“Hearing Voices, Living Fully” (a memoir) by Claire Bien (post 3): Diagnosis and Interviewing Voices

Bien says that she first became ill with voices and schizophrenia at age 31. After several hospitalizations, plus outpatient psychotherapy, and with minimal antipsychotic medication, she was able to negotiate with, and stand up to, her voices, so that they mostly stopped. She assures the reader that she did not hear voices before age 31, and had not been traumatized in childhood. But neither assurance is true.

Telling a Voice to Shut Up in College

“Once, when I was alone in my dorm room, I broke my study board over the post of my bed, saying as I slammed it over the post, ‘You won’t talk to me!’…I had no idea who I was ‘talking’ to…I continued to be depressed and angry throughout my twenties,” but “I graduated…with honors…” (1, pp. 36-37).

Voices Since Childhood

“The inner voices I grew up with were benign, often helpful, sometimes curious, and…sometimes inexplicably knowing…” (1, p. 244). “Until 1983 [age 31]…They had been for me as I imagine they are for most people: quiet thoughts not entirely my own” (1, p. 248).

Most people don’t have “inner voices” with “thoughts not entirely my own.” But people who do have them may assume that everyone else does, too.

Three Childhood Traumas

First, in early childhood, when Claire’s family emigrated from China to the United States, she was separated from the woman who had been her nursemaid, and was then “terrified” of losing her mother, too (1, p. 31).

Second, “I had severely crossed eyes” (1. p. 32), for which she had eye surgery at age nine.

Third, “I fell often, hitting my forehead on the ground so hard a lump would form because, for some reason, I never put my arms out to break the fall. I got so many ‘goose eggs’ that I have permanent, bony bumps on my forehead” (1, p 31).

I don’t know what to make of the third one. I am hesitant to speculate that an alternate personality, perhaps a precursor of the malicious alternate personalities that came out at age 31, was making her fall while restraining her arms. But something must have been going on.

Comment

Claire Bien says, “I was trained as a Hearing Voices Network facilitator in the summer of 2014 and in November 2014 began co-facilitating a Hearing Voices Support Group at Yale-New Haven Hospital. It is the first support group in a psychiatric inpatient facility in Connecticut” (1, p. 271).

My impression is that the Hearing Voices Movement and Hearing Voices Network (2) are against the “medical model” for treating people with voices, by which they mean that just giving a person medication to control voices is inadequate.

Part of their approach is to negotiate with voices. I see voices [with which you can negotiate] as alternate personalities, but they do not. Since negotiation with alternate personalities is a standard aspect of psychotherapy for multiple personality, I agree with them in regard to negotiation. But since they have little if any interest in multiple personality, I think their approach is not as good as it could be.

So what is the best diagnosis in this instance? It depends on what you want to do. Schizophrenia may be best for choosing medication. Deemphasizing diagnosis may be best to minimize stigma. Multiple personality may be best for psychological understanding.

Interviewing Voices

If I had been treating her based on the realization that she had multiple personality, I would have interviewed her voices. First, I would use her regular personality as an intermediary, asking her to relay my questions to a voice and tell me what the voice answers. After a while, the voice would get tired of going through her regular personality as an intermediary, and would come out and speak for itself (confirming the diagnosis).

To some extent, Claire Bien, herself, did the above: “I imagined that I was ‘talking’ with some of the new voices who seemed friendly…and who said they would help me when necessary. I thanked them and asked if they could tell me their names, as I wished to know who my friends were…‘Okay, call me Gary Putka.’ When I responded that I thought Putka was a silly name, the exasperated spirit said, ‘Then call me Gary Slutka!’ And we all laughed…In the weeks following my introduction to Gary Putka and his fellow guardian angels, I was encouraged…Believing that I had allies who were kind and mostly good helped me feel better” (1, pp. 183-184).

In the treatment of multiple personality, you need to meet and interview all (or at least the most important) alternate personalities. A few will really have their own names. Others, as in the above example, will suggest something to call them. Others, without names and who don’t see a reason to have one, will be addressed by their main characteristic, such as “the angry one.”

In my clinical experience, when I have tried to anticipate how alternate personalities will explain what they do and what has been going on, my guesses are usually wrong. I have found that you can’t really understand things until you meet and interview the personalities, themselves. Of course, you have to corroborate what alternate personalities say, to make sure they are not just making it up.

And when you interview an alternate personality with whom the regular personality is not co-conscious, then when the person switches back to their regular personality, they will have amnesia, a memory gap, for the conversation you just had.

1. Claire Bien. Hearing Voices, Living Fully: Living With The Voices in My Head. London and Philadelphia, Jessica Kingsley Publishers, 2016.

2. Wikipedia. Hearing Voices Network. https://en.wikipedia.org/wiki/Hearing_Voices_Network