I just did a rough draft of a handout which surveys the possible options when responding to voices and other intrusive experiences. I’m curious to hear what some of you might think about this. Notice that I am lumping unwanted and disturbing voices in with unwanted and disturbing thoughts, impulses, and emotions, since I think the dynamics are much the same in any case.
I have spent years trying to help people who have problems with voices and other sorts of mental events, and I have noticed that whenever I thing I have “the answer” someone comes along with a situation for which that answer does not work. So a better approach, I think, is to have a number of possible answers or approaches, and then move among them flexibly, choosing what best fits the situation. It is not good to rely too much on any particular method, because each method has disadvantages as well as advantages.
The handout may not make much sense without more explanation: if that is your reaction, let me know about that too……
Options for dealing with “Voices” and other “Intrusions”
It is common for human beings to experience things in their mind that they didn’t expect or want. These might appear to be coming from outside the person, as “voices” commonly do, or they might be more obviously coming from somewhere inside the person, as do unexpected and/or unwanted thoughts, impulses, images, feelings, emotions, memories, etc. (All of these are called “intrusions” by psychologists, because they seem to intrude into one’s consciousness.)
So, what can people do when experiencing such unwanted mental events? While there are innumerable possible responses, it is here being proposed that all the possible responses can be sorted into five basic categories. Those categories are fight, flight or distraction, submission, mindfulness, and selective integration.
And which category of response is most effective? It turns out that no one category of response is best for all situations; instead, it is helpful to become competent to flexibly respond to each situation, using responses from each category as needed.
The first three responses to be discussed are those that take less thought, and can be done more impulsively: fight, flight or distraction, and submission. Many people get stuck just using these methods alone to cope, or will try to do just one of them and then “flip” to another one when the first fails: for example, people will fight with or distract themselves from a voice or impulse, and then when they get worn out with that, will “flip” over to a state of submission to the voice or impulse.
Fight: in this mode, we organize to oppose the voice, impulse, etc. We notice what is wrong with it, argue against it, resist any tendency to give in to it, etc.
Flight or distraction: in this mode, we do whatever we can to avoid experiencing the voice, impulse, etc. This might include anything from sleep, to taking drugs or medications, to watching TV or other distractions.
Submission: in this mode, we just give in to the voice, impulse, etc. So we do what the voice or impulse wants us to do, we believe the thought, we surrender so much to the emotion or memory that we let it determine our actions or prevent us from seeing beyond it.
The last two categories of responses usually come a bit less spontaneously, and require more deliberate focus in order to be accomplished. Often for example people who hear voices may spend years trying to cope just by using fight, flight, and submission, without being aware there are the further options of mindfulness response, and of selective integration.
Mindfulness response: this means being aware of the intrusion but not making anything out of it or making any specific response. So the thought, voice, or impulse emerges, is noticed, and is allowed to fade away, without fighting it, attempting flight or distraction, or submitting to it.
Selective integration: this means being aware of the intrusion and its context, which includes all of one’s other thoughts and awareness, and finding some way to make sense of it within the whole picture of oneself and one’s world. There is a willingness to explore the intrusion and a curiosity about what might be going on underneath the intrusion, and information from this discovery process is allowed to affect decision making, though in a nuanced way, unlike in “submission.” An example might be a person hearing voices screaming as she contemplates a major decision, which she explores enough to give her clues which help her identify some major insecurities and concerns, which she then addresses as part of her decision making process. Notice how this is different from fighting with or rejecting the voice, or flight or distraction, or simple submission, or mindfulness which seeks to make nothing of the voice.
To better assist in picking the category of response for each situation, the following guide has been developed, which looks at each category of possible response in terms of its advantages and disadvantages.
Pro for Fighting: Especially when one is faced with thoughts, impulses, emotions or voices that push us toward destructive behavior, fighting can be helpful. For example, it might be important to really get passionate about resisting a suicidal impulse or voice, to avoid letting it take over.
Con for Fighting: Fighting takes a lot of energy, and makes us agitated, which can weaken us or make us look or act in a foolish way. Also, when we are fighting an intrusion, we may only notice what is wrong with it, and not notice other aspects of it that might be helpful if we opened our mind. And sometimes the more we fight, the more it seems like our only option is to keep fighting even more – an exhausting and destructive loop.
Pro for Flight or Distraction: When we find a way to get away from an intrusion or to distract from it, then the problem appears to be resolved without real effort or exertion. And because we are no longer facing the intrusion, we can be calm and even happy, which certainly feels like success.
Con for Flight or Distraction: In our efforts to get away from or distract from the voice or other intrusion, we might also distract or get away from much else that is going on in our life. And when we are avoiding facing the intrusion, we fail to get any more information about it, and we fail to learn that we are capable of facing it. So when the intrusion finally does find its way to us past all the distraction, we feel less competent to handle it and are more easily overwhelmed.
Pro for Submission: Unlike fight or flight responses, submission often seems easy, at least at first. So if we are on a diet for example, but have an impulse (or voice command) to eat a cookie, and we are tired of fighting it or trying to distract ourselves, the easy thing to do is just to submit and eat the cookie. And many times impulses, thoughts, and voices that people submit to are entirely benign: if we just give in and follow them, we can feel spontaneous and happy.
Con for Submission: If we submit to bad ideas, we make our life more difficult in the long run. And when we submit, we may make ourselves feel weaker, more dominated by thoughts, voices, impulses, emotions etc. that order us around. Or we might try to justify our submission to ourselves by only looking at the positive side of the intrusion, which might give us a dangerously unbalanced perspective.
Pro for Mindfulness: When we are simply aware of mental events but don’t respond or engage with them, then the costs of many of the other approaches can be avoided. We maintain our calm, unlike in the fighting approach, we keep our sense of presence and ability to face things, unlike in the flight or distraction approach, and we avoid making possibly poor decisions or feeling weaker than the intrusion, as in the submission approach. And the mindfulness approach is much simpler and easier to follow than the integration approach.
Con for Mindfulness: If we are simply mindfully aware of thoughts, impulses, voices etc. that bring us valuable ideas or directions, then we will fail to act on them, with negative consequences to our lives. For example, if we were always simply were aware of intrusive thoughts about danger, but consistently failed to act on them, then we would perhaps not be long in this world.
Pro for Selective Integration: This response can be seen to combine the best of all the above forms of response. So one might for example fight against giving in to something a voice is demanding, distract oneself from some other aspect, submit to a third part, and just be mindful of or make nothing of a fourth aspect. By being selective, one’s response becomes appropriate to one’s needs, values, and life context. As a result, one feels competent and in charge of one’s life.
Con for Selective Integration: This response is a lot of work. A person often doesn’t have the time or mental concentration available to deal with an intrusion in this manner. Also, since no one knows themselves or their situation perfectly, it follows that anyone attempting to use this method will still make mistakes from time to time. It is important that a person have other methods to use when one isn’t yet ready to integrate a particular intrusion.
Ron Unger LCSW is the author of this post and the blog Recovery from “schizophrenia” and other “psychotic disorders,” he is a therapist who works with people diagnosed with schizophrenia and other psychotic disorders, using a respectful and skill building approach called cognitive therapy for psychosis. Ron has a number of family members who have been hospitalized for “mental illness” including psychosis, and Ron himself has had experiences that might have earned him a “psychosis” type of label, had he been spotted by the mental health system at the time.
This article was first published on Ron Unger’s blog and was republished here with his permission.