I am thrilled to have been invited to write about the important and innovative work of the Hearing Voices Movement alongside so many eminent colleagues, critical thinkers and activists working together to bring about an essential revolution in the world of mental health.
We have just celebrated the anniversary of the rapidly expanding global Hearing Voices Movement which was founded more than twenty-five years ago following the ground-breaking research of Professor Marius Romme and Dr Sandra Escher. Romme and Escher have advocated for a radical shift in the way we understand the phenomenon of Hearing Voices; in contrast to traditional, biomedical psychiatry which views voices as an aberrant by-product of genetic, brain and cognitive faults, their research has firmly established that voices make sense when taking into account the traumatic circumstances that frequently provoke them (Romme and Escher, 1989, 2000, 2009, 2011). While ‘auditory hallucinations’ is the preferred jargon within psychiatric literature, the term ‘hearing voices’, which uses ordinary, non pathologising language framed subjectively, has been reclaimed. This is part of a wider aim within the mental health user movement to decolonise medicalised language of human experience.
Romme and Escher’s research shows that the majority of people who hear voices have had some traumatic experience which they connect with hearing voices. Subsequent research has confirmed their findings and attests to what many of us with first-hand experience of madness have always known – bad things that happen to you can drive you crazy. However, despite the well-established link between hearing voices and traumatic life experiences, the Hearing Voices Movement explicitly accepts all explanations for hearing voices which may include an array of belief systems, including spiritual, religious, paranormal, technological, cultural, counter cultural, philosophical, medical, and so on. As well as this, we welcome people with a range of experiences, including people who see visions or have other unusual perceptions or sensations.
Within the Hearing Voices Network (HVN) in England, which currently has the most well established national network, there are approximately 180 groups currently operating. Groups run mainly in the community but also within statutory and NGO sector services. These include acute psychiatric settings, adolescent services, low, medium and high secure settings. In addition a number of specialist groups for women, people from Black and minority ethnic communities, prisoners, children, young people and parents have also been established. As a respected British consultant psychiatrist recently said, “You clearly represent a movement and constituency that has gone well beyond offering a critique of the status quo and towards representing advocacy and example of alternative approaches which are increasingly being recognised as complimentary or better than traditional approaches”. (Roberts, 2013).
HVN creates sanctuary; safe spaces to share taboo experiences, where there are real possibilities for healing and growth. People are free to share and explore their experiences in detail including the content of what their voices say (Beavan and Read 2010), without the threat of censorship, loss of liberty or forced medication, a common feature of disclosure in traditional psychiatric settings.
As well as our group work, we raise awareness of the benefits of talking about voices, visions and other unusual experiences and the value of peer support. We promote this innovative approach to voice hearers, family members and mental health professionals. We regularly provide training to staff, support on-going research into hearing voices and allied subjects, and liaise with the media which has resulted in a number of positive broadcasts and publications about HVN and voice hearing, both nationally and internationally (Adams 2008; Dillon 2010a; Hilpern 2007; Kirsch 2007; Lakhani 2009: Smith 2007).
There are now Hearing Voices networks in 26 countries, across 5 continents: Australia, Austria, Belgium, Canada, Denmark, England, Finland, Germany, Greece, Holland, Ireland, Italy, Japan, Kenya, Malaysia, New Zealand, Norway, Palestine, Scotland, South Africa, Spain, Sweden, Switzerland, Uganda, USA and Wales. International developments are co-ordinated via INTERVOICE – the International Network for Training, Education and Research into Hearing Voices – an international organisation dedicated to spreading positive and hopeful messages about the experience of hearing voices across the world.
Representatives and members of the international networks meet annually, at the World Hearing Voices Congresses, to promote new developments, innovative practice, translation of materials, and to support activities in burgeoning countries and share a sense of community, solidarity and camaraderie. One of the fundamental strengths of the Hearing Voices Movement, which has led to its extraordinary success, is that it is based on mutually respectful relationships – authentic partnerships between experts by experience and experts by profession, working together to bring about the emancipation of voice hearers.
HVN’s starting point is that the crises that people experience are real and that they are happening for a reason which is directly connected to the person’s life. We endeavour to support people to make sense of the real events in their lives that may have precipitated their crisis. We show a genuine interest in the range of people’s inner, subjective experiences. When people describe experiences that are deemed ‘psychotic’ we look for the meaning in their madness. Sometimes people use metaphorical or symbolic language to convey their realities and sometimes they are talking literally about things that have happened to them. However crazy someone appears, we believe that they are making a meaningful attempt to survive maddening experiences.
