10 ms·

What happens when people with acute psychosis meet the voices in their heads?

158 points by sandebert 2y ago

HipstaJules 2y ago
This is incredible work. Kudos to the team who developed this!!
satori99 2y ago
This trial has its own website too. https://www.avatartherapytrial.com/what-is-avatar-therapy https://www.avatartherapytrial.com/what-is-avatar-therapy
dr_dshiv 2y ago
I wonder whether the mental inhibition of the voices ends up strengthening them. If you drop the conscious inhibition, they fade through other means.
JimmyBuckets 2y ago
Interestingly this idea of helping people to talk to the voices in their head is not new. The basis for IFS therapy (which emerged in the 80s) actively teaches people to have dialogue with their inner "parts". It is becoming one of the gold-standard therapies for CPTSD, anxiety, and a range of other trauma related conditions. The core discovery of the therapy is that the human mind has an inherent multiplicity. Once you accept that and go from there, the rest of the technique emerges naturally. It's really quite amazing. I highly recommend the book "No bad parts" by Dr Richard Schwartz, the discoverer of the technique. What really excites me here is the use of a virtual avatar that personifies the voice. That is really new to me and I can see all sorts of possibilities to link with IFS.
- ben_w 2y ago
  I suspect* that every school of psychotherapy represents a different internal configuration that human brains are capable of being in. Perhaps just as some but not all of us are aphantasic, some but not all of us may think in the IFS way, or Jungian, or Freudian. * from my comfortable armchair, don't read too much into this
  - JimmyBuckets 2y ago
    I would tend to agree with you here, with a caveat. All these theories are describing the same underlying phenomenon so there is a "blind men and the elephant" effect. They also substantially build on one another The caveat is that what really sets these models apart is how they propose to navigate the mind. This is where I believe IFS stands out. But it would take a much longer comment to explain that. Maybe it's worth writing an article about.
  - eru 2y ago
    Well, some of these schools are also just plain bullshit.
    - JimmyBuckets 2y ago
      I would hesitate to say bullshit. They are all models and very abstract relative to the complexity of the mind. But to extend the blind men and the elephant allegory, there is a practical difference between describing a leg and describing a trunk.
      - ulbu 2y ago
        and some say elephants don’t exist because they can’t see one.
        eru 2y ago
        To strain the metaphor: there are many true stories about elephants, but not all stories about elephants are true.
    - fsckboy 2y ago
      yes, and much of the criticism as well: it's called being humans
  - jdietrich 2y ago
    Most schools of psychotherapy are equally effective, with the very notable exception of CBT for anxiety disorders. For most patients, the school of psychotherapy only matters insofar as they buy into it - nearly all of the therapeutic benefit is totally independent of the particular methodology or even the training and experience of the therapist. Even therapeutic approaches specifically designed to be pure placebo turn out to be just as effective as everything else. If IFS or Freudian psychoanalysis are metaphors for how we think, then they just aren't useful metaphors. https://en.wikipedia.org/wiki/Dodo_bird_verdict https://en.wikipedia.org/wiki/Dodo_bird_verdict https://psychiatryonline.org/doi/10.1176/appi.psychotherapy.2021.20210041 https://psychiatryonline.org/doi/10.1176/appi.psychotherapy....
- soco 2y ago
  This reminds me of a book I loved and still love, which was mentioned recently in another topic: Peter Watts - Blindsight. Hard sf with a bit of everything, including this multiplicity you mention.
- ryandv 2y ago
  See also Genpo Roshi's Big Mind, Big Heart which has one assume the persona of various aspects of their mind and attempt to carry out a dialogue as that aspect.
akdor1154 2y ago
Fantastic piece of writing. Looks like a really promising approach to therapy as well.. right up until they said they'd stop voicing it by a skilled psychologist and get an AI to do it, while putting the psychotic person into VR instead of over a screen.. that was a big 'fuck no'.
- Nevermark 2y ago
  If they are going to get creative, perhaps apply the constructive effects of some mind altering drugs? Under AI shaman supervision of course! I have never heard voices, but experienced two forms of dissociation for a while after a trauma. Nothing was real, was one of them. Couldn’t trust any scene I was in or the chair I was going to sit on. Unending vertigo and feelings of experiencing a fiction. As a famous ex-newt once said: “I got better!”
- probably_wrong 2y ago
  I see where they're coming from, though: right now you have to be certified on this very specific program, meaning you only get the benefits if you have access to one of the 38 people currently trained for it in the UK. I would definitely want a professional to be in charge but, as the article itself points out, "Joe recently went back to his GP in search of help with his anxiety (...) The GP put him on a waiting list for NHS talking therapy, and warned that he could be in for a very long wait". Given how bad access to mental health resources is I may be willing to take "a community nurse, or a nursing assistant" now over "wait several months for a chance at a doctor who may not be the right fit for you". I wouldn't dream of allowing an AI to roam free - as the article says patients can get more psychotic and arguably "you should end it" could very well be part of the training data. But if the AI suggests lines that a trained human can oversee... then maybe?
  - gnfargbl 2y ago
    I think your proposal of AI therapists with human overseers would be okay if we were able to develop some kind of metrication and monitoring of the human oversight portion. Without that control, what would inevitably happen would be that the highly-scalable part of the system (the AI) would be scaled, and the difficult-to-scale part of the system (the human) would not. We would fairly quickly end up with a situation where a single human was "overseeing" hundreds or thousands of AI conversations, at which point the oversight would become ineffective. I don't know how to metricate and monitor human oversight of AI systems, but it feels like there are already other systems (like Air Traffic Control) where we manage to do similar things.
Dilettante_ 2y ago
>Trial participants would create an avatar of their voice: a moving, three-dimensional digital embodiment that looks and sounds like the persecutor inside their heads Shoulda just made a Jackie Chan tulpa instead
