The truth is like a lion; you don’t have to defend it.
Let it loose; it will defend itself.
– St Augustine
The Hearing Voices movement is a beautiful thing, and last year it was 25 years old. What has happened in 25 years? A confidence has grown in a different approach to hearing voices, listening and embracing rather than trying to control and silence voices. Key to this has been Hearing Voices groups and conferences, where people who hear voices are listened to with openness and curiosity. It’s not about telling people who hear voices to throw away their pills if they are taking them, its about creating spaces to listen deeply to what is happening.
In the highly recommended book Living with voices: 50 stories of Recovery (by Marius Romme et al), some people find medication helpful in managing their experiences. But everyone in the book talks about being listened to as helping them and in many cases learning to listen to the meanings of their voices. Hearing voices gatherings are liberating spaces because they welcome different understandings of the world and of the mind.
At events like the gathering in Cardiff in September last year to celebrate 25 years of the world hearing voices movement, I always meet a whole range of perspectives about voice hearing, including spiritual, psychological and clinical ideas. Its a wonderful mixing pot. I always get inspired and come away with new ideas. The new film “Voices Matter“ gives an insight into the dynamism of this event.
Hearing Voices conferences always hold the wisdom of personal stories of voice hearing as equally important to learn from as are academic and therapeutic knowledge. This is still going against the grain of Western conferences (relating to the mind) where personal reflection of any kind is still a rare thing. Rachel Waddingham (featured in the film) is creating spaces in London for children and young people to learn how to live with voices and flourish. Using creativity and media the Voice Collective project she manages is about finding ways to demystify voice hearing and show that it can be understood and managed.
This work was inspired by the work of Sandra Escher who found that it’s really important for children and their parents to learn from what the voices say and what they are like. Sandra Escher and Marius Romme (also in the film) have done lots of research showing that if you pay attention to the characteristics of the voices (e.g. how old they sound and their gender, the age they started, the content of what they say and what triggers them), this empowers people to realise what are the emotional conflicts and meanings the voices may relate to.
In my experience using this approach, very often the voices can clearly guide us to truths that have been ignored or buried. In contrast the dominant approach in mental health services is to ignore the content of the voices either seeing it as biological illness or as imaginary and nonsensical. When parts of us get listened to this allows us to feel relief. We can see voices as parts of our minds and of our experiences of the world. Even if we see voices as spiritual we can still see voices as messengers about what we need to strengthen in ourselves and understand better. Understanding voices work seems to lend itself to group and family meetings as well as one to one style meetings. In a way if someone is hearing voices it is a message to the whole community that something has happened that needs to be listened to.
The film features a debate about cognitive behavioural therapy (CBT) and the Hearing Voices movement’s approach. CBT is recommended as a talking therapy by government policies. The Hearing Voices movement has always sought allies, but there are some glaring differences in their respective approaches. The Hearing Voices movement sees itself as a social movement trying to educate society to accept and respect voice hearing rather than see it as caused by a disease. CBT practitioners might be sympathetic to this but generally conduct research that uses quite medical language (e.g. auditory halucinations, source monitoring errors), implying the content of voices is meaningless and caused by illness or deficits. In contrast I would see voice hearing as one of the mind’s ways of creatively responding to confusing experiences. Often CBT tries to reduce voice hearing and control it without really trying to understand it. In the Hearing Voices movement many facilitators of groups and trainers have personal experience of voice hearing and use this to inspire hope and convey the meaningfulness of their experiences. CBT therapists who are open about their own experience of voice hearing are about as rare as hen’s teeth. While I am sure that really helpful conversations happen under the title of CBT its important to debate how it is often used to try and change people’s thoughts rather than listen creatively to people’s experiences. I hope that we can dialogue with CBT psychologists so that they can move to a more accepting approach towards voice hearing and the possibility of listening to both the voice hearer and the voices themselves.
I wrote this poem a few years ago when I was in a debate with lots of CBT professors/therapists at a CBT conference. I knew I could not win so I performed this as a rap. I think it conveys how when we professionalise help giving we can lose the creativity and accessibility of more down to earth approaches rooted in self help principles:
CBT for Psychosis: Keeping it Real!
