The Video “Voices Matter” is an important video in many ways. It is the first video in what is going to be an ongoing open paradigm production, which I think is an exciting new development for MiA. As a voice hearer, I am excited that the first video is about the Hearing Voices (HV) movement and I feel it has captured the spirit of our movement extremely well. I was there in Cardiff and have many great memories from those couple of days when voice hearers from all over the world gathered together under one flag metaphorically speaking.
However this video also captures something else. It has captured the first signs, the first moments of professional interest, for as I wrote in a previous comment regarding Robin Murray a psychiatrist who also presented at Intervoice, we have become a powerful organization. (See Robin Murray’s presentation and the ensuing debate by MiA readers)
I believe this video, ‘Voices Matter’ not only captures these first moments but also hints at the dangers that inevitably are present when a movement threatens the established order of things. The HV movement that arose from a gathering of, in psychiatry’s eyes, schizophrenics talking about their symptoms are today threatening to destabilize the biogenetic illness paradigm that is required for psychiatry to retain power over distressed individuals. For we introduce meaning and understanding, acknowledging the often dreadful life events that those labeled ‘schizophrenic’ have experienced and by so doing, to use psychiatry’s words, ‘cure’ people, something psychiatry is notoriously unsuccessful at. Indeed, Robert Whitaker’s book Anatomy of an Epidemic shows that psychiatry has introduced a state of chronicity that is reaching epic proportions throughout much of the world, not to mention a shortened life expectancy of, on average, 25 years for those labeled ‘schizophrenic’.
We are introduced in the video to Alison Brabban, a CBT psychologist who also spoke at the conference, followed by, in her case, a debate between her and the conference participants; many of whom are voice hearers from around the world. I am sure she means well and believes that she is ‘doing us a good service’. However, Alison is not just any CBT psychologist, so before I write more, I want to backtrack historically speaking, so as to frame her and many other CBT psychologists.
The recovery movement, initiated in the 1970’s by survivors, shook psychiatry to its core. Originally rejected by the psychiatric establishment, psychiatry has later been forced to acknowledge and now incorporate recovery into its daily praxis. This has meant that chronicity, previously associated with schizophrenia, has been deconstructed, so though schizophrenia in the eyes of psychiatry is the diagnosis most associated with a biological etiology, the fact that people have and do recover challenges that biological foundation; so much so, that new stories must be created to incorporate this inconsistency.
Therefore, no longer able to avoid social context completely the new story that has proven to be highly successful at incorporating this inconsistency for psychiatry is the Vulnerability-Stress Hypothesis. This is an extremely good model, for here social context is readily acknowledged as playing a role, however psychiatry then immediately denies this causal role of social context by implying that the only reason a person reacts to their environment is because the person is vulnerable (= genetically predisposed to, e.g., schizophrenia) to start off with. Thus once again social and environmental contexts are neatly put in their place as inconsequential and the focus can, once again, return to psychiatry’s biogenetic explanations for human distress albeit in new wrappings, with a lucrative chemical solution. In other words, the psychiatric paradigm of care is unchanged; in fact, they have managed to make it sound better, as being told one is vulnerable is better than being told one is genetically defective.
However, psychiatry can no longer ignore life stories in quite the same way as before, therefore to give the impression that they are valued in psychiatry and that psychiatry is recovery orientated; therapy has now been introduced in the form of… Yes, you guessed it, CBT. Now why CBT? Because it never challenges psychiatry simply because it, too, rejects life stories by not engaging with it them. Instead CBT is a series of techniques to change thoughts and behavior in the here and now. Because it is also a manualized technique it lends itself very well to the research methods preferred by psychiatry and therefore situates itself extremely well within the psychiatric research paradigm.