Contrary to traditional approaches, HVN sees voice-hearing as significant, decipherable and intimately connected to a person’s life story. Consequently, we encourage and support people to listen to their voices and attest to their reality in order to better understand their meaning. We acknowledge that people are having normal reactions to abnormal stress. Instead of asking people – what is wrong with you? We ask them – what has happened to you? On a daily basis we hear stories of physical, sexual and emotional abuse, the impact of neglect, poverty and alienation, as well as of racism, sexism and classism. Those people, whose experiences do not fit so neatly into a category of trauma as it is currently understood, raise the question of developing our understanding of the huge range of painful and damaging experiences that can be inflicted on and endured by children and adults.
We show respect for the reality of the suffering that people have experienced, and a keen awareness of how this may limit their expression of feelings, ability to think clearly, or capacity to connect. A key part of our role is to magnify the voices of people who are not normally listened to, by promoting the belief that each person has a deep wisdom and expertise about managing and dealing with their own problems. We validate and support people’s resilience, creativity, stamina and emotional strengths, even when they themselves doubt the existence of these qualities.
Acknowledgment enables people to develop true insight into their own distress and suffering which leads to an increasing sense of meaning and purpose in their lives. We are interested in people’s subjective experiences – including their altered states of consciousness, unusual perceptions, ideas and ways of seeing and experiencing the world. When your own feelings, thoughts, experiences and bodily sensations, begin to make sense to you, insight is a natural consequence. When you understand your own ‘symptoms’ as meaningful and essential survival strategies, a more respectful and loving acceptance of yourself begins to emerge (Bullimore 2009; Dillon 2010b; Lampshire 2009; Longden 2010; McNamara 2011).
We recognise that recovery is an on-going process with no fixed end point and that each person’s recovery is unique. HVN recognises that crises may occur again because recovery is an evolving process, an expansive process not a reductive one which seeks to control and maintain people. We have faith in people’s inherent right and capacity to heal, to make mistakes, to learn and to grow. We know that there is much about human experience that we do not understand and we remain humble and curious and open to new ways of seeing the world. We are not interested in complying with social control or in servicing normality. ‘Instead of being a list of symptoms, with side effects on top, we are people who hear voices and see visions, have unusual thoughts, passionate feelings, intense experiences’(Dillon and May 2002). We celebrate our differences.
For many voice hearers and psychiatric survivors, active participation and social action supports and enhances the recovery process; having a shared survivor mission ( Herman, 1992), and becoming part of a collective voice creating change in the world, both inside and out, is healing, empowering and liberating. This is also true for many mental health workers, who have become increasingly disillusioned with an inadequate biomedical model, disturbed by the collusion demanded of staff in a mental health system driven by fear, control and bureaucracy. For them, becoming part of the Hearing Voices Movement also enables a recovery of meaning, purpose and optimism, a renewal of important values, a rediscovering of a sense of self. For all of us, the possibility of reconnecting to ourselves and each other as unique and equal human beings, is life affirming.
Questions, comments and/or reflections are welcome on this website or via Twitter @JacquiDillon
Jacqui Dillon’s website: http://www.jacquidillon.org
FOR FURTHER INFORMATION:
Intervoice – http://www.intervoiceonline.org/
Hearing Voices Network, USA: http://www.hearingvoicesusa.org/
Hearing Voices Network, England: http://www.hearing-voices.org/
Adams, W. (2008). The Listening Cure. Time, 21 February.
Beavan, V. and Read, J. (2010). Hearing voices and listening to what they say. Journal of Nervous and Mental Disease 198: 201-5.
Bullimore, P. (2009). My personal experience of paranoia. Psychosis 2: 173-7.
Dillon, J. and May, R. (2002). Reclaiming experience. Clinical Psychology 17: 25-77.
Dillon, J. (2010a). www.radionz.co.nz/national/programmes/ninetonoon/20100414
Dillon, J. (2010b). The tale of an ordinary little girl. Psychosis 1: 79-83.
Herman, J. (1992). Trauma and recovery. New York: Basic Books.
Hilpern, K. (2007). How I beat the voices in my head. The Independent, Mar. 6.
Kirsch, M. (2007). Voices in your head? You may not be crazy. The Times, 23 January.
Roberts, G. (2013). Personal communication.
Lakhani, N. (2009). A first-class recovery. Independent on Sunday, 25 October.
