Category: Severe Mental Illness

Laura and I would like to share some of our experiences and considerations concerning voices or energies that we have wondered how best to understand. Were we dealing with a meaningless illness or perhaps a spiritual phenomenon? And regardless of which they may be, how does one manage them? Particularly if they are extremely transgressive and frightening. Early on, Laura arrived at the realization that “fear is something that voices eat. It makes them stronger. Instead, one must practice curiosity. That leads to a positive feeling”. This is an understanding which Laura put into practice on her own and we also made such a curiosity as she recommended the leading principle for our common exploration.

Our conversations took place at Aalborg Psychiatric Hospital (Denmark) between August 2019 and February 2023. The present paper is based on our collective recollections, notes written underway and a number of sound recordings of our conversations in 2019 and 2020. Laura had asked to consult with me in order to better understand her voices and in order to share her own experience. Word had reached her of the work of documenting knowledges concerning voices that I was then engaged in. She desired to contribute to this and some of her voices had also encouraged her to do so.  

The Voices Make their Appearance

Laura began to be able to hear voices when she was 19 years old and found herself in difficult life circumstances. She had been orphaned at 16 and had been in a poor romantic relationship for a few years, while also busy attending school. She occasionally smoked cannabis during this time. Then it happened that a number of voices began to speak to her and comment on her appearance. This was also associated with a sudden experience of being observed. Suddenly a private life no longer existed for Laura.

Christoffer: Being constantly, invisibly observed and hearing voices commenting on you and having nowhere to hide would have many people end up sitting in a corner, rocking back and forth! 

Laura: I did. I wasn’t able to do anything. I couldn’t undress. I couldn’t shower. I showered fully dressed sometimes. I knew there was no turning back. I had cried so many times. There was nothing I could do. I couldn’t put a blanket over myself; they were still there. Then they would be in my head. No matter what, they were there. I recall one day I was wearing a summer dress and waiting by a traffic light, and I could feel someone looking up under my dress, but no one was there! I went home and got in front of the mirror and undressed. Then I said to myself “they are looking at you because you are a pretty girl”.

Christoffer: Was that a seminal event? 

Laura: Yes. Every time they would say “oh, you naughty girl” or something, I would say to myself, “they say that because you are a pretty girl”. I made it who I am. I also felt that actual people looked at me and then I would hear their thoughts. I also made that into “they are looking at me because I am a pretty girl. They think that because they are human, and you think that way too and that is okay”. Every time I felt they could hear my thoughts, I would think “they think that way too”.

Christoffer: Amazing.

Laura: You look positively stunned.  

Christoffer: Experiencing something that frightening and such a loss of control and privacy, and then doing what you did. It sounds paralyzing. And maybe the reason I am sitting here wide-eyed is that as far as I can tell, it seems you went through this alone and figured this out by yourself.

Laura: I did. I am immensely proud of myself. Changing how you look at yourself—that is gold.

In addition, Laura had the experience that the voices were able to take control over her body. She strove to come to terms with that as well and to see it in a positive light. It required her to accept not being in charge of her own body; otherwise the recurring losses of control would constitute a destruction of her reality every time it happened. Instead, she opted for a kind of permanent destruction of her reality so that she could rebuild herself from there.

Christoffer: A permanent destruction of your reality—was that what you did?

 Laura: Yes. Incredibly hard, but that is what I did. I then existed in a world where someone controlled me. I could do anything because nothing was impossible now. I made it a positive thing once again. I was suddenly able to draw like I never could before. And paint like I never could before. Everything just flowed. It was the sensation of being taken by creativity and the feeling that everything is just beautiful. Everything could be painted on.

I painted the underside of my table, lying on the floor, and I painted the top of the table. There was also something with mirrors. My voices would sometimes see through my eyes and show me what they saw. They can see me as being incredibly beautiful, or fat or something else. Then I see myself that way, like you would see me. Or how someone else would see another person. I said to myself “see the world with new eyes”.

Laura did other things to handle these phenomena as well. Around the time of these events, she developed a spiritual approach to life, and consequently it was also meaningful for her to view these speaking entities and influences on her body as being spiritual in nature. She oriented herself by an understanding of spirits as being the souls of the deceased that for some reason cling to the physical reality and influence the living. Her understanding of such spirits was that they were really supposed to move on in their spiritual development and let go of physical reality, but spirits that are insufficiently evolved may struggle to realize this and experience difficulty letting go.

She intuitively sensed that these voices perhaps needed to learn something from her. She developed a strategy on this basis: If the spirits perceive the physical world through Laura, then perhaps she could contribute to their development by means of what impressions she provided them with? She began to frequent beautiful places and go for walks in natural surroundings so that the voices could share in beautiful and edifying sensory experiences.

However, some of the voices were very violent towards Laura. During a period of time, whenever she went to bed to sleep, voices would approach and molest her. This was extreme and Laura discovered that she was powerless against these nocturnal attacks. She attempted to wrap herself up in blankets, sleeping fully dressed, keeping her legs pressed tightly together, but this did not prevent the assaults. When the attacker is not physical, it is no use to lock the door. They could always reach her. One night she desperately prayed to God for help, and suddenly she heard a voice that was different from the others. It said to her that God told her to do two things:

To fix her auditory attention to the sounds of the radiator and to spread her legs as far apart as possible. She did this and the assault stopped immediately for the night! She attempted this strategy several times and it was effective for several weeks, but less effective than the first time. Around this time, some of the voices became involved in protecting Laura. Some voices assaulted her, while others were concerned with expressing themselves through her and teaching her things, and finally, some wanted to protect her. She positioned these protective voices around her body, and consequently they served as a guard against attacks.

