Contentious Symptom

[DogMan]

I have a number of currently problematic symptoms

One cluster in particular my team can't agree on

I experience internal commentary, in the voices of people who have mistreated me. Different to my historical hallucinations in that they are internal inside my head, I know that they are internal and I don't go looking for the external source

They are voices of others. But I feel them. Like proprioception and interoception hallucinations. If the voice yells, my throat feels hoarse without yelling. I feel the experience while it is not me

Crisis team psychiatrist in February labeled them psychosis
Community Mental Health Team psychiatrist chalked it up to OCD, changed duloxetine to sertraline
GP, who was formerly a psychiatrist says they are hallucinations
Psychologist who did her masters on CPTSD says "Part Selfs" and "Inner Critic"

Some examples of the parts who commentate my life

-Dr Wong (GP)-"You're not trying." "Walk faster". And similar. Frequent during health professional appeasing activities like exercise, attempting leisure activities and self-care
-Beenish Shahzad (Psychologist from 2016 for 1 disastrous session)-Similar to Dr Wong, but angrier
-Rachel (Case Manager)-"No you're not" "You really should" type responses to self-voiced thoughts, just contrary jibes (She often insists on having the last word on things)
-Shaz (eldest sister)-Similar to Rachel
-Melissa (Former violent coworker from the creche)-Unintelligible screaming. Often triggered by sneezing, hiccuping. Very sensory, I feel her strongly
-Lynley (Director of creche)-"Wwhrrr" fired up rage. Fragments of yelled single words or phrases. Often mid internal argument with "others", Lynley's voice will pop up with this. And I feel it in my throat
-Matthew (Former husband of my eldest sister, Sharon)-Blaming me for steep hills, excessive distance on walks, bus time tables, drying time of paint etc
-Kate (Discommunicated sister)-Similar to Matthew. If I get something wrong, Kate or Matthew's voice often yells "You said xyz"
-Mum-Angrily asks me to repeat thoughts repeatedly

-The voices are of others, but I feel it. The experience is me yelling these things, my throat and chest feel the screams. But voice can be others as above

-Involuntary, Self-Voiced internal thoughts instinctively argue with others' voices. I don't want to, nor control arguing with the "Others" in my head. Rage builds and I become consumed. Maybe dissociated, but just altered awareness.

-Sometimes the others stop, but my "self" voiced thoughts instinctively defend against implied but not voiced criticisms. The "Implied criticism" is I think through body memory, physical sensations

The PRN Quietiapine settles the physical sensory aspects. But not the auditory (Whatever label you choose to attach)

These experiences also switch/alternate between re-experiencing past actual events. And completely imagined scenarios which have never happened. But play out in reference to actual environment, current surroundings/circumstances, or as response to thoughts

[Armee]

Just curious if anyone has looked at the dissociative disorders as being relevant to your treatment? People who have been through extreme childhood trauma can develop a kind of fracturing of the self...DID or the OSDD categories (other specified dissociative disorders).

In any case you have been through a lot and it is natural and normal that your brain has had to come up with ways to help you survive.

Edited ro add:

There's an Australian podcast called Psych Spiels and Silver Linings and they have done a really good job covering dissociation. They have a few episodes on it and the episode pages have a lot of extra info too. I'm linking the last episode they did which is on DID because that page has links to all the previous episodes on other forms of dissociation too.

https://www.chrismackey.com.au/demystifying-did-dissociative-identity-disorder/

And i thoroughly agree with what dollyvee wrote too. 

[dollyvee]

Hey DM,

I responded to your introductory post but being a complete amateur of course, I'm inclined to go with your psychologist and say parts/self and CPTSD. Have a look at Richard Schwartz talks on youtube. There are quite a few links on there and on the forum about what it is and how it works. Some of the voice of people you've worked with could be a need to reenact things as a form of hypervigilance and a way to ensure further trauma doesn't happen. This can happen when we internalize other people as inner critics.

