I’d never heard of the Hearing Voices Movement, but I don’t read the [spit] New York Times [spit]. Scott Alexander almost certainly also avoids reading the NYT, but he responds to a recent article there on the phenomenon that some of his psychiatric patients have reported:
The New York Times has an article out on the Hearing Voices Movement — ie people with hallucinations and delusions who want this to be treated as normal and okay rather than medicalized. Freddie deBoer has a pretty passionate response here. Other people have differently passionate responses:
I’ve met some Hearing Voices members. My impression is that everyone on every side of this discussion is a good person trying to make the best of a bad situation (except of course New York Times journalists, who are evil people destroying America). Some specific thoughts:
2:
Plenty of people hear voices. Some of these people are your typical homeless schizophrenic, but many aren’t. One of my patients was a successful computer programmer who had near-daily auditory hallucinations. He realized they weren’t real, did his best to ignore them, and got on with his successful life — just like he had been doing for the past twenty years. He was seeing me for unrelated depression.
This guy kept his condition secret from his friends and co-workers. I don’t blame him for this choice at all. But when everybody who can hide it does, we only hear about the people who can’t keep it hidden, who are usually worst-case scenarios. Also (as a bunch of 1980s gay people can tell you) keeping a basic fact about yourself hidden from everyone you know sucks.
I recommended Hearing Voices Movement to this guy. I can’t remember whether he took me up on it or not. But I thought it would be helpful for him to have people he could talk to about his situation who wouldn’t think he was crazy, or try to get him locked up.
3:
People hate admitting that some cases are mild, and others are severe. Especially the kind of people who work at the New York Times
I talked about this a while back in the context of the autism rights movement. Many autistic people live great lives, enjoy the beneficial parts of their condition, and find it annoying or oppressive when psychiatrists keep trying to medicate them. Many other autistic people can’t live outside of institutions and constantly try to chew off their own body parts. A reasonable conclusion might be “the first group seem mild and should be left alone, the second group seem severe and probably need intensive treatment”, but it’s surprisingly hard to convince people of this.
Calling some cases “mild” sounds trivializing. Calling other cases “severe” sounds stigmatizing. Whatever your criteria for a mild case are, there will be someone who fits those criteria, but says the condition ruined their life and you are dismissing their pain. Whatever your criteria for a severe case are, there will be someone who fits those criteria but is thriving and living their best life and accuses you of wanting to imprison them in a hospital 24-7.
And that’s just the activists! We psychiatrists have the same problem from a different direction: we have seen some crazy @#!$. No matter how mild your case is, we’ve seen some case that looked like that at first glance, then slowly descended into a horror movie premise. Our instinct is naturally to round off the person who uses Xanax once a month to the lifetime drug abuser, the mildly depressed housewife to the gory suicide victim, and the occasional voice-hearer to the guy who needs to be in a straitjacket.
Still, some cases are mild and others are severe. People with mild psychosis — like my patient the programmer — probably don’t need to be on really strong medications with severe side effects. They probably just need support. In a perfect world, expert psychiatrists would have a major role in providing that support. In the real world, a lot of these patients expect their psychiatrist to freak out, overmedicate them, and maybe even commit them to a hospital. This being the real world, many of those patients are right. So they look elsewhere.
