“Is dissociative voice hearing same as schizophrenia and madness?” – a discussion

The following is based on a discussion on our Facebook group. We’ve taken what people have said, tidied up spelling, expanded abbreviations removed names. Every paragraph is a new point.

HV = Hearing Voices

Apparently the distinction matters

Voice hearing is pretty similar regardless of diagnosis, main difference is 1) how person copes 2) any positive voice or any positive relationship to them at all in the mix. Dissociation occurs in many classified experiences I cannot see what is achieved by attempting to decide whether it’s ‘psychotic’ or not

Psychiatry loves to categorize Voice Hearing. HVM has done a lot of good in redefining those practices

Dissociation is not generally recognized by Psychiatry.

Yet I remember early HV interview/assessment schedules where dissociation was a part of them
This mistake has been made with services users diagnosed as BPD being told their voices are ‘pseudo’. Dissociation with VH occurs in people diagnosed with schizophrenia/psychosis and other diagnoses. Just address the experience!

Psychiatry defines ‘Pseudo’ Voices as being inside your head. But voices occur inside AND outside of the head for most people diagnosed with schizophrenia/psychosis.

Yes ‘pseudo’ Voices are not restricted to just BPD. It’s just the main one we hear about because they are treated so badly for it

I find the dissociative part the most ‘disabling’ aspect of voice hearing. I may accept at a level of discourse there is no single meaning for ‘schizophrenia’ as it does not represent a single biological disease that can be pointed to as representative of a larger set of symptoms, however until they sort out my social security right to financial support whilst ‘recovering’ autonomously from this disabling experience I am not going to get all evangelist about diagnosis whilst ignoring the concrete reality of the social and economic circumstances that people find themselves in, (unable to compete on equal terms in a job market that is getting harsher) due to these disabling symptoms and so am comfortable having it on my GP sick note to entitle me to ESA financial support and access to the ever more constrained, homogenised and smaller array of other services available to me on the NHS as a consequence of these symptoms that I cannot afford on the open market of complementary therapies.

Can someone explain to me what dissociative voice hearing means? I hear voices but I’ve no idea what “kind” they are…

I hear external voices (that is they come from outside my head) internal ones (they seem to be within my mind but seem alien. I also amongst external ones hear them in noises and ‘hear’ other people’s conversations about my ‘inner thoughts’.

However dissociation I experience as being unable to focus on what I am doing, or what the people actually talking to me using their mouths, in the same room as me, are saying. Where I am so caught up in dialogue with the voices I am unaware of what else is going on. I no longer get catatonic but I do dissociate.

Which comes first, the voices or the dissociation?

It might not always be clear cut, which comes first the HV or the dissoc, and it might not always occur in same order

I certainly relate to getting completely focused on the voices to the exclusion of everything else. I also have this inability to filter out background noise which can be overwhelming especially when combined with the voices.

Yeah voices turn up environmental sound volume for me

Unfortunately for the anti-med evangelists my meds lessen some of it. I have come off twice and been ok off until a bad experience happened and they got worse again, and so on meds to moderate them (they never fully go away) but meds are NOT a cure, it being in my mind both trauma and group dynamic communicative rather than biological, although clearly whilst experiencing these symptoms you brain chemistry changes, but there is no normal brain chemistry, so for some the meds work for others they don’t, but they are not the solution or cure, they are just temporary moderators whilst doing they therapeutic work.

Unfortunately because life stressors affect such things, then social factors from neighbours to environmental noise, to secure housing, to support network to financial situations affect this.

However if you are mentally well and have a low paid job you know full well these stressors are not ‘cured’ by work, so individual meritocratic recovery that negates class issues is just so much middle class wank.

I think they mean when people hear the voices of dissociated parts of self like in DID. I think the question was is hearing those voices the same as hearing voices when you aren’t diagnosed with DID

I have also been down this path, and this conversation would go into phenomenology, philosophy of consciousness including whose self memories are, but the upshot would be same above social and political argument.

I went down the Gestalt (Hal and Sidra Stone) voice dialogue path but making my voices ‘personal’ rather than ‘thoughts and ideas’ made my mental health far worse. For a start all the ‘personalities’ that latched on to the technique were ‘thicker’ than me, but were also a bit ‘Dunning Kruger’ with it, and so I started dissociating just saying ‘no’ to them far more than I used to when they were ‘voices’ or ‘thoughts’.

I tried voice dialogue it was disastrous my visual voices attacked me. You just cannot force voices to talk to others

Equally when one pops out unexpectantly it can be difficult if the prof has a fragile sense of self if the voices calls them a twat!!

Mine are real bastards – I’d rather not get into a discussion with them tbh.

“Great minds discuss ideas; average minds discuss events; small minds discuss people” This quote by Eleanor Roosevelt sums my experience up, from studying a PhD and having a clear mind thinking about interesting stuff after the dialogue method I ended up with a bunch of right wing ignorant conforming narcissist hostile gossips in my head

I find the gestalt thing can be exposing too

Would you say an internal voice is basically the same as an intrusive thought but with more of a coherent personality, like for example an inner critic that says the same phrases again and again like ‘you’re worthless’ etc? If not, I’m struggling to conceptualize the difference between the two things? Really interested in this discussion as I’ve heard about ‘internal voices’ for a while but have never really understood how they’re different from intrusive thoughts or my own experiences of having a psychopathic inner critic (esp when I’m triggered or ashamed) – if anyone could explain this it would be very helpful.