Lampshire, D. (2009). Lies and lessons: ramblings of an alleged mad woman. Psychosis 1: 178-84.Romme, M. and Escher, S. (1989). Hearing voices. Schizophrenia Bulletin 15: 209-16.
Longden, E. (2010). Making sense of voices: a personal story of recovery. Psychosis 2: 255-9.
McNamara, J. (2011). Can we sit and talk? Poems stories and some words of advice. Psychosis 3: 167-71.
Romme, M. and Escher, S. (1989). Hearing voices. Schizophrenia Bulletin 15: 209-16.
Romme, M. and Escher, S. (2000). Making Sense of Voices. London: Mind.
Romme, M. Escher, S. Dillon, J. Corstens, D. Morris, M. (eds.). (2009). Living with Voices: 50 Stories of Recovery. PCCS Books.
Romme, M. and Escher, S. (eds) (2011). Psychosis as a Personal Crisis. London: Routledge.
Smith, D. (2007). Can you live with the voices in your head? New York Times, 25 March.
In addition, many people have heard voices all of their lives which are benign and not harmful or problematic. All of the saints in the Roman Catholilc Church who had visions and heard voices would all be locked up and forcibly treated if they lived here and now. And yet, their messages from their visions and voices were truly spiritual guidelines that led many laypeople to lead better lives. St. Francis of Assisi, Hildegard of Bengen, St. Claire, St. Theresa of Avila……all of them would be locked up today and people would be told not to listen to them because they are delusional and psychotic!
What I like about your movement is that you accept the visions and voices that people experience as real and valid experiences. I know of psychologists in hospitals who lost their jobs because they actually worked with the voices that people heard. The psychiatrists on staff said that the psychologists were buying into the delusions of the patients and this would only make the patients sicker! Therefore, the psychologists were fired. Sad.
You are absolutely right Stephen that many people – 2/3 of voice hearers in fact, hear voices that are not problematic. As well as this, voices have been experienced by many significant people, including most religious and spiritual leaders, and many philosophers, thinkers and artists, throughout time. Historically, hearing voices was understood very differently and it was only with the arrival of biological psychiatry, that such experiences were deemed symptomatic of an illness. Fortunately, the work of the Hearing Voices Movement is reclaiming this experience as a common human experience and working to change this so that psychologists and other mental health professionals will no longer be penalised for simply honouring people’s experiences!
“For many voice hearers and psychiatric survivors, active participation and social action supports and enhances the recovery process; having a shared survivor mission ( Herman, 1992), and becoming part of a collective voice creating change in the world, both inside and out, is healing, empowering and liberating. This is also true for many mental health workers, who have become increasingly disillusioned with an inadequate biomedical model, disturbed by the collusion demanded of staff in a mental health system driven by fear, control and bureaucracy.”
“Social action supports and enhances the recovery process?”
Here in our group setting of a HVN meeting we sit in a circle and face each other with open non-judgemental acceptance, there is talk of hearing voices with positive feedback on acceptance, re-framing a previous message of FEAR.
This all happens at a conscious level of hearing other peoples voice and seeing their facial expressions.
Is there also an “unconscious” process happening simultaneously?
Are we triggering each other “social engagement system,” a neural network in the brain, which regulates visceral state and those ancient mechanisms of freeze/flight/fight which may produce the phenomenon of hearing voices? For example, is hearing voices a product of predation FEAR? Neural networks deep in the brain stem and operating well below the threshold of conscious awareness.
Please consider this conversation with the dicoverer of a third branch to our autonomic nervous system, he calls “the social engagement system.” Professor Stephen Porges.
“SP: The theory has two important parts. The first is the link between the nerves of the face and the nerves that regulate the heart and the lungs. The second is the phylogenetic hierarchy that describes the evolutionary sequence from a primitive, unmyelinated vagus related to conservation of metabolic resources, to a sympathetic-adrenal system involved in mobilization strategies, to a myelinated vagus related to modulating calm bodily states and social engagement behaviors. The hierarchy emphasizes that the newer “circuits” inhibit the older ones. We use the newest circuit to promote calm states, to self-soothe and to engage. When this doesn’t work, we use the sympathetic-adrenal system to mobilize for fight and flight behaviors. And when that doesn’t work, we use a very old vagal system, the freeze or shutdown system. So the theory states that our physiological responses are hierarchically organized in the way we react to challenge, and the hierarchy of reactions follows the sequence in which the systems evolved. Additionally, the linkage between the nerves that regulate the face and the nerves that regulate the heart and lungs implies that we can use the facial muscles to calm us down. Think about it: when we’re stressed or anxious, we use our facial muscles, which include the ears. We eat or drink, we listen to music, and we talk to people to calm down.