I was asked to discuss the future of CBT for psychosis
Its spreading across the country like Mixamatosis…
But unfortunately it’s far too professional.
It uses clinical jargon making it so medical.
Clinical terminology has quite a negative effect you see
Words like symptoms, interventions, relapse prevention and abnormality
Is the language of deficit and illness, it makes us want to feel less
and so we wait for the pills to work and give up responsibility.
Clinical language (pushes an ideology that) puts the therapist on a pedestal and promotes passivity.
What we need is not language that smacks of technology
We want the language of experience that says it so respectfully.
Recently I met the mother of a son with paranoid thoughts
Scared of going into hospital, he ran away to not get caught
He was found in a disused building, dying of exposure.
“What would have helped the most?” I decided to ask his mother. “
To meet other people who were making a recovery”
If you’ve been in hospital, stories of hope are quite a discovery!
At a public meeting called Evolving Minds she made this observation
Here people are seen as people not carers, staff and patients.
I would like more cooperation between CBT and Self-help movements
But where CBT is thriving, Self-help groups are not started
Birmingham is a good example of this, perhaps we should ask Max Birchwood.
Why is it in a region that has focussed so much on services for psychosis
Hearing voices self help groups are as rare as reindeer with red noses?
Is it implicit in CBT to maintain the (expertise) ‘them and us’ divide?
Or can it become more emancipatory? this is what we must decide.
In the final pages of Richard Bentall’s book ‘Madness Explained’
He suggests the way forward may have to be changed.
Liberation rather than cure could be the answer
Following in the footsteps of Marious Romme and Sandra Escher:
The International Hearing Voices Network is another global epidemic,
Where ‘experts by experience’ are seen as important as academics.
Yet at CBT events, professorial monologues still tend to dominate.
We need a different kind of dialogue that I think will stimulate
A broader type of thinking and a broader range of people
If that was the case then I’m sure that such conferences would be full
Of a diverse range of citizens
Who would be given the ammunitions
To really develop communities of healing hope and democracy.
As John Read has shown us we need to go to the roots
Of people’s suffering, if we don’t ever, we are in cahoots
With the notion that psychosis is an arbitrary biological illness.
When in fact it is a meaningful subconscious expression that can guide the way to wellness!
But while chemical cosh prescribing practice continues to promote suppression,
We should work with holistic therapies to help avoid the oppression
Of tardive dyskinesia, weight gain and akasthesia
The blocking of affection and empathy, enthusiasm and creativity.
But with mindfulness, yoga and tai chi
People can naturally balance their energy
So CBT needs to think more openly
Acknowledge that there is no one right way to see
And that spiritual and emotional wisdom can sometimes be
More important than biomedicine and psychology.
Remember delusions are in the beholders eye
And thought manipulation is difficult to justify.
You must go very carefully
With techniques that push rationality.
Because it is only one world view
And the person on the receiving end may not thank you.
When we work with people’s voices
We should give them real choices.
One technique is to help the person communicate
With the voices that tend to dominate.
With voice dialogue using chairs we can open up a conversation
And the voice hearer and voices get some mediation.
So my last word is creativity holds the key
Listen to your heart as well as your head
And together we can demand more than just CBT!
The Hearing Voices movement promotes trying to learn from the experience. Its not about trying to get rid of voices, it’s about helping people change their relationship with their voices. When this happens voices may stick around and become companions or they may go away.
One workshop I went to in Cardiff was about coping with not hearing voices. Anders Schakow (also in the film) described how, now that he no longer heard voices, it was just as important for him to understand the different parts of himself (and how they interact with others). This is a premise in Hal and Sidra Stone’s Voice dialogue approach, that we all have different sub-personalities or energies that we need to listen to and negotiate with. In a way we all have to learn to live with our many voices.
Thanks to the Open Paradigm Project for making this lively film about the 25th anniversary Hearing Voices Congress. It’s well worth watching.
For more information about the Hearing Voices movement please see the Intervoice Website.
…so long as you’re recovered..
