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I am no expert on these types of experiences. I know they can be frightening as a family member has gone through it.

I can tell you what S.N. Goenka says on the long courses in his tradition of Vipassana. If you come across experiences of said nature you can just say "Mara, you are seen" And continue on with your meditation. Mara being the personification of our defilements or the troublesome deva from the stories of Gotoma Buddha. It helped me at a certain stage in my practice when I felt overwhelmed by negativity. It brought me back to being mindful and not immersed and rolling in what was occurring.

Or if I was in your position, I would note those voices as just "noise' or "voices" and objectify the hell out of them, making them a part of you meditation. And don't roll in them nor let the "noise" take you way from being mindful.

I am sure you will get better advice from some of those more experienced in these things. Hang in there!

Metta

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!

Thank you for your detailed response J Adam.

The voice isn't that troublesome and I can get along most of the time without it being much of a bother. I haven't had much sleep the past couple days (4-5 hours) and this is what is making it a little more prominent. I'll make sure to get some rest. Taking extra seroquel has helped too.

I tend to drop into "Fear" when I'm falling asleep (or wake up in the middle of the night) and I tend to ride it out by focusing on bodily sensations until I fall back asleep. I get the heebeejibbies and it feels like I'm surrounded by some sort of ominous presence while the voice is saying the "cheat death" thing. I have a high tolerance for pain and bizarre experiences and can deal with this pretty well without freaking out or bleeding it out onto other people.

I hadn't thought of it being a dissociative symptom, but that is an interesting observation. I'm not experiencing depersonalization or derealization though (I have in the past, years ago). Also, I previously dealt with mixed state flare-ups with concentration practices. The samatha jhana usually silences the thoughts and boosts the mood. However, I'm slightly out of practice with my meditation.

..So I'll make sure to put time back into practice again. You're correct, it isn't too hard to note the voice out unless I'm in Fear. Avoiding getting involved is probably the best policy.

It sounds like you're well equipped to skillfully deal with the dark night. You seem to have the bipolar under great control, if hearing a voice during Fear is the only symptom you're getting from sleep loss. And in all honesty, that kind of thing happens to plenty of people with absolutely no psychiatric stuff complicating their insight practice at all.

Having the ability to deal with bizzare and/or unpleasant experiences without getting sucked into dramatic content is going to serve you so well in insight practice! I'd encourage you to keep building up that strength if you can. Just make sure that during insight practices, you balance that strength with its counterpart: curiosity and energetic investigation.

Getting back into practice with shamatha is a pretty useful thing to do all around, and it might be a good idea to touch up your familiarity with strong concentration. However, as you realize, it's hard during the dark night because attention is so panoramic. I think of dark night attention like a donut: there's a "hole" in the center, where you're trying to focus. The actual awareness is strongest around the center, not in it. But if you're already experienced with the third jhana or especially fourth jhana, then you'll know how to skillfully use attention of that quality anyway, because the third jhana (whether vipassana or shamatha jhana) is where that quality of attention comes from.

If you don't have familiarity with the third jhana, then it may not be very useful for you to cultivate shamatha because the type of attention present in the first and second jhanas isn't helpful during the dark night -- you need to be aware of what's going on around the edges, because that's where you learn the stuff you learn about during the dark night.

So, getting past fear: see through the voice (or other sensory experience) like you've been doing, and if you're still in fear after seeing through it, then try and notice what's around the edges. The vibrations in the edges are rather irritating. In fact, if you keep looking at them, they seem quite Miserable. Hey, the next stage! In Misery and Disgust and Desire for Deliverance, being able to "bear the pain" may not be the most skillful way to move past those stages. If you're bearing the pain, then you're attending to the pain, which could be involvement with content. (Especially if it becomes a type of "hero's journey" or martyrdom thing. Those kinds of feelings are sure signs that a person is in content.)

I don't know if you have any tendency to do that sort of stuff, so maybe I'm rambling about things that are irrelevant to you. But if you do start getting those kinds of feelings/thoughts, then the remedy is to stop bearing the pain and start seeing through it. It's a sign that you need to generate more curiosity and investigation. Examine the sensations that make up the pain, or the sensations that make up any sort of martyr feelings, or the sensations of a sensory input that isn't particularly emotional.

Phew! That was a lot of stuff I didn't know I knew until I typed it out. I hope that it's correct and that I remember it, because it's about to be useful to me as I start trying to move past the early dark night stuff and into the later stages.