Having An Illness

These overwhelming experiences finally led to Laura being hospitalized at the psychiatric hospital. Here, she was told that her experiences were due to schizophrenia, and she was administered an antipsychotic. She continued to be able to hear voices and experience her body being taken over by them. She would allow them to temporarily control her body so that they could use it for dancing, writing or painting. Her perception of herself changed. She was divided into present and past selves and there was a prominent sad self which she did not experience as being her own conscious identity. Her core was covered by layers of voices and on top of all those layers was Laura’s consciousness. Well-meaning voices took it upon themselves to protect Laura's body and core and to take over control because Laura herself was unable to do so. To Laura this was an experience of letting go of herself due to intense emotional pain.

This new understanding of her experiences as being the result of an illness also changed Laura’s relationship with herself and the voices:

Laura: I discovered that I myself was important. The voices can be whatever they want to be. They weren’t as important anymore after I found out I have an illness. Now I was important. I could help the rest of the world rather than them being the ones to do so. I could before as well because I did believe that I had a message to deliver. That is what I believed in. I still do, really, because everyone has messages to deliver, but it is not about the voices all the time. Now it is more about me.

It was after this that she began to deal with them as “voices” rather than “spirits”.

The violent attacks ceased over time and the experiences of being controlled by the voices became less frequent and intense. The voices did not disappear, however, and Laura continued to experience a division of herself into multiple selves, surrounded by different voices, some of which were unpleasant, possessive and sexually transgressive, while others were protective and guiding, or just kept her company. She also experienced her mind differently after receiving psychiatric treatment in the form of an absence of thoughts. She used to have a creative and active inner life, but this was now significantly reduced. Likewise, she began to distance herself from the spiritual world view she had before. Some of the voices were displeased with this.

Brazilian Associations

Our collaboration began in 2019, six years after the voices first appeared. Laura told me her story as described above. The first thing that occurred to me when I heard all this was that it reminded me of Spiritism! This spiritually oriented approach that she had initially taken, her attempt to help the spirits to evolve and the sexually transgressive behavior of some of the spirits, as well as the experiences of them taking control of her body for dancing and writing reminded me of phenomena described in the anthropological literature that I was familiar with. I asked her if she was spiritually inclined. She confirmed that she certainly was earlier, but less so now that she considered it to be schizophrenia.

Asking about any prior knowledge of Spiritism, she denied any formal involvement or training in anything of that sort. I silently considered whether it might be helpful to consider conceptual possibilities and structures that might be available to us in spiritual frameworks. Such an approach has been suggested by a number of psychologists (1-4). I therefore inquired with Laura whether she would be interested in considering spiritual conceptual frameworks. Indeed, she was. I now shared with her the associations that had coming to me regarding her story:

(I) Her understanding that the spirits needed to learn through her, which she strove to provide by means of positive impressions, reminded me of Spiritist practice. Spirits of the deceased may lack sufficient spiritual insight and moral integrity to let go of the physical world. They then try to fulfil their desires by attaching to a living person and attempt to sway that person in the direction of what the spirit wants. The solution is moral teaching and spiritual insight called ‘doctrination,’ which intends to evolve the spirit so that it may move on to its destination in the afterlife. Similarly, more evolved spirits may function as guides and helpers to the living in order to promote their own evolution through moral work. Laura’s intuitive practice appeared to have something in common with the Spiritist concepts of doctrination and spiritual/moral evolution (5, 6).

(II) Laura’s experience of spirits controlling her body reminded me of possession phenomena in both Spiritism and Afro-Atlantic religions such as Santería and Candomblé. For example, Spiritists make use of automatic writing where a spirit controls the hand of a medium and thereby delivers messages (5). In Brazilian Candomblé, possession by a spirit is desirable under the right circumstances, and these African spirits enjoy dancing through the bodies of their worshippers (6, 7, 8).

(III) In the worship of spirits like Exú and Pomba Gira in Brazil, there is a tendency for strong erotic expressions and desire for bodily sensuality from these spirits. Sexual intercourse is also a metaphor for spirit possession in Candomblé (6). Might the sexually oriented attacks and desire from the spirits that Laura described be meaningful in such a light?  

I also told Laura that while Spiritism and these Afro-Atlantic religions have common features and have influenced each other, they do also tend to differ in some regards: Spiritism aims at assisting spirits to let go and move away from the physical towards transcendence, while Candomblé rather strives to help certain spirits to obtain a stronger connection to the physical world. Such understandings and practices are a prominent part of the culture in some places in Brazil, and there are even Spiritist psychiatric hospitals (8, 9).

Then something remarkable happened! Laura now informed me that a number of her voices were quite interested in what I was describing and that indeed they desired for Laura to travel to Brazil. She did not share that desire, however, nor was it what I had in mind. I suggested that these understandings might inspire some ideas as to how Laura might establish a more acceptable relationship with the voices. It is common for spirits in Brazil to be initially violent or cause trouble in people’s lives until the right relationship is established (10, 11). Perhaps it all had some meaning?

