Good vs. Bad Voices In the Head

A child of seventeen—a girl—country bred—untaught—ignorant of war, the use of arms, and the conduct of battles—modest, gentle, shrinking—yet throws away her shepherd’s crook and clothes herself in steel, and fights her way through a hundred and fifty of hostile territory, never losing heart or hope and never showing fear and comes—she to whom a king must be a dread and awful presence—and will stand up before such an one and say, “Be not afraid. God has sent me to save you!” Ah, whence could come a courage and conviction so sublime as this but from very God Himself!

—Joan of Arc by Mark Twain

Hearing disembodied voices in your head has a bad name these days. 

One patient I had in an emergency department was bothered by voices in his head that he called demons. At one point in the ER visit, he got up from the gurney and bashed his head into the wall repeatedly.  

“Get out of my head!” he shouted. “Get out of my head!”  

After that outburst, his head didn’t look damaged. There was no obvious deformity, no bruising, no abrasions, nothing at all like that.  

The wall, however, was another story. There was a head-sized indentation in it.  

A CT scan revealed no bleeding in his brain, that he had a normal brain for a man in his 40s. 

 The night before, he pulled a knife blade out of his thigh leaving a 3-inch long stab wound. A demon had attacked him during his sleep, he said. 

Later that same night in the same emergency department another man checked in. The voices in his head were telling him to kill himself. “I was released too soon from the mental health unit last week,” he said. 

The wall head-butting man had about six different illegal psychoactive drugs in his system. The latter suicidal man didn’t have any. Joan, presumably, didn’t have a cocktail of drugs in her system either. Having voices in your head isn’t always a matter of drugs.

Calling them “auditory hallucinations” seems disingenuous. They’re very real, at least to the person themselves.

Joan of Arc 

As I write this, I’m in the middle of reading Mark Twain’s biography of Joan of Arc. Hearing voices, in our time, has a bad name. They’re usually implicated with them telling someone to kill themselves, telling people they’re ugly, horrible people. 

Yet hearing voices worked out pretty well for Joan—and France. Claiming to be guided by visions from the archangel Michael, St. Margaret, and St. Catherine of Alexandria, 17-year-old Joan was able to lead an army and break up the siege of Orleans in 1428. She then scored another decisive victory at the Battle of Patay. Historians credit these victories and others allowed the French to win the Hundred Years’ War several decades later. 

In my experience, I hear far more about the bad effects of hearing voices than any of the good effects. Beyond the story of Joan of Arc, you’ll hear people say, “God told me to do this.”  

Sometimes you’ll have people have dreams about deceased relatives. The relative tells them one thing or another. 

All of these examples are instances of hearing voices in your head. 

Lesson takeaways 

The first lesson here is you need to avoid drugs that cloud your thinking, especially the illegal ones. Nothing good can come of screwing up your perceptions of reality. If you’re able to remember your dreams, there’s no reason to take them anyway. Dreams and hallucinations have a lot in common, but dreams are natural and hallucinations aren’t. Make all your head trips natural. 

The second takeaway is to pay attention to the content of the voice. Joan of Arc was outwardly focused. She was worried about her village, the people she loved, and the advance of the English army. Whether or not she was advised by two martyred saints and an archangel doesn’t matter. The veracity of that vision was for Joan and the people who followed her to determine. That they didn’t dismiss her story out of hand is to their credit. Joan was an illiterate teenage peasant girl.  

The two ED patients, on the other hand, were besieged by voices telling them to kill themselves. They were right in seeking out help.  

If you’re besieged by voices, the content of the message matters. Are the voices telling you to forgive others, to try to understand others? 

Are they giving you a warning?  

Are they cutting you down? 

There are lots of different takes on this phenomenon that many have had throughout time. It’s not necessarily off or bad—but that’s not to say that it doesn’t have a stigma, especially when the voices urge suicide.

 

Also on the blog:

James Cobb, RN, MSN, is an emergency nurse and the founder of the Dream Recovery System, a top sleep and dream blog.

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