InDubioProRubio 2y ago
The whole schizophrenic spectrum is a reversion to survival mode. This is what a animal hears all day- "They are out to get me, its one huge conspiracy" is the thought process of a mouse. Its low energy by default, as it does not require complex thought processes, relative little communication, very little planning for the future. Its a adaption to a warzone and economic stressors shake it loose.
- deleted 2y ago
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- markovs_gun 2y ago
  I don't know if this is true. The way psychosis manifests is influenced heavily by culture. In some places, hallucinations from psychosis are largely positive rather than threatening. https://news.stanford.edu/stories/2014/07/voices-culture-luhrmann-071614 https://news.stanford.edu/stories/2014/07/voices-culture-luh...
  - deleted 2y ago
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  - ryandv 2y ago
    Indeed; the Oracles at Delphi were revered for their ability to divine wisdom from auditory hallucinations which were literally equated with gods. In some modern western cultures, by contrast, you even have active gaslighting of those who are vulnerable to such conditions and exacerbation of their negative qualities.
    - markovs_gun 2y ago
      I would be careful equating the oracles of Delphi with psychosis, since religious practices can bring about visions and out of body experiences without drugs or underlying pathologies. For example, some Eurasian shamans practice "ecstatic dance" where oxygen deprivation and exhaustion result in shamanistic experiences (visions, auditory hallucinations, etc) without the use of drugs.
throw4950sh06 2y ago
Don't do it without supervision, I nearly jumped 100m because the voices in my head convinced me I'm a Star Trek captain and will be transported to my bridge mid-jump. Never do anything to confirm a paranoid person's psychosis unless you have total control of the situation and a psychiatrist supervision. Never try to peace them by saying unrealistic things, you never know what's going on in their head that you just confirmed. My GF tried to reassure me by saying she will be with me in 15 minutes, but she was 100km away and I thought "okay well that makes all of this real, let's do it".
- rightbyte 2y ago
  I guess she was calling for help, so the strategy of postponing wasn't that bad even in retroperspective? Or do you mean you called her becouse you kinda knew you were mad and wanted her to also say it?
  - seszett 2y ago
    Since she was 100 km away, it didn't make sense she was going to be there in 15 minutes by normal means, so it meant either she was lying or OP was actually going to be teleported. OP apparently chose to believe the latter, since it confirmed their current delusion. So it didn't postpone anything, maybe if she had given a realistic ETA (or just said "I'm coming, wait for me") it would have worked though. It's very difficult to know what to do in these situations though, I've been on the side of that girlfriend and you just can't have a full understand of what's going on in the head of the other person, everything is just walking on eggs, except the eggs are actually landmines.
    - aleph_minus_one 2y ago
      > I've been on the side of that girlfriend and you just can't have a full understand of what's going on in the head of the other person, everything is just walking on eggs, except the eggs are actually landmines. The problem here in my opinion is rather that most people are used to lie, manipulate and betray (in society this behaviour is actually euphemized via the term "white lies"). In this particular case, such a behaviour does have consequences. See the example of this thread where the girlfriend claims she will be there in 15 minutes, despite being 100 km away. Since most people are not used to being honest (or, I assume, actually never were), they give similar descriptions of their difficulties when their lies do have consequences like your "everything is just walking on eggs, except the eggs are actually landmines".
AlexDragusin 2y ago
This concept has been explored in the "The Outer Limits (1995)" episode 5 of season 2: "Mind Over Matter" "A doctor uses a virtual reality A.I. device that gives him direct access inside the human mind to enter the mind of a colleague he deeply cares about and help her after she's hit by a car and slips into a coma. Things go horribly wrong." https://www.imdb.com/title/tt0667922/ https://www.imdb.com/title/tt0667922/
- jumping_frog 2y ago
  In Ted Chiang's short story Exhalation, a person looks at his own mind's workings. Brilliant description of the process.
DevX101 2y ago
One of my favorite speculative hypotheses is Bicameral Mind Theory, which asserts that something like schizophrenia was relatively common until relatively recently, about 3000 BC. It argues that it was relatively normal for humans to hear voices in their head directing them. So when we read religious texts about the gods commanding so-and-so to do such-and-such, it wasn't just a spiritual metaphor, but an actual voice people heard in their heads and interpreted as higher powers.
- Gooblebrai 2y ago
  I thought it had been debunked already?
  - jumping_frog 2y ago
    Richard Dawkins called Julian Jaynes’s 1976 book, The Origin of Consciousness in the Breakdown of the Bicameral Mind “either complete rubbish or a work of consummate genius, nothing in between”
    - nabla9 2y ago
      Idea or theory can be great, well constructed and intellectually interesting without being true. Aquatic ape hypothesis is similar. It's a initially a great theory and explains many things. Only when you start to investigate other explanations, the theory starts to fall a apart. Endurance running hypothesis on the other hand seems to hold. Incidentally it explains many of the same things as aquatic ape hypothesis, and there is more supporting evidence.
  - deleted 2y ago
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  - mensetmanusman 2y ago
    With a Time Machine?
  - jerf 2y ago
    It's really a non-scientific idea, in the Popplerian sense. How would you debunk it? How would you confirm it? It's not in that class of idea. A lot of people have been taught to read that as "therefore it's false" or "therefore it's true" or "therefore it's unimportant", but really all it means is that it is not amenable to scientific confirmation or debunking. That, and nothing more. Many things are not amenable to scientific confirmation or debunking that are true and false and important and unimportant and everything else.
nabla9 2y ago
