Monday, July 10, 2006

Roy: Hearing voices

When I was in medical school I recall seeing an unkempt-looking fellow standing on the sidewalk, talking to himself and spinning round and round. People walking past were giving him a wide berth. I stood near him and said, "Excuse me." At that utterance, he immediately stopped spinning and began walking down the street as if he were a skipping record and I just nudged the needle (hmm... do people even get this analogy in the CD-era... I'm feeling old).

As an aside, this symptom of spinning is an interesting phenomenon that has often been mentioned in older schizophrenia literature [PubMed]. What I find interesting is that the spinning is usually in the same direction (counter-clockwise), often attributed to asymmetrical changes in dopamine physiology. Hmm... wonder if it is clockwise in the Southern hemisphere.

So anyway, it was one of those brief, random interactions that you don't forget... never having an explanation to fully understand it so that it can be neatly categorized and put away.

I was at the ocean this past week and had several experiences of seeing folks standing or walking on the boardwalk, talking to themselves. At times, they seemed to be gazing in my direction, prompting an "Excuse me?" as I wondered what they were asking of me. After getting no response, I realized they were plugged in to a Bluetooth headset, chatting away on their phones, oblivious to the world around them.

It's funny (funny strange, not funny ha-ha, as Gilligan would say). If I saw the headset, then I did not get confused... I immediately realized they were chatting to someone else and didn't give it a second thought. But when the headset was in the ear I could not see, it caused an ambiguous moment, not knowing if they were talking to an unknown person, maybe hallucinating. It's funny how our (not just psychiatrists, but all of us) brains are wired to notice odd or unexplained behavior, while instinctively filtering out things which fit neatly into our "normal" or "expected" categories of behavior.

As the world becomes more wired (weird?), I wonder that our expectations about human behavior will change. Having a one-sided conversation no longer seems so clearly psychotic. The idea of a transmitter implanted into one's tooth no longer seems so clearly delusional. I still see people with schizophrenia having paranoid delusions, but I note that I more often discount their concerns that there are cameras watching them (there are) or that their email is being monitored (it is). The technology reshaping the world will turn us all on its ear.