By Jerad J. D. Rider

This article will show how Clive Barker’s 1986 horror novella The Hellbound Heart could serve as an allegory for catastrophic hyperacusis and tinnitus. I’ve read a lot of horror books, with none evoking substantial comparisons to these hearing conditions. This one broke the trend. If we didn’t know we were reading supernatural fiction, these excerpts might trick us into thinking they’re describing hyperacusis and tinnitus.

“His ears were no less sensitive. His head was filled with a thousand dins, some of which he himself was father to. The air that broke against his eardrums was a hurricane; the flatulence in his bowels was thunder. But there were other sounds—innumerable sounds—which assailed him from somewhere beyond himself. Voices raised in anger, whispered professions of love, roars and rattlings, snatches of song, tears. Was it the world he was hearing—morning breaking in a thousand homes? He had no chance to listen closely; the cacophony drove any power of analysis from his head.”

It sounds like hyperacusis, doesn’t it? Instead, the author is putting anguish to words for antagonist Frank’s descent into the Cenobites’ netherworld. The Cenobites—extradimensional disfigured humanoids—deliver unending sadomasochistic experiences. For a couple characters in the story, that entails sound abuse. Here are some examples of protagonist Kirsty’s tortured state.

“The bell was getting louder in her head. Someone had looped their entrails around her neck, and was pulling the knot tight.” (This is like tinnitus and a rarer form of noxacusis, also known as pain hyperacusis, where sound causes pressure or cramps in the neck.)

“She held on to the thought through the mounting din of bells, so loud now that her skull seemed ready to crack open.”

That’s just a sample of what’s to come. We’ll examine tons of excerpts throughout this article, covering many topics to illustrate how the book and the ear conditions are alike. Other than noxacusis, loudness hyperacusis, autophony, reactive tinnitus, and standard tinnitus, these topics will include: the prevalence of the story’s situation in relation to the likelihood of getting these ear conditions; the overlap between how characters in the book and those in real life meet these states of suffering; the nature of enslavement and loss; the chances of escape or recovery; the ways in which loved ones or friends of characters in the book influence their situations (including the devastating side of that), and how the same is true for those with disabilities; and much more.

If this book were an allegory for hyperacusis and tinnitus, then the Cenobites would represent the injuries themselves (the type II afferent nerves, tensor tympani muscle, central gain, etc.). Catastrophes incarnate. And these catastrophes, attached to their companions, deliver aural symptoms (physical pain to normal sounds or sounds becoming deafening, tinnitus, etc.; plus the problems that follow sound intolerance: suffering; enslavement; emotional trauma; loss). The Cenobites’ very appearances give the impression they believe sophisticated types of glory come from being injured, with the most famous one having a face covered in pins driven into the skull. They wear their scars and mutilations like they’re proud and flaunting them. They’re unemotional. Black, cold, lifeless eyes. Cosmic voids essentially, where good and bad aren’t registered. They don’t choose their victims with a personal vendetta; in many cases the victims come to them by making lifestyle choices (like abusing sound, if we’re making this an allegory; we’ll study the causes further in the “Causation” section). Perpetual torture is the consequence.

To mete out pain and anguish, the Cenobites bombard their prey with hooks combined with chains, descending and shooting from all directions, sort of like how noxacusis victims describe their torture from omnipresent sounds.

“He was in extremis, hooked through in a dozen or more places…”

The torturers also retain possession of their victims’ souls in the afterlife. So all that remains for the captives is a mockery of humanness, utter devastation, and pining for the past—when freedom was their right. While the text does not assign religious meaning to their fate—Hell, in other words—one can draw comparisons. Their situation is a marriage between emotional and physical barbarism that is unrelenting and catastrophic.

What is catastrophic?

Before we move on, I need to preface this piece by saying that I know some milder hyperacustics may roll their eyes that I’m claiming this book is like these disabilities. I have loudness hyperacusis, pain hyperacusis, and reactive tinnitus, all very severe, or what I consider “catastrophic.” Catastrophic is when you can’t meet life’s necessities (i.e., even with earplugs and earmuffs, your symptoms are worsened significantly, often permanently, by things as simple as bathing or brushing your teeth). Forget cooking and talking; those are off the table. And leaving home, of course; basically there’s no way to leave without further wrecking your disabilities. Pain even comes from bassy and high-pitched noises a quarter mile down the road (sometimes farther, shockingly). There are others who report they’re in the same situation, where everything is undone. All that remains is enslavement entangled with torture. And that is why I couldn’t help but notice the parallels between these ear conditions and the book: the round-the-clock dread and existential crisis that come from being owned and brutalized by unforgiving monsters, and losing everything.

There are different severity levels for any health condition. For example, there may be people whose backs get minor pain when going to work, shopping at the grocery, or with any physical labor. And then there may be people whose backs are so bad that the slightest of movements summon leg or lumbar pain with knifelike, burning tentacles. Often they are bedbound, shifting in the sheets to try to yield comfort, but finding no relief. There’s no escape, you see? Those two groups’ quality of life is apples and oranges, isn’t it? It’s common sense, my friends.

Appealing to Outsiders

In keeping with the spooky season, I felt that analyzing this novella could help shine a light on what the catastrophics deal with. Yes, it is fiction, though the fact that the writer elected to give his infernal plane a type of aural suffering—an infinite dimension where the vilest scenarios consume its helpless victims—gives us jarring insights into just how bleak and terrible these ear conditions are when they are at their worst. The blurb of the book reads that Frank’s demise is something “only a sick-minded soul could invent.” Sound familiar? Many with hyperacusis and tinnitus think the devil must have cooked them up, that they’re too malignant to be accidents from nature.