>As much as 8 percent of the population reports experiencing auditory hallucinations on a regular basis (13 percent hear them at least occasionally), compared to just 1 percent who are diagnosed with schizophrenia. https://medicine.yale.edu/news/yale-medicine-magazine/article/when-researchers-listen-to-people-who-hear-voices/ https://medicine.yale.edu/news/yale-medicine-magazine/articl... Hearing voices may be a symptom of something serious, but not always. As long as a person's grasp of reality is not in danger and voices don't stress out people, they can live with them and not even seek help. Not all people hear negative voices. Older lonely people have been known to say that voices keep them company. > voice-hearing experiences of people with serious psychotic disorders are shaped by local culture – in the U.S., the voices are harsh and threatening; in Africa and India, they are more benign and playful. https://news.stanford.edu/stories/2014/07/voices-culture-luhrmann-071614 https://news.stanford.edu/stories/2014/07/voices-culture-luh... Maybe the most famous case of a high-functioning outlier was Carl Jung. He hallucinated complete persons since childhood ,visually and everything. He discussed matters with them. In the end, he was able to get rid of them when he decided that they were not helpful anymore. It's easier to understand his weird theories and spirituality when you have read his autobiography. The guy was off the charts but not disabled by it.
- ryandv 2y ago
  > Maybe the most famous case of a high-functioning outlier was Carl Jung. He hallucinated completely people since childhood ,visually and everything. It's maybe easier to understand his focus on individuation, or integration of the component parts of the psyche into a cohesive whole, in light of this. Jung draws from esoteric alchemy and other related traditions (see his work: Psychology and Alchemy) which, instead of viewing the mind as a singular, monolithic entity, prefer conceiving of it as an organism comprised of many parts - Hermetic Qabalah being one such example.
arijo 2y ago
I've been diagnosed with schizoaffective disorder when I was in my early twenties. I've had several full blown psychotic episodes and been hospitalised several times. Fortunately there was one medication - Amisulpride - that kept me stable enough to be able to have a professional career, though not without a lot of struggling and sacrifice. I know what psychosis is and honestly, this avatar therapy feels a bit like bullshit to me. When in psychosis, you are not listening to your voices - you are your voices and they can command you to do things you do not want to do. You are not in control of you consciousness. There is hope though. A revolution in mental illnessis going on - check the metabolic mind site for more info - https://metabolicmind.org https://metabolicmind.org I talk about my experience in my blog - https://www.feelingbuggy.com/p/finding-hope-after-decades-of-struggle https://www.feelingbuggy.com/p/finding-hope-after-decades-of... Many other people have substantially improved because of metabolic therapy and there are dozens of random control trials going on with very promising early results. There are ever more cases of successful treatment via metabolic therapy Under the risk of being unpopular, it's my responsibility to let people know about this treatment option and bring hope to those who suffer from this terrible illness.
- Workaccount2 2y ago
  I wouldn't call it bullshit, it's just unlikely to work for everyone.
  - arijo 2y ago
    I don't question the good faith of the researcher but i think we should prioritise what works - and there is a growing volume of evidence that metabolic therapies work. I take back the bullshit qualification though - it was a mistake on my part.
weard_beard 2y ago
We all have personalized profiles with little daemon AIs actually tracking and persecuting us. Torturing our every waking moment with judgmental advertising. No wonder, then, if we are all depressed or terrified or generally mentally ill. It’s directly caused by the lack of privacy controls and harm done by being online.
mensetmanusman 2y ago
The multiplicity of the mind is a subset property of the universe; the human mind is the ability of the universe to ask ‘why something, not nothing’. It took billions of years for the seeds of the mind to flourish, and prayer is a slow reconciling with this property of the universe.
beowulfey 2y ago
Kind of relevant to this, there is literature to support the notion that the 'personality' of internal voices is shaped by society -- people experiencing it in Western nations tend to have voices be very negative and violent, whereas people of other nations tend to have more friendly relationships with their auditory hallucinations. It definitely fits with this therapy, where building a relationship with the voice tends to benefit the mental health of the person [1]. [1] https://pubmed.ncbi.nlm.nih.gov/24970772/ https://pubmed.ncbi.nlm.nih.gov/24970772/
protoman3000 2y ago
Reading this article makes me wonder. Whenever I am too stressed, I become very self-conscious and I interpret everyday things and normal nuisances under the umbrella of "See, this is how big of a failure you are, you pathetic loser". Is almost as if there's another voice - not my voice - in my head who tells me this abusive stuff, sitting on the side and being judgemental. Does this also count as psychosis?
- 123pie123 2y ago
  I use to have this, the book "the power of now" explains how to minimise and remove it. remember that the internal monologue is not (the whole of) you. I managed to get rid of of my imposter syndrome by getting rid of that constant internal voice
- gs17 2y ago
  That sounds a lot more like "automatic negative thoughts". I don't think it's considered a form of psychosis, even if arguably it's sort of similar (you're hearing a voice that isn't there telling you things that aren't real).
teknopaul 2y ago
I could have told you that voicing deamons in your head gets rid of them 20 years ago. A bunch of my friends know this trick too. I have successfully used this in therapy, i.e. helping friends on many, many occasions. Strange that this is news in the psychiatric world: we "discovered" it by caring, and listening, and trying stuff out. If psychiatric community is not listening to patients and conversing with them and their demons, and trying pills as a solution while knowing this doesn't work, it should be considered malpractice. No wonder everyone hates psychiatrists. Calling themselves doctors and the humans in front of them patients, is probably the root cause.
- aphantastic 2y ago
  Jesus did the same 2000 years ago. But scientists tend to be superstitious of anything He demonstrated.
iandanforth 2y ago
