occasionally blurting a sentence that doesn’t make any sense, like “put that burrito on reservation.”

My point here is that ignoring it isn’t always the easiest or most necessary option. And to understand why this is a fact, we need to understand a little more about this.

Some people are really obvious about their inner experiences. They’ll be talking out loud or gesturing to no one. They might be laughing or crying or whispering. This is what scares people, both people, and what can make getting acquainted with our voices such a daunting experience; we’re aware (some of us) how we appear and that judgement is enough to warrant withdrawal. This tends to make things worse.

But let’s be clear: screaming at yourself at 3am probably isn’t the best way for your roommates to get to know you, nor is it a good way to get to know your voices.

It’s kind of a novel idea, to promote the “getting to know” process of things that don’t exist. But they do exist; they speak, they can have names, we can even have images to describe their non-existent physical features. They may not exist for your little brother or your mom or dad, but they exist for you and that’s still valid.

Psychiatrists and therapists aren’t trained in helping you with this process because school will tell them not to entertain delusions and to teach their clients how to cope with voices by ignoring them. This may be helpful for the clinician so they have a reason not to feel guilty when their client doesn’t remarkably improve, but it’s not always helpful for the client.

Ignoring needs to happen sometimes. But as a primary coping mechanism it sucks.

And so there’s something called “dialoging”, which I didn’t know about until attending a hearing voices workshop put on by the Hearing Voices Network. This is essentially someone on the outside speaking with your voices, getting to know them, their motives, their personality, and validating their existence. It’s for the voice hearer as well, so they can participate in a conversation instead of a shouting match. Because, again, what happens when you shout at someone? They shout back.

It’s also a common misconception, especially in clinical practice, that everyone who hears voices hears them externally.

I read a report of an experiment which examined this. They say that external voices have always been thought to represent more “severe” psychopathology, and to be more common, but that “empirical evidence has been equivocal”, meaning ambivalent. You can read for yourself at this link.

To summarize their study:

  • Some people experience only internal (coming from inside the head) voices
  • Some people experience only external( perceived as outside the head) voices .
  • Some people experience both.
  • In 1996 it was thought external voices were more severe. This project suggests, from observations, that internal ones can be more “disturbing, negative, persistent, involving, and commanding”.
  • Voices commenting and conversing observed (reported as) more internal.
  • “…no differences have been identified between internal vs. external hallucinators in other symptoms or levels of overall psychopathology.”
  • Another study, (cited Stephane et. al 2010) “found that schizophrenia patients with only internal hallucinations performed more poorly than those with only external hallucinations on an internal ‘say/think’ source memory task, suggesting that internal hallucinators may be less able to discriminate between internal versus externalized stimuli…”
  • Those with internal voices were observed to have more insight into the self-generated nature of their voices.

Why is any of this important? Well, it’s important for clinicians to read these kinds of findings and realize that experiences vary, and that one-shot generalized treatment WILL NOT work.

But it’s also important for those of us who do hear internal voices. First of all, it’s validation. Maybe you’ve been disregarded in the mental health system because your experience is perceived as “lesser”. Remember when we talked about the Soggy Boxes and the hierarchy of the mental health system? If you don’t, take a quick read at an older post of mine entitled The Soggy Boxes and The Variation of Us.

I’ve personally been reluctant to ever tell anyone about the internal half of me, because I knew the standard the system held. I also didn’t know they were voices. I did, but I didn’t.

So all this really does is remind us how different and similar we can be with each other. It also proves that the stale mental health system needs to readjust its understanding of life, of humanity, and experience in order to catch up with where we are. They’re behind US. It’s not the other way around.

If you are struggling with this currently, I’d encourage you to reach out to someone you can trust. If you trust no one, find the person you can trust the most. If you know someone who has been through similar things, reaching out to them may be the most helpful. If your options are limited, feel free to email me (info here). People seem to like connecting on Instagram better lately, so you can also reach me via my social media handles (info below).

People are fearful because they don’t understand. The nice thing is that there are many people who will make an effort to understand if you can have the patience to teach.

If you are a voice hearer and are comfortable with sharing your experience, pop it down in the comments below. If it’s a long story and you’d like a guest blog post spot, contact me! I’d love to feature your story on here.

Would you like to continue the conversations accompanied by beautiful photos? Great! Follow me:

Instagram: @written_in_the_photo

Twitter:@Philopsychotic

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