Outsiders (healthy people) would likely raise their eyebrows at such a statement. It’s hard for people who haven’t experienced these ear conditions to understand what it’s like to have them. It is not uncommon for families and friends of sufferers to find themselves puzzled, at their wits’ end, or, even worse, not believing the sufferers’ assertions of debilitation, chalking them up to mental illness. Why can’t people understand? Those bewildered read a book, watch its film equivalent, and offer credit where its due—acknowledging that in their pages and their frames are nihilistic nightmares—but then they cannot empathize with brutal disabilities, I think because with a horror book or movie people are willing to suspend their disbelief. In real life they aren’t. Sometimes they understand what we’re explaining, but think such horror can’t exist beyond the page or frame. And for good reason, right? Their trust is placed in misinformation on the Net. Even advice from doctors can lead them astray because the doctors hold little knowledge of these rare ear conditions. And first impressions—while wrong—coax them into thinking that a problem with the ears, juxtaposed with other things, couldn’t be so bad. I hope that by reading this piece and discerning how much this book has in common with these ear conditions the skeptics will see the errors of their ways. (In the “Hearts of People” section, we’ll take a deeper look at how families’ and friends’ behaviors factor into these situations.)

Let’s examine the book and glean comparisons.

Loudness Hyperacusis

The quote I shared in the intro highlights Frank’s first encounter with the Cenobites’ dimension, where everything is loud. What’s responsible for warping all the sounds? A Cenobite remarks: “There are conditions of the nerve endings…the like of which your imagination, however fevered, could not hope to evoke.” This is eerie because noxacusis and loudness hyperacusis are sometimes thought to be nerve-related injuries, usually from sound abuse, ototoxic meds, or traumas to the head, like concussions. So in a quest to wreak havoc on Frank, the Cenobites target his acoustic nerves, thereby creating symptoms more representative of loudness hyperacusis than pain hyperacusis. Everything is deafening, so much so that Frank is hearing things from miles—maybe farther—down the road.

As I mentioned earlier, the severest cases of hyperacusis are assaulted by sounds that trespass from miles away. For loudness hyperacusis, the sensations are labeled as “discomfort” or “everything sounding 10 times louder than it should,” but they do not bridge to “pain.” I’m one of these people confronted by distant sounds that healthy ears don’t notice. In my case, however, they also summon pain, since I suffer from noxacusis, too.

Even in my own home, torture is routine. Sound takes on a three-dimensional quality—it’s not just heard but felt. And earmuffs and earplugs offer limited respite. That means pain from neighbors cutting grass or having get-togethers, construction far away, lumberjacks with chainsaws, planes flying over, rambunctious kids or dogs—the list is truly endless. They’re all unruly guests, and life becomes unruly, as sound and life are one.

I’m at the mercy of other people’s actions, and exposing to noise or trying to power through it worsens my condition, often permanently. I haven’t seen another soul in over three years, besides a few family members who respect my conditions and are careful to be quiet. This level of hyperacusis requires a kind of control that usurps life completely. As I write this I’m getting pain from construction a quarter mile west, which feels like something tugging on my eardrums, and tinnitus is rising. In my life every sound hurts to some degree, and many take on the sensations of daggers plunging into my ears.

Ironically, with pain being a central theme in The Hellbound Heart, these characters experiencing “pain to sound” isn’t supported by the text (besides two examples, and they’re only figurative from my point of view, sounding like something different than their literal meanings; the first I shared in the open and said it resembles cramps or pressure from sound abuse; the second I’ll share in the “Tinnitus” section because it also involves tinnitus). That’s a point where real life is worse than what the story says (noxacusis is usually considered the most aggressive form of hyperacusis). There’s another point that demonstrates how noxacusis is worse than the story’s sound abuse: noxacusis never leaves your side when it is chronic; in the book, however, the sound abuse seems to come and go; even in the Cenobites’ realm, it doesn’t appear that the victims are perpetually assailed by noise. (This of course would apply to tinnitus, too—because it’s permanent, it’s worse than the story’s bells.)

As smart as Barker was when thinking up this tale, people who haven’t had hyperacusis may not be able to fathom the extent of sound’s brutality. Perhaps it didn’t come to mind to write the sounds as painful. People can understand the annoyance of loud noise; that’s a universal thing. Saying it causes sensations of searing pain isn’t. It’s hard to rationalize—that the cochlea is capable of such intense betrayal (or the brain—whatever is causing it). Also, I’m guessing his inclusion of these symptoms was not influenced by hyperacusis or tinnitus; rather, his writings were solely the work of a fertile imagination for the worst kinds of torture.

When icons of horror write something similar, it’s probably coincidence. (Rod Serling also did for season five of The Twilight Zone, episode “Sounds and Silences.”) They mimic disabilities, and show us, yet again, how writers understand how hostile sound could be (to some degree, at least). Their revelations are obtained from fiction’s giant well, with filthy water coming out when pumping for ideas, sometimes black as oil.