Personally, I'm a bit leery of official diagnosis. I was labelled by a therapist as part histrionic/borderline (in a small amount). However, this was before CPTSD diagnosis even became a thing. So, what someone thinks something is at one time could always morph and change as our understanding grows. It never really stuck with me or made sense that I was those things and I don't think it was denial, which made me feel a bit lost for a while but I kept learning and eventually came across CPTSD. There are also different therapies which work for different people. So, CBT may work for some but DBT for others etc. I think it would be helpful to make sure you have a good trauma therapist who is able to deal with your background which sounds like your psychologist is.

Hope you're able to figure it out,
dolly

[DogMan]

Armee, I've not been formally assessed for dissociative disorders. Therapist says that I do dissociate quite a bit, but it's not been explored in depth

I also have periods of amnesia with extreme emotions, particularly rage. I'll spare details, but I get flashbacks years later of things which I have done

Dolly

I'm looking into parts. I'm a slow researcher these days. Long gone are my postgraduate research skills. I might see if  Richard Schwartz has some podcast which I can listen to, which is better for me than video

Thank you both for replying

[Armee]

Dogman, I want to add, now that it is a proper time for me to be awake that I  don't mean to pile more potential diagnoses your way. It's more that it struck me that perhaps a dissociative disorder alone (along with cptsd because repeated trauma is necessary for those "disorders" to develop) might fit better.

Schizophrenia requires a lifetime of harsh medication whereas dissociative disorders require healing the underlying trauma and the fragmented self. A dissociative disorder would not be something additional "wrong" with you, it is how brains sometimes cope with unbearable trauma to keep surviving.

And so you don't feel alone....I do occasionally hear internal voices too and have things that appear as hallucinations but later turned out to have been flashbacks. I'm so glad your latest doctor is looking into cptsd and parts with you. You deserve to be treated for the trauma you endured.

[Papa Coco]

Hi Dogman

I also responded to your introduction before I read this deeper detail.

I agree with Dolly and Armee. Particularly about the official diagnosis's. 

My story is that I'm 62 years of age. One of five children in a nasty, selfish Catholic family. I'm in the Seattle area of the US. I have suffered in many ways like you, with a lifetime of memory blackouts, voices in my head that I know are in my head and are therefore not a genetic illness such as schizophrenia or psychosis. My mental torments are not genetic illness, but are damage done to an otherwise healthy brain. I liken this to a car with a design flaw that cannot be fixed, versus a perfectly healthy car with a dented door which can be fixed. To me, mental illness and emotional damage may appear with similar symptoms but are to be cured by two totally different methods. Medications are required for a mental illness where the sufferer is hearing voices, but emotional damage means the voices can often be dealt with through talking and learning how to understand why we hear them. I now know that the voices that led my inner torment were a gift from my brain, imitating my abusers for the specific purpose of trying to stay one step ahead of them, like a chess match, to premptively avoid stepping into another one of their constant verbal traps.

I often, still to this day, hear voices in my head saying, "I'm sorry" or "Please love me" or "STOP STOP STOP!" or "JUST SHUT UP NOW!!!" or "WHY DO YOU HAVE TO BE SO STUPID?" whenever I start to feel like I might be nearing an emotional trap or feeling some overly exaggerated shame for things I said or did as a child. But, like you, I'm fully aware that these voices are not from ghosts or spirits or guides or any other external visitor. I know these are my brain, trying to stop me from stepping into a trap.

I began therapy in 1980 when psychiatry was more like archaic leeches and bloodletting. During the years 1980 to 2000, I'd seen 6 bad Cognitive Behavioral Therapists (CBTs) who did me more harm than good by bullying me into being ashamed of my reactions, and, because I'm good at forcing myself to comply with my abusers, believed they'd cured me. I believed I was cured. I forced myself to behave as if I was cured. So win/win. Right? The CBT could pat himself on the back for curing another one, and I could leave him mistakenly believing I'd been cured.