Laura had surprising news when we met one week after this conversation. An entire group of voices had informed her that they would now leave her and go to Brazil. And so, they did. They were gone now. Many other voices remained, but a whole group had disappeared! I found this to be indeed puzzling, and I was curious to know how this was possible! Some of Laura’s remaining voices were likewise interested in this question and even asked during our conversation; “how do we go to Brazil?” Laura’s own impression was that it is something voices may choose to do, but probably only voices that have reached a sufficient level of awareness – something Laura believed she had contributed to developing. During the following couple of weeks, more voices similarly said farewell to Laura and told her that they were going to Brazil. It was very mysterious.

However, one voice reacted differently to these considerations. A couple of weeks after our discussion about Brazil, Laura paid a short visit to the psychiatric emergency room. She was not hospitalized on this occasion. The reason was that she had become concerned about a voice that had attempted to control her body and wanted her to call him/her god. Considering how our perception of the voices seemed to have the capacity to affect them, just as Laura had experienced them being affected by the shift to a psychiatric perception of them, I became worried about our considerations. Might it pose a risk to Laura to consider various possibilities for what voices may be and how to interact with them?  

Might we risk shaping them in problematic ways? Laura assured me, however, that it was okay and that she wished to explore different ways of perceiving things. She wanted knowledge of as many understandings as possible in order to better make up her own mind about it. In addition, she told me that so much had happened since we started that she definitely wanted to continue.

Over the coming weeks and months, we explored the connections between voices and selves and how Laura had developed certain systems for managing the voices. These systems proved rather difficult to put into words, however, and difficult for Laura to even recall clearly. She was able to describe a system for dismantling the voices’ control of her body, and she employed this system during part of our collaboration: First she had to notice subtle shifts in the body that indicate that a movement is not her own but controlled by voices.

Then she would consciously allow the voices to perform this control and then interfere with it by making a deliberate action contradicting theirs. By doing so, she nonverbally communicated to the voices that this was something she wanted to control herself. Over time, some voices learned in this way to step back and transfer control to Laura, a control that they had initially assumed in order to help her when she was unable to do so herself. We discovered that some voices were associated with particular selves that were in turn associated with particular periods in Laura’s life.

They were cut off from the present Laura and for that reason not necessarily up to date concerning her present situation. Laura had the feeling that they were listening in on our conversations, but as someone occupying a separate room and putting their ears to the wall to listen. Some of the voices turned out to appreciate tea and coffee, which I started serving them. Laura sensed how the voices, lacking hands, would suck the beverage from the edge of the cup.  

Assault and Mana

In early 2020, Laura and I considered whether a reduction in antipsychotic medication might alleviate her experience of being detached from her thoughts. She worried about reducing the dose for fear of the voices that wanted to touch her to once again becoming violent like they were leading up to her hospitalization.

I suggested two ways of understanding voices: 1) They are external entities that come to you for some reason. 2) They have their origin inside yourself and reflect something in your life. Laura inclined towards the second option. If the voices that desired her sexually reflected something in herself, what could it be? Was there something related to love, intimacy or sexuality that Laura was not on good terms with? Laura didn’t immediately think so.

Christoffer: Perhaps some of the voices know something about this? Voices, do you know anything about this desire to touch Laura? 

Laura: A voice says “yes”.

Christoffer: Why do you have this desire to touch her? What is the meaning of it?

Laura: A voice says, “you have been raped.” But that isn’t true. I have never been raped.

Christoffer: Are any of the voices that have been involved in touching you, and who have this erotic attraction to you, present today? Are they listening in?

Laura: Yes.

Christoffer: Why do you want to touch Laura?

Voice: I want Laura.

Christoffer: Why?

Voice: I want her to become sexually aroused.

Christoffer: Why?

Voice: Because she likes it.

Laura told me what she thinks of erotic desire, trust and consent and I informed the voice that Laura did not appreciate being touched without consent. The voice said it didn’t care. Laura went on to describe how she felt when that group of voices assaulted her while she desperately and despairingly tried to cover herself up to prevent it, and how she had to conclude that she could do nothing to stave them off. She never spoke to anyone about this while she was hospitalized because it was too intimate. Her attempt to see it in a positive way was a desperate survival strategy.

Christoffer: This sounds like traumatic events to me, and as far as I can determine, it constitutes rape. Voice who touches Laura, you have to stop this. Do you understand? You cannot do this to Laura anymore.

Voice: I don’t care.

Laura: Now my sad self is sort of over here to the one side and the voice is over at the other side and the sad self is screaming at the voice and saying, “you raped me!”

Christoffer: How is the voice responding to that?

Laura: He looks sad and he is crying. He says, “that wasn’t my intention”. But then he dries his eyes and says, “but I still don’t care”.

Christoffer: Was he actually affected, but then he puts on a hard face like a tough guy?

Laura: Maybe.

Christoffer: We have to find a way to stop this. Make a deal with these voices or convince them to change their minds.

Laura: He isn’t interested in any deals.

Christoffer: Right. Nonetheless, we have to find a way. I wonder what the circumstances were that led up to all this. Back when these voices started gaining access to your body, what went on at that time? Was your personal power to resist or spiritual barrier damaged, allowing them to enter? Does that make sense—the idea that you have an inner power that protects you and that it can be damaged?

Laura: Well, I smoked cannabis at the time.

Christoffer: Yes, but there was more. Your mother died when you were a teenager, and your father wasn’t around. And difficulties even before that.

Laura: Yes. My mother died and I moved away from home before I was 18. I lived with a guy who was hard on me and made threats to leave me. The thought of being abandoned was like being left behind in a black hole.

Christoffer: I imagine you had to adapt to him and submit yourself?

Laura: Yes, I did that. I couldn’t bear the thought of being alone.