“The air that broke against his eardrums was a hurricane…”

Another instance of loudness hyperacusis. Referencing my own experience, I know that when I’m outside and wind rushes through me, it’s like a hurricane—extremely loud and awful, and pain of course emerges. The sound is not only howling into my ear canals, but pushing on the walls of my eardrums, too, as if in a bid to puncture them. It resembles something trying to tear my ears apart. Screaming, clutching, pulling. That’s the best I can describe it.

Autophony

Frank’s experience has autophony indicators when he’s hearing his internal body doing things: “His head was filled with a thousand dins, some of which he himself was father to…the flatulence in his bowels was thunder.”

Victims of catastrophic autophony cannot handle talking, eating certain foods, swallowing certain ways, or even breathing deeply. The sounds barrage their skulls. Their meals consist of mushy/soft foods—bread, yogurt, oatmeal—since crunchy/chewy options are intolerable. They cannot brush their teeth, as the bristles’ abrasion is so unbearable it’s like a loud report. They cannot scratch their heads. Especially with plugs and muffs, which increase the occlusion effect (sounds booming in your head). Bathing is impossible, washing their skin and hair insufferable clamors digging into wounded ears.

Tinnitus

“The bell was getting louder in her head.”

As established the Cenobites like to use noise to torment their prisoners. One scene finds Kirsty enduring a cacophony of bells.

“She held on to the thought through the mounting din of bells, so loud now that her skull seemed ready to crack open.”

Throughout the book the bells announce the Cenobites’ arrivals. When Frank first tinkers with Lemarchand’s Configuration—a black glossy puzzle box full of treasures untold, if the puzzler solves it (according to legend, anyway)—he starts to hear the bell. This is the beginning of his problems. (In the “Causation” section we’ll explore what attracts him to the box.)

“At some point in his labors, the bell had begun to ring—a steady somber tolling.”

This reminds me of tinnitus bleeding through when someone tinkers with a dangerous sound, like the dangerous puzzle box. Maybe they go to a concert or a club, and after a while their ears start to ring. It’s a warning sign they’re playing with fire. Since temporary ringing is a common side effect of loud activities, people brush it off and harbor little fear, assuming they will wake to daylight free of this unwanted guest. Silence once again!

But for some unlucky souls, such reprieve will never come. The bells will only grow, and with them other sounds: pitches, frequencies, timbres, and disturbing deceptions in the form of spacial location. You’ll swear that your neighbor is having a boisterous get-together, with thumping or heavy bass. Like Frank you’ll find that the search for “the bell” is disorienting.

“For a few moments he supposed the noise to be coming from somewhere in the street outside—but he rapidly dismissed that notion.”

You’ll rush to the window and draw the curtains back, finding that your neighbor’s lights are out. Everyone is sleeping! No one’s lights are on. Where’s the noise coming from? Deep inside your ears, or maybe from your brain.

Next thing you know it’s reacting to normal sounds. It worsens in their presence, climbing by the minute, and every sound becomes forbidden territory. You’re shocked to find you pushed the envelope by having conversations, where as a result your ringing has gotten unquestionably louder, a brand new CHIRP CHIRP CHIRP your devilish companion. Some victims vent that extra tones are added every week. “The bells” refuse to leave their sides, taking over everything, wanting more and more; their thirst cannot be quenched.

“…his stomach churned so violently at the sound of the bell it might have been ringing half a lifetime.”

Reactive tinnitus shouldn’t be confused with standard tinnitus; they’re completely different conditions. In The Hellbound Heart the bells are menacing due to being loud, but their volume doesn’t climb with sound stimulation. So this is another instance where the real condition is more debilitating than the book’s fictitious one. Those condemned with catastrophic reactive tinnitus can’t bear sound at all. When exposing to sound it picks at their auditory systems like a chisel to a wound. This means they have to avoid stimulation—at whisper-levels, too—which restricts everything since everything is tied to sound. Catastrophic tinnitus is also loud, like you’re stuck in the belfry while the bell is tolling.

“Then she was staggering downstairs, with wolves howling in the walls, and the bells in turmoil…”

Besides the story’s “version of tinnitus” (“the bells in turmoil”) reacting to Frank’s demise, this excerpt would lead you to think that Kirsty is battling hyperacusis, too: sounds attacking through the walls, biting like a pack of wolves. Wolves are often figuratively used by writers to describe hurtful things. In this case it’s more likely they’re being used to portray the threat of the house collapsing. Or the racket of elated demons basically saying, “Yayyy! Victoryyy! Frank is ours forever!” That’s what makes reading figurative language fun, right? We can interpret it a lot of ways. If a picture is worth a thousand words, then figurative language is worth a thousand meanings.

There’s another point that demonstrates why catastrophic tinnitus is worse than the story’s version: the bells and wolves are fleeting, but real tinnitus isn’t (as I touched on earlier). It’s continuous. Also, tinnitus can be tons of sounds, while the book has only one—bells; and even if the howling wolves were literal, that’s two, not a lot. The worst kind of tinnitus consists of a symphony. Mine has eight noises: static, the bassy-neighbor one described above, crickets, Morse code, one that sounds like EEEEEE, a bus idling, an out-of-tune accordion, and electrical zapping that physically hurts (phantom pain assigned by the brain).

“…she could no longer hear what he said.”

Kirsty can’t hear a thing with the deafening bells tolling; even people’s voices are drowned out. My tinnitus hovers in the 90 to 100 dB range, but it doesn’t cover voices. Yet it does for many tinnitus sufferers, as their consorts demand their full attention. Some confess their volume teeters at concert levels or firearms. Can you imagine that? A collection of obstreperous villains tagging along at all times?

