Perhaps I had an ear infection. I spent my breaks in front of a sink, trying to slosh them out with water. I blew my nose, repeatedly, in case it was my sinuses. I knew that meditation has been found to physically alter the structure of the brain. Could some sort of accidental neurological fracture really have taken place over such a short period? More likely, I was imagining things: the isolation and the tofu lunches must’ve got to me. But as I lay in bed on the penultimate night, I could make out five separate tones, five mechanical screams, five blue lasers of searing din firing from somewhere in my cochleae to the deep interior of my brain. I squeezed a pair of ear plugs in. I couldn’t sleep. I just lay there, listening to the cold symphony, trying to tell myself that I’d get used to it, that maybe it would stop, you know, just switch off, get better…
Tinnitus doesn’t get better. I already knew this – I’d read it somewhere, in a newspaper. For at least seven years, I’d been aware of a single, faint tone, loud enough to be perceptible in the stilled minutes before lights-out, but sufficiently subtle to mostly ignore. Occasionally it would disappear entirely. Around the time it first sang itself into existence, I read an account written by a sufferer. He said tinnitus occurs when the tiny vibrating hairs in your ear snap and stick to the floor, thus emitting a constant racket. They’re microscopic: you can’t mend them. And – and this bit was so disturbing, it left me instantly haunted – he said tinnitus can trick you. It can appear to fade away, sometimes for extended periods, before cruelly roaring back into life, louder than ever, and no one knows why.
At the end of the retreat, when our vow of silence had been lifted, I sat down with one of the Buddhist staffers who, when she wasn’t generating equanimity and boiled tofu on top of a secluded mountain, was a nurse. As we settled on a weather-beaten bench near a koi-filled pond, I was still convinced I was being silly. Who’d ever heard of meditation making tinnitus worse?
“It has been heard of,” she nodded, reluctantly. “But meditation hasn’t made it worse. Over the ten days, you’ve been increasing your awareness, and you’re now more aware of your tinnitus. But you must remember what you’ve been taught: if awareness and equanimity are not of equal size and strength, the bird cannot fly. Everything in life arises only to pass away. ”
Somewhere in amongst the shrieking beams of sound that were criss-crossing the inside of my my skull, there was the mind of a man who was quickly becoming furious. I lowered my voice and leaned towards her.
“But tinnitus doesn’t ‘pass away’,” I said. “That’s the whole bloody point of it.”
She sighed, smiled beatifically and, looking down upon me with all the aching pity of an angel watching a faithless wretch being cast to the fires, said, “I suggest you do some more work on your equanimity. I can hear it in your voice: “It doesn’t pass away”. What have you been learning for the last ten days?”
It’s probably illegal in about ten different ways to punch a Buddhist, so I slunk off, unreconstructed and scared, with the iPod I’d been looking forward to playing stowed safely in my bag, where it couldn’t do any more damage to my slain ear-hairs. I went home and I didn’t sleep.
I didn’t work, either. I’d made a solemn vow never to meditate again and the five tones responded well by coalescing back into a single shriek. But it was still louder than ever. I’d sit in front of my desk in my small office, listening. It was almost as if it was being emitted by something electric; like the sound of static that used to radiate from the boxy televisions of my youth.
Hope’s cruelty lies in it’s power to blind; to seduce us into humiliating acts of faith. When you’re outside looking in, it’s often easy to see how nakedly pitiful another’s optimism can be, especially in matters of health. But I really thought I might’ve had it solved, that day, as I pushed my ear up to my computer monitor and the speakers of my stereo, just in case it was them. I switched everything off and on again. I pulled out all the plugs. Then, reluctantly, dreadfully, I sealed my ear canals with the tips of my fingers. And there it was. Just like last night, and the night before that: eeeeeeeeeeeeeeeeeeeeeeeeeeeeee
After hearing that tinnitus can be caused by accumulations of ear wax, I booked an appointment with my doctor. Peering into my head through some sort of auricular telescope, he murmured, “Yes, you do seem to have a layer of wax covering your ear drum.” I felt a giddy wash of excitement, as he took a large metal syringe, filled it with warm water and flushed by skull out. I had an urge to giggle, as if the liquid was giving my homunculus a tickle. Cradled to my neck was a kidney-shaped dish, into which dropped a browny-yellow plug about the size of a dice. (In my memory, it’s hairy, but I’m sure it probably wasn’t). I was sickened: humiliated, as we always are, by gory reminders of our animal nature. “That’s disgusting,” I said, by way of an apology. But I was also thrilled. Of course that’s what was causing the ringing. How could you be carrying that around inside your own head and not expect some deleterious effect or other? But the doctor shrugged. “That’s pretty normal, actually.” I’d been mugged by hope again. I glumly concluded that the meditation and the five-tone orchestra of blank screaming must’ve been a coincidence after all. Then I went home, and I didn’t sleep.
