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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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