Christoffer: I wonder if your personal power and barriers were weakened by these circumstances.

Laura: I don’t quite follow you.

Christoffer: Right. I am reading a book about a collaboration between a psychiatrist and a Māori healer in New Zealand. This healer talks about ‘mana’—that personal power and spiritual authority that a person possesses. It can be weakened, and then you become receptive to negative spiritual influences. For example, influences that try to corrupt a young person’s talents and contributions to life. The healer uses certain prayers to separate these influences, but that is not sufficient. He focuses on supporting the person to build her or his mana so that you are protected and able to push away negative forces. I can’t help but think of the concept of ‘mana’ in relation to your story. If your mana was stronger, maybe these voices could not reach you.

Laura: Oh, this is really strange.

Christoffer: What is strange? These ideas?

Laura: It is as if everything just changed. As if I stepped into another dimension. There is a wall between me and the voices, and it is like they are at a distance. I can still contact them if I want to, but I am separate from them.

Christoffer: Wow! What is happening?! Is this a good state to be in?

Laura: Yes!

Christoffer: How did that happen? This is fantastic! Was it something we were talking about? Something I said?

Laura: I don’t know. Sometimes these shifts occur.

Christoffer: Such uncanny things have happened. It is as if we sometimes push a button without knowing it. Like when all those voices went to Brazil. I wonder what it is this time. Was it something to do with mana? Or prayer?

Laura: I am interested in this mana.

Christoffer: Shall we try to find a way to restore your mana?

Laura: I would really like that, but I don’t know how.

Christoffer: Let’s give it a try.

The following week, Laura told me that this different state had faded after this conversation and that there had been no reactions from the voices. She was unable to point to any particular trigger for the event, but stated that she sometimes had experiences like that, seemingly out of the blue.

Guardian Spirits and Dreams

During our collaboration, we often discussed spiritual conceptual frameworks and particularly wondered how to make sense of the violent voices in such a light. Laura understood the spiritual realm to be full of love and in light of that, the voices’ assaults were difficult to comprehend. She also had an understanding that the souls of some deceased people could cling to the living and attempt to satisfy their own desires—for example, a desire for intoxication. Such spirits really ought to let go of this world. I made reference to widespread ideas in many cultures that the spiritual realm contains both helpful as well as dangerous forces, and that the individual often enjoys the protection of a guardian spirit. Perhaps some spirits are damaging, and humans may be particularly vulnerable to them if there is a problem with your guardian spirit or if something has happened with your mana? While we were entertaining such ideas, Laura had a recollection:

Laura: Actually, I had a strange dream. A long time ago, I dreamed that I was running along a path and a giant grey wolf was chasing me. I turn around and look into its eyes and see that… I get a feeling. I just can’t remember what it was, but then the wolf throws a fit. I get the feeling it doesn’t want to hurt me, but then it does anyway. It has an outburst of rage. Then I run down a path and a big green hill in bare feet and wearing a soiled white dress. I reach a rampart made of stones. I run past it and can feel the wolf hot on my heels. It is gigantic. Twice, thrice the size of a normal wolf. Then I reach a group of farmers holding pitchforks and torches. I run through the crowd, and they shield me from the wolf. Then I think I woke up. And the funny thing is that just recently I had another dream about this wolf. The head was on a spike, and it was blue. The eyes were still yellow. It was in a castle or something. I could see the spike through its mouth and then it spoke.

Christoffer: It was separated from the body?

Laura: Yes, it was only the head. And then it spoke.

Christoffer: Could you hear what it said?

Laura: No, I don’t remember it, but it said something. It was as if it was too far away for me to hear it, but I saw its mouth moving.

Christoffer: That means something!

Laura: The first dream felt extremely real, as if I was really running. I had the first dream just when I started hearing voices.

She didn’t know what to make of the dream, but it seemed intriguing that the dream of being chased by a wolf occurred just as the voices had started to speak to her. The second dream happened shortly before this conversation. We did consider the possible meaning of it at the time, for example whether it might reflect the bad relationship she was in leading up to the arrival of the voices, or if it had something to do with fear. It is also notable, however, that Laura recalls these dreams precisely in the context of speaking of guardian spirits.

One may interpret such a dream in several ways, whether one is partial to Freudian or Jungian frameworks. Nonetheless, I find the connection to guardian spirits particularly interesting, not least because Laura dreamed of a supernatural wolf again at a later time and because Laura received a message that the wolf was her guardian spirit while in an altered state of consciousness in connection with a meditation practice in 2022. In that case, her interaction with the wolf in these dreams should perhaps be understood very differently than as a metaphorical expression of her own fears.

Something Else for the Voices to Desire

In March 2020, Laura and I had arrived at a perception of her selves as being connected to various periods of her life, and that various voices co-existed with these selves in partially compartmentalized mental spaces. The violent voices who had assaulted Laura were now contained together with one of her past selves. It was all the pain and suffering at that time that had caused the compartmentalization as a way for Laura to protect herself. Thus, the attackers had been encapsulated. Our hypothesis was that a reunion of the selves could put Laura at risk of new attacks. We therefore needed a way to manage this group of voices before a reunion and healing was possible.

