Colonization or Postpsychiatry?

Olga Runciman, Cand Psych BSc
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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!

64 COMMENTS

  1. Great writing Olga, thanks. I just love your descriptions and language – “sniffing out” “bring us back to the fold” (as if) – your mention of HV as a civil rights movement, taking back the power. Just like I thought the peer support movement was going to be in Scotland, but it wasn’t, rather an employability tactic, getting folk off benefits and back to work.

    Your points about Alison Brabban are well made and even though I wasn’t at the conference I could see that she was making a pitch for CBT while at the same time trying to make the non-conformist conform. The power base in psychiatry just won’t let go and the same with their handmaidens. Evidence is what you make it in psychiatry where the ‘medical’ notes are subjective and used to justify treatment and behaviour, of staff and patients.

  2. Very interesting video, thank you. Alison Brabban made me laugh (bitterly) at around 18:24. It seems that if you give a scientific-sounding name to what you do at Hearing Voices you’ll be greatly rewarded by the Powers That Be. Make sure it’s a name with a catchy acronym though, that’s the most important part. I’d suggest: Altered Perception Endogenous Intertransactional Therapy, or APEIT for short (get it? Ape it… I’m sorry)

    I think professionals get very nervous when they are left out of the loop. If you don’t classify what you do and give it a nice acronym, they cannot teach it at university and make money from it themselves, and they can’t eventually tell you how in fact you are doing it wrong because you are not a qualified practitioner of APEIT. If you classify it and give it a good acronym you can then stop looking at the people and concentrate on following the manual; you don’t need empathy, sensitivity, intelligence or (God forbid!) first-hand experience; it is enough that you follow your manual accurately en efficiently. And of course politicians and bureaucrats love that, that’s all they really understand.

    This has nothing to do with science; nothing stops researchers from approaching Hearing Voices groups and doing a longitudinal study of outcomes of people in those group so they can compare them with outcomes of people receiving drug therapy or CBT. I would love to see that study, but it is certainly not HV’s job to do that study, their job is to help people heal. You do what you do because it works – I think clinging to that is the best way to avoid colonization. It is not about big social changes in the future (those never quite work out the way we want), but helping real people in the here and now.

  3. Thanks so much Olga!
    Psychiatrists and doctors are brainwashed themselves by the indoctrination they receive. It is difficult for them to have open minds, hearts and spirits. It is also very difficult for the people they can sincerely try to ‘help’ to realize they are so damaged by the ‘ treatments’ psychiatry has to offer. Yes, people should have choice in a free world. Where is the choice for people who have been severely damaged of lost their lives to psychiatry? Lets face it psychiatry has very little to offer people in real distress. Many people have to be content to sacrifice their humanity to exist in this world and they have no choice. Many of us are the lucky ones who managed to survive and thrive against all the odds. It is difficult to work outside the system but in the long run we need to go slowly and make sure we don’t join forces with the ‘tyranny of good will’ many of us know as coercive, deceptive, fear driven psychiatry.
    Thankfully all the people who have received tunnel vision training are not brainwashed and are doing their best to expose psychiatry as we have come to know and dislike it. We who know how it works, how it is so power driven, cannot join forces with our oppressor.
    “Of all tyrannies, a tyranny exercised for the good of its victims may be the MOST OPPRESSIVE.” C.S.Lewis
    Your soul sister,
    Mary.
    http://www.mindfreedomireland.com

    • I agree about the *brainwashing* that happens to med students and interns. I work in a state hospital where one of the units has med students and interns from the state university medical center. I watch the classes that two of the psychistrists at the hospital teach and it’s nothing but the drugs, drugs, drugs! They never learn how to listen to and talk with individuals; all they learn is what drugs to poke down people and how to coerce them if they don’t want the toxic drugs. It really is shameful and I’m often tempted, as a former patient of one of these very psychiatrists, to burst into the room where he’s lecturing to them and scream for them to not listen to anything he says. Of course, I’d be hustled out the door by security and without a job right afterwards!

  4. I am really appreciating the language of “colonization” and de-colonization that I see around the Hearing Voices Network. Those words are such powerfully true descriptors of what is happening between industry, idea, and individual, power, meaning, profit and effect.

    Thanks for framing it as what it is.

  5. While I agree for example that it is important the the Hearing Voices Movement maintain its independence from professional efforts and that it continue to focus on emancipation and challenging professionals and psychiatry, I also think this article over-simplifies some key issues.

    For example, while CBT uses the vulnerability-stress model, it does NOT assume that vulnerability is genetic – instead it definitely is interested in the possibility that vulnerability may come from difficult or traumatic early life experience, and it is very interested in understanding the role of such experiences.

    I would also argue that it is very untrue to state that CBT never challenges psychiatry. One small study was already completed by CBT therapists showing that CBT can be helpful for people who choose not to take medications for “psychosis” and a larger study is now underway: this explicitly challenges the psychiatric notion that medication is a pre-requisite for helping people with psychosis. By proving that people can get better just by experimenting with the way they think and act, such studies can be helpful to our movement generally.

    I understand many of us are rightfully wary of professionals, and there are reasons to continue to be appropriately wary, but let’s not be so wary that we overlook potential alliances or so wary that we inaccurately represent research and approaches that could be helpful.