This reminds me of mirror box therapy for phantom limb syndrome. Amputees sometimes feel intense pain in the limbs that they have lost. This is measurable activity in the brain. Unfortunately all of the feedback mechanisms for that activity have been removed with the limb. By showing people a mirrored version of their remaining limb. And then stimulating that limb in a way that would remove pain say massage or touch or unclenching a cramped clenched phantom hand, the patient gets the feedback to the part of their brain via their visual system that there's nothing wrong with that limb. This activates inhibitory circuits that would otherwise be inaccessible. In this therapy a combination of visual and audio input as well as external control over the behavior of the Voice allows for a feedback mechanism which does not exist otherwise.
eszed 2y ago
This is fascinating. What I note is that the therapist is collaborating with the patient to create "theatre". I think they should lean into this, new therapists should be explicitly trained in performance and theatre facilitation. There are a lot of solved problems with which they may otherwise struggle.
eth0up 2y ago
I've never fully understood this voice in the 'ed thing. Does anyone with internal dialogue have schizophrenia? Or is this literal, auditory voice, indistinguishable from actual voice? Also, there's old technology in the wild capable of doing this[1] and I'd not be surprised to see it eventually become more easily available as hardware decreases in cost. It's already on the 'table' for advertisment purposes, albeit not microwave based. 1. https://en.m.wikipedia.org/wiki/Microwave_auditory_effect https://en.m.wikipedia.org/wiki/Microwave_auditory_effect Edit, Various Links: https://gizmodo.com/we-will-beam-advertisements-directly-into-your-brain-390600 https://gizmodo.com/we-will-beam-advertisements-directly-int... https://www.holosonics.com/ https://www.holosonics.com/ https://www.timesofisrael.com/futuristic-device-from-israeli-firm-puts-music-in-your-head-without-headphones/ https://www.timesofisrael.com/futuristic-device-from-israeli... https://phys.org/news/2008-02-pentagon-lasers-voices.html https://phys.org/news/2008-02-pentagon-lasers-voices.html https://www.wired.com/2007/06/darpas-sonic-pr/ https://www.wired.com/2007/06/darpas-sonic-pr/ https://futurism.com/the-byte/laser-beam-speech-mit https://futurism.com/the-byte/laser-beam-speech-mit
39896880 2y ago
The Atlantic reported on similar research in 2014. The article from The Atlantic is titled "Learning to Live with the Voices in Your Head" [0]. Here's a choice quote from that article: >“The problem,” [Intervoice founder Dr. Marius Romme] writes, “is not hearing voices, but the inability to cope with the experience.” In 1987, after two decades of clinical work, the Dutch psychiatrist began promoting a drug-free therapy in which patients were encouraged to accept and analyze their voices. The article linked in this post has a similar sentiment from one of the patients: >She hadn’t expected them to go. “My aim wasn’t to get rid of them – just to get along with them,” she told me. “I wasn’t quite sure I wanted to let go. I’d never really been on my own. As abusive as it was, it’s still a relationship.” Hopefully the therapy takes off, and we don't keep re-discovering this every 10 years. [0]https://archive.is/pfKrC#selection-1413.89-1413.360 https://archive.is/pfKrC#selection-1413.89-1413.360
stego-tech 2y ago
I’m glad this sort of treatment is getting more exploration and research. While I’ve never heard voices myself, childhood trauma did teach me to anthropomorphize my thoughts so I could discuss things more casually, instead of clinically; I felt more at ease verbally sparring with myself in isolation instead of cooping big, complex thoughts inside my head or onto paper. I chalked it up as a quirk until a therapist recently told me that sort of coping mechanism was quite healthy and “advanced, something it can take patients years to develop with guidance” - so I keep doing it. Avatar therapy could have implications far beyond psychosis, I think. My “round tables” have helped me begin piecing together why certain behaviors follow seemingly unrelated events (e.g., why going for a walk often ends with my coming home with candy), and untangle the automatic decision-making processes of my own brain. It’s also helped me identify what I actually desire in my own life, as opposed to what I’m sold on during “autopilot”. Said revelations have steered me back towards therapy yet again, seeking professional guidance on my own observations, which I think is the best possible outcome for mental health quandaries. All of which is to say, I hope to see more human to human research on this topic. The end part, where they want to place AI in command of the voices so it can scale, seems incredibly risky for all but the most “mainstream” of cases, and far too risky for those struggling with literal psychosis; then again, I’m not a Doctor, so I could be very wrong in my concerns. Guess we’ll see when the study wraps.
criddell 2y ago
> if you ask voice-hearers to elaborate, you might engage in ‘collusion’: you may make [the voices] more real for people. Validation therapy does exactly this, although I think the people are usually dealing with dementia, not schizophrenia.
swayvil 2y ago
Hallucinogenic mushrooms. When trip (it's been a while) I invariably hear voices and have conversations with them. I call them "spirits". They're friendly. Offer advice and such.
ne0flex 2y ago
I've read that the voices that people with schizophrenia hear can vary depending on their cultural background (people from US hearing violent/confrontational voices, people from India hearing more playful voices / helpful voices). This case talks about affirming for those with violent voices. Wonder how that is with someone who hears pleasant voices.
dmonitor 2y ago
I know a few people that tell me they experience "voices", but not necessarily hostile ones. The common mechanism they use to organize their thoughts is to assign a name to the voice (or multiple voices) and possibly an appearance to it. I believe it's referred to as a plural system? I honestly don't know what to make of any of it since it's so unlike anything I've personally experienced. They seem to not be self-destructive, though, so whatever they're doing must be effective for themselves. I can't imagine that the mechanism behind it is too different than the one responsible for psychosis, so it makes sense that a similar approach would be effective.
- kybernetikos 2y ago
  There's an approach to pschotherapy called internal family systems that sounds a bit like this.
deleted 2y ago
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158 points by sandebert 2y ago

