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At last, the fourth and final part of my reflection on “hearing voices that are distressing.”  You can catch up on any of the previous posts by clicking on part 1, part 2, or part 3.

The conclusion of this simulation involved a “community outing.”  We were assigned to a particular outing based on the slip of paper that we pulled from a basket.  My paper told me that, while hearing the voices, my assignment was to walk outside and talk to the man at the parking lot kiosk.  I had to find out from him how I could attain a parking permit.  I’m not usually very comfortable talking to people I don’t know, especially when it’s staged like this for an assignment.  But I had no choice.  The paper told me I had to be back in ten minutes.  So I went.

As I walked outside toward the parking structure to ask about how to obtain a parking permit, I was afraid to be alone with the voices.  I had found refuge in the audible dialogue in which I had engaged with the psychiatrist, even if she did make me feel worthless.  As I walked along the sidewalk, the voices began to curse and demean me again.  They made my stomach turn and my heart race.  I get scared easily by thoughts of evil, and these voices sounded evil.  I thought about how, if I were a long-term voice hearer, it would be difficult for me to maintain a rational sense of self.  How would I know which voices were true or not?  What would I believe about myself after years of persecutory voices?  How would I know who the “real” me actually was?  How would I be able to separate “my” thoughts from the “other” thoughts?  Would it even be possible?

I was glad when I finally reached the parking kiosk and was able to engage in conversation again.  I did not feel any stigma or judgment from the parking attendant.  I was polite to him, I smiled, and he was very helpful.  Even though I got the information I needed within a minute or so, I continued to ask him friendly questions related to purchasing a parking permit.  My interaction with him felt like an escape from the “other world” where everyone knew who I really was.  Where they knew my diagnosis – my label – and expected distraction and impaired reasoning from me because of it.  But this…this was like a fresh start.  I could walk outside and talk with a stranger, and it didn’t make a difference what my label was.

As I returned to the classroom, satisfied with my interaction with a stranger, the voices persisted.  They hissed and snarled and told me I was worthless.  I continued to think about how difficult it would be to really establish a clear sense of self if, for so many years, I had voices in my head that were telling me things about myself that were contrary to what I believed.  How could you ever separate them?  Doesn’t the “true you” and “the voices” eventually become so intertwined that you can’t tell them apart?  How does that work?

Suddenly, a new voice came into my ears.

“You are one of the lucky ones.”

Immediately, the voices stopped.

I recognized that last voice as that of the creator of this program, that woman whose video lecture we had watched prior to engaging in the simulation.

I took out my earbuds and looked around the room as other students also slowly began to detach themselves from their devices.  We all looked at each other, not really sure what to say.  What do you say?  “Wow” seemed so insufficient.

Once the remainder of our class completed the simulation, we engaged in a debriefing session with our Mental Health professor and all of the “professionals” who had evaluated us during the exercise.  The “supervisor”, the “psychologist”, and the “psychiatrist” all were OT students who had done this simulation before, or they were our own professors, talking down to us as if we truly were psychiatric patients.  They all apologized for having to pretend to be so rude to us.  For the next hour, we  participated in a passionate and reflective discussion about everything we had just experienced.  We brought it back to our course readings of theory and first-person narrative accounts about the experience of illness and of recovery.  Our professor encouraged us to take care of ourselves for the remainder of the day – to engage in positive sensory and social experiences.  She reminded us that, although a useful tool in student learning, a simulation of hearing voices that are distressing can never allow us to fully and truly understand what it’s like to live with voices day in and day out.  But she encouraged us to hold onto this experience so that someday, if and when we are afforded the opportunity to be an occupational therapist for a person who hears voices that are distressing, we can approach the situation with humility, empathy, and an appreciation for the individual.

I am sure that this experience is one that I will not soon forget.

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If you’ve been following my multi-part reflection on the “Hearing Voices That Are Distressing” exercise in which I participated as part of my Mental Health class for OT school, then you know that this section I am writing about has already been preceded by two other stations: the problem solving station with the “supervisor” and the reading comprehension station with the “psychologist.”  After working with the psychologist, we were sent to the “waiting room” in anticipation of our meeting with the “psychiatrist.”