    Rufus May has called for a dialog between CBT and those whose knowledge comes from experience. I’m someone who has my feet in a variety of worlds, including practicing and teaching CBT, and I’m interested in that dialog. I hope to get a post up about it in the near future, going into some more detail on what I think might be some helpful perspectives regarding these issues.

    • Reference for that small study I mentioned:
      Morrison, A. P., Hutton, P., Wardle, M., Spencer, H., Barratt, S. (2012). Cognitive therapy for people with a schizophrenia spectrum diagnosis not taking antipsychotic medication: An exploratory trial. Psychological Medicine, 42.5, 1049-1056.

    • But is it not the point that the HV movement is NOT a therapy? A therapy by its very nature has a structure therapist-patient, and no matter how much to try to disguise that structure it is always there defining and conditioning the relationships of the people involved. On the other hand HV, not being a therapy, has a completely different underlying relationship between people who take part – between its members (not “patients”).

      Clearly CBT is a therapy, so while dialogue -exchange of information- is of course possible and welcome, I don’t see how you can mix HV and CBT; they can be good neighbours, but not bedfellows. If you try to turn HV into a therapy you will alter its structure and completely destroy it – it will lose that which makes it work in the first place.

      Also, I don’t think the vulnerability-stress model issue is a small detail; it’s like saying that it’s OK for a group of people who work for the emancipation of black slaves to think black people belong to an inferior race, because slaves should be happy for any help they can get. As for a non-genetic vulnerability, I’m afraid I’m not sure I understand what you mean. The whole point of a vulnerability is that it is innate (maybe not genetic, but innate and “biological”); if it is the result of trauma then it is not a vulnerability but simply damage caused by trauma, which accumulates up to the point where it becomes symptomatic (“psychosis”). The vulnerability in the “vulnerability-stress” model is always innate, and once “triggered” by trauma there is no point trying to treat the “trigger”, which is why neither conventional psychiatrists nor CBT therapists give genuine importance to life histories and to making sense of past experiences and their relation with present experiences as part of the healing process. I think the only dialogue possible between HV and any group that believes in the vulnerability-stress model is to show that group that the model is wrong. That should be the basic starting point.

      • Hi Morias, I certainly agree that the Hearing Voices Movement and CBT should not try to be the same thing, but they can work really well together – people can participate in both at the same time with each reinforcing the other, there doesn’t have to be any contradiction.

        I disagree with your analysis of the role of “vulnerability in two ways. I don’t agree that vulnerability is necessarily permanent, and I also don’t agree that vulnerability has to be thought of as just a defect.

        Early trauma does seem to make people more vulnerable to psychosis, but people can also work through trauma and resolve it, and eventually that person may be even less vulnerable to psychosis than others. Good CBT does take an interest in helping people do this (though I’m also sure you can find lots of crappy CBT that doesn’t!)

        Various kinds of sensitivity or tendencies to be creative or imaginative can also increase vulnerability to psychosis, at least until the person understands well how to work with those differences. CBT for psychosis emphasizes “normalizing” and helping people see how otherwise positive qualities might also increase vulnerability can help with self acceptance as well as practical learning about how to handle oneself in the future.

        • Then we agree to some extent, but I’d suggest “vulnerability” is the wrong term, as it does imply a degree of irreversibility. At least I think you’ll agree that most people who talk in terms of vulnerability use the term in that way. I don’t think the concept of vulnerability includes the possibility of its being derived from a “positive quality” but on the contrary it is often associated with the need for life-long treatment of one kind or another – almost inevitably it leads to people perceiving themselves as “ill”. I think perhaps what you describe could be better called a Hypersensitivity-stress model, where early exposure to high levels of stress (trauma) leads to a stress hypersensitivity – a better model than the vulnerability one but still, I think, incorrect.

          In previous comments I have used the analogy of “the gene that codes for better food absorption and the contaminated food”. I won’t repeat it again because it gets quite long, but the point of it is precisely to emphasize the difference between a vulnerability (or predisposition for a disease) and a positive trait which in the presence of a deleterious environmental agent (trauma) can become disadvantageous for the individual that possesses that trait. The two things might be difficult to tell apart but they are fundamentally different.

          This difference is very important for lots of reasons, but I’ll mention only what I think is key in connection to the relationship between the HV movement and something like CBT (and I admit I don’t know much about CBT… or the HV movement). The key question is: how do you view “psychosis”? Or to narrow it down, voice hearing; how do you view voice hearing? As a positive or a negative trait? Is voice hearing an expression of health or of disease? My own reply is that it is an expression of health – and I don’t say this to make voice hearers feel good about themselves.

          What do I mean then, that voice hearing is an expression of health? To put it very briefly, I’d say that voice hearing is a defence mechanism is the presence of extreme trauma. In other words, it is the healthy “normal” response of a healthy “normal” human organism when it is exposed to certain deleterious environmental agents. But if voice hearing (or other forms of “psychosis”) is the healthy response, what is then the unhealthy response? Isn’t the healthy response worse than the disease? Not when you put things in context; the unhealthy response is mainly death or extreme forms of withdrawal. Psychosis is what a healthy brain does when the only other logical response is jumping out the window.