Prevalence

When you use the word “rare” to classify loudness hyperacusis, pain hyperacusis, reactive tinnitus, or even autophony, it doesn’t do their prevalences justice. They are very rare.

Likewise, a Cenobite highlights the rareness of Frank’s position—winding up entrapped in their disturbing lair: “There have been others….A handful at best.”

I live in Columbus, Ohio, and two known cases of severe noxacusis existed in the city as of 2022, and its population is almost a million. I’m sure there are other less-severe sufferers. I know of two in nearby areas of Central Ohio. These numbers provide an example of just how rare these ear conditions are.

ENTs and other doctors hardly ever encounter hyperacusis patients, and their chances of meeting them should be higher than most. James A. Henry, PhD—author of The Hyperacusis and Misophonia Book—stated in our interview that he only met one while serving as an audiologist for several decades. Hyperacusis patients often report that their ENTs remarked that they have never had hyperacustics walk through their doors until they, the patients, showed up. Mine hadn’t, either.

This is my opinion after conversing with the sufferers who are part of worldwide communities for hyperacusis: the truth is that authentic forms of loudness hyperacusis and noxacusis might affect 500 people or less for every million, or something equally miniscule—and that might be a generous estimation. Is it even one percent of people dealing with these nightmares? No, certainly not, because surely one in 100 are not tormented or feeling these conditions (or even reactive tinnitus or autophony). In that regard they’re almost too small to measure percentagewise.

“A handful at best. But a few have dared to use Lemarchand’s Configuration.”

Causation

How does a person get sucked into the world of the Cenobites? Unchecked desires, or unrestrained longings that beckon destructive actions. Frank is a hedonist, seeking pleasures through sex with lots of women, drugs of many kinds, and opportunities that test his limitations with forbidden new fruits. The book seems to indicate that these are the people who find Lemarchand’s Configuration. It’s as if a supernatural energy reels in the lustful and covetous individuals. They solve the box and boom, ruin overtakes.

Greed is a central theme of The Hellbound Heart, that one can never have enough, or may tire of their frivolous life. Frank is one such person, who, perhaps unknowingly, acknowledges his greed when on the precipice of entering the Cenobites’ dimension, oblivious to its danger. That’s when he’s consumed—in his weakness. Greed is weakness. It makes people unappreciative of good. Good is never good enough, and great is always this phantom they hope they can catch someday. Deep down they don’t believe it’s real, probably, but desire keeps them chasing it, like a paradox.

“Outside, somewhere near, the world would soon be waking. He had watched it wake from the window of this very room, day after day, stirring itself to another round of fruitless pursuits, and he’d known, known, that there was nothing left out there to excite him. No heat, only sweat. No passion, only sudden lust, and just as sudden indifference. He had turned his back on such dissatisfaction. If in doing so he had to interpret the signs these creatures brought him, then that was the price of ambition. He was ready to pay it.
‘Show me,’ he said.
‘There’s no going back. You do understand that?’
‘Show me.'”

They show him, all right, and that’s when he realizes he made a terrible decision.

In the aftermath of getting hyperacusis and tinnitus, many feel they took their lives for granted, and that greed and desire may have factored into their undoings. I agree with that for my situation, and identify with Frank’s descent into “hell,” as I wrote in the intro. I first acquired tinnitus, noxacusis, and loudness hyperacusis at 17 as a sophomore. Acne had been plaguing me for years, and my unchecked desire for perfect skin attracted destructive decisions, trying accutane (only briefly, though) and salicylic acid cleaning pads. For a year or more I obsessively wiped my entire face, to the point where my skin was peeling and red. Mild tinnitus arrived, and not long after mild noxacusis and loudness hyperacusis. I overused the pads. Salicylic acid can be ototoxic like aspirin when used excessively.

Unchecked desire leads to devastation.

Even after my symptoms improved with time and silence several years later, the sum of my diligence left me on the mild spectrum of these three acoustic demons. Unchecked desire once again resulted in my downfall as the years progressed. Bodybuilding drew degenerative disc disease. The pain was so severe I tried turmeric, a herb hyperacustics said was safe. Well six days into using it my mostly dormant symptoms blew like loud volcanoes. That was 2021, over four years ago, and the magma hasn’t stopped. It is flowing faster than it ever has, sadly, and now I’m catastrophic.

Unchecked desires lead to devastation.

Countless sufferers lament that unchecked desires fostered untimely reckonings, whether from sound abuse or other risky things. Thrill-seeking, more or less. They wish they hadn’t hung out at those clubs, seeking companions for love or giving in to their urges to dance to techno music despite the health risks (ignoring former instances of temporary tinnitus that served as warning signs), or jamming to music while wearing headphones, or taking certain medicines to simply feel better, or dabbling with dope, or riding rollercoasters, causing bad concussions, or target practice without ear protection. They’re full of deep regrets, and like myself tend to blame themselves for winding up destroyed. I tell myself if I had had a Christian moral code, my health would be okay. I wouldn’t have fixated on my pimply complexion, or drug my thirsty ass to Old School down on High Street (the only club I went to in my life) to meet and woo that funny pretty girl from my AOL Buddies List. I was just a teen, and why did I think I had any business mucking about in a club with inebriated people? I was immature, desire blinded me…I was too intent.