Report comment
Since the time of Socrates seeing things, hearing things and having unusual perceptions was an accepted part of “culture” in many places. Madness was always something else.
Re-liberating people who have these unusual (or not so unusual perceptions) from the orbit of the professions is a great thing.
It does rather leave “The Mad”, that quality that defies further description beyond madness in the same black hole they have always been in…..
You have to have experienced Madness to know the difference….
Report comment
I think we need to move away from ‘them and us’ thinking. I have found that no matter how mad someone seems, if you can create the right support systems and community around them, the madness starts to make sense. It is our fear of madness that makes people madder. The community changing and accepting diverse emotions and states of mind is an important part of this work. We can all experience confusion and I believe we need others to help us navigate it. I have found this in my own experiences of navigating powerful mind states. But I dont think because I have had these experiences that makes me superior in my abilities to help others or to recognise that they are going through. I think anybody that realy wants to listen open mindedly and deeply can be a uge resource in assisting others to navigate a confusing and often cruel world.
Report comment
I’d agree with that inarticulatepoet [actually I think you’re very articulate!].
Truth, a bit like recovery is malleable..
All the stories are ‘recovery stories’, the terrible ‘before’ and fantastic ‘after’ and there is overt hostility to those who don’t go with it with sneers of personal failure, laziness and assumptions of being a medical model apologist. This is being reflected everywhere not only the hearing voices movement, but if it were a ‘social movement’ then it would look at the reality that it’s not yet a complete alternative to state mental health services and housing/financial/health/social care is entwined with a medical model. If diagnosis is junked [which would be great] how do we ensure people get the flexibility and support they need socially because that all requires a psychiatric diagnosis [or ability to adhere to set aims], not everyone can get jobs in the recovery business [or wants to]. The Szasz sink or swim attitude [like our government] is all very well but I see people hitting the deck because they can’t recover quickly enough and are losing all their support. This is a problem survivor groups don’t want to look at, it almost seems like an embarrassment to them. I remember listening to a survivor privately telling me that they did not feel recovered and didn’t really go along with everything said in these respects, but this person couldn’t say it publicly. It wasn’t the first time I’d heard that, people privately and publicly saying two different things, and you have ask why is that?
Hearing voices isn’t always a great experience and where is the space for those stories, for those who don’t have a recovery narrative or not one which would be recognised by today’s high standards of recovery?
Report comment
@Joanna
Thankyou, thats kind. I agree with everything you are saying. With respect to people losing support for not recovering quickly enough….there is a kick back that has been going on from G.P.s who are being asked to pick up the slack that you might well be aware of. Of course they don’t have the capacity….interesting to see how it will all plays out in the brave new world of clinical commission groups now that the PCT’s have nearly gone….
I’m going to stop there before I go an a ramble about NHS politics…:-)
Report comment
I am interested in building healing community with others and as you say there are many obstacles. We live in deeply unequal societies, which are individualistic, and encourage people to be passive consumers. There is also a lot of resources invested in policing people with authoritarian paternalistic practices. We need to come together not as survivors but as people, interested in doing that work to free each other up to live more harmoniously and fruitfully. its a nice critique you offer of recovery stories and there is a danger they become another product and form another rigid hierarchy. I think we need to keep challenging each other to be real, and to learn to be with vulnerability not suppress it. Hearing aggressive voices can be tremendously difficult. It sems to me they are made more difficult if we try only to suppress them. We are finding if in stead of shunning them if we find ways to face them and come to terms with the griefs they point towards they do change and become more peaceable. Of course this needs human resources and we need to build those resources which can be very difficult if we are isolated as som amny people are. I think is helpful to celebrate when people become more confident and flourish. It can be very inspiring for others who may have thought they were stuck forever. At the same time we need to acknowledge how each persons journey is unique and there is no correct pace of healing. In the UK outcomes are constantly being measured and this must create a huge pressure to see people’s lives as commodities that neeed to make a profit.
I think we should see healing less as the sole responsibility of the individual, I am more interested in giving the responsibility as much if not more to the community around the person. We all need to change to help someone gain greater freedom in their life. My life progressed significantly when people began to trust me and give me responsibilities. Without that happening I would have stayed misunderstood and dependent.