          Of course the objection to this idea is that not all psychotic people, not all voice hearers, appear to have been exposed to what we might call “extreme trauma”, and there are also people exposed to trauma who do not become voice hearers. And “psychotic episodes” are usually not brought on by traumatic incidents but by everyday-type stress. Hence this idea of vulnerability: the voice hearer as someone less able to cope with trauma or stress… it really is too complex a subject to go into it in a blog’s comment, I have to cut it short here. But I hope this might make you look more closely at the Vulnerability-stress model and ask yourself this question: is hearing voices a “natural therapy” with which the healthy body tries to combat a “relational disease” (traumatic relations created by one type or another of abuse)? Or, on the contrary, is voice hearing a symptom of a disease (psychological, physiological; same difference)? Is voice hearing to be carefully encouraged because it gives the voice hearer the best possible tool to deal with underlying emotional distress? Or is it to be discouraged, the aim of therapy being to minimize voice hearing and seek other avenues of dealing with emotional distress? Is voice hearing a cause of stress or a way to deal with deep-seated underlying stress caused by a history of trauma?

          And one last thing: if we are talking of encouraging voice hearing, can anyone other than someone with first-hand experience of voice hearing take on that responsibility, no matter how highly trained a therapist they may be? I’m not so sure.

          • Morias, I think CBT for psychosis uses the term “vulnerability” in a common sense way as something that may or may not be permanent, though I would agree that in the mental health field, it is more common for people to use it with the “delusion” that they are talking about something necessarily permanent. I don’t think that means we need a different word, vulnerability is a good word in a lot of ways, we just need to be clear how it should be understood.

            You ask “Is voice hearing a cause of stress or a way to deal with deep-seated underlying stress caused by a history of trauma?” I would think that for many it is both. Ways of coping with trauma frequently cause unintended consequences that amplify stress rather than result in successful coping – one of the strengths of CBT is that it recognizes the possibility of such non-linear effects.

            I don’t think there is a problem with people who haven’t heard voices helping people who do hear voices explore coping options, as long as they do so in a humble way, paying attention to whether they are helping or not. After all, just having some voice hearing experience is no guarantee of understanding another person’s experience that may be different in important ways….

          • I’m a voice hearer and I self-harm and understanding, making sense of your life trauma’s doesn’t in itself always heal everything. I thought it was the holy grail but it isn’t for everyone, and people like me have little place within the HV movement because we don’t have a recovery narrative. I almost feel like starting a group up for the unrecovered so we have somewhere to go.

        • Ron, I’m glad you bring up humility since what spurred me to comment on this post was what to me seemed a remarkable lack of humility in Alison Brabban’s intervention (true that the video only shows small fragments out of context). I wonder how it struck you. I could not help thinking that given the relative successes of the HV movement and conventional therapies -when you adjust for differences in funding, access, etc.- conventional therapists such as Alison should be approaching the HV movement with a lot of humility and a learning, rather than a teaching, attitude.

          Regarding the other points you make I fear we are misunderstanding each other, which is not surprising since we are dealing with subjects that cannot be discussed in a few short phrases. I won’t press the point of “vulnerability” although I’d ask you to consider the impact that kind of terminology has at a policy-making level on issues such as enforced medication, etc.

          I will make however on last attempt to clarify the question of whether “voice hearing is a cause of stress or a way to deal with deep-seated underlying stress caused by a history of trauma.” I can see from your comment that the way I phrased it was too confusing.

          Of course the experience of hearing voices will often be stressful (to say the least), that is in fact the whole point: the voices act as a channel through which the voice hearer can access emotional trauma (as well as other aspects of him or herself, but let’s leave that aside) and deal with it through symbols at a conscious level. Without the voices the trauma would still be there, but would be harder to “reach” and come to terms with, and would potentially cause more damage: self-harming, aggression, suicide, etc.

          The voices are, so to speak, tunnels which give access to the trauma buried deep within the person. If through them you can reach the trauma and heal it (as far as that is possible) the voices should cease to be a source of distress; in some cases they’ll disappear, in others become part of an harmonious self. Of course facing trauma and making sense of it, although necessary for the healing process (CBT might disagree with that), is in itself an stressful experience and the voices might be frightening and hurtful even if they are part of a positive healing process.

          Needless to say this is an extremely crude oversimplification of something very complex, but that’s the general idea. And of course, where the trauma is severe the voice hearer might be overwhelmed by emotional distress, overwhelmed “by” the voices, and be in need of help, therapy (for the underlying trauma, not for the voices themselves) or in extreme cases emergency interventions to guarantee his/her safety or that of others (the damaging abuse that takes place in those emergency interventions as carried out in current practice is a different story, but it needn’t be like that). A therapist trained to heal trauma might indeed have a lot to offer (whether CBT is best suited for this, that’s also a different story) and his or her job as a therapist should be in fact facilitated by the voices, if he or she knows how to listen to them. But that’s one of the difficulties, without first-hand experience or at least a “native guide” he or she might get lost navigating the voices and miss the unique opportunity for healing that the voices represent.

          Anyway, I’m getting tangled up in my own rhetoric and this comment is already far too long so I’ll leave it at that.