We now endeavored to solve this problem. Speaking about this, some voices opined that they had no interest in any deals and that I should mind my own business. This made me think of my collaboration with Alice (12). Alice’s voices were preoccupied with violence and gore, but Alice and I discovered that their bloodthirst could be sated by having them watch gory movies. We didn’t even have to watch it with them. I asked Laura; “would you say that these voices are attracted to things sexual or erotic?” which she confirmed. I described the experiences with Alice’s voices and continued,

Christoffer: As you have said, the problem with these voices is that you cannot lock the door on them or call the police. What to do, then? May I be frank here? This idea is forming in my head, but it may be outrageous or just far out. Would it be okay if I say something that sounds crazy, and if it doesn’t make any sense, then we just drop the idea?

Laura: You just go right ahead.  

Christoffer: Well, bloodthirsty voices like gory movies, so maybe voices with sexual interests like… erotic material? Not for us

[Editor’s Note: The following article begins with an excerpt from the author’s book, Losing the Atmosphere, A Memoir: A Baffling Disorder, a Search for Help, and the Therapist Who Understood, followed by a portion of the Afterword by her therapist, Jeffery Smith.]

The Saddest Present

“Do you got anything to tell me?” Wendy asked, her custom at the start of a session. It was late October, 1998. I looked at Jeffery trustingly, expecting his usual No.

“Yes,” he said softly, reluctantly.

“What is it?” Not Wendy’s confident voice, but someone’s who felt she was about to be dropped.

“I’m going to be away from December sixteenth to January fifth.”

Three weeks. A long moment of silence. Then Wendy again. “You know dose doll-babies I cut up with scissors a few years ago? I need to see them.”  

Jeffery lifted the couch seat and rummaged through the storage chest beneath. That was where he kept my blanket and pillow, crayons, and drawing pad, what made his office my special place for four hours — two double sessions — each week. I looked away, not wanting to see what else he stored there.

Hearing the lid close, I faced him. He handed me a small paper bag. I turned it upside down and tiny plastic body parts fell to the floor.

AlmostVivian had bought the dolls several years before, when I was still seeing both Sarah and Jeffery. It was during the time the babies on the bottom level were coming out often in sessions, alternately moaning and screaming. I listened and was amazed because I didn’t feel any torment. Sometimes, I tried to stop the sounds by choking the babies in me, putting my hands around my neck and squeezing so tightly I coughed. Jeffery would pry my hands off so I could breathe, telling me to let the sounds happen, that even though I didn’t know what they were about, someone in me did, and eventually I would, too.

But outside of session, I felt their neediness coursing through my veins, a hunger and yearning that could never be satisfied. I was sure that monster neediness would repel Sarah and Jeffery and I would lose them forever. I hated the babies and wanted to bash them out of me. I needed Sarah and Jeffery to know about the hate. It was too big for me to handle alone. On the walk home from work one evening, AlmostVivian got the idea of using dolls instead. She stopped at a toy store and bought their entire stock of miniature plastic babies, 12 of them. Each was about four inches tall, sealed in its own cellophane package, with dimples and blue eyes.

In my next session, which was with Sarah, I took the dolls and a pair of sharp scissors from my backpack. Laughing diabolically, I held the closed blades like a dagger and plunged them into a doll’s stomach. “I’m going to kill you!” I said, as I began cutting through the waist. It was a voice like that of TheOneWhoCursesCars but raging at the Inside babies instead of Outside people. The plastic was hard, and the scissor loops dug into my fingers. I kept cutting. When the doll’s body was severed, I pulled on her head. It came off with a popping sound. I tossed the three pieces aside and attacked the next doll.

At the same time that one part of me was gleefully plunging scissors into the guts of the dolls, another part was aware of Sarah, sitting silently on the floor with me. As if I were in her head, I knew she was uncomfortable. I also knew it troubled her to be uncomfortable, because she felt that as a therapist, she should understand and accept what I was doing. I didn’t want her to be uncomfortable. I needed her to talk in her gentle Mommy voice and look at me with the soft eyes that were ordinarily filled with love for me. I needed her to understand the desperation behind my lunatic laughter. But the more I butchered the dolls, the more uncomfortable she seemed.

Suddenly I felt dirty. Unacceptable. Sarah was good and pure. She believed in God and went to church. I stopped cutting, threw everything back into the paper bag — the three dolls I had mutilated, the nine still sealed in cellophane, the scissors — and stuffed the bag into my backpack. For a minute I looked at Sarah, not saying anything, trying to win her back with my eyes. She regarded me dubiously.

I felt my face get soft and my body relax. Then I heard Emily’s whisper. Young, trusting, shy. “Sarah?”

Sarah cocked her head and looked at me from a different angle.

“Sarah?” I whispered again.

The warmth came back into her eyes. “Emily?”

I slid my hand toward her along the floor. She took it in hers, and we locked eyes. “Hi, Sarah,” I said.

“Hi, Emily.” She smiled kindly at me. All was well again.

The next day, in my session with Jeffery, I continued the massacre.

“Somebody’s really angry at the babies,” he said.

Once I saw I didn’t repulse him, I let go, stabbing and cutting. “Now you’re going to die!" I growled.

Theoretically, I knew this killing spree wouldn’t free me from the babies. I also knew I was supposed to embrace and care for them, because they were part of me and needed to heal. But I didn’t want them to be part of me. Shrieking and giggling, I dismembered all but one, then stopped. If I destroyed the whole lot, how would I get them back when I was ready for them to heal? I tossed the last cellophane-wrapped doll to safety on the other side of the room, then snatched one of the severed heads off the floor and cut it into tiny slivers.

Several years had passed since then. The bottom level was less dominant, and I less needy. I had forgotten about the dolls until now, with Jeffery’s three-week absence looming. Looking at the body parts on the floor, I knew I had to fix the most broken baby — the one with her head in slivers — before he left, so I could take her home and care for her myself while he was away.

