Medicine Nonfiction Reflection

Assuming Intentions from Behaviors.

The fear first appeared in his eyes, then washed over his entire face.

“Hey, how did you do that?” His voice grew louder. “You’re supposed to help me! How did you tell the voices what to say?”

I realized that this was not going to end well.

“The voices in my head are now saying that there are robots in my brain!” he shouted. “That’s illegal! You’re not allowed to do that!”

“I have no ability to put voices in your head or anyone else’s head.”

“But you did! Before you told me about what I supposedly said the other day”—he had told my colleague that there were robots in his brain—“the voices never talked about robots. YOU did this!”

“I did not.”


My heart sank further. Many people who experience auditory hallucinations learn to avoid sharing this with others. This man did not realize how others would dismiss his suffering.

“I’m going to go.”

“NO! You can’t go! You’re doing something illegal!” He saw an officer approach. “GUARD! GUARD! This nurse is doing something illegal! She’s putting voices in my head!”

Though he has worked on the unit for years, I suspect that he had some innate skills in talking with people who were overwhelmed.

“Hey, you don’t need to yell, I’m right here. She’s trying to help you….”

He managed to shout, “HEY, COME BACK HERE, YOU NEED TO STAY!” as I slipped away, but he stopped yelling before I was out of earshot. The officer later told me the man demanded that I call his parents to tell them that I was putting voices in his head.

There’s no way this could ever happen to you, right?

But aren’t there times when we believe that someone did something to us… except they didn’t?

Like those times when we say, “She makes me so mad!”

Or, “He’s trying to make me jealous.”

We assume intention from behaviors. Sometimes our assumptions are correct, but not always. We feel whatever emotions we feel, but that does not always mean that somebody else is responsible for our emotions.

“But, Maria,” you might retort, “there’s a big difference between hearing voices and feeling emotions. We all feel emotions. Only sick people hear voices.”

… except there’s data[1. Prevalence of auditory verbal hallucinations in a general population: A group comparison study and A comprehensive review of auditory verbal hallucinations: lifetime prevalence, correlates and mechanisms in healthy and clinical individuals.] that suggests that anywhere between 5% and 28% of the general population hears voices. They are your coworkers, friends, members of your family, people you routinely see in your community.

And even if we don’t hear voices, our running internal dialogue—while not “voices”, per se, but “thoughts”—can transform an event into something else that never actually happened.

I felt sad as I was walking away from this man. First, do no harm. Our conversation went sideways and caused him distress. I replayed the interaction in my mind—my own internal dialogue was loud—and recognized several points where I could have taken a different approach. The outcome still may have been the same.

The truth remains, though: I did not put voices into his head. I don’t know how to do that. My hope is that he will recognize and accept that in time.