          • Morias, you wrote that you thought Alison Brabban should have come to the conference to learn and not to teach, but I think she was invited there as a presenter, so we can’t blame her for wanting to teach what she knew after she was asked to do that! I didn’t really try to judge her by the short bit I saw in the video. In general I do think professionals should be interested in learning from the Hearing Voices movement, but I also think this field is complex enough that people in the hearing voices movement can also learn a thing or two at times from open minded and compassionate professionals, and mostly we need dialog where we can share our understandings, compare differences, and help each other understand more.

            I thought your bit about voices and trauma made a lot of sense, and it really isn’t different from the more progressive CBT understanding. Well, one point of minor difference might be that your comments could be interpreted to say that voices inevitable make a positive contribution to people’s healing: I think people in CBT would be more likely to see voices as contributing to healing only if the person interprets and relates to the voices in the right way: other interpretations and forms of relationship with the voices can send a person spiraling into more trauma and disorganization. But that’s really not a viewpoint at odds with the hearing voices movement, since both CBT for psychosis and HVN see lack of ability to relate successfully to the voices, and not the voices themselves, as the problem.

    • The CBT study is really interesting Ron, but I do think it’s fair to say that generally speaking CBT and it’s variants don’t challenge psychiatry and can be used to suggest ‘preferred’ belief systems/interpretations. I can think of people who would be most creative using CBT, and others who would simply use it to promote the thinking of nice thoughts instead of bad ones. Equally voice dialogue in the wrong hands could be a disaster. There are few approaches which are immune to being used badly, although for myself of those I view as near as ‘fool proof’ as is possible with an intervention, I’d have to say the Maastricht Interview is pretty hard to beat. It’s hard to go wrong with that one, but, I still know it wouldn’t suit everyone, and the experience of it can still be enhanced further by a good interviewer.
      The problem with interventions researched by the NHS is that funders require standard outcome measures such as ‘treatment adherence’, symptom reduction, cessation of certain actions, etc. The outcome measures are more quantitative than qualitative bearing in mind service aims and funding. CBT has been used here politically via IAPT as part of the drive to get people into work, that was it’s main aim, not to help people with their difficulties and in many areas those defined as having psychosis or with history of self-harm are precluded access.

      • Hi Joanna,
        I think the better forms of CBT seek to collaborate in exploring what beliefs, thoughts, and approaches might be most helpful, and that is similar in some ways to what might happen in a Hearing Voices Group. So it isn’t about the therapist deciding what is most helpful and telling it to the person they are supposed to be helping. A good CBT therapist is humble: he or she might have ideas about what might work, but also knows those ideas might be wrong for particular people or situations, and knows people have to decide for themselves.
        I have heard about some of the limits in what NHS would fund in the UK, and the CBT therapist I talk to over there was pretty upset about that herself. I don’t think it’s fair to blame all of CBT for the limits put in place by funding sources.

  6. I am sorry Olga but the hearing voices movement has not worked totally seperate from psychiatry even right from the beginning, it was founded by a psychiatrist, the very early movers and shakers in England were psychiatric nurses, development workers and voice hearers working together, and all the years the movement has carried on it has been the same, people from with in the system and without working together even funding groups and conference to spread the word, in Denmark this is true also , If both Jorn Ericson & Trevor Eyles had not dedicated time and resources to the movement in Denmark it would not be the same today, this is true in italy, Australa, NZ, france, scotland and most other countries I know who have started networks, it has always been about workers, and voice hearers together, If we distance ourselves from that we will again be sidelined. Workers are crying out to have a different skill set to enable them to work more effectively with voice hearers. if we ignore that need we can only ever change things on the periphery. Ye of course we have to watch out for colonisation, but I do believe that working together way out weighs that possibility. We are still only a tiny flea on a huge big dog, yes I believe we can change the world otherwise I would not be involved in this work, but please let us do this together as allies for change. Please dont make all workers into the enemy which this article is in danger of doing.
    in the early days ron used to celibrate every time a psychiatrist walked out of a presentation by him. Now he see’s it as defeat if this happens, as it is important to take people with us. Increasingly on our travels we are encountering an unease with intervoice as it seems to becoming more and more “anti” psychiatry. We had the lowest number of professionals at last world congress than at anytime in the past this may be due to economics but I am concerned that we are beginning to see a resurgence of almost a hate message. I just do not believe this is helpful. Olga you are both a voice hearer and a worker, you straddle both sides but i do not see this in this piece of writing, i am very clear about what is wrong about psychiatry, I am very clear about colonisation but that has never stopped Ron or I teaching and working with workers to try to make the difference, because it is the possibility to save lives that is most important, if we are seen as just another angry voice this will turn more & more potential allies away. Its not about becoming part of the system, but we do want the system to become a tuned and willing to promote hearing voices groups and individual ways of working with voices so that the majority of voice hearers can learn about our methods not the minority.
    I entered this conversation because i do believe intervoice is in danger. It worries me that there is a 2 tier system evolving , that you are only recovering properly if you dont take medication. Intervoice and the hearing voices movement has always about meeting people where they are at and being respectful of different views, so if a voice hearer thinks their voices are connecting to God that is fine, if another believes they have a medical condition called schizophrenia that is also fine, it doesnt mean we cant discuss different views but i think if we start sewing seeds of separation we are loosing our original values which are what made us successful in the first place which is working together and accepting difference, we are actually modelling how we would like to see services.
    I dont think it is so black and white , good against evil, there are much more shades of grey. At a recent event a voice hearer was happy for us to demonstrate voice profiling , the audience was nearly all professionals, many were very emotional , and one psychiatrist was in tears, because her own doubts about psychiatry had just been validated in front of her eyes by what was revealed by the voice profiling, workers are hungry for different effective approaches that are not medication driven we need to be more proactive in enabling them to understand and use our methods, yes some colonisation may take place but if the rest genuinely believe in what we do it will be a revolution of change that will impact on many voice hearers lives in a positive way. In fact will safe many lives