This is incredible work. Kudos to the team who developed this!!

This trial has its own website too. https://www.avatartherapytrial.com/what-is-avatar-therapy https://www.avatartherapytrial.com/what-is-avatar-therapy

dr_dshiv 2y ago

I wonder whether the mental inhibition of the voices ends up strengthening them. If you drop the conscious inhibition, they fade through other means.

JimmyBuckets 2y ago

Interestingly this idea of helping people to talk to the voices in their head is not new. The basis for IFS therapy (which emerged in the 80s) actively teaches people to have dialogue with their inner "parts". It is becoming one of the gold-standard therapies for CPTSD, anxiety, and a range of other trauma related conditions. The core discovery of the therapy is that the human mind has an inherent multiplicity. Once you accept that and go from there, the rest of the technique emerges naturally. It's really quite amazing. I highly recommend the book "No bad parts" by Dr Richard Schwartz, the discoverer of the technique. What really excites me here is the use of a virtual avatar that personifies the voice. That is really new to me and I can see all sorts of possibilities to link with IFS.

ben_w 2y ago
I suspect* that every school of psychotherapy represents a different internal configuration that human brains are capable of being in. Perhaps just as some but not all of us are aphantasic, some but not all of us may think in the IFS way, or Jungian, or Freudian. * from my comfortable armchair, don't read too much into this
- JimmyBuckets 2y ago
  I would tend to agree with you here, with a caveat. All these theories are describing the same underlying phenomenon so there is a "blind men and the elephant" effect. They also substantially build on one another The caveat is that what really sets these models apart is how they propose to navigate the mind. This is where I believe IFS stands out. But it would take a much longer comment to explain that. Maybe it's worth writing an article about.
- eru 2y ago
  Well, some of these schools are also just plain bullshit.
  - JimmyBuckets 2y ago
    I would hesitate to say bullshit. They are all models and very abstract relative to the complexity of the mind. But to extend the blind men and the elephant allegory, there is a practical difference between describing a leg and describing a trunk.
    - ulbu 2y ago
      and some say elephants don’t exist because they can’t see one.
      - eru 2y ago
        To strain the metaphor: there are many true stories about elephants, but not all stories about elephants are true.
  - fsckboy 2y ago
    yes, and much of the criticism as well: it's called being humans
- jdietrich 2y ago
  Most schools of psychotherapy are equally effective, with the very notable exception of CBT for anxiety disorders. For most patients, the school of psychotherapy only matters insofar as they buy into it - nearly all of the therapeutic benefit is totally independent of the particular methodology or even the training and experience of the therapist. Even therapeutic approaches specifically designed to be pure placebo turn out to be just as effective as everything else. If IFS or Freudian psychoanalysis are metaphors for how we think, then they just aren't useful metaphors. https://en.wikipedia.org/wiki/Dodo_bird_verdict https://en.wikipedia.org/wiki/Dodo_bird_verdict https://psychiatryonline.org/doi/10.1176/appi.psychotherapy.2021.20210041 https://psychiatryonline.org/doi/10.1176/appi.psychotherapy....
soco 2y ago
This reminds me of a book I loved and still love, which was mentioned recently in another topic: Peter Watts - Blindsight. Hard sf with a bit of everything, including this multiplicity you mention.
ryandv 2y ago
See also Genpo Roshi's Big Mind, Big Heart which has one assume the persona of various aspects of their mind and attempt to carry out a dialogue as that aspect.

akdor1154 2y ago

Fantastic piece of writing. Looks like a really promising approach to therapy as well.. right up until they said they'd stop voicing it by a skilled psychologist and get an AI to do it, while putting the psychotic person into VR instead of over a screen.. that was a big 'fuck no'.

Nevermark 2y ago
If they are going to get creative, perhaps apply the constructive effects of some mind altering drugs? Under AI shaman supervision of course! I have never heard voices, but experienced two forms of dissociation for a while after a trauma. Nothing was real, was one of them. Couldn’t trust any scene I was in or the chair I was going to sit on. Unending vertigo and feelings of experiencing a fiction. As a famous ex-newt once said: “I got better!”
probably_wrong 2y ago
I see where they're coming from, though: right now you have to be certified on this very specific program, meaning you only get the benefits if you have access to one of the 38 people currently trained for it in the UK. I would definitely want a professional to be in charge but, as the article itself points out, "Joe recently went back to his GP in search of help with his anxiety (...) The GP put him on a waiting list for NHS talking therapy, and warned that he could be in for a very long wait". Given how bad access to mental health resources is I may be willing to take "a community nurse, or a nursing assistant" now over "wait several months for a chance at a doctor who may not be the right fit for you". I wouldn't dream of allowing an AI to roam free - as the article says patients can get more psychotic and arguably "you should end it" could very well be part of the training data. But if the AI suggests lines that a trained human can oversee... then maybe?
- gnfargbl 2y ago
  I think your proposal of AI therapists with human overseers would be okay if we were able to develop some kind of metrication and monitoring of the human oversight portion. Without that control, what would inevitably happen would be that the highly-scalable part of the system (the AI) would be scaled, and the difficult-to-scale part of the system (the human) would not. We would fairly quickly end up with a situation where a single human was "overseeing" hundreds or thousands of AI conversations, at which point the oversight would become ineffective. I don't know how to metricate and monitor human oversight of AI systems, but it feels like there are already other systems (like Air Traffic Control) where we manage to do similar things.

