Monday, July 10, 2006

Roy: Hearing voices


When I was in medical school I recall seeing an unkempt-looking fellow standing on the sidewalk, talking to himself and spinning round and round. People walking past were giving him a wide berth. I stood near him and said, "Excuse me." At that utterance, he immediately stopped spinning and began walking down the street as if he were a skipping record and I just nudged the needle (hmm... do people even get this analogy in the CD-era... I'm feeling old).

As an aside, this symptom of spinning is an interesting phenomenon that has often been mentioned in older schizophrenia literature [PubMed]. What I find interesting is that the spinning is usually in the same direction (counter-clockwise), often attributed to asymmetrical changes in dopamine physiology. Hmm... wonder if it is clockwise in the Southern hemisphere.


So anyway, it was one of those brief, random interactions that you don't forget... never having an explanation to fully understand it so that it can be neatly categorized and put away.

I was at the ocean this past week and had several experiences of seeing folks standing or walking on the boardwalk, talking to themselves. At times, they seemed to be gazing in my direction, prompting an "Excuse me?" as I wondered what they were asking of me. After getting no response, I realized they were plugged in to a Bluetooth headset, chatting away on their phones, oblivious to the world around them.

It's funny (funny strange, not funny ha-ha, as Gilligan would say). If I saw the headset, then I did not get confused... I immediately realized they were chatting to someone else and didn't give it a second thought. But when the headset was in the ear I could not see, it caused an ambiguous moment, not knowing if they were talking to an unknown person, maybe hallucinating. It's funny how our (not just psychiatrists, but all of us) brains are wired to notice odd or unexplained behavior, while instinctively filtering out things which fit neatly into our "normal" or "expected" categories of behavior.

As the world becomes more wired (weird?), I wonder that our expectations about human behavior will change. Having a one-sided conversation no longer seems so clearly psychotic. The idea of a transmitter implanted into one's tooth no longer seems so clearly delusional. I still see people with schizophrenia having paranoid delusions, but I note that I more often discount their concerns that there are cameras watching them (there are) or that their email is being monitored (it is). The technology reshaping the world will turn us all on its ear.

16 comments:

Dinah said...

Roy, Welcome Back, I'm so glad you've returned to Blog. That down the ocean, hon, stuff was getting old. Clink and I missed you! Glad to hear you were unsticking the stuck.

Spiritual Emergency said...
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Spiritual Emergency said...
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NeoNurseChic said...
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On the Same Page said...

I haven't had the full opportunity to find the citations, but I recall as a resident visiting a day-treatment program for autism-spectrum disordered children. In the gym, they had three old-style barber chairs, surrounded by mats, and tipped back into a near Trendelenburg. They would then spin the children counter clock-wise, to my mind with a great deal of force. The children were delighted and quite animated following the experience. I remember the phrase, allocation of attention, but I haven't been able to locate it yet. But then again, I live near the ocean and use a Mac PowerBook G4, so probably nobody cares about the citation...

Roy said...

Carrie, I probably would have but the damn hotel didn't have wifi (Commander hotel in OC). If I walked a block to the library, their wireless was on.

jw said...

Whenever I hear a psychiatrist mention "voices" I think of two items which have importance.

A) Richard Feynman PhD was refused admitance to the US Army because he heard voices. Uhm? Feynman was one of the small number of people who could recall an actual recording of an earlier heard conversation / lecture / music / etc.. That is not, at all, "hearing voices" but to many psychiatrists, it is. Sad ...

B) I, like my sons and father wear a partial lower denture. When I had my partial replaced about 8 years ago I had a noise problem. The denture was picking up AM 610, a Toronto Talk-Radio station. I mentioned this to my Dr. who immediately said I was psychotic ... My denturist fixed the problem in a few minutes. Sadly, I've seen this problem with other people.

Hearing voices may well not be hearing voices.

Dr. A said...

BusinessWeek just came in the mail yesterday. Here's the lead article: "The Plot To Hijack Your Computer"
*THEY watch you surf the web
*THEY plague you with pop-up ads
*THEY cripple your hard drive

The internet IS psychotic and I'm definitely paranoid...

Spiritual Emergency said...
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Dinah said...

This is why it's good to have a psychiatrist who spends more than 5 minutes assessing your symptoms...

NeoNurseChic said...
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NeoNurseChic said...
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Roy said...

JW- like Dinah said, it pays to actually take a good history, rather than complete a checklist. What you describe, I would never classify as "voices" or hallucinations. I often hear, when taking a history, that someone hears her name called sometimes, or that after Granny died he'd see her standing at the end of the bed or sitting in her favorite chair. These are not really hallucinations (well, at least not in the psychotic sense), and I tell these folks that these are normal phenomena and not of concern.

Dr A- let's hope Robert Heinlein's prediction never comes true. If it does, "Michael" (self-aware internet) will know enough about each of us to drive us all mad.

Neo- yes, Md OC. Sounds freaky with the growling IMs. My mac makes a cricket chirp with every email.

Dinah said...

what, no link to Gilligan??

Anonymous said...

Roy, Roy, Can you hear me Roy????
Okay, I changed the forwarding address for comments, does it come to all of us on autopilot???
I'll screech if it doesn't.
--dinah

Anonymous said...

Just wait into the pharmaceutical revolution really gets going. Then things will really start to get weird. I took 60 mg of Ambien about twenty minutes ago, and as usual, the quiet little hints of distant voices have begun to make themselves heard. They're fragments of thoughts I'm not consciously thinking (though perhaps they are fragments of unconscious thoughts). Most of the time, they don’t make much sense. I don’t believe them to be real or significant in the least. At best, they are mildly interesting. But until I started taking Ambien, I never figured I’d end up having to explain to someone that “Yes, I do hear voices,” but that “you know, it’s really not such a big deal.”