  7. The ‘old’ survivor movement [viewed as irrelevant these days despite the fact that many of us worked hard for ground people now take for granted] worked to build bridges with professionals as well as doing separatist work and there are a few examples of where this has worked out well, and the early HV movement was ALL about collaboration.
    I can think of professionals who are not on the very hip HV scene and yes even do CBT, they wouldn’t be viewed the same as the superstars, but they are quietly doing something different within the system and doing their best to get it ‘evidence based’, and there are those who write it up as CBT as required but that’s not what they do in the consulting room. Innovation doesn’t just happen within HV conferences. I’ve stated time and time again with it falling on deaf ears about the 2 tier system being played out within the wider survivor movement including the HV movement – the political divide & rule is happening amongst us and it’s about use of services, use of medication [I’ve seen Youtube videos of survivors practically calling their peers stupid for ‘poisoning themselves’], and it’s also about employment and social housing [with vicious attacks on people in receipt of disability or housing benefits], and being ostracised if you refuse to state you’re recovered or ‘in recovery’ if you don’t feel it.

    CBT doesn’t challenge the social and political causes of distress but perversely can attempt to get people to accept the unacceptable, and the ‘recovery model’ within psychiatry in the UK is a joke.
    However, I would also argue that survivor orgs can also neatly side step the social and political causes of distress favouring different versions of recovery which are also prescribed to some degree. CBT doesn’t challenge psychiatry, but survivor orgs are not challenging governments to separate need from diagnosis. Abolition of diagnoses don’t look at how people access social support and live without a required diagnosis [financial/health/social care/housing systems all entwined with having to have a diagnosis]. It’s all very well taking a Szasz social Darwinist approach but not everyone can get a secure home and nice job.

    The HV movement is not yet psychiatry’s biggest threat because it’s been quietly used by mental health Trusts – they refer their patients to HV groups – yes that’s good in itself but – they do this AFTER they’ve medicated, and then people are put into ‘recovery groups’ for a few weeks and then it’s discharge back to GP, and crisis care is another matter. Long admissions are not happening now [except in secure services] but we have more people on CTO’s.
    What I observe is psychiatry using the best bits of the HV movement but it’s still wrapped up in a medical model, they are indeed colonizing it, but equally some of us have been willingly colonized by them in recovery work to promote service and political definitions of recovery.
    Then some of the paid recovery posts within services are a poisoned chalice – survivors do it because it’s often better than the alternatives, but they parrot whatever service commissioners tell them to, whilst others have cringed at what they are expected to teach [or it that preach].

    The PD industry has massively grown here in secondary and secure care, we had a diagnosis in the UK developed by our Home Office, it didn’t even come from psychiatrists, but it helped shape the last review of our Mental Health Act [and not for the better]. We have people deemed to be Schizophrenic left on depot injections to rot with no other support – they are then shoved into these stupid recovery groups for a few weeks and if they fail to recover do you know where they end up?
    In PD groups, because that’s the only area of mental health services which offer longer term support for 1-2 years. Their problems are then reframed as relational. I’ve seen this happen to people who have had a diagnosis of Schizophrenia for many years, being redefined as PD to fit the services left on offer.

    I believe PD is as much the diagnostic and political frontline of diagnosis as Schizophrenia. Ok all the genetic rubbish isn’t hinged on it as with Schizophrenia or psychosis [the HV movement routinely refers to psychosis], and I understand the biological backbone of psychiatry has always been psychosis, but PD could be said to be the psychological backbone of it. That’s much harder to disprove.
    In terms of human rights abuses, people diagnosed as PD in secure services and in the community from my observation get the worst of everything. They are vilified and rejected or hammered. They are given antipsychotics the same as for psychosis, and the worst of behavioural regimes, and the worst of blaming attitudes, and their life trauma’s [and childhood abuse] dismissed as their personal failure to cope with it. They get the worst of all worlds. I never envisaged feeling this passionate about this area but what I’ve witnessed over the years has led me to believe that PD is as bad or worse than Schizophrenia as a diagnosis and more dangerous in how it’s being wielded.
    It’s just terrible to witness how friends are treated in A&E for serious self-harm if they have a PD diagnosis, their lives are viewed as pointless. I almost feel guilty for receiving better treatment than them [and I haven’t had it easy] simply because I don’t have their diagnosis. Then what saddens me further is to hear of a survivor group member referring to someone’s suicide as “letting us down”. We really have to get our own house in order..

    Making sense of voices really matters but as been discussed elsewhere, everything is far from rosy in the recovery business both within the survivor movement and outside of it, we can’t be complacent because as a survivor [and voice hearer] I don’t feel welcome anywhere because my survival was declared substandard because I failed to produce a ‘recovery story’, so frankly I feel as fucked over by my peers as I do by psychiatry.