Dilettante_ 2y ago

>Trial participants would create an avatar of their voice: a moving, three-dimensional digital embodiment that looks and sounds like the persecutor inside their heads Shoulda just made a Jackie Chan tulpa instead

InDubioProRubio 2y ago

The whole schizophrenic spectrum is a reversion to survival mode. This is what a animal hears all day- "They are out to get me, its one huge conspiracy" is the thought process of a mouse. Its low energy by default, as it does not require complex thought processes, relative little communication, very little planning for the future. Its a adaption to a warzone and economic stressors shake it loose.

deleted 2y ago
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markovs_gun 2y ago
I don't know if this is true. The way psychosis manifests is influenced heavily by culture. In some places, hallucinations from psychosis are largely positive rather than threatening. https://news.stanford.edu/stories/2014/07/voices-culture-luhrmann-071614 https://news.stanford.edu/stories/2014/07/voices-culture-luh...
- deleted 2y ago
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- ryandv 2y ago
  Indeed; the Oracles at Delphi were revered for their ability to divine wisdom from auditory hallucinations which were literally equated with gods. In some modern western cultures, by contrast, you even have active gaslighting of those who are vulnerable to such conditions and exacerbation of their negative qualities.
  - markovs_gun 2y ago
    I would be careful equating the oracles of Delphi with psychosis, since religious practices can bring about visions and out of body experiences without drugs or underlying pathologies. For example, some Eurasian shamans practice "ecstatic dance" where oxygen deprivation and exhaustion result in shamanistic experiences (visions, auditory hallucinations, etc) without the use of drugs.

throw4950sh06 2y ago

Don't do it without supervision, I nearly jumped 100m because the voices in my head convinced me I'm a Star Trek captain and will be transported to my bridge mid-jump. Never do anything to confirm a paranoid person's psychosis unless you have total control of the situation and a psychiatrist supervision. Never try to peace them by saying unrealistic things, you never know what's going on in their head that you just confirmed. My GF tried to reassure me by saying she will be with me in 15 minutes, but she was 100km away and I thought "okay well that makes all of this real, let's do it".

rightbyte 2y ago
I guess she was calling for help, so the strategy of postponing wasn't that bad even in retroperspective? Or do you mean you called her becouse you kinda knew you were mad and wanted her to also say it?
- seszett 2y ago
  Since she was 100 km away, it didn't make sense she was going to be there in 15 minutes by normal means, so it meant either she was lying or OP was actually going to be teleported. OP apparently chose to believe the latter, since it confirmed their current delusion. So it didn't postpone anything, maybe if she had given a realistic ETA (or just said "I'm coming, wait for me") it would have worked though. It's very difficult to know what to do in these situations though, I've been on the side of that girlfriend and you just can't have a full understand of what's going on in the head of the other person, everything is just walking on eggs, except the eggs are actually landmines.
  - aleph_minus_one 2y ago
    > I've been on the side of that girlfriend and you just can't have a full understand of what's going on in the head of the other person, everything is just walking on eggs, except the eggs are actually landmines. The problem here in my opinion is rather that most people are used to lie, manipulate and betray (in society this behaviour is actually euphemized via the term "white lies"). In this particular case, such a behaviour does have consequences. See the example of this thread where the girlfriend claims she will be there in 15 minutes, despite being 100 km away. Since most people are not used to being honest (or, I assume, actually never were), they give similar descriptions of their difficulties when their lies do have consequences like your "everything is just walking on eggs, except the eggs are actually landmines".

AlexDragusin 2y ago

This concept has been explored in the "The Outer Limits (1995)" episode 5 of season 2: "Mind Over Matter" "A doctor uses a virtual reality A.I. device that gives him direct access inside the human mind to enter the mind of a colleague he deeply cares about and help her after she's hit by a car and slips into a coma. Things go horribly wrong." https://www.imdb.com/title/tt0667922/ https://www.imdb.com/title/tt0667922/

jumping_frog 2y ago
In Ted Chiang's short story Exhalation, a person looks at his own mind's workings. Brilliant description of the process.

DevX101 2y ago

One of my favorite speculative hypotheses is Bicameral Mind Theory, which asserts that something like schizophrenia was relatively common until relatively recently, about 3000 BC. It argues that it was relatively normal for humans to hear voices in their head directing them. So when we read religious texts about the gods commanding so-and-so to do such-and-such, it wasn't just a spiritual metaphor, but an actual voice people heard in their heads and interpreted as higher powers.

Gooblebrai 2y ago
I thought it had been debunked already?
- jumping_frog 2y ago
  Richard Dawkins called Julian Jaynes’s 1976 book, The Origin of Consciousness in the Breakdown of the Bicameral Mind “either complete rubbish or a work of consummate genius, nothing in between”
  - nabla9 2y ago
    Idea or theory can be great, well constructed and intellectually interesting without being true. Aquatic ape hypothesis is similar. It's a initially a great theory and explains many things. Only when you start to investigate other explanations, the theory starts to fall a apart. Endurance running hypothesis on the other hand seems to hold. Incidentally it explains many of the same things as aquatic ape hypothesis, and there is more supporting evidence.
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- mensetmanusman 2y ago
  With a Time Machine?
- jerf 2y ago
  It's really a non-scientific idea, in the Popplerian sense. How would you debunk it? How would you confirm it? It's not in that class of idea. A lot of people have been taught to read that as "therefore it's false" or "therefore it's true" or "therefore it's unimportant", but really all it means is that it is not amenable to scientific confirmation or debunking. That, and nothing more. Many things are not amenable to scientific confirmation or debunking that are true and false and important and unimportant and everything else.