“So intent was Frank upon solving the puzzle of Lemarchand’s box that he didn’t hear the great bell begin to ring.”

Like Frank, sufferers often think that their desire captivated their focus and blocked any chance of sensing danger. They went to clubs and heard “the great bell”—tinnitus arising—but thought It’s no big deal. It’ll pass. Always does. I am in control!

It’s important to note that many visit clubs, for example, with the hopes of finding love or sexual bliss. Yet they don’t get destroyed. Life isn’t fair. (In the section “Prospects of Escape,” I’ll talk about genes and some other things that are pertinent.)

“He had been arrogant in his dealing with the Order of the Gash, he saw that now; but there were everywhere—in the world and out of it—forces that encouraged such arrogance because they traded on it.”

Frank’s unchecked desires combine with arrogance. He’s too confident, and his character flaws breed with the puzzle box to bear his problem with the Cenobites. This excerpt is also relevant to hyperacusis and tinnitus sufferers, since even though we might have craved decibels, our world encouraged dangerous hearing habits. Pride and press come to a sports arena when hitting 142 decibels and shattering the Guinness World Record (Daily Mail, 2014). Many things are drenched in sound: clubs, movie theaters, restaurants and bars. The louder the better, people think; sound is linked to celebrations without any warnings. Sometimes it’s the ones who fell that later spill their guts and say they clung to arrogance or even ignorance, too secure in their beliefs that they would be impervious to any threats that come along, pressured by society’s encouragement to worship sound. It was like a trap.

Unchecked desires led to devastation…and with these disabilities, sometimes there is no way to mend what was destroyed.

Dead but Still Alive

“There was no compassion to be had on this side of the Schism; there was only the weeping and the laughter. Tears of joy sometimes (for an hour without dread, a breath’s length even), laughter coming just as paradoxically in the face of some new horror, fashioned by the Engineer for the provision of grief.
There was a further sophistication to the torture, devised by a mind that understood exquisitely the nature of suffering. The prisoners were allowed to see into the world they had once occupied.”

“…they had brought incalculable suffering…they’d initiated him into experiences that his nerves still convulsed to recall.”

These excerpts are ripe with comparisons to hyperacusis and tinnitus. For one, the catastrophic crowd is quick to point out there is no floor for these conditions; they can sink lower. Mercy is a foreign thought. Like the Cenobites, these conditions have none, can’t be reasoned with. Sound incidents, leading to a worsening of symptoms, or random escalations, confirm that it’s the monsters holding all the power. The first excerpt mentions the Engineer creating fresh forms of grief. This is also the case with hyperacusis and tinnitus, where symptoms have minds of their own and tank with new decrees of permanent punishment.

Denial, anger, and yes, even laugher, come in wretched cycles, the laugher the type associated with unhappy thoughts or maybe sarcasm, not of joy or hope. The kind of laughter a soldier would have in war when he knows he’s been outsmarted seconds before his death. The shock of your misfortune does not abate when you’re declining constantly. Daily you stare the monsters down, but it doesn’t get easier. Denial holds you captive.

“’This isn’t happening,’ she told herself aloud, but the beast only laughed.
‘I used to tell myself that,’ he said. ‘Day in, day out. Used to try and dream the agonies away. But you can’t. Take it from me. You can’t. They have to be endured.’
She knew he was telling the truth, the kind of unsavory truth that only monsters were at liberty to tell. He had no need to flatter or cajole; he had no philosophy to debate, or sermon to deliver. His awful nakedness was a kind of sophistication. Past the lies of faith, and into purer realms.”

Two, catastrophic noxacustics tell of pain unlike anything they have felt before: sounds induce earaches on steroids, burning coals or knives into their ears, acid pouring into their canals, radiating cramps across their cheeks, jaw, rear of their head or forehead, sometimes in the neck. As I stated earlier, to catastrophic noxacustics, sounds resemble the violent hooks and chains that take ownership of Frank, shooting from every direction in a world rich with noise.

“He was in extremis, hooked through in a dozen or more places, fresh wounds gouged in him even as she watched. Spread-eagled beneath the solitary bulb, body hauled to the limits of its endurance and beyond, he gave vent to shrieks that would have won pity from her, had she not learned better.”

Three, the worst sufferers never leave their homes, since they can’t or they’ll worsen with sound exposures. Again, earplugs and earmuffs aren’t enough to protect them from damage. I haven’t left my house in three and a half years. I cannot go outside, for even the ambient noise of nature triggers pain and loudness symptoms through my ear protection. We’re left to watch the world like exiled mourning hermits. The losses and suffering are “incalculable,” as the excerpt says. We witness our families and friends engaging in life through social media. We can’t spend time with them, as most won’t honor our crucial need for silence. We’re haunting our former homes, as Frank does in his lost decrepit state, yearning for our old lives while only getting taunted, sick at the sight of our bygone dignity, for we know it won’t return. Many in these shoes will tell you they’re in hell, as if the Lord had cast them into it.

“The prisoners were allowed to see into the world they had once occupied.”

Four, sometimes sufferers will have a better day. Maybe their symptoms will calm a little bit. Just a hair’s width. But like the excerpt says, it’s enough to yield a minor vacation from dread. Most of the time, however, the dread is in the air—and how could it not be, knowing their fates are imprisonment for the rest of their lives? Like the story’s flayed rotting Frank, these people are facing incarcerations of inhumanity, some of them unable to bathe and brush their teeth, as once again those hygiene habits permanently worsen them. Isn’t that unfair? Grossly inhumane? They’re bodies are covered in dead skin and oil, their scalps crusty layers, their teeth cloaked in tartar, their odors emulative of corpses. They’re in extremis, like Frank, dead but still alive.