Nothing could be more wrong. One of my biggest symptoms of my abuse was that I learned how to comply, whether I wanted to or not. I am a Fawn--a doormat--who will comply with anyone in order to keep myself from being further punished. (Fawning is an IFS example of how my brain protects me by telling me to comply so I don't get shamed even more by my abusive caregivers). A year or so after each of these CBTs shamed me into pretending, and personally forcing myself to believe with them that I was cured, all my symptoms would return, only they'd return stronger, because I now had further proof that I was incurable.

In 2005 or so I switched to a Dialectical Behavioral Therapist (DBT) who leads his practice on compassion for his patients, and whose primary focus, as a DBT, is to help me blend all my emotions and fractured parts back together. He doesn't rely on official diagnostic labels. He doesn't shame me. Here on this forum, nobody shames me, or tells me to "just get over it" the way non-traumatized people tend to do.

Specialists diagnose based on their training
It seems to me that doctors specialize in narrow fields. When you're a hammer, everything's a nail. When you're a neurologist, every patient is neurologically damaged. When you're a chiropractor, everyone just needs an adjustment. When you're a naturopath, every patient needs a new diet. When you're a CBT, every patient just needs to be trained on how to behave as if they are healthy. In my opinion, once I discover that the last doctor's cure was wrong, I try another type of specialist. I eventually found DBT, IFS, C-PTSD, Pete Walker's book, Jay Easley's book, this forum, Ketamine Infusions, and am now exploring the newly legalized Micro Dosing that is hitting the US market. But that's after I tried too many doctors who believe I fit into their specialty field, and gave me their brand of a cure that ultimately made my problems worse, rather than better. Specialists only know the cures to the disorders they've been trained to focus on.

I call CBTs, Dog Trainers. More than one of them told me that to stop having horrific nightmares all I had to do was scream into a pillow every now and then, or go to bed at a different time, or listen to soothing music while I slept. They all tried to teach me to just decide to stop letting my mean family be mean to me. One tried to get me to go out and purposely cut into the front of a line at a grocery store so I could practice confrontation. That was his asinine cure for me being raped and abused and bullied from childhood on and had become terrified of the people who'd abused me my entire life. Another one thought that snapping a rubber band on my wrist would train me to stop being afraid of the people who'd abused me sexually, emotionally and physically for the duration of my entire childhood. My fourth CBT actually called himself a "behavioral modification therapist." If modifying behavior isn't the same goal as a dog trainer, I don't know what is.


Where my voices came from:
My story is that I allowed my nasty narcissistic family to control me from ages 0 to 50. At 50, they finally pushed me too far. I say "My family finally became so ugly that even I couldn't love them anymore." My middle sister was the worst. 11 years older than me, she'd manipulated my doormat personality so badly that her voice was the lead voice that had always been in my head, laughing at me any time I ever accomplished anything. Her goal was to constantly knock me back down--put me in my place--as her servant who would, at her beckon call, paint her house, raise her children, front her cash, loan her a car, etc, etc, etc. My mother would force me to stay in my sister's life. Any time I ever tried breaking away, dear old Mom would stage an intervention, trick me into a family gathering and sit there and cry and moan "I just want all my children to get along" until I would concede, give in, comply, and force myself to forgive my evil narcissistic sister for what she'd done to me again, and so that I'd resume being her unpaid servant. Call it Stockholm Syndrome if you like, because I was trapped into this relationship by the fact that I wanted to love my family, and I wanted to stop being abused. So I complied. As a child, I'd been groomed to be the family scapegoat, who took blame for all my relatives' misdeeds and misfortunes. It was so easy to blame me, because I let them. I let them, because they'd trained me from birth to do so. The old saying rings true: You teach people how to treat you. By being their compliant scapegoat, my siblings and parents had created in me, an easy location for their shame, so I'd have to deal with it instead of them having to.