***
And there was more. Flanagan went onto explain that although, just as I’d read, tinnitus can begin with broken hairs, it’s not their sticking to the wall of the cochlea that causes the sound, but an abnormal signal the brain sends through a rogue neural pathway (whose actual purpose is, intriguingly, a mystery). This pathway leads directly to the limbic system, whose central function is related to emotions. “Almost always, if you get stressed or anxious, it’s like a volume control. It cranks the tinnitus up.”
“I was very stressed and anxious,” I told him. “It was one of the worst things I’ve ever done.”
“Well there you are,” he said. “Now, you say you’ve had some ringing for seven years or so. Was there any trauma that caused it originally?”
The answer to that is also yes. Trauma, definitely. Lots of it. I spent my youth and early adulthood deliberately assaulting myself with as much noise as possible. It started in the mid-eighties with a pillar-box red plastic Walkman the size of a bible, with which I’d commune with my own Gods, Adam Ant, Duran Duran and Nik Kershaw. Then came puberty and heavy metal and the new kind of headphones that stick directly into your ear canals. And then drinking and sex and having my heart broken. That’s when the trauma really began.
For reasons that still confuse me, from the day the first grain of manly grit made itself heard in my voice-box, up until 2002, when I met my current partner, I lived my life in a condition of almost constant romantic dereliction. Again and again, I was cuckolded, dumped and unrequited. I fell in love with cutters, paranoiacs and a girl prone to violence who eventually tried to kill herself. It went on and on. What this Satanic carousel of unholy relationships has to do with tinnitus is this: music, my most effective method of coping.
The moment I found the perfect song for the crisis was the moment I knew I’d get through it. If the lyrics verbalised what I thought and the melody described what I felt, I had it – on repeat; over and over and over and over. Repetition is the soul of pop because it induces a strange and magical hypnotism through which the sound and the hurt become indistinguishable. The music meshes with the pain and then it lifts it from you; it takes it’s weight. In some essential way, the song becomes you. And the louder the volume, the greater the effect. Whether it was the rock ballads of my teens or the alternative-country of my mid-twenties, I always found the most efficient tool for hammering the heart back together was the decibel. Today, like a de-tuned radio picking-up the distant echo of the big bang, I can still hear the noise of all that dead love. And I think it only right and proper that it sounds like a scream.
But that’s not what I tell the doctor. To him, I just say, “I used to listen to headphones.”
He puts me through a series of simple examinations, which involve placing a donged tuning fork on top of my head and looking down my ears and, whilst he does, entertains me with some facts about the condition. For a start, almost everyone has it. Back in 1953 researchers Heller and Bergman placed 80 apparently tinnitus-free students in a soundproof booth and 93% reported a buzzing, pulsing or whistling. A certain level of aurally-generated white noise is thought to be normal, as it blocks out the background and helps us concentrate on the sounds we want to. Between 15% and 18% of the population has some degree of ‘pathological’ tinnitus, and between one and two percent of that will experience it as ‘intrusive’. The most common variety is the high-pitched squeal, but heartbeats, machinery noises, clicking and popping are also reported. Some people’s tinnitus sounds so similar to the dry sawing of cicadas that it’s not uncommon for it not to occur to them, for many years, that anything’s wrong. “They’ll turn to their husbands and go, ‘These cicadas are everywhere. We’ve come to Thailand and they’re still here’. That’s when they realise they have a problem.”
And the problem can be torture. Occasionally, Dr Flanagan will immediately refer a patient to a psychiatrist. “It’s not that infrequent that someone will say, ‘I’m not really serious, but if this doesn’t get better, I could kill myself’. There’s a few people a year who do. That’s not necessarily only because of the tinnitus, but it is a large part of it.”
With my tests over, the doctor declares me well.
“The hearing in your right ear is slightly less than the hearing in your left, but I can’t find any physical condition that might be causing it. The best case scenario is that the brain eventually realises what is – it’s a bit annoying but it doesn’t worry about it too much. But if it’s getting to the stage where it starts to get intrusive and you’re worrying about it, then sound therapy is the way to go.”
I tell him I’ve already looked into sound therapy. It seemed to amount to collection of CD’s of the wind and retailed at $660. But Dr Flanagan says I could just as easily sleep with the window open, and listen to the distant crashing of the waves outside our unit. This, says the theory, will help train the brain away from using it’s ‘abnormal pathway’, that whistling pipe of evil that goes straight from the ear to my emotions.