  8. ps.
    There are some practitioners in the NHS you really wouldn’t want doing HV movement approaches like voice dialogue, in the wrong hands it wouldn’t be good. We have professionals who say the ‘right’ things but in practise you wouldn’t really want them anywhere near you. Or they talk recovery but baulk at assisting a person with a travel card because apparently you can’t be recovery orientated and benefit from things which require a medical model diagnosis. Yet those same professionals forget every single patient they see has to be Care Clustered with a diagnosis. Those same ‘recovery orientated’ practitioners don’t like their service users speaking of iatrogenic damage or criticizing psychiatry.

    I want a future where we work out a different way of running economies because survivors don’t fare well with capitalism where their only measure of worth is their economic productivity. A future where everyone contributes whatever they can in whatever format they can manage and have a guaranteed livable income and stable housing.

    From there psychiatry would be available alongside everything and anything else from people to choose from but with no forced treatment [but I’m not against short term containment where life is at risk].

    Yes, I know I really am deluded..

  9. Power is not the exclusive preserve of psychiatry, politicians in the UK want to opt out of the EU and Human Rights Act. To date they’ve effectively removed legal aid and the right to appeal negative decisions in welfare and housing.
    If a survivor is forced onto Workfare and the HV group clashes with the hours, Workfare would have to take priority because otherwise it means being sanctioned [which means having no income].

    • Thank you @inarticulate poet, I think some of our history has been forgotten [or written out].
      I remember the first event to discuss survivors being paid for their time. Payment is something which is taken for granted now, it’s assumed time is paid for, but back then it was controversial! People contributed in paid, unpaid and freelance capacities, no one cared, whereas now the word ‘activist’ can be turned against you if it’s unpaid. I remember when there were no offices and people met in lounges, no computers, doing mail outs by hand writing out 400 envelopes, dragging a case to a charity offering to frank it, bartering for offices and equipment in return for teaching sessions. I remember the initial involvement of service users in local services where I lived where professionals rolled their eyes and struggled with their language and we didn’t know all the acronyms, making alliances on common ground with people with very different views, and attending conferences where psychiatrists were enraged by our presence. It was hard being deliberately targeted, publicly humiliated and practically stalked at these events, not taking the bait and keeping our cool, crying with a peer afterwards waiting for you at the station. This wouldn’t happen quite like that now, I’m glad of that, but some of us trod that ground for the first time so that it would be easier for others to do so. I remember how much we mentored each other, giving up places to speak for first timers, helping them find their voice, holding their hands [sometimes literally]. I remember ‘mind guarding’, where we would offer support to each other speaking. I remember how great our formal and informal advocacy was. I’m thankful to those who did it before me and angered as how those in powerful positions now don’t appreciate or devalue their contributions because sometimes they came up with the most enduring of statements like Eric Urwin of CAPO [Campaign Against Psychiatric Oppression] who once said, “People are as much consumers of psychiatry as woodlice are of Rentokill”, lovely!

      It’s ironic that taking meds can be viewed as part of recovery to mental health services with a ‘recovery focus’ in their ‘recovery colleges’ where you learn about your ‘illness’ and healthy living, a bit of mindfulness then onto the real business of the day; getting out of services and into work, yet in other quarters not taking medication is viewed as recovery then onto the real business of the day; getting out of services and into work.
      I don’t care what anyone finds helpful whether it’s medical or non-medical or where and how it’s accessed [although my own bias is non-medical], but if the often quoted mantra that survival/recovery is ‘whatever we want it to be’ – which it currently is not – then ALL of us have to stop drawing pictures and let each other draw our own and not rip up the pictures we don’t like [we do it along with governments and services].
      I’ve helped someone to get sectioned [when I wouldn’t want it for myself] because that’s what they wanted.
      I’ve helped people escape a section because that’s what they wanted.

      I believe we must accept a wider range of outcomes in people’s lives irrespective of whether we would want them for ourselves and to work towards all emotional and social support being separated from money and administration, because we can all wish for the DSM/ICD to go away but unless everyone can recover pretty quickly and remain working/housed then it’s pretty difficult because the UK government is removing services and social support from people at an alarming rate, this is a greater concern for many service users than getting sectioned. Our government is separating all support from any notion of distress, so they are trying to rip away what little people have in the name of said distress not being valid or serious enough. That’s not the separation we need, we need the recognition of distress [on very different terms] without having social support removed.
      For many people not in the more protected recovery/mental health work every time they engage with the outside world of work their mental health history beats into them, then others are forced to admit to an ‘illness’ to keep their jobs.
      A friend said, ‘We need a revolution in what survivors need and have a right to expect – humanity, equality, access to decent care and housing’.
      We’ve become too insular in corners of single issues when there really are a few issues which would probably unite the majority, if we wanted to.

      • @Joanna

        Every word you say is true.

        The rise of the sickness schools, which I am sure will become a feature of the mental health service landscape, is part of a Recovery model predicated on the first step being the acceptance and internalization of a particular way of thinking about oneself. This is axiomatic to the Recovery Model as it is being sold…

        I feel the same way about peoples freedom to chose how they want to understand themselves….I am sure that you would agree that the problem is that people are only being offered one way of thinking….