This constituted our third station:

My third station involved my mental status examination with the psychiatrist.  I sat in the waiting room, trying to find interesting reading material in the magazines and newspapers available to me.  The voices were persistent, and I couldn’t really block them out enough to be able to concentrate on any of the interesting reading materials I had found.  Dealing with the voices in silence was taxing.  I couldn’t get away from them.  Although it felt like a half an hour, I was relieved that I only had to wait a few minutes before the psychiatrist came and retrieved me as her first patient in my group.

I stepped into the psychiatrist’s corner and sat down facing her.  It was hard for me to hear her voice, as well as my own, due to the earbuds and voices in my ears.  When I talked to her, however, I was able to tune out the voices and concentrate more than when I had been doing silent activities such as reading and problem solving.  I found solace in the external noise and I discovered that, if I focused on the pronunciation of my words when I was talking, I could tune out the voices even more successfully.  The psychiatrist looked at her clipboard and coldly asked me my name and social security number.  I thought I clearly communicated them to her, but she made me repeat them to her, clearly annoyed that I had made myself difficult to understand.  She asked me why I was there, and I suddenly realized that I didn’t have a good explanation.  The professors had told us not to “role play” or pretend that we were a psychiatric patient, but to just be ourselves.  I had no idea how to respond to the psychiatrist’s question, so I said, “I don’t know…I’m tired?”  “You’re tired?” she retorted back to me.  “You’re here because you’re tired?”  I knew it was a bad answer.  I looked at her, searching for an answer that would just get me to the next question.  Fumbling for words, I finally blurted, “Because of the professors.” I immediately realized how crazy that sounded.  “The professors?” she responded.  “Who are the professors?”  I knew I would not be able to explain myself because she already had it in her mind that I was incapable of producing an acceptable answer.

Clearly unsatisfied with my answer about why I was there, the psychiatrist decided to move on with her examination of my mental state.  The creepy whispers continued in my ears.  I continued to find refuge in the audible conversation with the not-so-nice psychiatrist, though I had to concentrate extra hard to make sure that I was answering her questions the way I wanted to and not becoming overly distracted by the voices.  She asked me who the last four presidents of the United States were.  I made my way slowly through the list, just to make sure that I answered them correctly so she didn’t think I was stupid or out of touch with reality.  Then she asked me who the current Vice President of the United States is.  I know who that is – it’s Joe Biden.  But in that moment, his name was on the tip of my tongue and it took me probably ten seconds of serious memory-searching to come up with the words to communicate the picture of the Vice President that I had in my head.  I couldn’t tell if she was pleased or not that I had finally answered the question correctly.  I was relieved when she asked me to subtract by 7’s from 100, though I went so slowly for fear of making a mistake that she shushed me before I made it down to zero.  She then asked me to explain to her what I thought the following abstract phrase meant: A rolling stone gathers no moss.  Usually, I’m really good at coming up with explanations for things on the spot.  I tried to reason through the adage, but I couldn’t think clearly.  I felt really dumb.  The voices continued.  She presented me with another expression to explain to her: People in glass houses shouldn’t throw stones. Even though I felt I explained this one well, it didn’t seem to matter to the psychiatrist.  She just glared at me and made me feel like no answer I could offer her would be good enough for her.

I was completely flustered when she finally dismissed me to my community activity.

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Yesterday I shared a reflection on the first of four parts of the “Hearing Voices That Are Distressing” simulation in which I recently participated.

Now it’s time to move onto the second station:

After several minutes of shamefully unsuccessful attempts to complete the problem solving tasks, I was relieved to shuffle over to the second station – the reading comprehension activity with the psychologist. I was looking forward to this station because I am usually good at reading comprehension, as opposed to the visual spatial problem solving tasks at the previous station.

The psychologist who administered the reading activity, however, managed to turn it into a daunting task by giving us only five minutes to read a one-page essay on how to break into the music industry and then to answer several questions about it.  I tried to be strategic, scanning for keywords and details, but as I attempted to speed read, the voices kept distracting me.  I could not block them out.  They became persecutory.  They cursed at me.  Shit, shit, shitty. You’re shit. This seemed ironic to me, since I know that I’m usually skilled at reading comprehension.  So, even though I couldn’t block out the voices, I managed to not give into the meaning of the words they were feeding me, disallowing them from influencing my belief in my ability.