nabla9 2y ago

>As much as 8 percent of the population reports experiencing auditory hallucinations on a regular basis (13 percent hear them at least occasionally), compared to just 1 percent who are diagnosed with schizophrenia. https://medicine.yale.edu/news/yale-medicine-magazine/article/when-researchers-listen-to-people-who-hear-voices/ https://medicine.yale.edu/news/yale-medicine-magazine/articl... Hearing voices may be a symptom of something serious, but not always. As long as a person's grasp of reality is not in danger and voices don't stress out people, they can live with them and not even seek help. Not all people hear negative voices. Older lonely people have been known to say that voices keep them company. > voice-hearing experiences of people with serious psychotic disorders are shaped by local culture – in the U.S., the voices are harsh and threatening; in Africa and India, they are more benign and playful. https://news.stanford.edu/stories/2014/07/voices-culture-luhrmann-071614 https://news.stanford.edu/stories/2014/07/voices-culture-luh... Maybe the most famous case of a high-functioning outlier was Carl Jung. He hallucinated complete persons since childhood ,visually and everything. He discussed matters with them. In the end, he was able to get rid of them when he decided that they were not helpful anymore. It's easier to understand his weird theories and spirituality when you have read his autobiography. The guy was off the charts but not disabled by it.

ryandv 2y ago
> Maybe the most famous case of a high-functioning outlier was Carl Jung. He hallucinated completely people since childhood ,visually and everything. It's maybe easier to understand his focus on individuation, or integration of the component parts of the psyche into a cohesive whole, in light of this. Jung draws from esoteric alchemy and other related traditions (see his work: Psychology and Alchemy) which, instead of viewing the mind as a singular, monolithic entity, prefer conceiving of it as an organism comprised of many parts - Hermetic Qabalah being one such example.

arijo 2y ago

I've been diagnosed with schizoaffective disorder when I was in my early twenties. I've had several full blown psychotic episodes and been hospitalised several times. Fortunately there was one medication - Amisulpride - that kept me stable enough to be able to have a professional career, though not without a lot of struggling and sacrifice. I know what psychosis is and honestly, this avatar therapy feels a bit like bullshit to me. When in psychosis, you are not listening to your voices - you are your voices and they can command you to do things you do not want to do. You are not in control of you consciousness. There is hope though. A revolution in mental illnessis going on - check the metabolic mind site for more info - https://metabolicmind.org https://metabolicmind.org I talk about my experience in my blog - https://www.feelingbuggy.com/p/finding-hope-after-decades-of-struggle https://www.feelingbuggy.com/p/finding-hope-after-decades-of... Many other people have substantially improved because of metabolic therapy and there are dozens of random control trials going on with very promising early results. There are ever more cases of successful treatment via metabolic therapy Under the risk of being unpopular, it's my responsibility to let people know about this treatment option and bring hope to those who suffer from this terrible illness.

Workaccount2 2y ago
I wouldn't call it bullshit, it's just unlikely to work for everyone.
- arijo 2y ago
  I don't question the good faith of the researcher but i think we should prioritise what works - and there is a growing volume of evidence that metabolic therapies work. I take back the bullshit qualification though - it was a mistake on my part.

weard_beard 2y ago

We all have personalized profiles with little daemon AIs actually tracking and persecuting us. Torturing our every waking moment with judgmental advertising. No wonder, then, if we are all depressed or terrified or generally mentally ill. It’s directly caused by the lack of privacy controls and harm done by being online.

mensetmanusman 2y ago

The multiplicity of the mind is a subset property of the universe; the human mind is the ability of the universe to ask ‘why something, not nothing’. It took billions of years for the seeds of the mind to flourish, and prayer is a slow reconciling with this property of the universe.

beowulfey 2y ago

Kind of relevant to this, there is literature to support the notion that the 'personality' of internal voices is shaped by society -- people experiencing it in Western nations tend to have voices be very negative and violent, whereas people of other nations tend to have more friendly relationships with their auditory hallucinations. It definitely fits with this therapy, where building a relationship with the voice tends to benefit the mental health of the person [1]. [1] https://pubmed.ncbi.nlm.nih.gov/24970772/ https://pubmed.ncbi.nlm.nih.gov/24970772/

protoman3000 2y ago

Reading this article makes me wonder. Whenever I am too stressed, I become very self-conscious and I interpret everyday things and normal nuisances under the umbrella of "See, this is how big of a failure you are, you pathetic loser". Is almost as if there's another voice - not my voice - in my head who tells me this abusive stuff, sitting on the side and being judgemental. Does this also count as psychosis?

123pie123 2y ago
I use to have this, the book "the power of now" explains how to minimise and remove it. remember that the internal monologue is not (the whole of) you. I managed to get rid of of my imposter syndrome by getting rid of that constant internal voice
gs17 2y ago
That sounds a lot more like "automatic negative thoughts". I don't think it's considered a form of psychosis, even if arguably it's sort of similar (you're hearing a voice that isn't there telling you things that aren't real).

teknopaul 2y ago

I could have told you that voicing deamons in your head gets rid of them 20 years ago. A bunch of my friends know this trick too. I have successfully used this in therapy, i.e. helping friends on many, many occasions. Strange that this is news in the psychiatric world: we "discovered" it by caring, and listening, and trying stuff out. If psychiatric community is not listening to patients and conversing with them and their demons, and trying pills as a solution while knowing this doesn't work, it should be considered malpractice. No wonder everyone hates psychiatrists. Calling themselves doctors and the humans in front of them patients, is probably the root cause.

aphantastic 2y ago
Jesus did the same 2000 years ago. But scientists tend to be superstitious of anything He demonstrated.

