Monday, January 14, 2013

Toxic Voices

In my last blog I discussed internal critical voices, voices we’ve all taken in from our early childhoods that criticize us and highlight our deficiencies in one form or another. These are voices that we all carry with us and, as I said previously, if we’re lucky, we have sufficient positive voices to allow us to function relatively comfortably in our adult lives.

There are, however, people who carry around voices I call toxic voices for they are unceasingly critical and condemning. Again, I’m not talking here about hallucinations, although the intensity and persistence of these voices can sometimes approach the experience of a voice that comes from outside the self.

There may be many reasons for these strident, toxic voices, some easily understood – like early neglect or abandonment - or some unknown physiological sensitivity. If a child has been sexually abused, especially by a parent, these toxic voices are almost inevitable. A sexually abusing parent will often tell the child she is bad, attempting to excuse their inexcusable behavior by blaming the child and saying the abuse is a punishment for the badness. [I am using the feminine pronoun, although boys are clearly similarly abused].  And children are more than willing to accept the blame as theirs, for it is far preferable to feel bad, guilty and ashamed, than to feel powerless and at the mercy of a parent who is so cruel and self-involved to never consider their child’s needs or feelings. Children need their parents, however awful the parent might be; they are helpless, dependent little people, who would much rather see themselves as evil, than to realize they are at the mercy of an evil caretaker.

There are times it can feel overwhelming to be with someone who is plagued by these toxic voices. At times these voices are directed outwards and rage fills the treatment room. At these times I have been accused of being incompetent, insensitive, worthless, stupid, ineffective, judgmental, controlling, etc., etc. Although I certainly don’t enjoy being raged at, I find it easier than sitting with someone who is viciously attacking themselves. I have had patients talk of fantasies of seeing themselves hanging from a rope and repeatedly stabbing themselves with a knife. I have had patients talk about watching in a mirror as every inch of their skin is pulled off. And I have had patients talk about their not having one redeeming feature, every part of them bad, bad, bad.

In addition to listening of these horrific descriptions in my office, they often stay with me. It is as though these patients’ toxic thoughts penetrate my mind. They take over, so that I find myself thinking about the patient, about the images, about the “badness.” And, at some unconscious level, that is exactly the point, for the patient’s toxic thoughts reflect not only their own feelings of badness, but an expression of their rage as well. As with critical voices, toxic voices are also directed not only at the self, but at the other as well. Many of these patients have very good reasons to be enraged. Although they might have learned the necessity of keeping that rage turned on the self, the therapist’s experience of being taken over by these toxic thoughts, may be the first inroad to helping the patient express the rage in a less self-destructive manner.

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