This has opened doors for psychologists to enter the prestigious corridors of the psychiatric system and share in the powers that are invested there. Again I am not rejecting CBT it has many useful tools and I use CBT methods if and when they are applicable in my eclectic toolbox when trying to support people who are suffering. Indeed Richard Bentall has done some very interesting work from a CBT perspective. But its role in giving the illusion of a therapeutic psychiatry has been very damaging for the recovery movement and certainly in Denmark the ‘severely mentally ill’ i.e. those who suffer psychotic breakdowns do not have access to therapy. In 2009 which is the last time the Danish psychological society looked at who got psychological support (CBT) in psychiatric settings only 8% of those with psychosis were offered therapy. This is a telling figure when one considers that the hospitals tend to be filled mostly with people who fulfill the criteria of being severely disturbed, i.e. psychotic.
There are those who argue, myself included, that the recovery movement has been colonized. It was such a threat that when recovery wouldn’t go away the next best thing was to take it over, as going into a direct confrontation would have meant that the myth of mental illness to quote Szasz could potentially have become public in the sense that psychiatry might well have been seen as having no clothes on. So now psychiatry has changed garments and is now wearing its new ‘recovery outfit’ and the public though skeptical have bought into it.
I would today posit that the HV movement is now psychiatry’s biggest threat. After all ‘schizophrenia’ is psychiatry’s raison d’être if one is to go by the amount of research, human rights abuses and fear mongering that surrounds what can arguably be seen as the most extreme expression of human distress. To keep this form of expression as meaningless madness, justifies psychiatry’s position of power, its treatments and the illusion that psychiatry is a scientific endeavor. However, not only does the HV movement make madness meaningful, normalizes voices and other unusual beliefs, it offers a true alternative to helping people to not just exist as marginalized, medicalized people, but to truly recover and become fully functioning and contributing citizens in the community. In all my years working in psychiatry as a psychiatric nurse I never saw that happen there.
So to return to Alison and my statement that she was not just any CBT psychologist. She is highly placed in academia working as a staff member at the school of Medicine, Pharmacy and Health at Durham University, she works as a Consultant Clinical Psychologist in early intervention for psychosis and has published papers in such prestigious annals as the Schizophrenia Bulletin and the Psychiatric Bulletin. Yet she is at Intervoice, why? Psychiatry promotes CBT, Alison represents psychiatric CBT, and it is clear from this video her mission is not to meet us, the voice hearers, but to bring us back to the fold, so to speak. Her message is: if we listen to her words of reason we will see the error of our ways, because to get into accepted mainstream psychiatry we, and our methods, must be evidence based and very importantly conform to the ‘traditions’ set out by the psychiatric paradigm so as to be allowed in.
This video shows how completely she has misunderstood the whole concept of the HV movement. Our strength lies in doing exactly what we are doing which is refusing to conform, refusing to value psychiatric guidelines, refusing to engage with traditional psychiatry and instead choosing to work outside of psychiatry in a true post-psychiatric manner. For the HV movement is also a civil rights movement. Can you imagine women fighting for women’s rights saying yes to presenting models of emancipation to men so that they can be researched and tested to see if they work? Or, slaves going to their masters with methods on how to set themselves free which can then be judged and juried by the slave owners? No I think not! But if we were to conform, if we were to accept the guidelines and traditions of the psychiatric paradigm then yes we would become part of psychiatry… but we would disappear our voices silenced once again as colonized patients.
Therefore, my comments here are referring to the very real dangers of colonization, and my question is how do we prevent being colonized? We are now on the map, we threaten the whole concept of schizophrenia, in fact, we threaten to profoundly destabilize psychiatry. Therefore, it would be extremely naïve to believe psychiatry has seen the light and wishes to value our ways. In fact to be honest I am offended that two people so entrenched in traditional psychiatry think that we would fall for transparent platitudes and promises of being allowed to sit at the high table of psychiatry as evidenced by Robin Murray and Alison Brabban’s presence at Intervoice. (See Robin Murray’s presentation)
I have chosen to focus on only one aspect of what is told in this video yet this video has so much more. It has not only managed to capture the first hints of psychiatry’s interest, its sniffing around but, more importantly, it has captured the spirit of the HV movement, the diversity, the power and the beauty of the song of our voices! How wonderful that the first video of what is going to be ongoing presentations by MiA is about the Hearing Voices Movement!