How I lowered the volume of the voices
I am NOT a professional. I am not telling you how I think you should handle your situation. I'm here, sharing my own personal story, so that you have my perspective to think about as you work with your professional doctors there to do what works best for you. I had no sleep deprivation. In fact, bed is one of the few places I feel safe in this world, so my story is different than yours, and my healing will be slightly different in that respect. My point is that I have found some things that do work for me. What worked for me, in my unique situation, was I walked away from my entire family at age 50. Full No Contact. Taken out of the will. Changed all my phone numbers and email addresses. But for me, it took a solid year to get my evil sister's voice out of my head. But by "out of my head" i don't mean completely. I just mean that I've learned how to not listen to it anymore. No matter what I did in life, I always heard her laughing at me or insulting me for how I chose to comb my hair, what shirt to wear, who to be friends with, etc, etc, etc. But the problem I was trapped in, was that she was a narcissist, so her own thoughts were inconsistent. If I combed my hair left, she'd laugh at how stupid I was for not combing it right. But what I didn't grasp at the time, was that if I'd have combed it right, she'd have laughed at me for not combing it left. It wasn't about my behaviors being wrong, it was about making sure, every day, that she got into my head and controlled me. That's all narcissists care about...being in your head. Period. And it worked. Holy-moly, she was in my head so deep it was torture. Her goal was to constantly remind me that I had no right to take care of my own family instead of hers. I left her life in 2010, but her voice didn't quiet from a roar to a whisper until 2011, and, sadly, she still pops up every now and then, but with far, far less ferocity. And now I feel strong enough to not listen to it much.

IFS, and how my inner voices were given to me by my brain because it loves me and is trying to keep me safe
I learned well that my own brain was mimicking their voices in attempt to keep me safe. To keep me from walking into traps, my brain tried to predict what insults my actions would bring. It would use that voice to kind of show me what was coming if I did or said anything. It turned me hypervigilant. Always watching the landscape for landmines laid by my own family and authority figures. Some would call me twitchy. Scared of my own shadow. "Strung too tight". My CBT's voices, my sister's voice, Mom's voice, all the voices of those who could break my spirit further, were there in my head to protect me, by showing me what it believed would happen to me if I said or did anything. No way could I live freely. I was in an ugly, evil chess game, where my brain was trying to keep me two steps ahead of my abusers.

I was a wild horse whose spirit had been broken so I'd be their servant instead of run free on my own terms. When breaking the spirit of a wild horse, the rancher has to punish that horse any time it tries to have its own thought. The horse eventually gives up and accepts being held in a pen, led by a rope, synched up under a saddle, yoked to a plow, and fed out of a bucket when allowed to. That was me. In order to avoid being emotionally whipped, my brain created an irrational response to make me comply before being whipped. It used predictive voices of 6 bad CBTs, Mom and Sis and scores of others, narcissistic nuns, priests, bad bosses at work. My brain adopted their voices to protect me.

The good news for all of us now on this forum, (and the millions of people globally who don't realize that they are chronically reacting to past trauma), is that it's 2022 and more and more of our psychologists are putting away the leeches and rubber bands and are finally learning how to understand C-PTSD for what it really is. Help is blossoming as we speak. New therapies, new medications, micro-dosing, etc, are being developed like a wave of help in more and more countries and more and more doctor's offices. The light is on at the end of the tunnel.

For those of us who are actively persuing healing from our own outdated reactions to past traumas, help is landing on the planet. 

Seek and you find. Knock and the doors will open. My current therapist is always praising me for surviving. I know that when I was 19, two of my male classmates who'd suffered similar abuse as mine, took their own lives. My therapist reminds me that I'm still here because of my diligent refusal to accept defeat. Every bad diagnosis I got, just led me to try a different door. His pride in me makes me feel better and better about myself.  This may be a lifelong journey of healing, but who in this world is having a really good time anyway, Right? Everyone seems to have an Achillies Heal of one kind or another. This is the hand I was dealt.

I hope I wasn't off base with too much of my response. I am happy to see you on the forum, taking advantage of the resources that are available. Keep it up. There's hope for those of us who choose to seek and accept it.