iandanforth 2y ago

This reminds me of mirror box therapy for phantom limb syndrome. Amputees sometimes feel intense pain in the limbs that they have lost. This is measurable activity in the brain. Unfortunately all of the feedback mechanisms for that activity have been removed with the limb. By showing people a mirrored version of their remaining limb. And then stimulating that limb in a way that would remove pain say massage or touch or unclenching a cramped clenched phantom hand, the patient gets the feedback to the part of their brain via their visual system that there's nothing wrong with that limb. This activates inhibitory circuits that would otherwise be inaccessible. In this therapy a combination of visual and audio input as well as external control over the behavior of the Voice allows for a feedback mechanism which does not exist otherwise.

eszed 2y ago

This is fascinating. What I note is that the therapist is collaborating with the patient to create "theatre". I think they should lean into this, new therapists should be explicitly trained in performance and theatre facilitation. There are a lot of solved problems with which they may otherwise struggle.

eth0up 2y ago

I've never fully understood this voice in the 'ed thing. Does anyone with internal dialogue have schizophrenia? Or is this literal, auditory voice, indistinguishable from actual voice? Also, there's old technology in the wild capable of doing this[1] and I'd not be surprised to see it eventually become more easily available as hardware decreases in cost. It's already on the 'table' for advertisment purposes, albeit not microwave based. 1. https://en.m.wikipedia.org/wiki/Microwave_auditory_effect https://en.m.wikipedia.org/wiki/Microwave_auditory_effect Edit, Various Links: https://gizmodo.com/we-will-beam-advertisements-directly-into-your-brain-390600 https://gizmodo.com/we-will-beam-advertisements-directly-int... https://www.holosonics.com/ https://www.holosonics.com/ https://www.timesofisrael.com/futuristic-device-from-israeli-firm-puts-music-in-your-head-without-headphones/ https://www.timesofisrael.com/futuristic-device-from-israeli... https://phys.org/news/2008-02-pentagon-lasers-voices.html https://phys.org/news/2008-02-pentagon-lasers-voices.html https://www.wired.com/2007/06/darpas-sonic-pr/ https://www.wired.com/2007/06/darpas-sonic-pr/ https://futurism.com/the-byte/laser-beam-speech-mit https://futurism.com/the-byte/laser-beam-speech-mit

39896880 2y ago

The Atlantic reported on similar research in 2014. The article from The Atlantic is titled "Learning to Live with the Voices in Your Head" [0]. Here's a choice quote from that article: >“The problem,” [Intervoice founder Dr. Marius Romme] writes, “is not hearing voices, but the inability to cope with the experience.” In 1987, after two decades of clinical work, the Dutch psychiatrist began promoting a drug-free therapy in which patients were encouraged to accept and analyze their voices. The article linked in this post has a similar sentiment from one of the patients: >She hadn’t expected them to go. “My aim wasn’t to get rid of them – just to get along with them,” she told me. “I wasn’t quite sure I wanted to let go. I’d never really been on my own. As abusive as it was, it’s still a relationship.” Hopefully the therapy takes off, and we don't keep re-discovering this every 10 years. [0]https://archive.is/pfKrC#selection-1413.89-1413.360 https://archive.is/pfKrC#selection-1413.89-1413.360

stego-tech 2y ago

I’m glad this sort of treatment is getting more exploration and research. While I’ve never heard voices myself, childhood trauma did teach me to anthropomorphize my thoughts so I could discuss things more casually, instead of clinically; I felt more at ease verbally sparring with myself in isolation instead of cooping big, complex thoughts inside my head or onto paper. I chalked it up as a quirk until a therapist recently told me that sort of coping mechanism was quite healthy and “advanced, something it can take patients years to develop with guidance” - so I keep doing it. Avatar therapy could have implications far beyond psychosis, I think. My “round tables” have helped me begin piecing together why certain behaviors follow seemingly unrelated events (e.g., why going for a walk often ends with my coming home with candy), and untangle the automatic decision-making processes of my own brain. It’s also helped me identify what I actually desire in my own life, as opposed to what I’m sold on during “autopilot”. Said revelations have steered me back towards therapy yet again, seeking professional guidance on my own observations, which I think is the best possible outcome for mental health quandaries. All of which is to say, I hope to see more human to human research on this topic. The end part, where they want to place AI in command of the voices so it can scale, seems incredibly risky for all but the most “mainstream” of cases, and far too risky for those struggling with literal psychosis; then again, I’m not a Doctor, so I could be very wrong in my concerns. Guess we’ll see when the study wraps.

criddell 2y ago

> if you ask voice-hearers to elaborate, you might engage in ‘collusion’: you may make [the voices] more real for people. Validation therapy does exactly this, although I think the people are usually dealing with dementia, not schizophrenia.

swayvil 2y ago

Hallucinogenic mushrooms. When trip (it's been a while) I invariably hear voices and have conversations with them. I call them "spirits". They're friendly. Offer advice and such.

ne0flex 2y ago

I've read that the voices that people with schizophrenia hear can vary depending on their cultural background (people from US hearing violent/confrontational voices, people from India hearing more playful voices / helpful voices). This case talks about affirming for those with violent voices. Wonder how that is with someone who hears pleasant voices.

dmonitor 2y ago

I know a few people that tell me they experience "voices", but not necessarily hostile ones. The common mechanism they use to organize their thoughts is to assign a name to the voice (or multiple voices) and possibly an appearance to it. I believe it's referred to as a plural system? I honestly don't know what to make of any of it since it's so unlike anything I've personally experienced. They seem to not be self-destructive, though, so whatever they're doing must be effective for themselves. I can't imagine that the mechanism behind it is too different than the one responsible for psychosis, so it makes sense that a similar approach would be effective.

kybernetikos 2y ago
There's an approach to pschotherapy called internal family systems that sounds a bit like this.

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