It wasn’t the first time that I was psychotic, but it was, maybe, the first time that anybody noticed, the first time that I was unable to hide it from others, and therefore from myself. What follows is an abbreviated account of how I learned—haltingly, with setbacks, over the years—to cope with chronic schizophrenia. There have been near-collapses, but I have managed to keep a job for 30 years. I have not, until recently, been open about my diagnosis (excepting my wife and a close friend).
I have hallucinated music since childhood. Voices came later, and visual hallucinations later still. Often the voices are distant, a conversation that does not involve me, and I can ignore it. Sometimes the voices are closer, and sometimes they speak to me. These voices are commonly of people I know, but sometimes they are strangers. Sometimes they are critical. Sometimes they comment on what is happening. Sometimes they blather. Occasionally they are encouraging.
Musical hallucinations do not distress me. Voices are a different story—they are rarely intrinsically disturbing, but uncertainty about their origin is. For some time, it felt important to figure out whether the voices were coming from people who are physically present. My doctor called it “reality-check.” Sometimes reality check is easy, eg, if there is a voice whispering in my ear but nobody near my ear. But often reality check is very difficult. In a crowded place, hearing a conversation, does one ask people whether they just said anything? Does one snoop around to find the source of the talking? Does one stare at people’s mouths to see whether they are talking?
The doctor was half-right: I felt better when I was sure about the origin of voices, and anxious when not (especially when they were directed at me). But sometimes it is awkward, difficult, or practically impossible, to gain that assurance. My frequent inability or unwillingness to do a reality check caused anxiety, which makes symptoms worse, and things can spiral out of control. Once I figured these things out, I typically avoided situations where it would be a problem. There are a lot of those situations, so this solution is not great.
Some years ago, a funny situation changed my approach to hallucinations. The scene is a cold, dark, morning, in a coffee shop. There are no other customers. I order my coffee and pastry, sit down, and start working. Soon I hear a conversation. Normally I would have done my reality check, and doing so would have been easy (it’s a small shop), but I felt confident that nobody apart from the sole employee and myself were present, and the voices were not inherently disturbing, so I kept working. Then one of the voices said my name, directly to me. Hearing my name almost always gets my attention, and I turned around, although still expecting to see nothing, but there were two people behind me—real people!—and I knew one of them; he had recognized me and was saying hello.
I suppose that sort of thing had happened before, but in that moment I realized something that I had not realized before: It is not important to know where the voices are coming from. It had just been demonstrated to me that prior to turning around I did not know their origin, and yet I was comfortable having taken on the “mere belief,” and as it turned out the false belief, that nobody was there. I realized in that moment that the comfort that came from successful reality-checks came not from knowledge or certainty, but from a clear belief about the voices. In this situation, that belief, even though it turned out to be false, was enough. And after I was forced to change my belief, it was still fine. I was able to turn back around and continue working, now believing that the voices were coming from people behind me. “And what if,” I thought, “those people quietly left, but I kept hearing the conversation, believing it to come from them?” Well, I’d probably eventually discover that they weren’t there, that the conversation was no longer real, and that would be fine too.
As trivial as these events might seem, they were life-changing. A similar pattern has played out with other symptoms. Here are two examples.
The first is close to “thought-broadcasting,” and for some time I did worry that others might hear my thoughts. I tried hard to think nice thoughts, or to think nothing. After extensive self-reflection, I realized that something slightly different is going on. I realized that it is difficult to tell the difference between speaking out loud and thinking. When I’m focused, I can tell the difference by paying careful attention to my body—especially my lips and throat—but one cannot always focus in that manner, and the resulting uncertainty about what has, or has not, been said out loud can kindle anxiety. Many of my conversations are laced with uncertainty about what I have said out loud, versus merely thought to myself.
After I realized what is going on, I tried to avoid this uncertainty, either by trying not to think or say anything (which is difficult), or by frequently repeating myself (which is obnoxious). More recently, I’ve accepted that it rarely matters whether others have heard me. If I happen to mention (or merely to think?) that I’m allergic to eggplant, it matters very little whether you heard. So these days, most of the time, I just make my own determination about whether the other person heard, just as one might do after making an off-hand remark on the periphery of a conversation, and that determination is good enough. I don’t double-check, repeat myself, or ask whether you heard, unless it really matters. This habit produces some false positives and some false negatives. It turns out that most of the time, it just doesn’t matter.
The second example concerns mirrors. It often seems to me that there are cameras, or persons, behind mirrors. I used to check mirrors (and still do sometimes), but I have come to realize and to accept that most of the time, it doesn’t matter. If there are voyeurs on the other side, that’s their wretched problem, not mine. For me, the path of least resistance is to allow that there probably is something on the other side. As long as I’m clear with myself, all is well.
There is a common theme to these strategies. It’s definite belief, not certainty, that allows me to get along. It’s not that certainty, or something like it, never matters. If you are fixing dinner for me I’ll try to be clear about the eggplant allergy, and I might repeat myself. And as I do when I teach students, I’ll monitor you for a sign that you have heard and understood, and I might even ask you to confirm it. I might, in other words, be a little obnoxious about it, and I hope that you’ll be patient with me. But most of the time, just having a definite, if unconfirmed and possibly false, belief about the situation is fine. It allows one to get along.
by Michael Dickson, Schizophrenia Bulletin | Read more:
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