Good point – voices can be externalised intrusive thoughts

I do find myself wondering if it’s all basically the same thing but in slightly different flavuors – and if shrinks are over-complicating basically the same process by dividing it into all these subcategories and making each experience seem so distinct just because it’s a bit different on the surface. I could be wrong but it’s just something I’m thinking to myself more and more. I have never heard voices in a traditional sense but the more I listen to voice ‘hearers’ share what their voices actually say, the more I can relate to it, and some of the phrases are eerily the same as my inner critic, like identical in both their wording, motivations, and the situations in which they intensify and are triggered. The only difference is that they are ‘heard’ whereas mine is experienced more like thoughts.

I think there’s little difference in the VH experience whether we’re diagnosed with schizophrenia, psychosis, DID, even OCD, PTSD, BPD

Different variables sure

I suppose I can clearly distinguish between what I feel as my own created thoughts and those unbidden ‘voices’.

The idea of intrusive thoughts is slightly different and there is the idea of thought insertion, which is rarer but when I have experience what I would call ‘thought insertion’ then it is a horrible intrusive experience of feeling like someone else is trying to make you think something that is somebody else’s idea or belief about you, not your own, very controlling.

I get them inserting or dropping or merging their thoughts into mine and yes I’m clear they are not mine

But with regards ‘heard’ voices, I both get voices that are acousmatic, from no discernible source, that are not, shall we say, carried on soundwaves; voices that I can fully ‘hear’ as sound; and also voices carried on/with or through other sounds eg car wheels, birds twittering, other people talking (so physically present witnesses will hear them say something else)

The thought insertion is like someone kind of nudging you into an adjacent untruth. A bit like a leading question in law where a leading question implies guilt in the question so cannot be answered without complicity

I experience it as being aware gradually hang on that’s yours not mine, through to mental equivalent of physical force

Yes, it feels quite forceful sometimes, hard to explain what that feels like though, describing bodily sensations I mean
Mental rape

I have called it that too

I have screamed no means no at them. But they manipulate it that I am responsible for their behaviour

Worst case thankfully rare scenario, they push their words out my gob

Even if they are my reflection they are a reflection of the power disparity in the way I am treated

I mean in a group way. No single individual could possibly have that power

Yes because much has got into our fabric

Although individual personalities is not the way I relate to voices. Or rarely. Or rather never used to be.

Annoyingly the various (I have a large number of) phantasm/assemblages seem to insist on treating me as a distinct personality and that is where i have a problem as it is clear they do not know me and so inevitably they come across as prejudiced

Many are nomadic. There is an obvious logic that the less prejudiced they are the more they are ephemeral. Even when, and i will, unconsciously but seemingly intentionally, trigger them from my unmet needs they will pass on. They are momentary. And ironically these voices are, and always have been more numerous.

It is what comes across as intentional focus or gaze that is the real issue and because of it will necessarily always have a more bigoted source.

But how does one evade them once targeted without losing oneself as a passive docile conformist.

I once said to someone of all people to appease it is the most understanding. Why on earth would one wish to orientate oneself to appeasing the most bigoted as an ethical practice? I have the right to say fuck off you bigot. Leave us alone.

Interesting reading. I have never considered myself to hear voices but I definitely experience overwhelming intrusive thoughts, and inner conversation that is not my own self, speaking about me, but as though it is someone else. Like replaying something someone else has said about me.

Because a lot of the experiences sound similar or with a common thread, do people think they are on a spectrum that ranges from your own ‘lucid’ thoughts, ones you own and control, to full blown psychosis that controls you? Would this make daydreaming, spontaneous thoughts, and inner dialogue part of the spectrum – fitting within a ‘healthier’ range – and gradually going into the range that impairs functioning?

Where do you think disassociation would fit? The same spectrum? Different? Is there crossover?

*Note to self: Maybe joining HV Network would be useful after all… didn’t want to seem like a knob with ‘fake’ voices joining a group that didn’t apply to me

I would say yes to spectrum except it often implies a linear concept which is wrong.
‘Manifold’ is the word i would use but i don’t have quote to explain it. It is a moving topology in 4 dimensions. Brains have a manifold shape. But it is does not have to have the ordered shape chaos theorists like

There is overlap across experience, there’s not always a clear dividing line of ‘this is schizophrenia/psychosis/DID/PTSD/BPD’

Dissociative VH, psychosis VH, spot the difference?

It seems to me that psychiatrists and others want to have neat categories – self harm = BPD, voice hearing = psychosis, pref schizophrenia etc. when the reality for people is much more complex, as you have all described.

Psych’s would say antipsychotics produces a differential response

I often think in the end, we need to define our own experiences regardless of what psychiatry says and does. I guess that can be achieved by trying to create a level of distance from MH services. Of course that can be impossible sometimes when a crisis occurs. But ultimately, in my opinion, no one should have their experiences defined by someone else.

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