Report comment
Thank you for quoting my words Rufus about the hearing voices movement having been beautiful, but like anything it’s not perfect and should still be open to debate and criticism rather than clever words and defence, and the reason you hear this rather than a tsunami of praise is because too much debate about some fundamental things for survivors has been airbrushed out and deleted.
You were not around in groups which did just that, argued the toss and respected difference and never directly or indirectly wrote people off. It kept leaders of that time with their feet on the ground. Not perfect, not by a long stretch but the difference was the difficult stuff wasn’t ignored, it was directly engaged with. The subtext of much around now about ‘taking responsibility’ [as though no one has till now?], and ‘deciding’ one afternoon to not be an XYZ is not encouraging. Survivors self-managed and acted as role models to other before the rise of recovery and being ‘in recovery’ is not the only hope we can offer each other. Those you won’t see at conferences might also like to know that there are others like them, maybe getting by or hanging on, not recovered, maybe not attaining the life ‘milestones’ typically held up as recovery. Knowledge of endurance and different types of lives are also helpful.
Report comment
I aggree the hearing voices movement is not perfect. There were things I wanted at the Cardiff conference that were not there. For example more spaces for reflection for dialoue and being. I want us to make conferences less didactic and more interactive. I am part of a group called Evolving Minds which again is not perfect but we do try and hear each others different perspectives on wellbeing and living in a crazy world. And they are very interactive spaces. We meet monthly and are organising a retreat on meditation and extreme experiences. I did go to survivor meetings in the 90s and learned a lot from them. Maybe we were not at the same meetings! But i am learning from people of all ages and backgrounds. I do appreciate your scepticism of a corporate approach to recovery and share your concerns about its potential to exclude and suppress.
Report comment
“Liberation rather than cure could be the answer”
Liberation as cure.
Yes, it very well could be, for everyone. I think you’re spot on in your thinking about the shortcomings of any practice that reinforces the dynamics of clinical authority and pathologized meaning. The evidence-based practices re: psychosis largely characterize experiences as undesirable, to be tolerated, reduced and ameliorated, not to be honored and explored as some interesting and challenging aspect of our human experience at that particular moment in time (a moment which can admittedly sometimes last for years). Yes, for some folks what they experience is very much undesirable and no fun to explore at all. To be honest, emotional literacy, dialectics, and distress tolerance skills are pretty essential to me.
I am playing around with draft outlines for a potentially crowdsourced manual and skill-book re: navigating “psychosis”, what is helpful to know and to have the opportunity to think about, learn about, or speak of. I work in an REC and need to do a thesis. I want to help create liberation opportunities for folks who experience psychosis or some experiential variant thereof. I want something like that to exist. Maybe it does already? Accessibility is important.
Although @ work we (particularly the peers) are inclusive and supportive/non-pathologzing of folks with experiences typically characterized as clinical psychosis there is not a distinct educational or mutually supportive space for people to really explore their experiences and lives.
Anyway, thanks…and thanks, @…poet, for bringing up the complicated issue of people who really are…what? Actually struggling in ways they don’t deal well with, can’t deal well with…are just really…what?
Yeah, there are some hornets nests in that topic.
I think Joanna made a great observation about “recovery” and folks who may find their place in empowered groups. I have experienced and seen some straight up sanism in some empowered circles and that’s fairly perplexing to me. I feel like, sometimes, I am inadvertently perpetuating some candy-colored recovery world. It’s weird that the particular trajectory of my life could be characterized as ableist…even though I can’t work a 40 hour a week job and have never been successful in that endeavor. I literally cannot. My sensory system and stress situation gets overloaded no matter what I do and I get to the point where I cannot speak and it is not good. I would clinically be considered to be delusional most of the time, but I am awesome at double-booking and keeping it in all in check. I cannot recover from the way I process stimuli and information, nor do I necessarily want to. However, I have changed the way I experience and contextualize my cognitive, social, emotional and sensory situations.
So, we all are here and there, just making our own ways…often the best we can.
I think these are important things to talk about.
