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1 Hearing of Voices Dr. Samuel Pfeifer

2 1. Inner Dialogue („I tell myself“, „as if a voice was telling me...“ Ego-syntonic 2. Dialogue with God („God tells me...“, „The Bible talks to my heart“, „The Holy Spirit has pointed out to me”) Ego-syntonic (religious style) 3. Dialogue with spirit beings (Angels, spiritual beings, ancestors) In sensitive persons sometimes with anxiety can lead to psychosis 4. Voices coming through a Medium (Spiritism, Shamanism) Trance-Induction Four Aspects of Inner Voices

3 Hallucinations – organic Organic: Delirium (e.g. alcohol withdrawal), Disorientation (e.g. functional brain disorder) Toxic Substances: e.g. LSD Severe Psychotic Depression: Example: “The devil is laughing at me”; “I hear the police siren, they are coming to bring me to jail, where I belong.” Context: Severe Depression, often in old age. Typical: When the causing substance or brain condition subsides, the “hearing of voices” disappears.

4 Hallucinations – Schizophrenia 1. Quality: external, ego-dystonic, “thoughts becoming audible, loud”, often with anxious feelings 2. Content: muffled sounds, murmuring, single words, sentences, laughing, commentaries, insults. Often unspectacular comments, orders... 3. Additional phenomena: thought insertion, expansion, incoherence, bizarre delusions; clearly impaired ability to cope 4. Religious aspects: often search for explanations, rarely complex prophetic content; not congruent with the surrounding culture or religious group Criteria of DSM-IV

5 Obsessional Ideation 1. Quality: “I know that my thoughts are unrealistic, but if I do not give in, I am developing unbearable stress and anxiety.” 2. Content: fear of contamination, inappropriate behavior etc.; sexual or religious content; controlling, washing, ordering etc. 3. Additional phenomena: exaggeration of “normal” concerns and rules; varying severity; causing marked distress 4. Religious aspects: intrusive thoughts of blasphemy, religious symbols (“666”); obsessional doubting; Religious content in obsessive-compulsive structure

6 Origin: Dissociation of partial personalities in extreme trauma during childhood (“Persons”: victims, “tormented” children, guides, protecting alters, persecutors, functioning facade etc.) Inner Dialogue among the “persons“: dealing with past and present trauma; discussions: “Can we trust this person?” - “How do we cope with this situation?” etc. Crying or stiff upper lip? Not multiple: when a person feels “torn” between two options; when there are two streams of consciousness at the same time; frequent emotional swings; projective identification (“I feel like my mother”) Real DID: Emphasis on the existential experience of “real” persons, not mood swings or different emotional states. Varying behaviors, amnesia for substantial amounts of time. -- Further Criteria of DSM-IV. Multiple Personality (DID)

7 Limbic System Frontal Lobe Sensory Areas Brain Stem The Brain

8  Neurotransmitter Imbalance (Psychotic Disorders)  Toxic Influences  Sensory Deprivation  Stress  Strain  Trauma - Dissociation POSSIBLE NEUROBIOLOGICAL CAUSES OF HEARING VOICES STRESS AND VULNERABILITY

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