Hearing voices

I am not a dottoressa.    So often, this past month, visiting Trieste, people assumed I was a dottoressa, a psychiatrist.  Why else would I be here spending time researching this system?    I have tried to explain my motivation for spending a month in Trieste, but I think it is hard for people here in Italy to understand why someone whose job it was to take care of Hollywood Boulevard would find visiting Trieste relevant to anything that might happen in Los Angeles.  So as I tell this story, please realize that I am not a clinician.  I am a lay-person, and the notion of “hearing voices” has always left me curious. 

In my quest to better understand the system of social cooperatives and associations here in Trieste, I had the pleasure to meet a young man, Federico.  He shared with me the story of a group who had come together to organize an association that would, in his words, allow users in the system express their views and raise awareness about issues related to mental illness.  The association, however, ceases to exist!   When pressed as to why, he said the stress of keeping it organized and seeking the funding proved too much of a burden for the president, and it folded.  What was left was a website, Kairos, and he sent me a link to peruse.

On the site, I  found myself transfixed by a short 20-minute video called, “La Gabbia Oscura” (the dark cage).    I am posting it here because this short film tells a compelling story that is both frightening yet filled with hope.  Federico informs me that the purpose was to show the A-B-C of a psychotic disorder.

In the film we meet a young couple, Susanna and Lorenzo.  They move into a flat and are excited to start a life together.  Lorenzo receives a job promotion, and though he still must finish school, the prospect of making more money beckons.  He thinks he can handle both.  Within the confines of this short film, we start to witness Lorenzo “losing it.”  It is evident that he is burning the candle at both ends and one night, while he is up very late trying to study, he feels as though someone is watching him.  He is coming home late at night over and over and you can sense that he is not getting enough sleep.

La Gabbia Oscura (the dark cage)

On another occasion, working on his computer after midnight, he hears some voices. He goes upstairs to check on Susanna, but she is sleeping.

Little by little, things start to happen that don’t make sense.  It starts to drive a wedge into their relationship.   I found myself drawn into the anxiety he was feeling about his inability to explain away the strange sounds and the voices that are becoming more menacing.  He is clearly reluctant to share with Susanna what is occurring – and this seems understandable, since what he is experiencing seems hard to put into words. 

Finally, he suggests to Susanna that they should leave the apartment.  He says he doesn’t feel safe.  Again, he doesn’t elaborate, but she counters by saying, “this is a flat just like others.  Bricks, nails and wood.  There’s nothing wrong with it.”    

Things do not improve.  One night while studying, his computer screen is reduced to gibberish.  In the climax, he tries to leave home for work one morning, and encounters a wall outside the door.   He reenters the house and then he feels trapped.  The voices are quite sinister.   He thinks he hears a woman’s scream, and he runs up to the bedroom to find a skeleton’s head on the bed.  He is overcome with grief and gently cradles the head of Susanna, as he perceives it, and crouches against the wall in a near fetal position. 

The Scream. Edvard Munch 1893. This image came to mind as I watched the film. I cannot say if this (hearing voices) is what the artist has in mind. However, the artist wrote this on the frame: “I was walking along the road with two friends. The Sun was setting – The Sky turned a bloody red
And I felt a whiff of Melancholy – I stood Still, deathly tired – over the blue-black Fjord and City hung Blood and Tongues of Fire
My Friends walked on – I remained behind – shivering with Anxiety – I felt the great Scream in Nature ” E.M.

Soon we hear Susanna’s voice, and she arrives in the room to find him completely overtaken by the grief from thinking she is dead.  We now see that he is clutching a soccer ball.  He jumps up and runs to the bathroom and attempts to slit his wrists, thinking that will bring him closer to Susanna, whom he thinks is now dead.  Susanna knows she needs to call for help. 

As I watched this, I think I stopped breathing.  This story seemed so plausible.  More than any description I’ve ever read or heard about what it must be like to experience delusions or paranoia and voices, this made it very real to me.  I could see myself in this story, or a loved one, and it was scary.

The “hearing voices” symptom has always been confusing to me.  I have a lot of curiosity.  Why are the voices so negative?  Why can’t they be uplifting?  What does it sound like?  When I see people on Hollywood Boulevard having full-on conversations with someone invisible, is that hearing voices?  Or is it something more sinister? 

I recalled watching a compelling piece done by Anderson Cooper several years ago in which he agrees to wear headphones that simulate hearing voices.  It’s quite riveting, because he has a hard time doing very simple tasks, like answering a quiz or making a paper boat.  As he is walking through the streets of Manhattan with the headset, he ends the simulation; it is too much for him.    

La mente sta bene, può fare grandi cose;

se si ammala, può trasformarsi in una gabbia oscura. 

(If the mind is well, it can do great things;

if it gets sick, it can turn into a dark cage.) 

So what happens next in this video is quite remarkable and is a testament to the system that exists here in Trieste.  The paramedics are called. Lorenzo reflects upon this and admits that everything was very confusing, but being hospitalized was a turning point.  From what I’ve experienced here in Trieste, his time at the hospital was likely very brief. In the film we see him in his room at the community mental health center. He is shown taking some medication and he says that he was able to catch up on his sleep.   He says that ongoing sessions with both psychiatrists and psychologists “helped me recover.” 

There is a scene where he is meeting with the psychiatrist at the community mental health center.  It does not look like a medical facility.   Lorenzo says that he wishes he could reduce his medication, and the doctor says that they will discuss that together over time.  Lorenzo asks, “what happened?”  The doctor answers that he had a serious disorder, probably caused by acute stress, “a psychotic episode.”  A loss of a connection with reality.  The doctor describes that this can impact three percent of young people, so it is fairly common. 

Susanna asks if it will happen again.  At this point, I’m empathizing with both Susanna and Lorenzo, because these would be my questions.    And the doctor, who is matter-of-fact about the truth, also offers hope.  He says that it is possible to have another episode, but “most people recover totally, everyone in his own time.” 

The psychiatrist says, se la mente sta bene, può fare grandi cose; se si ammala, può trasformarsi in una gabbia oscura.  (If the mind is well, it can do great things; if it gets sick, it can turn into a dark cage.)  Reassuringly, he tells Lorenzo that he is not the only one who has gone through this and gives him hope that he will come out of it.

The pychiastrist sets up another meeting for a week later, where they will discuss how Lorenzo is doing and how the medication is working.   From what I have witnessed this month, this film is an accurate depiction of the  Trieste system and how it operates.  This story underscores the importance of intervention at the earliest stages of the manifestation of the disease.  In the end, you have a sense of hope that Lorenzo will return to work – but reduce his load.  His relationshp with Susanna will survive. And even if he experiences a set-back, he has a community center to which he can turn.

Postscript: details about the film. 

Produced:  2014  (See Facebook link)

Writer and Director:  Davide Stocovaz

Lead Actor:  Giulio Settimo

Lead Actress:  Enza DeRose

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