“Do you got any glue?” Wendy asked.

So began our routine for the next few weeks. At the beginning, middle, and end of each session, I glued one sliver of the baby’s face in place, allowing time for it to set, all the while joking about my pediatric trauma unit. It was painstaking work. I wouldn’t let Jeffery help but was glad he was there, watching each piece make the baby more whole.

I also asked questions.

“Are you going to be in another time zone?”

“Yes.”

“What airline are you taking?”

“I think it’s Tower.”

I had been expecting something like United or American. Those flew to many places in the United States. Tower went mostly across the Atlantic Ocean. Best not to ask where. “Make sure you’re careful.”

“I’ll be very careful.”

Things could happen even if he was careful. Dr. Welch died while he was on vacation in Europe. “Are you going to come back?”

“Yes.”

In our last session, before Jeffery left, I worried that I wouldn’t be able to hold onto the reality of his existence for three weeks. He said some of us knew he existed when I couldn’t see him. Others didn’t. “You need to set up a bucket brigade, so the ones of you who do know can pass the information to the ones who don’t.”

I liked that idea and sprawled on my stomach, crayons in hand, to draw 21 tiny buckets. I cut them out, wrote one date on each, and heaped them, like a pile of multicolored confetti, on top of the mended baby. She had scars on her face that would never go away, but she was whole.

Jeffery drew me a coupon: two stick figures, big and little, him and me, holding hands. There was a dotted line connecting their hearts, and a border around the whole picture.

“Is dat border because you and me are in the same world together, even if you can’t see me and I can’t see you?”

“That’s exactly right.”

“And even if you’re in a different place, you’re still the same person?”

“That’s exactly right. I’m me, and I never change on the inside even if I wear different clothes, or my voice sounds different, or I’m in a different place.”

When it was time to leave, I put everything into my backpack: mended baby, paper buckets, coupon. As I stood in the doorway, I realized Jeffery’s office would be empty for three weeks. That was scary. I hoped he wouldn’t die.

Atmosphere people never died. People in bodies did.

“Be very careful,” I whispered.

He nodded and waved.

We said goodbye three times and I backed out, holding him with my eyes until I closed the door.

For the first time since Jeffery started becoming more of a flesh-and-blood person than an Atmosphere person, all of us believed he existed, even though he was away. Every few days, we mailed a letter to his office, along with the cutout paper buckets for the days that had passed since the previous letter.

On the day he was scheduled to fly back — three days before my session — I visualized him in his body. He orders a drink when the flight attendant comes down the aisle. He rests it on his tray table while he reads a magazine. He gets in line for the bathroom. All day, I listened to the radio — for plane crashes. I worried that he wouldn’t be able to land because of the snow, even though most of it was in the Midwest.   

The phone rang late that evening.

“Hi, Vivian. It’s Jeffery. I’m back.” We had prearranged that he would call.

“Thank you for telling me,” I said, and we hung up.

I played his words over and over in my head. Was his voice different? Was he the same person?

Tuesday came at last. To avoid seeing the patient before me leave, I walked through the waiting room to hide in the kitchen, as had long been my custom. Soon I heard the first in the usual sequence of sounds. The door to his office. Next, the hall door. He or she was gone. Now the noise of the sliding-door closet in the waiting room. I peeked out. He was standing in front of the closet. In a body-shape; Jeffery, yet not Jeffery. He took off his shoes and put on another pair. So that’s where he hid the new ones that upset me. I knew I should step back, because he would pass the kitchen door on his way to the next sound: the bathroom. But I ran into the waiting room.

“I saw you!” I laughed, jumping up and down. “I saw you go into the closet and change your shoes.”

Jeffery looked momentarily surprised. Then he smiled, a wide smile that deepened the crinkles in the corners of his eyes “Hi, Vivian.”

“Are you really back?”

“Yup. It’s me.” His smile got bigger.

He’s obviously happy to see me. I’m glad he’s happy. I’m devastated he’s happy. His happiness is proof that he wasn’t with me in the atmosphere all along. I hate him. I love him. I hate him. I punched him in the arm.

Still, he smiled.

“So, how are you?” I said, a little girl trying out sophisticated talk. It sounded funny. I giggled and tried another phrase. “Nice to see you.” Oh my god. That’s what you say to someone who has been away. The scary words kept tumbling out of me. “How was your trip? It’s been a long time.” He smiled. I wanted to cry. I punched him again and giggled some more.  

I tried to frame him in a familiar context, but nothing fit. He wasn’t the Atmosphere Jeffery because he didn’t know everything I thought and felt and did while he was gone. Yet he connected eyes with me in the old way. But he was in a physical body and his body had probably been across an ocean. Could the Jeffery who smiled at me now be continuous with the Jeffery who had waved goodbye three weeks ago?

I spent the entire session trying to merge the before and after Jefferys; I looked for the mole he used to have on his forehead. It was still there. Most of all, I kept checking his voice and eyes. The old Jeffery was in both. Yet I couldn’t settle and never got to tell him all the things I had saved up. I left feeling empty and cheated.

When I got home, I wrote a letter that I mailed the following day.

You think you came back, but you didn’t. Your smile came back, but not your insides to our insides… You can’t expect to take up from where we left off….  