        Coming into contact with services and all that entails is isolating in itself so people just never hear about alternatives….people can reach the point of being employed as recovery workers and sickness school facilitators with out knowing anything of the history of how they came to be in the roles they now occupy…

        Ultimately it is as you say a case of finding the issues that would unite….and framing them in language that the majority can coalesce around…

          • @Duane

            It’s great when we can find the things we agree about! To often I feel we whittle out the things we disagree about (of course thats important as well) and consume all our energy disagreeing with each other. We lack power so these discussions get heated and we turn in on ourselves and each other.

            I am very guilty of this!

          • @Theinarticulatepoet,

            Thank you for your comment.

            Unfortunately, I’m guilty of the same sometimes.

            IMO, the readers on this site share some common interests and concerns, and it’s great when we support each other.

            Thanks again for your comment.

            Duane

  10. Sickness schools lol I like that!

    Yes that’s right, because the recovery model is predicated on acceptance and internalization of a particular way of thinking [whatever it is] this is what makes it potentially as dangerous as a medical model. With the latter it’s clear what that is and there’s no concealing it, but with the former, it is because it can be wrapped around literally any ideology good or bad, medical or social, that makes it harder to challenge.
    Sigh yes, the Trust recovery ‘champions’ and sickness school facilitators believe they are achieving the pinnacle of survivor progress whilst service commissioners must be laughing all the way to their boardroom meetings because they’re getting some of us to do their work.
    Yes, we badly need to unite on a couple of key issues but national groups here are in their own corners and NSUN should have been a coordinating group

    • Similar to how the original PAMI/NAMI groups became co-opted by Pharma/Psychiatry, I do see the trend towards using the word “Recovery” as an entree to mischief by those not really interested in a person’s well being. Those that do this are sly and many of the consumer/survivors are vulnerable which makes this practice particularly distasteful.

    • @Joanna

      I agree it is harder to challenge…my approach is to use it as an opportunity to highlight what the real problems are…

      For instance, I will use the example in any forum I can, to say when someone is held down and injected in a seclusion room or bedroom they are not on a personal journey. (The personal journey trotted out so often) They are being ganged up on….so the need reinforcements….they need other people. They need other people when the government is try to remove benefits…and so on to highlight how “Recovery” obscures the collective….

      NSUN faces a challenge….at the end of the video below from it’s recent conference it refered to being for “service users” and “survivours”. That they make that distinction is a bit of a worry….Anne Beales at the end makes a good point about NSUN needing to decide if it is still part of a social movement or will it turn into something else…The website itself is plastered in “Recovery”….it looks a long way from Survivours Speak Out. (I don’t mean that in an overtly critical way…more of an observation)

      I do know that NSUN are getting some work from some commissioners to survey service users in local areas?? No comment.

      http://www.nsun.org.uk/about-us/our-videos/

      • @theinarticulatepoet
        Yes I could puke at the ‘personal journey’ and your two examples and statement are pertinent.
        In my entire life I have never known as many survivors speak [calmly and privately] of their suicide plans for if they lose their income and housing, both of which are a serious possibility now because of housing/welfare policies. The right to appeal decisions has been effectively removed because of protracted UNPAID mandatory ‘reconsideration periods’ which are never reimbursed, people cannot live on no money for months.
        This is before an appeal which takes 12 months. That period is at the minimum payment and some people cannot access a CAB and there’s no legal aid for appeals.
        I don’t think European and world survivor networks are aware of how bad this situation is in the UK, it’s a bloody holocaust.
        There have been admissions, attempted and actual suicides to date because of loss of, or the potential loss of support, income and housing but not a single national survivor group is speaking of it, and this is just as bad as being forcibly injected. These people have left notes clearly stating this is why they have killed themselves.
        I know people who have stopped going out because of what the relentless right wing media in this country have been doing for the last 3 years now by portraying anyone in receipt of any state support as useless eaters. We have ministers referring to ‘work is the solution’, ‘stock’, ‘stockpile’, ‘parasitic underclass’.
        NSUN was hamstrung from the outset and is far removed from grass roots activism such as saw in SSO, but I cannot say anymore..self preservation.

        • Yes, puts into stark relief NHS awards/gongs for “good practice for suicide prevention”

          I’ve seen a little bit of coverage about people committing suicide due to benefit cuts but most of the “news” is about people claiming HB for penthouse apartments in Chelsea…which is of course the norm…I mean we all have one of those don’t we….

          http://www.youtube.com/watch?v=5eBT6OSr1TI

          The government has done a great job of pitting the working poor against the non working poor thereby obscuring the real problem of wealth inequality between the richest and poorest….

          I could highlight a few chinks of light but I don’t want to ruin the mood….lol

          I know what you mean about self preservation…I am being circumspect as well….

      • There is a survivor speaking at the World survivor meeting happening right now on the social and economic conditions needed for decent survivor advocacy/organisations (comparing Scandinavian countries where people can freely do movement work because their benefits are secure to repressive environments in Georgia and the UK). Wish I was there to listen to her..

  11. “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.”

    Stockholm syndrome sufferers are one of our (our = survivor movement which is a superset of HV) movement greatest threats. It is not easy to fight injustice. The temptation of going back to what seemed like an easy life is there.