“He was a travesty. Not just of humanity, of life.”

“…now there were scraps of humanity everywhere, throwing into yet greater relief the catastrophic nature of his wounding.“

Frank’s appearance is one of a man who somehow survived after being entrapped in an inferno. His skin is gone, muscles exposed, bones peeking through. What remains is nothing more than the vicious derision of the human that he once was. People with catastrophic tinnitus and hyperacusis regularly think: I remember the days when I was human.

Prospects of Escape

“Sometimes it seemed that eons came and went while he lingered in the wall, eons that some clue would later reveal to have been the passing of hours, or even minutes.
But now things had changed; he had a chance to escape. His spirit soared at the thought. It was a frail chance, he didn’t deceive himself about that.”

“There were ways to escape, he’d heard it whispered, loopholes in the system that might allow a mind supple or cunning enough egress into the room from which it had come.”

Frank is trapped in the wall of his house, which now serves as a doorway of sorts to the Cenobites’ dimension since he dabbled with the box. The problem is the door is shut and locked. This is like catastrophic hyperacusis and tinnitus. In the book a prisoner can escape (and Frank tries, believe me). This is also true in Hyperacusis Land, though like The Hellbound Heart, escaping is a complicated goal that usually doesn’t happen. It’s not impossible. We do see it happen.

I need to reiterate that while many with hyperacusis do improve, sometimes significantly, the focus of this article is the catastrophic crowd. The ones who usually can’t. But as the excerpt says, there are “whispers” from others proclaiming that they can. They’re whispers because they carry little weight or influence in a lot of sufferers’ minds. Whispers are faint and not commanding presences. Whispers can be hard to hear and misunderstood. They’re unreliable hope. Most lose hope and think they’re damned. The dread is undeniable. They’re whispers because, while they do happen, they’re rare occurrences, since escaping is unlikely. So the voices of success get overpowered by the more common group of wailers that are unable to trespass on freedom’s property. There are also whispers that cling to hopes for future cures. Quiet optimism.

When catastrophics witness a fellow catastrophic flee from Hyperacusis Land, it reinstates hope, a glimmer of possibility, however feeble it may be. But for others it strengthens their resolve that the person who escaped was not catastrophic to begin with. In other words, the meaning of “catastrophic” is subjective, one person’s definition differs from another, and some believe if you’re truly that bad off there is no path to freedom. They conclude that the people who got away must have been moderate and not chronic moribund survivors, meaning the true catastrophics have too much damage to their auditory systems to undo their travesties.

Some think that drugs like clomipramine can bring about success. Others physical therapy, splints, nerve blocks, and experimental surgeries. These procedures have shown promise, sometimes stellar change, but they’re not guaranteed. Some can’t escape. It’s probably more accurate to say that many can’t when catastrophic. Even Jastreboff gave up on Category 4s, his version of “Abandon all hope, ye who enter here” (Alighieri, 1321). It isn’t the catastrophic’s fault; his or her body won’t play ball.

Unlike The Hellbound Heart, “loopholes” don’t provide a fair potential among the prisoners for escape (meaning factors unrelated to the problems, which enable Frank to ditch the Cenobites, which we’ll explore in “The Hearts of People” section due to its overlap with that specific topic). For hyperacusis and tinnitus the things that dictate the chances of recovery are probably the person’s genes, cofactors, and the extent of their injuries.

Some people try to escape by taking risky meds or doing surgeries, because they’re ready to suicide anyway. The way they see it, what do they have to lose? That was Frank’s logic.

“Indeed it was no risk at all. What punishment could be meted out worse than the thought of pain without hope of release?“

Since I worry about the afterlife, suicide is a no-no. The fear of Hell keeps many alive—the concept of perdition, or eternal unrest, as depicted by many religions. Damnation is one way the book is worse than real life: assuming you don’t escape, you’re the property of the Cenobites forever. In real life, suffering is finite. This of course conforms to the assumption that you either go to Heaven when you die, reclaiming your health and well-being, or take a dirt nap, ceasing to exist. But Hell is still in play, as some think only Christ gets you to Heaven, and Hell lies in wait for those who reject Him. Or other religious views that concern perpetual punishment.

It’s important to cling to hope, but it’s equally important to tell the world the truth of what these folks are up against, a situation that is almost undoable when peering through the lens of several decades. (Especially when symptoms continue to worsen, which happens with the catastrophics.) As the excerpt says, it seems like eons come and go. Minutes mimic hours, hours mimic days, days mimic months, and months mimic years. To never leave home is crushing beyond words. Even outsiders can understand that. They had to do it for weeks or months during COVID-19 in 2020. Imagine doing it for decades, with aural torture, too. For the sufferers it is not a choice; it is a necessity. That is what they’re tasked with.

I want to end this section by noting that I did recover many moons ago from moderate noxacusis and loudness hyperacusis. Mostly, anyway. I was very, very mild, and life was normal once again; victory was magic. Though it returned with a vengeance after my turmeric use. My reaction was exactly what Frank experienced after he had escaped the Cenobites and they returned to claim him.