Over the next few months, as Jeffery’s presence in the Atmosphere continued to fade, the entire Atmosphere began to lose potency. Though Sarah and Marybeth were still in it, their essences were weak, not enough to sustain me. There were major upsets over minor events. Jeffery forgot to call when he said he would, or he remembered to call but his voice was ever-so-slightly hurried; either way, I was sure he hated me, and I had lost him forever. Jeffery wore a new sweater; this evidence that he went to a store or received a gift meant he was gone from the Atmosphere, and I had lost him forever. Jeffery changed my session from Fridays to Thursdays so his weekends could begin earlier; it was clear I was a burden to him and had lost him forever.

With each incident, I felt betrayed anew. “I HATE YOU!” the angry ones screamed. The hurt ones whined. “You said you would call, and you forgot. You shouldn’t say something if you can’t do it.” The abandoned ones became paralyzed and mute. Each time, Jeffery reassured me that I hadn’t lost him, and he hadn’t changed. Only my perception of him had changed. Each time, I would feel better. Until the next time.    

The more Jeffery became real as a flesh-and-blood person, the more self-conscious I was about the nonsense syllables and noises that had seemed natural and acceptable before. But I was unable to talk about Inside concerns in regular English words, so I filled long stretches of my sessions with prattle about Outside happenings: my boss was being fired; the traffic on the way to his office had been horrendous. All the while, Inside yearned for the kind of connection I used to have with the old Jeffery.

I brought a computer to a session and found I could type what I couldn’t say out loud. Jeffery answered either by typing back or talking, depending on what I indicated I wanted. This became our new method of communication. Often, I didn’t know what I was going to say until I saw the words appear on the screen. It was as if they flowed from my fingertips, bypassing my brain.

One day I wrote about what I considered Jeffery’s shortcomings as a skin-container person, and how much I missed his Atmosphere version. I finished typing and handed him the computer. When he lowered his eyes to the screen to read, I took the opportunity to scrutinize his body. Who was this person trying so hard to reach me? I looked for things that would make him real and found them in comforting imperfections: a small hole in his sock, one unruly gray hair sticking out of his thick black eyebrows, an ink spot on his shirt pocket. He typed something, then held out the computer to me.

I’m a skin person, but I’m a lot more like an atmosphere person than what you think of as a skin person. Because you think of a skin person as somebody who drops you. Somebody who breaks the connection with you. I’m not the kind of skin person who does that.   

I looked up to see a sincere face that matched the words. His eyes met mine and held them, and I felt a tiny bit of the connection I used to feel with the Atmosphere-like Jeffery. At the same time, I was aware that he was not in the Atmosphere. The eyebrow hair was still sticking out.

Only Wendy could report in out loud words about anything that mattered to Inside. Before I had this new conception of Jeffery, she used to appear just at the beginning of sessions, a scout checking for potentially dangerous skin-world manifestations in the otherwise Atmosphere-like Jeffery. But with Jeffery rarely in the Atmosphere anymore, Wendy now stayed out for most of the session, a lone soldier on the front line, and no one else got a chance to be with him. At first, because Wendy was perky and chatted freely, Jeffery thought I was adapting well to my new perception of him.

“Wanna hear a joke I heard on the radio?” Wendy asked one day in her saucy little-girl voice.

“Sure,” Jeffery said.

“What’s the difference between an HMO and the PLO?”

“I give up.”

“You can negotiate with the PLO.”

Wendy was delighted when Jeffery laughed.

“I know a joke, too,” he said.

Jeffery had never told us a joke before. Atmosphere people didn’t joke. “What is it?” she asked, trying to maintain a cheerful voice

“How can you recognize a happy motorcyclist?”

“I give up.”

“He’s the one with dead bugs on his teeth.”

Wendy managed the required giggle, but there was an earthquake Inside. Jeffery had violated a boundary, crossed further into skin territory than Wendy could protect us against. Her giggle stopped abruptly, and she punched him in the arm. “You’re not supposed to tell jokes,” she said angrily. “Only we’re allowed to tell jokes.”  

His face turned serious. “I’m sorry. I won’t do it again.”

“And don’t smile! Don’t act glad to see us when you first come in.” She punched him in the other arm. “That’s just to make it even,” she said in a more gentle voice, “so your arms will be balanced.”

We had had the conversation about smiles many times. Jeffery knew we saw his smile as proof that he was seeing us for the first time after a break. If he had been in the Atmosphere, there wouldn’t have been any breaks. “It’s good to remind me,” he said.

I did keep reminding him — about his smile, his tone of voice, his mannerisms — in an attempt to preserve what little remained of the Atmosphere. I still needed it for time-outs from the real world, though it wasn’t as soothing as it used to be.

Atmosphere people were no longer pure essences, so completely mingled with mine that I never felt self-conscious about anything I did. Now they were separate, looking down on me from someplace near the ceiling, where they hovered in invisible bodies. “Alone” in my apartment, I was embarrassed when I pulled my pants down to sit on the toilet, because they could see me. Once, when I was cooking fish, I opened the window to get rid of the smell — not for me, but for them. I felt foolish whenever I did things like that, yet I kept doing them.

The only times I felt satisfyingly connected to Jeffery were when we had toast, my ultimate comfort food. He let me keep supplies in his kitchen: a toaster on the counter, a loaf of artisanal white bread and a stick of butter in the refrigerator. We developed a ritual of having toast at the beginning and end of each session “Breaking bread together,” Wendy called it. She was usually the one who ate with him, chatting, using big words, playfully comparing the designs his bites and hers made in our slices. Jeffery and I may have been separate people, but we were having the same sensations of taste, smell, and crunch.

