Make the Choice You Can

When I first started grappling with hyperacusis, a specialist explained that I was showing signs of what doctors call “loudness hyperacusis” and “pain hyperacusis.” He also warned me that patients often progress to experience more forms of hyperacusis, including what they call “annoyance hyperacusis” and “fear hyperacusis.” Understanding the differences, he urged, could help me engage and improve my symptoms. 

That doctor offered me a map of the world that opened up possibilities to make choices. I think he knew I wanted to choose for this sudden neurological fluke to go away. But that wasn’t the choice I was offered. Instead, I could use an understanding of the four kinds of hyperacusis to help my condition not worsen while we worked to improve my functioning.

4 Kinds of Hyperacusis

Loudness hyperacusis is like a form of super hearing where even moderate sounds are experienced as too loud, causing discomfort, disorientation, and often an exaggerated startle response. Pain hyperacusis seems functionally different, involving pain receptors in auditory processing. That means sounds don’t just sound louder than normal, but stabbing or jabbing pains accompany sound conduction. 

I was experiencing these at onset. But there were others I needed to understand. 

Annoyance hyperacusis often develops with prolonged experience of loudness hyperacusis, exhibited by adverse emotional reactions to sounds. Dread, anxiety, and irritability can quickly develop when the world around you feels too loud. That meant with my loudness hyperacusis, I needed to engage and care for my emotional health, addressing and being aware of my emotional responses to sounds so I didn’t develop ingrained emotional patterns that would be hard to unravel. Fear hyperacusis seems to be a kind of hyperacusis that could affect me even in the absence of sounds, generating fear and avoidance of sounds because of my negative associations. That doctor helped me understand that my condition left me vulnerable to fear and withdrawal.

In the setting of this neurological challenge, the potential for unaddressed pain and emotion to turn into fear and self-defeating choices was put on display.

But I think that is true for all of us. Unaddressed pain and unprocessed emotions turn into fear and self-defeating choices for everyone.

It was like an echo of what I learned from a psychologist who mentored me in college. We were exploring mental health issues whose flare-ups and episodes left lasting detrimental impacts on the brain. Like many health conditions, the prognosis of some mental illnesses varies depending on early detection and treatment. At the time, I was reading An Unquiet Mind by Kay Redfield Jamison, adapting part of her captivating memoir of living with bipolar disorder to perform as a member of our collegiate competitive debate and speech team. On one of the rare college speech competition trips, I recall attempting to embody Dr. Jamison in a monologue that only the life of a bipolar clinical psychologist could produce.

One truth left an indelible mark on my psyche as I tried to bring that performance to life: make the choice you can.

Some days, when that manic energy would begin to rise, Kay would have a sense something might be off. The first warning bell is often quiet, but it rings while you still have the power to choose. The choice to ask a friend for perspective. The choice to step back from a situation that could make things worse. Whether Dr. Jamison meant it that way or not, the message I heard was “you can say ‘I’ll pull back later.’ but later isn’t guaranteed. If you can pull back now, now is the time to do it. Later, you may not have the strength, the awareness, the sanity.”

Whether we’re dealing with neurological, genetic, situational, or interpersonal challenges, we can be tempted to stew in our emotions, to snooze the early warning bells that something is wrong. But when we do that, we often abdicate our opportunity to make an intentional choice, surrendering to the overwhelm, mania, panic, or despair that develops in the crock pot of un-dealt-with feelings.

Make the Choice You Can

But what does it mean to make the choice you can when early alarm bells go off? What if relationships, projects, and situations keep catching fire around us?

 In the context of my hyperacusis, that helpful doctor who reminded me there were four types of hyperacusis nudged me to participate in whatever small ways I could to reduce progress from loudness and pain, into annoyance and fear. I didn’t have control of my body’s sudden shift in auditory processing, but I could take steps to shovel the emotional snowfall while it came down rather than waiting until I was snowed in, trapped in an escalated neurological state harder to dig out later.

Sometimes, shoveling emotional snow is about ourselves. We can choose to pay attention to the flutters of insecurity, resentment, anger, or sadness when they show up rather than denying they’re there. For example, if a colleague’s snub makes me feel invisible or unworthy, I might be tempted to deny the feelings by dismissing that person as “not worth my energy.” If instead, I notice, “it seems like I was hoping for more engagement and camaraderie…more appreciation and praise…” I can make some choices. 

One choice might be to recognize I need more of something, such as connection or feedback, and I can more directly seek it in a constructive way. While dismissing the colleague as “not worthy of my energy” is likely to make me more socially closed (resulting in a reduction of connection and camaraderie), noticing I need more of those things might make me more proactive in offering connection, encouragement, or praise to others in order to build social bridges. 

Another choice might be to take a moment of reflection to see why that person’s behavior seemed to trigger a dip in my personal worth. To get curious about what I’m basing my self-worth on, and start investing the emotional pain back into my inner life to expand my connection to meaning, my source of identity and worth.

In college, studying the spectrum of bipolar disorder, I began to take quite seriously the possibility that opportunities to make changes don’t last. The chance to change an attitude, to improve well being, to gain perspective are never guaranteed. So when we have them, we need to let the gentle tug of awareness break our inertia and make the choice today that may not come again tomorrow.