“It said his name, lightly, as if calling a child out to play.
‘Frank.’
His face dropped for the second time that night. A look of puzzlement flitted across it, and on its heels, horror.
Slowly, he turned his head round to look at the speaker. It was the Cenobite, its hooks sparkling.”

I was standing in my room, the TICK TICK TICK the wall clock made was loud and throwing daggers, my brother’s voice was acid, and tidal waves imbued with dread were washing over me. The demons had returned! How? Oh my go—

Noise that was once harmonious—amicable and calm, existing in the background with habituation’s help—took on a discordant air. I could feel every sound, like the bloody hooks.

“They had their books in him, the flesh of his arms and legs, and curled through the meat of his face. Attached to the hooks, chains, which they held taut. There was a soft sound, as his resistance drew the barbs through his muscle. His mouth was dragged wide, his neck and chest plowed open.”

The Hearts of People

One theme of The Hellbound Heart is that you can’t always know who people are until it’s too late. Trust is called into question for many of the characters, unspeakable betrayals come to light, and the hearts of people speak for themselves.

Rory, Frank’s brother, is married to Julia. Prior to their marriage she cheated with Frank, and later finds she’s in love with him instead of Rory. Julia plays an instrumental part in Frank’s escape from the Cenobites after a gash to Rory’s hand while hammering spills blood, mixing with trace amounts or Frank’s remains on the floor, and allowing him the chance to resurrect into the realm of the living (one of those “loopholes” described in “Prospects of Escape”). She conspires with her paramour, helping reanimate his body by luring men from bars and killing them so he can feed on their nutrients. The hearts of people commit to evils.

“It was four years since she’d last stepped into a church: the day of her marriage to Rory, in fact. The thought of that day—or rather, of the promise it had failed to fulfill—soured the moment.”

She despised her husband.

“’I need you,’ he said, raising his mouth to her ear. Once, half a lifetime ago, her heart had seemed to skip at such a profession. Now she knew better.”

“She wanted to throw him off. More, she wanted to take him by his clammy hand and show him the death-defying monster he had been so close to stumbling across.”

So what does all this have to do with hyperacusis and tinnitus? Well, accepting the hearts of our families and friends is one of the hardest pills to swallow when having these conditions. They hurt us, betray us, invalidate our suffering. Unsupportive people are commonplace. This can make the sufferers’ conditions and situations markedly worse. In a life and death scenario, it can lead to death, just as it does for Rory. Even his coworker and friend, Kirsty, couldn’t thwart his shocking end. Imagine the hurt that Rory must have felt when discovering Frank’s and Julia’s actions against him. Likewise, our hearts get broken by those we love, those we swore we could trust, those we grew up with our whole lives. When we need them most, we see their true colors.

“Rory’s corpse was upstairs, left to lie in Frank’s shunned bandaging. The usurped skin was now wed to his brother’s body, the marriage sealed with the letting of blood.”

Dr. Marsha Johnson—who owns a private practice in Portland, Oregon called the Oregon Tinnitus & Hyperacusis Treatment Clinic, and has treated countless patients since 1997—talked about this subject in an interview with Hyperacusis Research. “Many parents cannot accept that there is something chronically wrong with their child. This is a serious issue, and families sometimes make the situation worse….People have all sorts of hidden conditions, like a migraine, but for some reason, with hyperacusis, others shut down their sympathy.”

The quintessential example of what can go wrong when families reject the truths of these conditions is Patient X, who I’ll leave unnamed for legal reasons. Her family rejected the notion that her symptoms were physically real, and claimed they were mental illness, despite the research and models present in the medical establishment that counter such a claim. The family took her hearing protection away, which was more or less like pushing a woman out of her wheelchair and demanding she stand. Demanding she listen to sound—the thing that caused her torture!

Not surprisingly, her symptoms got more torturous and proved to be too much. So she took her life. Again, because these conditions are invisible skepticism runs rampant. People can’t even defer to an X-ray, CT scan, or MRI for proof of our disabilities (heaven forbid a sufferer got an MRI; they’re earsplitting and usually pointless when trying to diagnose these ear conditions, unless you have a tumor, which is rare). Naysayers conclude a problem without a visual marker must not be a big one, or must not be so bad since they can’t see it.

“Kirsty looked at the Cenobite, then back at the nurse. They stood no more than a yard apart.
‘She doesn’t see me,’ it told her. ‘Nor hear me. I belong to you, Kirsty. And you to me.'”

Patients with unbelieving families often get sent to mental wards, where noise exists in abundance since hospital patients carry traumas, screaming and talking being the loudest threats inflicted. Doorbells and alarms from medical equipment add additional layers to pervasively chaotic acoustic atmospheres. Choosing to send a hyperacusis sufferer to a mental ward is (a) not believing him or her, (b) subjecting him or her to torture that will likely worsen their condition permanently, and (c) ironically increasing the chances of suicide. It’s a recipe for disaster.

Why families send their loved ones to wards is understandable, as they listen to experts who say a person’s suicidal ideation is suited best for such an institution. While this is true for most types of people at risk for suicide, hyperacusis is the exception to the rule, because the nature of the illness stands in contrast to mental illnesses. Hyperacusis patients are confronted with suicidal ideation only because of the physical torture at hand. It’s a human response to insurmountable suffering.

