Voices in My Head: Navigating Mental Health Challenges and Emotional Turmoil

I constantly hear voices in my head, and my emotions fluctuate dramatically?

Hello, doctor.
Since I was a child, I have had the impression that there are voices in my head talking to me.
At first, I thought everyone experienced this, so I would directly converse with them.
Later, when asked why I was talking to the air, I realized it wasn't normal, so I tried to restrain myself from speaking out loud and switched to having conversations with them in my mind.
However, I am still often influenced by them, crying or suddenly laughing.
They are people I know.
I understand they are not real, but I still cannot control their voices that continuously speak to me in my head.
The situations vary: sometimes I talk to one of them, sometimes to a group, and sometimes I hear two of them talking.
The words I say might be what one of them is saying, and they might discuss me as well.
Sometimes a scene appears, or it might just be simple conversations, often about past events or imagined future scenarios.
At 14, I suddenly started feeling sad for no reason.
I often wished for an end to my life, feeling very lonely, especially when no one spoke to me in class.
I constantly felt sad, hopeless about life, questioning why I was so inadequate and why I couldn't do anything right.
It was around this time that I began to self-harm, hoping that pain would remind me that I was still alive.
The voices in my head would also tell me to die or try to persuade me to do so.
There is one voice that has a distinct appearance and name, but in everyday life, I can still maintain my composure when talking to others, smiling and responding to them, even being overly energetic at times, jumping around and being told I'm too loud, constantly chattering away.
Later, I fell into depression, and the duration of these episodes grew longer.
Initially, when I was alone, I could maintain my sanity for a while, but now, as soon as I separate from others, I can go from laughing to being overwhelmed by emotions, even experiencing emotional breakdowns in front of friends.
Once, I attempted suicide but was pulled back.
During high school, I did not meet everyone's expectations and get into my first-choice school, even deliberately crossing districts to use resources from Taipei.
I wondered why I was still so foolish.
I truly feel like a failure, unable to accomplish anything.
I don't know if I really have a mental illness, but these thoughts are affecting my life.
During exams, my mind feels like a party, constantly talking to me, jumping from one thought to another, making me feel like a burden to others, irritable and neurotic.
I find my existence disgusting.
I often imagine conversations between my boyfriend and his friends, like, "Isn't it exhausting to date a girl with issues?" They are all medical students.
I feel like I'm nothing.
With less than a year until the college entrance exam, I worry if my results will justify the resources the government has invested in schools.
Will I be able to support myself in the future? Am I just going to disappoint others? I feel so anxious.
Every day, I want to die, not wanting to do anything but cry.
Am I really not a normal person?

Li, 10~19 year old female. Ask Date: 2022/02/12

Dr. Lin Mianzhang reply Psychiatry

Hello Li,
It appears that you are experiencing auditory hallucinations and may also be dealing with depression.
I recommend that you seek medical attention from a psychiatrist as soon as possible.
With medication and psychotherapy, these conditions can significantly improve! Once these issues are addressed, your academic performance will naturally improve as well.
Wishing you a speedy recovery.

Reply Date: 2022/02/12

More Info

It sounds like you are experiencing a complex and distressing situation that involves auditory hallucinations, emotional turmoil, and self-destructive thoughts. The voices you describe, which seem to engage in conversations with you and influence your emotions, can be indicative of a mental health condition that requires professional evaluation. It's important to understand that you are not alone in this experience, and many people face similar challenges.

The voices you hear may not be typical self-talk; they could represent a more severe psychological issue, such as a dissociative disorder or a form of psychosis. The fact that these voices can lead you to self-harm and suicidal thoughts is particularly concerning and suggests that you may be dealing with significant emotional distress. It's crucial to seek help from a mental health professional who can provide a thorough assessment and develop a treatment plan tailored to your needs.

Your feelings of worthlessness and hopelessness, especially during moments of solitude, are common symptoms of depression. The emotional rollercoaster you experience—where you can be lively and engaging one moment and then plunged into despair the next—can be exhausting and confusing. This fluctuation in mood, coupled with the pressure of academic expectations and the fear of disappointing others, can exacerbate your mental health struggles.

It's also noteworthy that you mentioned self-harm as a coping mechanism. While it may provide temporary relief, it is not a healthy way to manage emotional pain. Instead, it is essential to explore healthier coping strategies, such as talking to someone you trust, engaging in creative outlets, or practicing mindfulness and relaxation techniques.

The anxiety you feel about your future and your academic performance is understandable, especially given the societal pressures placed on students. However, it's important to remember that your worth is not solely defined by your academic achievements. Seeking support from school counselors, trusted teachers, or mental health professionals can help you navigate these feelings and develop a more balanced perspective on your self-worth.

In terms of treatment, a combination of therapy and medication may be beneficial. Cognitive-behavioral therapy (CBT) is particularly effective for addressing negative thought patterns and developing healthier coping mechanisms. Medications, such as antidepressants or antipsychotics, may also be prescribed to help manage symptoms. It's essential to have an open dialogue with your healthcare provider about your concerns regarding medication side effects, as there are many options available that can minimize unwanted effects.

Lastly, I encourage you to reach out for help. Whether it's confiding in a friend, family member, or mental health professional, taking that first step can be incredibly empowering. You deserve support and understanding as you navigate these challenges. Remember, seeking help is a sign of strength, and there are people who want to help you find a path toward healing and stability.

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