RD: So we could use dramatic facial expressions to calm down?
SP: Absolutely. Think about how pranayama (a yogic breathing technique) works. When you do these breathing exercises, you’re actually “exercising” both the sensory and motor nerves regulating the facial muscles; you are controlling breath and maneuvering the oral motor cavity. It’s a very efficient way of working on the system. A lot of people don’t like to teach pranayama because they think it’s too powerful. Polyvagal theory explains how pranayama might work and how other methods of stimulating the same system, including social interactions, can result in similar benefits to our health and mental state. The social engagement system includes the nerves regulating the face and the myelinated vagus regulating the heart and bronchi.The power of the social engagement system is amazing both in terms of its effects on behavior and mental state, but also in terms of the speed with which it works.
RD: So do humans have the ability to consciously access our more recently developed neurological systems, instead of reverting automatically to our reactive systems? If so, can we use them to override the vague anxiety with which many of us live?
SP: Let’s take a very optimistic viewpoint. Let’s say that some of these behaviors—at least the shutting down of social engagement to facilitate defensive behaviors—are not voluntary choices. However, often when this occurs, it is as if the nervous system has betrayed us.”
Learning “sensation awareness,” of what is happening within my nervous system helps me to engage socially ay HVN meeting and send the right “unconscious” feedback signals to others, which facilitates good communication, by reducing FEAR?
Are we fully self-aware, conscious creatures, or there something unconscious happening when we hear voices?
You raise some important questions David about the importance of attending to the subtle and not so subtle changes that happen at multiple levels. In answer to your question about whether there is something unconscious happening when we hear voices, for me, communication from my voices seems to make audible what may be lurking, deep within my unconscious…
Congrats to Jacqui Dillon and the Hearing Voices Movement! You show so clearly that we are human beings with human feelings. We cannot be categorized or put into boxes. We cannot be fixed.
Now that many of us have survived oppression in the name of ‘help’ we refuse to be labeled and are helping and encouraging each other. Psychiatry cannot help while it refuses to recognise us a human beings, while it diagnoses ‘diseases’ that do not exist. We are helping each other to overcome the trauma of psychiatric maltreatment.
I still remember the first time I heard you speak in Manchester. I was so delighted to hear your powerful, heartfelt words that I stood up to give you a standing ovation! Many others took to their feet also. You are an outstanding woman and I am proud to add my voice to yours to be part of the change we want to see in the world!
MindFreedom Ireland also celebrate our 10th anniversary with you this year. Happy Anniversary!
Thank you for those heartfelt words Mary – really great to hear. I remember meeting you for the first time in Manchester at the Hearing Voices Network 15th Anniversary conference – look how much has been achieved in that time! Happy Anniversary to us all!
And I can only second that Mary!
Great minds think alike! 🙂
Hi Jacqui, great article and grat to be reading you her at MadINAmerica. ‘Foreign Correspondent’ cool.
What’s the big deal about “Hearing Voices”?
I find that many folks in N America think its just a new name for a certain diagnosis- till they discover it incorporates a whole way of thinking, being and acting that’s quite a bit different from anything else they’ve come across certainly in “mental health”….
Just like the title of your article – we go beyond simply critiquing what others do or don’t do – we actually do something else, creating alternatives and offering a choice.
We work together – experts by profession and experts by experience working together, learning from each other.
For example: here in Toronto – this week – we have our first training for mental health workers – designed and lead by voice hearers.
We’re a community, and a global one at that, many of my supports live in diiferent timezones, on different continents, yet we find common spirit. You’re never alone when you hear voices, but there’s also always someone else awake somewher you can reach out to.
There are so many good things in the hearing voices movement and so many inspiring people – and you’re one of them.
Great to hear you affirming what I have said in this post about how incredibly important the work of the Hearing Voices Movement is fo a number of reasons: that it offers a completely different way of thinking about AND responding to human distress and extreme experiences, that our work is about sharing power and moving beyond the them/us divide, and that we are a worldwide movement – how comforting and fantastic it is to have a support network that spreads across the globe! And look what cool people you get to meet! Hope the training in Toronto went well – I bet it did!
All best wishes,
nearly forgot…And that goes for you too, Olga Runciman!
Absolutely, Olga Runciman very much too!
most people at the hearing voices group I attend are worried sick about losing their disability benefits which for some has resulted in ending up in hospital on section. Is HVN and Intervoice doing anything on this issue?