So yes, sometimes families betray their loved ones and disown them. As I laid out in the intro, hyperacusis has a lot of misinformation. I think people would prefer to trust it, too, because it puts the blame on the sufferer instead of the condition. It argues that, while roadblocks do exist, there are always detours. There are always fixes or solutions. This isn’t always true. Remember, sometimes people can’t improve. People don’t want to hear that, and certainly don’t want to deal with it. Since life is married to sound, it’s a big inconvenience to live alongside these sufferers.

One school of thought from the hearts of outsiders is that everyone can improve, and if they don’t it’s their fault. Many have tried their best. As I said in “Prospects of Escape,” they’ve resorted to dangerous experimental surgeries or powerful medications, only to find that they didn’t improve at all or worsened.

I’ve had these ear conditions for 23 years, and have seen my share of apathetic hearts. One time at a former radio job, I told some coworkers about my conditions. I was looking for support, human decency, and minor accommodations, because radio is loud; I needed to be careful. Well guess what happened, then? They started making fun of me! From that point on, they’d hold their ears with their index fingers and laugh, call me “Super-Hearing One,” talk behind my back, and stoop to other things, like complaining when I kept the volume low on the mixing consoles. I regretted telling them my secret.

I’ve had family members who didn’t believe my health problems are real. Doctors, too, of course. A lot of weird looks…accusatory looks, as if I were a nut. Being denied was hard to bear. I felt depressed, anxious, misunderstood, alone, like an extraterrestrial. I didn’t fit in at all, and wasn’t cool anymore. People didn’t accept or respect my situation, so I concluded I was small and insignificant. I thought that I mattered to people. These conditions in and of themselves are horrific, and then the insensitivity from people who act like you’re fibbing or exaggerating adds additional layers to the horror.

The reason the doctors were skeptical can be explained by research. Hyperacusis Central’s Scientific Advisor, Kelly Jahn, conducted a survey that showed that even audiologists only get five or less hours of training for hyperacusis; her findings were published by Hyperacusis Research. Many GPs, neuros, and other doctors have never heard of hyperacusis. So no one understood or believed me.

Like a wise teacher, hyperacusis had shown me a side of the world I didn’t want to see—an ignorant ugly side—and the apathy I witnessed painted a portrait of humanity hard to reconcile. I was disgusted with it all. People looked at me like I was a freak. Their staring with a raised brow, or, even worse, gnashing their teeth or rolling their eyes. It showed me the worst of human behavior. I felt like one of those characters in a horror movie that everyone shoos away or wants to throw in a mental ward—the guy claiming the boogeyman is real. “He’s not!” they protest. “He’s imagined and a sham.“ Well in my universe, he was very real, and they were full of shit. And now I’m catastrophic, once again bearing witness to apathetic hearts. It is beyond exhausting and downright heartbreaking.

In Conclusion

We covered a lot of ground with Clive Barker’s novella The Hellbound Heart. Of course I recommend the book, though some may find it triggering if they read it, given their hyperacusis and tinnitus situations. I’ve read it twice and consider it my favorite of Barker’s works. His writing has outstanding finesse. He’s one of the writers who inspired me to take up the craft. The Hellbound Heart is a perfect read for Halloween, or if you’re a fan of horror or the Hellraiser franchise, which was inspired by this book (the first movie was also written and directed by Clive Barker). Thanks for taking the time to read this article. If you’re suffering keep your head up. We’re always here for you. Drop a comment if you want. Happy Halloween! 🎃 💀 👻

*AI wasn’t used to write or edit this article.

DISCLAIMER

If you’re suffering from suicidal thoughts, you’re not alone. You can call or text 988 for the Suicide and Crisis Lifeline. You can also chat with 988lifeline.org. Or text MHA to 741741 for the Crisis Text Line. Or, for a comprehensive list pertaining to different countries, visit the following link: https://en.m.wikipedia.org/wiki/List_of_suicide_crisis_lines.

REFERENCES

[1]. Barker, Clive. The Hellbound Heart. HarperCollins Publishers, 1986.

[2]. Kansas City Chiefs fans break world record for loudest outdoor sports stadium with 142.2 decibels recorded at Arrowhead. Daily Mail. Sep 2014. https://www.dailymail.co.uk/sport/nfl/article-2774707/Kansas-City-Chiefs-fans-break-world-record-loudest-outdoor-sports-stadium-142-2-decibels-recorded-Arrowhead.html#:~:text=Arrowhead%20Stadium%20recorded%20at%20142.2,for%20loudest%20outdoor%20sport%20venue.

[3]. Alighieri, Dante. Inferno. 1321.

[4]. Interview with Marsha Johnson, Au.D. “A toothache in your ear — the pain is severe and incapacitating”. Hyperacusis Research. Jun 2025. https://hyperacusisresearch.org/interview-with-marsha-johnson-au-d-a-toothache-in-your-ear-the-pain-is-severe-and-incapacitating/.

[5]. Jahn, Kelly, Cohen, Joyce, Llodra, Owen. What patients say and what audiologists say. Hyperacusis Research. Mar 2025. https://hyperacusisresearch.org/pain-hyperacusis-what-patients-say-and-what-audiologists-say/?fbclid=IwY2xjawJVFFlleHRuA2FlbQIxMQABHS3aWv8pblG-pkyKPuzejV7ZwLhqRos5oRDFI2gblJIprtzwe0Y0XlBoNQ_aem_wAL5oZxapWpTJL6P9ifwfA.