| | Yeah, you probably don't want to get involved with what the voice is saying. It's content, so it's not appropriate for insight meditation, and I just can't see how it would be a good idea to use it as an object for concentration meditation. My recommendation would be to maintain your attention on some other sense base, like touch or vision, because voices of any type can be pretty distracting. If you note the voice in, say, the A&P or Dissolution, it's pretty easy to make it go away. However, during Fear, something like this could become pretty scary, so your best bet if Fear hits you strongly may be to switch to a sense base whose input isn't quite so ominous.
While it would be extremely inappropriate for me to give you medical advice to changing your medication levels without first consulting your doctor, it's quite reasonable for you to consider upping the seroquel with your doctor's approval if the dark night is aggravating any psychiatric symptoms. I think that hearing your own thoughts as if they were external voices could be considered a dissociative symptom if accompanied by other dissociative stuff like derealization, or it could be considered a nonpsychotic hallucination.
To my knowledge, upping the lithium isn't going to be particularly helpful in getting rid of a hallucination, psychotic or nonpsychotic, unless it's due to a manic episode or a depressive episode with psychotic features. Plus, the dose of lithium required to be effective in controlling bipolar symptoms isn't too much lower than a toxic dose. So I really wouldn't advise you to screw with the lithium levels -- it can take weeks to get a response to the dose change anyway. You might not even still be in the dark night by the point the lithium increase was effective.
If you want to up your medication, I'd say go with the seroquel. You already mentioned that it shows some effectiveness in alleviating the voice. This makes sense, given the nature of its action -- it works on hallucinations and similar symptoms whether or not they have anything to do with a psychotic state or any location on the bipolar mood spectrum. You could give seroquel to someone tripping on acid and it would probably terminate the trip, even though the person isn't psychotic in the least.
One reasonable concern about upping the seroquel is that the sedation may cause sloth and torpor during meditation. However, for insight, you could just try examining the sensations that make up the feelings of sloth and torpor. Also, if you're getting restlessness from worrying about what the voice is doing, a bit of sedation may be good.
But my first recommendation would be to stick with your current medication levels until your doctor recommends otherwise in a consultation, and keep working on seeing through the sensations that make up the voice. Do try and get plenty of sleep (shouldn't be a problem if you take all/most of the seroquel dose at bedtime) and keep being as skillful in managing your daily life as you can, so that you don't aggravate the bipolar. And consider switching to other sense bases during insight meditation if you're having trouble seeing through the voice clearly.
One last thing: keep away from caffeine if you can. If you're tired, you've ~got~ to sleep. Sleep deprivation and stimulant use both love to trigger manic episodes, so combining the two isn't a great idea. It would suuuuuuck to trigger a flareup in the middle of the dark night and end up in a mixed state! |