[Vision2020] The Violence in Our Heads

[Art Deco]

  [image: The New York Times] <http://www.nytimes.com/>

------------------------------
September 19, 2013
The Violence in Our Heads By T. M. LUHRMANN

STANFORD, Calif. — THE specter of violence caused by mental illness keeps
raising its head. The Newtown, Conn., school killer may have suffered from
the tormenting voices characteristic of
schizophrenia<http://health.nytimes.com/health/guides/disease/schizophrenia-disorganized-type/overview.html?inline=nyt-classifier>;
it’s possible that he killed his mother after she was spooked by his
strange behavior and tried to institutionalize him. We now know that Aaron
Alexis, who killed 12 people at the Washington Navy Yard on Monday, heard
voices; many observers assume that he, too, struggled with schizophrenia.

To be clear: a vast majority of people with schizophrenia — a disease we
popularly associate with violence — never commit violent acts. They are far
more likely to be the victims of violence than perpetrators of it. But
research shows us that the risk of violence from people with schizophrenia
is real — significantly greater than it is in the broader population — and
that the risk increases sharply when people have disturbing
hallucinations<http://health.nytimes.com/health/guides/symptoms/hallucinations/overview.html?inline=nyt-classifier>and
use street drugs. We also know that many people with schizophrenia
hear
voices only they can hear. Those voices feel real, spoken by an external,
commanding authority. They are often mean and violent.

An unsettling question is whether the violent commands from these voices
reflect our culture as much as they result from the disease process of the
illness. In the past few years I have been working with some colleagues at
the Schizophrenia<http://health.nytimes.com/health/guides/disease/schizophrenia/overview.html?inline=nyt-classifier>Research
Foundation in Chennai, India, to compare the voice-hearing
experience of people with schizophrenia in the United States and India.

The two groups of patients have much in common. Neither particularly likes
hearing voices. Both report hearing mean and sometimes violent commands.
But in our sample of 20 comparable cases from each country, the voices
heard by patients in Chennai are considerably less violent than those heard
by patients in San Mateo, Calif.

Describing his own voices, an American matter-of-factly explained, “Usually
it’s like torturing people to take their eyes out with a fork, or cut off
someone’s head and drink the blood, that kind of stuff.” Other Americans
spoke of “war,” as in, “They want to take me to war with them,” or their
“suicide voice” asking, “Why don’t you end your life?”

In Chennai, the commanding voices often instructed people to do domestic
chores — to cook, clean, eat, bathe, to “go to the kitchen, prepare food.”
To be sure, some Chennai patients reported disgusting commands — in one
case, a woman heard the god Hanuman insist that she drink out of a toilet
bowl. But in Chennai, the horrible voices people reported seemed more
focused on sex. Another woman said: “Male voice, very vulgar words, and
raw. I would cry.”

These observations suggest that local culture may shape the way people with
schizophrenia pay attention to the complex auditory phenomena generated by
the disorder and so shift what the voices say and how they say it. Indeed,
that is the premise of a new patient-driven movement, more active in Europe
than in the United States, which argues that if you treat unsettling voices
with dignity and respect, you can change them.

The Hearing Voices <http://www.intervoiceonline.org/> movement encourages
people who hear distressing voices to identify them, to learn about them,
and then to negotiate with them. It is an approach that flies in the face
of much clinical practice in the United States, where psychiatrists tend to
assume that treating such voices as meaningful encourages those who hear
them to give them more authority and to follow their commands.

Yet while there is no judgment from the scientific jury at this point,
there is evidence that at least some people find that when they use the
Hearing Voices approach, their voices diminish, become kinder and sometimes
disappear altogether — independent of any use of drugs.

This evidence is strengthened by a recent study in London that taught
people with schizophrenia to create a computer-animated avatar for their
voices and to converse with it. Patients chose a face for a digitally
produced voice similar to the one they were hearing. They then practiced
speaking to the avatar — they were encouraged to challenge it — and their
therapist responded, using the avatar’s voice, in such a way that the
avatar’s voice shifted from persecuting to supporting them.

All of the 16 patients who received a six-week trial of that therapy found
that their hallucinations became less frequent, less intense and less
disturbing. Most remarkably, three patients stopped hearing hallucinated
voices altogether, even three months after the trial. One of those three
patients had heard voices incessantly for the prior 16 years.

The more we know about the auditory hallucinations of schizophrenia, the
more complex voice-hearing seems and the more heterogeneous the
voice-hearing population becomes. Not everyone will benefit from the new
approaches. Still, they offer hope for those struggling with a grim
disease.

Meanwhile, it is a sobering thought that the greater violence in the voices
of Americans with schizophrenia may have something to do with those of us
without schizophrenia. I suspect that the root of the differences may be
related to the greater sense of assault that people who hear voices feel in
a social world where minds are so private and (for the most part) spirits
do not speak.

We Americans live in a society in which, when people feel threatened, they
think about guns. The same cultural patterns that make it difficult to get
gun violence under control may also be responsible for making these
terrible auditory commands that much harsher.

T. M. Luhrmann is a professor of anthropology at Stanford University and a
contributing opinion writer.

 More in Opinion (2 of 21 articles)Editorial: Another Insult to the
Poor<http://www.nytimes.com/2013/09/20/opinion/another-insult-to-the-poor.html?src=un&feedurl=http%3A%2F%2Fjson8.nytimes.com%2Fpages%2Fopinion%2Findex.jsonp>

Read More »<http://www.nytimes.com/2013/09/20/opinion/another-insult-to-the-poor.html?src=un&feedurl=http%3A%2F%2Fjson8.nytimes.com%2Fpages%2Fopinion%2Findex.jsonp>



-- 
Art Deco (Wayne A. Fox)
art.deco.studios at gmail.com
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