Four months after his Tower Air Christmas vacation, in the last week of April 1999, Jeffery and I were sitting on the floor in the kitchen at the start of a session.

“Do you got anything to tell me?” Wendy asked.

“Yes.”

I stiffened and waited.

“I won’t be here next Thursday.”

I felt a stab. “Did you forget it was my birthday Friday?” We had planned to celebrate during our Thursday session. The stab went so deep, I couldn’t even punch him. I inched backward until I felt the wall behind me, then slumped forward, head between my knees.

“I’m sorry,” Jeffery said.

He did sound sorry. I looked up to see him sitting cross-legged on the mat.

“I hate you!” screamed an angry voice. “You forgot my birthday,” whispered a devastated one. I punched his arm several times. He pressed his arms into his sides but didn’t flinch.

It suddenly struck me that all this was ridiculous. My body would be 57 next week and I was carrying on like a three-year-old having a tantrum. Jeffery wasn’t an Atmosphere that had deserted me. He was an ordinary human being, the kind you might see in the supermarket, but a very wonderful human being. It was rare that he missed a session. He must have something he really needed to do, and I was making it so difficult. Part of me was still upset. Another part felt a surge of love for him.

While one voice was whining, “It was gonna be my birthday,” another voice, grownup and calm, interrupted with, “Wait. I think it’s time to give you a present.”   

Jeffery looked at me quizzically. I reached for my computer and began typing.

…When you are a baby, you would never think of giving your mother a present, because your mother just IS. She is part of you, and you are part of her. But when you get a little bigger, you realize your mommy is a separate person, and she can get glad at you, and she can get mad at you. That is very scary. Now you have to do things to make her like you, or you will use her up. When you realize, you are supposed to buy your mother a present for Mother’s Day, you cross into a whole different dimension. You lost something you will never get back.

I passed the computer to Jeffery. He read. But before he could type an answer, I took it again and continued writing.

We never thought of you as someone we needed to give a present to. But last weekend, something made us know that now we did. We remembered when you used to say you needed to be seen. And we knew you would be seen if we gave you a present. So, we walked up and down the booths of the Columbus Avenue crafts fair, and then we saw a very special puzzle box with a secret compartment… When we were packing up the shopping bag to come here tonight, we put the box in, and we were very depressed about it. Then we forgot it was there — until we just got so upset when you asked us to change the session next week when it is our birthday. We realized we were right. It’s time to give you a present. It’s the saddest present we ever gave. But it’s also a very nice present.

I handed the computer to Jeffery. This time, when he finished reading, I reached inside the shopping bag and passed him a small package wrapped in white tissue paper. Jeffery held it in his hand and looked at me, as if he didn’t know what to do.

“Open it!” I commanded.

Rigid with anticipation, I watched him unwrap the layers of tissue. When at last he held the round box in his hand, he still didn’t say anything. He just turned it over slowly examining the top, the bottom, the side. But I saw that he was admiring the graceful streaks of dark brown grain running through the blonde wood, polished as smooth as satin.

“Take it apart,” I instructed. “The side piece first.”

He fingered the side, then slid it up. It came off in the shape of a crescent moon. He slid the top off sideways to reveal another cutout piece underneath. I watched his face and was thrilled to see his appreciation deepen as he lifted the last piece and discovered the hidden compartment, lined with dark brown felt. It was a truly magical box, small enough to fit in the palm of your hand, large enough to hold a secret.

“Thank you,” he said, looking up. “It’s a very beautiful box.”

I felt powerful — and grownup. I had given Jeffery a present that made him happy. I had let him know I saw him. But underneath, a deep sadness started to roll over me. Before it completely engulfed me, Wendy, always close to the surface, popped out. “I think it’s time to have some toast,” she said gaily.

“Good idea,” Jeffery agreed.

Retracing the Human Journey of Attachment

from the Afterword by Jeffery Smith, MD- Vivian's Therapist   

Losing the Atmosphere is more than an account of living with multiple personalities. In telling her story, Vivian opens a window into the drama of early attachment: how, during our first three years, we become connected to our caregivers and, through those connections, gain awareness of ourselves and begin to forge the capacity to cope with strong emotions.  

The best way I have of understanding Vivian’s Atmosphere is to think about the experience of birth. After existing in the insulated, warm, muffled environment of the womb, humans are suddenly ejected into a world with loud sounds, sharp sensations on the skin, and cold air. The shock must be enormous. Now imagine a protected childlike Vivian facing the emotional equivalent of birth. The Atmosphere was ever-present, existing in the form of molecules intermingled with hers, so there was total, immersive contact. This womblike protection kept her from ever experiencing aloneness. Any fear was met with a reassuring presence; emotional pain was instantly understood and thus barely felt. After years of being surrounded by this protective Atmosphere of benevolent beings with no needs of their own, constantly attuned to the feelings of one small girl, she is suddenly subjected to the harshness of raw emotions.

Losing the Atmosphere is about encountering, for the first time, fear, pain, and separateness. We have all gone through these very experiences but so long ago that they lie beyond the reach of memory. Because Vivian’s self was split into separate parts, and because some parts were shielded from these universal experiences until adulthood, she is able to give a firsthand account of a journey we all make on the way to becoming attached and emerging as social beings.   

This material is excerpted from Losing the Atmosphere, A Memoir: A Baffling Disorder, a Search for Help, and the Therapist Who Understood, by Vivian Conan, and re-printed here with explicit permission of the publisher, Greenpoint Press.