[DogMan]

Thank you

Papa Coco, this is a worksheet from my therapist. She didn't say it was IFS (which maybe with OCD tendencies always reads in my head as irritable fart syndrome) but apparently it mostly is? https://drive.google.com/file/d/1fS0erTxOq5IcvHAT9YEUFQH3GOQwlNWi/view?usp=sharing

Armee, my current homework is working on triggers and timeline of voices starting. It is hard going, but there often seems to be FIRST some form of dissociative state, as opposed to dissociation from the stress of hearing voices

[woodsgnome]

Hi, DMan. I'll try and keep this short. I'm not keen on super-analysis these days, but it has its place, especially at the stage of wondering 'what the .... is going on?

I have the identical symptom of hearing those now disembodied voices, from multiple abuse sources in FOO, schools/church people, and later when, in my desperate susceptibility to fall for someone I felt I could trust, I fell into the clutches of a crafty narcissist.

So your tale resonates deeply with my experience. In the process of weaving how awful this feels into the ongoing therapy I've doing for around 6 years, I've tried less to go by what the books and analyses say (or I think they're saying) and build on how my T and I work/play with whatever it is that's happening.
At their worst, these voices made it seem like I was surrounded by dozens of radio, all with angry voices blaring at me, while all I could do was to clutch a pillow around my ears as much as possible, but they still penetrated.

My T is wonderful at nudging me towards my own comebacks to symptoms, at least at first. She did this with these as well, until she just simply wondered if I only reacted, or could stand to be a tad pro-active, and send the screams back -- literally (I live in an isolated rural area, which helps -- there's no humans around to hear and be concerned).

That almost sounded too simple,  , but slowly I began doing my own comebacks, in any combo of words that came -- and was surprised at how that helped. Of course I was eager that this would rectify the terror of hearing those voices, such wasn't the case. But it was a start, and began feeling more at ease after venting in that way.

The voices can still happen by, but I react now, and that's made a world of difference with my attitude about dissipating their immediate effect. One small detail, in my case, was explained by my T in regards to how the stimulant part of the brain that can generate this stuff is also apparently associated with feeling when the body is exhibitin phyical pain. Yup -- that ties in with my acute levels of arthritic type of bodily pains -- and when they flare it seems my emotional memories -- with the voices -- also flare.

One difference with what you noted is that the voices I hear are related to actual incidents; unfortunately all of them. However, at least I'm getting the chance to scream and cry back at those incidents, and more so the memory of the many abusers who once projected those voices.

Ah, once again I've made this longer than I intended. Perhaps it's not helpful, but I wanted you to at least know that there are others who experience what you're talking about. Apparently these voices got so internalized they're just hard to evict, but at least in my case I've found some breathing room. I know it probably sounds too simple almost; while gobbling up all the theories and such about this, but also staying off of drugs to deal with it, I've at least turned a corner on my path.

But that's my own tale -- I can only hope you will find relief in whatever form that works out for you. Like anything with this sort of thing, it may take awhile, but the best news is that you're actively trying to arrive at a solution.

[DogMan]

Just curious if anyone has looked at the dissociative disorders as being relevant to your treatment? People who have been through extreme childhood trauma can develop a kind of fracturing of the self...DID or the OSDD categories (other specified dissociative disorders).

In any case you have been through a lot and it is natural and normal that your brain has had to come up with ways to help you survive.

Edited ro add:

There's an Australian podcast called Psych Spiels and Silver Linings and they have done a really good job covering dissociation. They have a few episodes on it and the episode pages have a lot of extra info too. I'm linking the last episode they did which is on DID because that page has links to all the previous episodes on other forms of dissociation too.

https://www.chrismackey.com.au/demystifying-did-dissociative-identity-disorder/

And i thoroughly agree with what dollyvee wrote too.

I have been looking into this since you said this, and also linked to reading about IFS

A lot to process, but I will raise this with my psychologist

[Armee]

It is a lot to process and no need to process all now. Filing away in the back of your head is ok too. It just raises some minor flags for me when someone with such an extensive trauma history has been diagnosed with schizophrenia....it's totally possible to have both but the symptoms of trauma-related dissociation can mimic psychosis. Or it can be both for sure too. But treating the trauma can at least relieve some symptoms. Either way I wish you some relief from the symptoms. It sounds like it's been a difficult month.