Even a small taste

In a psych-rotation simulation this spring, I wore a headset that played a layered loop of voices for half an hour. The point was to try to do basic tasks while a chorus of negative, overlapping commentary ran in your ears. I expected to handle it clinically. I had read the literature. I had real empathy for what patients with auditory hallucinations go through.

The hardest part was that there was no break. Not a long quiet stretch where the voices receded, just the constant pressure of having to work harder than usual to hold a thought. My attention scattered in a way that felt familiar but more extreme. I noticed myself reaching for the same coping moves I use in normal life. Some of them helped. Some of them were just autopilot.

Knowing that hallucinations are distressing is one thing. Trying to hold a conversation while they are happening is another. After half an hour I had a felt sense of why some patients I’d seen on the unit looked checked out, or why a routine intake question seemed to land at the wrong angle. I would not call that empathy. It is closer to a tax I now know is being paid.

The clinical move that follows is not to ask more questions or push for more information. It is to be a quieter presence in the room. Reduce sensory load. Speak less. Match the pace.