As the voices continued, however, I found myself reading the same sentence repeatedly, lacking comprehension.  The pressure of the time limit continued to build.  The psychologist spoke up and reminded us that we only had a little bit of time left, so we needed to hurry, while also reminding us that this important, so we needed to take it seriously.  I hurried through the remainder of the passage, and when I got to the quiz, barely any of the material seemed familiar.  I must have missed a lot of details due to the distracting voices and the time pressure.  Hey! You smell. I did my best to make educated guesses based on the content I had read.

When the psychologist announced that time was up, we put down our pencils and checked out answers.  Stop it!  Stop! She asked us to go around the table and report how many we had answered correctly.  All of us only answered a few of them correctly, well below a 50% grade.  She made us patronize the person who answered the most questions correctly by clapping for her quietly.  I was relieved when the psychologist finally dismissed us to the “waiting room” so that we could wait to be seen by the psychiatrist.

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Over the course of the next few days, I’ll be sharing four parts of an elaboration on an assignment that I recently completed for my Mental Health class.  This assignment served as a simulation of the type of distressing voices that a person with a mental illness such as schizophrenia may experience (keyword being simulation, as nothing can really re-create how a person with a psychiatric illness may actually experience it).

Prior to the simulation, we viewed an hour long preparatory video lecture given by a woman with a PhD in Clinical Psychology.  She spoke about schizophrenia and hearing voices that are distressing (which is different, she argues, than simply hearing voices), and her words carried weight because she knew what she was talking about.  When she was a child, she was diagnosed with schizophrenia.

Just as students in Physical Disabilities classes may engage in a 24-hour wheelchair assignment in order to gain perspective and empathy, this assignment was meant to immerse us in 45 minutes of an experience that we will not soon forget.  It was not meant to make us able to fully understand what it’s like to have schizophrenia, or to hear voices that are distressing.  No class assignment can do that.  But it was meant to give us a perspective that we can carry with us into our professional lives as occupational therapists, whose goal it is to help people increase their participation and successes in their occupations of everyday life.

After we viewed the video introduction, we received an explanation about what exactly we were going to be doing over the course of the 45-minute simulation.  We were told that we would move through four experiential stations.  Each station was meant to give us a glimpse into the system that a person who hears distressing voices may go through, and the stigma that he or she may experience on a daily basis.  These were our stations:

1. Problem solving with the “supervisor”

2. A visit with the “psychologist”

3. A visit with the “psychiatrist”

4. A community “outing”

I admit that I was nervous heading into this simulation.  I can be easily freaked out.  I was afraid that I would have nightmares that night (which I didn’t).  I know many of my classmates felt the same way.  I was put at ease by the fact that this entire simulation was something that was very well put together and that was meant to be experienced as  a whole, and not just as a press play on your CD player (yep, CD player) and deal with it on your own.  It was all part of a program, with extensive preparation prior to and debriefing following the simulation.  I could tell that the creator of the simulation (the woman whose lecture we watched), as well as our teaching staff, cared about helping us have the most positive and beneficial experience possible.

The following is my reflection on my experience at the first station:

My first task while hearing voices was to engage in the match problem solving activity.  I guessed that I would become engrossed in the task and be able to tune out the voices.  I was wrong.  I could not complete the first puzzle and I was unable to tune out the ambiguous whispers that were already haunting me.  They reminded me of the creepy whispers on the TV show LOST.  I felt paranoid and ashamed each and every time the supervisor walked by, noticing that I was staring blankly at the matches in front of me.  I was sure that she thought the voices were preventing me from concentrating.  I even said to her, “I’m not good at this,” just so that I could try and explain myself.  I wanted to make sure she knew it was not because of the voices.  My sense of self was already being affected, as I attempted to separate “the real me” from “the pretend me.”  I probably would have performed just as poorly had I not been hearing the voices, but their presence did not make the task any easier.  I was relieved when, after a few minutes, we were told to move to the next station.

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