“And the next step would be tinnitus retraining therapy and cognitive behavioural therapy, which has about an 80% success rate. You’re the perfect person for CBT as your hearing is essentially normal. But the important thing to know is that it doesn’t turn off. It’ll always be there. And you need to stop using ear-plugs at night – you’re encouraging the abnormal pathway. The cure is not silence.”
I thanked Dr Flanagan, excited about my first guilt-free iPod session in a very long time. Then I went home, and I didn’t sleep.
***
“A lot of people have had negative counseling, whether it’s through the internet, friends or health professionals,” she told me. “They’ve been given this perception that nothing can be done and that it’s going to get worse, and that drives the brain. It’s thinking ‘Oh my goodness this is a threat’ and it’s going to keep monitoring it. What we do is try and reverse that.”
What Harasymczuk was saying is that the newspaper report I read, all those years ago, which described tinnitus as immortal and devious, just waiting for the moment to rear-up and throw an even more deafening sonic sack over my head, could be the reason why I’ve found it so hard to ignore. It’s made my neural systems react to the sound with spotlights and sirens when a more useful response would be a bored shrug of the synaptic shoulders. The proper term for the latter response is ‘habituation’. We’re habituated, for example, to the sensation of the elastic in our underpants clinging to our skin. It’s there, all the time, but we just don’t notice it. What I need to do is, then, somehow develop a pantesque response to my ringing.
The first step in the process is learning the neurophysiological model of the condition. Understanding, in other words, the science of the limbic noise-pipe and the consequences of the mind’s treating it as a threat. I quickly realise that its true – I’ve come to view my tinnitus irrationally, as a living enemy. It has a soul; it has a purpose; it has a name and a shape; it came from somewhere with a secret armoury of dark strategies that won’t reveal themselves until they’re put into action; until I awake, one future morning, sufficiently tortured that I’ll think, for the first time, “I’m not really serious, but if this doesn’t get better…”. What I’m engaged in is a genuine war. The point of TRT is to remind us that we’re not. It pulls up the blinds and de-fangs the monster. It bores it into the daylight with photocopied fact-sheets containing flow-charts and acronyms and sentences that end with the words, ‘sympathetic arousal of the autonomic nervous system.’ And it’s surprisingly effective.
The next stage is the CBT – the surprisingly bizarre practise of thinking about thinking. CBT reminds us that it’s often not the situation that’s destructive, but our response to it. And those responses are often borne of irrational thoughts. Indeed, research has shown that some people have tumultuously thunderous tinnitus and yet react to it in a way that would make the equanimous Blue Mountain meditators break out a congratulatory slab of tofu. Others may have a whisper that sends them insane. CBT seeks to turn the former into the latter. When the full glistening irony of this finally presents itself, it’s all I can do not to gasp: in effect, if not in practise, CBT seeks to make Buddhists of us all. I have come full circle.
It’s Harasymczuk’s job to expose the patient’s illogical, automatic thoughts. Sometimes, for example, even if they’re not consciously aware of it, they’ll believe their tinnitus to be the symptom of a tumour. Others imagine it’ll stop them playing with their children, socialising, or enjoying life at all. Once these unhelpful beliefs are revealed as false, they’ll be bombarded with positivity. “For instance, somebody might say ‘I hear my tinnitus 24 hours a day’. And then I ask it ‘Do you hear when you’re asleep? No? So it’s not 24 hours a day. Do you hear it when you’re engrossed on the computer? No?’ They start to become aware that their original thought isn’t actually based on fact.”
“But some facts are accurate, and they’re not all positive,” I said.
“There are constructive ways of thinking about most situations,” she said. “We’re changing their perspective, giving them a choice about the effect the tinnitus has on them. Ultimately when they start to be have more neutral thoughts, we see a big change in their response to it.”
***
And beneath even that, I could sense some darker, larger and more fugitive fears, ones that lumbered about with fuzzy outlines and indistinct shapes, that were brought to life by all this thinking about not hearing silence ‘forever’. They were to do with death, I suspect, and they scared me more than anything.
I spent some time dispassionately peering at these ‘automatic’ thoughts, just as my GP had peered into my head all those weeks ago with his auricular telescope. I studied the neurophysiological model and took out my earplugs. I began going to bed with the window open. And to my amazement, the effect was almost instantaneous. It’s not gone, of course. But it’s mostly back to the manageable level it was before the retreat. But writing about it is making it worse, causing the sirens to sound and the spotlights to search as the elastic tightens around my waist. I can hear it now, slightly louder in the right, eeeeee’ing at me in it’s exhaustingly inexhaustible way. So if you don’t mind, I’m going to stop now, before I spoil my newly rediscovered ability to finally, finally go to sleep.
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Words & photos copyright 2005-2010 Will Storr
