New York Times article on Hearing Voices: Most psychiatrists fail to recognize rational auditory hallucination as voice of alternate personality.

The Times article—“An Alternative Form of Mental Health Care Gains a Foothold” or “Care Without Labels”— says that an anti-mainstream, anti-medication approach to hearing voices is taking root. An example of such an approach is the case of Sarah:

“ ‘I was told I was a ticking time bomb, that I’d never finish college, never have a job, never have kids, and always be on psychiatric medication,’ said Sarah, a student at Mount Holyoke who for years has heard a voice — a child, crying — and in college started to have suicidal thoughts. She was… put on medications that had severe side effects.

“In the [alternative care] group, other members prompted her to listen to the child’s cries, to ask whose they were, and why the crying? Those questions led, over a period of weeks, to recollection of a frightening experience in her childhood, and an effort to soothe the child. This altered her relationship with the voice, she said, and sometimes the child now laughs, whispers, even sings.

“ ‘That is the way it works here,’ said Sarah, who is set to graduate from college with honors.”

The following is from a textbook on multiple personality:

“The majority of MPD [multiple personality disorder] patients will experience auditory and/or visual hallucinations…” which “typically include voices that berate and belittle the patient (usually the host personality) or command the patient to commit self-destructive or violent acts. The voices may discuss the patient in the third person, commenting on his or her thoughts or actions, or may argue among themselves. The patient may hear crying, screaming or laughter. Typically, the crying sounds like an infant or small child in distress. There may also be voices that give solace, support, or advice…The hallucinatory voices of MPD patients often carry on lengthy discussions that seem coherent and logical to the patient” (2, p. 61-62).

“The patient may hear the alter personality speak as an inner voice within, often as one of the voices that the patient has been hearing for years” (2, p. 94).

Initial therapeutic engagement of the alternate personality may be as simple as addressing questions to the voice, with the voice’s answer being heard by the patient (host personality) and relayed to the therapist. If this is done in a way that builds trust, and neither the voice (alternate personality) nor the host (regular personality) feels threatened, then the voice will eventually come out and speak for itself, confirming that it was the voice of an alternate personality.

Sarah’s case (see above) shows that good therapy may be done without knowing that the voice is the voice of an alternate personality, and without pursuing full-blown treatment of the multiple personality. Sometimes less is more, so to speak, and all you want to do is change multiple personality disorder into its normal (distress and dysfunction free) version.

1. Benedict Carey. New York Times. http://www.nytimes.com/2016/08/09/health/psychiatrist-holistic-mental-health.html?hpw&rref=health&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well&_r=0

2. Frank W. Putnam, MD. Diagnosis and Treatment of Multiple Personality Disorder. New York, The Guilford Press, 1989.