    In these situations it helps to remind everyone that PSYCHIATRY IS NOT OUR FRIEND.

    The friend of the average psychiatrist is his/her salary and the bribes he/she can get from Big Pharma. The friend of the average Big Pharma executive working on psychotropic drugs is putting as many people on drugs as they possibly can. The friend of average forensic psychiatrist is to use his/her pseudo science to make a living out of making the life of other people miserable in legal proceedings. These are hard facts. The only reason it might seem otherwise is that all these guys are seeing their livelihoods threatened. Morally speaking (I insist: MORALLY) they are no better than slave owners who, in a attempt to mollify freedom seeking slaves, were willing to entertain the notion of improving their working conditions.

    Before you submit to the temptation, ask yourself sincerely, why are you here (here= MIA, and other survivor networks)? I assume that the average answer goes something like this: psychiatry ruined your life; it humiliated you by either labeling you X or by forcing itself into your life or both (my case), it destroyed your body (I almost got my kidneys and liver irreparably damaged), it made your relationships with your friends and families toxic (in my case, it caused a divorce and an estrangement from my parents), it deprived you from life opportunities (be them economic or social). That’s why the average survivor is here. And that’s what awaits you if you ever think to go back to “compliance”.

    Our only hope is to delegitimize‎ psychiatry as an oppressive force. Until that happens, psychiatry might be on the defensive for a while, as it is now, to then come up with its next scam to ruin more lives like yours. The only solution to slavery in the US was The Emancipation Proclamation. And the only solution to the psychiatric problem is to have psychiatry striped of its status as a legitimate branch of medicine. Nothing less, nothing more.

  12. Olga:

    Thanks for your eloquent description of the ‘colonization’ of the HV movement. This language is excellent because it ties the HV movement to other movements for social, economic, and political change and gives activists a framework for organizing effectively into coalition groups with groups fighting racism, homophobia, global warming, etc. the downside of fighting or resisting his ‘colonization’ as you call it, is to become segregated, secretive, less transparent,, and exclusive. Radical, as the Greeks understood the word ‘back to the root’ is good. Radical, as defined as extreme, to the point of requiring secrecy or verification of allegiance or ‘belonging’ to a certain class or race, or ideology in order to participate in the activities of a social change movment is a dangerous slope to ascend.

    Here in Oregon, as a mother of a psychiatric survivor, I ignore NAMI, finding it to be a very dispiriting organization that caters to parents who want to put their children on potentially harmful medications, by force, if necessary, and if someone goes wrong, it is invariably the victim (the one with a label) that gets blamed, never the medical system. This approach kills hope especially as my ultimate hope is that my daughter’s healing will be of the deepest, most lasting kind, a spiritual metanoia that goes hand-in-hand with my own healing, the healing of our entire family as well as our entire community, our entire planet, currently oppressed by a corporate, capitalist system is making people crazy and it kills joy and wonder and incarcerates and institutionalizes the most vulnerable among us, Greed, exploitation, and compartmentalization are rewarded while ‘psychosis’ an obvious rejection of reality as I’ve described it here, is punished by putting individuals in chemical strait jackets.

    In my wanderings, I have settled into a community of like minded mothers, consumers, survivors, and other allies located in Portland, Oregon USA and we call ourselves Rethinking Psychiatry. (www.rethinkingpsychiatry.org). Our goal is to bring the community together to showcase the wealth of alternatives in the field of mental wellness by hosting monthly speakers and when, time and resources allow, an annual conference. We support one another personally and find that activism brings us personal comfort, if nothing else. The problems you describe are mirrored in the U.S. by the co-optation of the peer movmement (peer delivered services, peer run organizations, etc.)by government workers. For a complete description of this process I believe you can read Ted’s blog or consult with David Oaks or look it up on Mindfreedom’s website (www.mindfreedom.org)

    I think that it is good that you are making others aware of this ‘colonization’ process, however I caution the founders and evangelists of this movement to resist the temptation to over-correct the problem by limiting participation to only those who hear voices. Those of us who do not identify with being a voice hearer want to speak to and rub shoulders with voice hearers who are in recovery and have empowered themselves and live meaningful lives! It gives us a framework to understand and support our loves ones who are struggling and most importantly, hope! We sure can’t get that kind of hope from NAMI!

  13. Your movement is engaging mainstream psychiatry–of course: confrontationally and by offering strict alternatives, the way the engagement needs to be carried on.

    I am looking at your article after having read Tanya Luhrman’s reporting on her experience of one of the Movement’s recent conferences.

    The work that gets accomplished by individuals outside the constraints of the enforced system and beyond its hierarchical controls creates a standard of value for self-help and critical approaches to psychiatric rhetoric that should never become de-emphasized. The purist who works outside the system is the first that those who stand together within the system will seek to displace.

    Right now, in Academia, and in the recovery movement overall, there is very little showing the way to a bright future, as psychiatry co-opts and sidelines messages and heralds its own triumphs very successfully, and professors and psychologists and sufferers alike generally keep wanting its Truth to be true and tend to forget the human rights aspect of the ethics implicated in traditional paradigms.

    Thanks for risking yourself out in the open on all fronts, Olga.