Very nice poetics, er…Dr. May?/Rufus…matter-of-fact liberation blended with elements of strong appeal for those whose ears are attentuated to the narrow measures of clinical prose.
Thanks for good reading and thinking.
This, in particular, was very important for me to read at this particular moment:
“The subtext of much around now about ‘taking responsibility’ [as though no one has till now?], and ‘deciding’ one afternoon to not be an XYZ is not encouraging. Survivors self-managed and acted as role models to other before the rise of recovery and being ‘in recovery’ is not the only hope we can offer each other. Those you won’t see at conferences might also like to know that there are others like them, maybe getting by or hanging on, not recovered, maybe not attaining the life ‘milestones’ typically held up as recovery. Knowledge of endurance and different types of lives are also helpful.”
This -> “Survivors self-managed and acted as role models to other before the rise of recovery and being ‘in recovery’ is not the only hope we can offer each other.”
Thanks again…
Report comment
Hmmm, interesting. I misspelled attenuated…then I realized I had mis-used it, too. It means, rather than to be attuned to, to be weakened in force or effect.
ex. “The authority of the DSM is becoming attenuated.”
Thanks for the learnin’!
Report comment
‘Give me a mind not colonised and Ill show you a soul that can breathe’ Renee McCallister. Thanks for these comments I think a big part of healing is acceptance, so i think if we can create accepting community this creates liberating possibilities. We need to keep dialoguing and learning form each others perspectives. Any helpful idea or strategy can become problematic as we see in talk about ‘recovery’. So we do need to keep challenging each other and finding ways to listen to what needs are being ignored.
Report comment
I did go to survivor meetings in the 90s and learned a lot from them. Maybe we were not at the same meetings!
No we weren’t [not a criticism].
I do appreciate your scepticism of a corporate approach to recovery and share your concerns about its potential to exclude and suppress.
You’re not a part of it?
I think we should see healing less as the sole responsibility of the individual, I am more interested in giving the responsibility as much if not more to the community around the person.
That could be taken in different ways Rufus..how many times have I heard the ‘responsibility’ line from Szaszian social Darwinists [sink or swim], to hard line recoverists [no meds, no services, must be employed], through to medical modelists [accept your biochemical imbalance] – each saying it is ‘your responsibility’. We can tell people it’s ‘their responsibility’ wrapped around any ideology.
When people are up against punitive housing/welfare systems which make it difficult to live, where they have no control over that process other than attempting to contort themselves into ever decreasing circles of ‘eligibility’, how much control do you think they have?
Ditto people in High Secure services having to look and sound “normal” enough for years to earn discharge. Ditto people in the community not able to access much of use to them.
As for community recovery, how is that possible within the current political climate? Rising levels of disability hate crimes, a very damning view of [non-celebrity] mental health, I know users/ex-users who [if they receive any kind of state support] have stopped going out because they fear their communities even seeing them walking, to be viewed as ‘fraudulent’, they fear that more than getting sectioned. Diagnosis is the raspberry sauce of all our financial, administrative, health & social care, welfare/social housing structures, and no survivor group appears to be doing political campaigning regarding social justice [with no legal aid/dwindling CAB’s, sanctions and conditions which mean people being left with no money for months or being forced into Workfare].
No one in mental health is looking at that. The community is hostile outside of nice groups and protected recovery work.
The only ‘responsibilities’ being given to service users now is that they must recover and get employed asap, but the middle bit of how and what is left out. Voluntary work is no longer an accepted outcome for example. For people who can’t access alternative places/groups [and don’t have a computer] they are stuck with the NHS which invariably means PbR’s “evidence based” variants of time limited CBT and meds and nothing else. Responsibility is a fine thing if you have some control over what you can access and perhaps more importantly – what is socially and politically acceptable to achieve.
Report comment
Sometimes people [who won’t toe the party line or promote survivors thinking] are forced to accept a mental illness diagnosis in the workplace in order to keep their jobs. The problem of diagnosis being entwined with our ability to survive is wider than welfare/housing/social care issues, and all the campaigns to abolish diagnosis are not looking at this
Report comment
Also what is with all this ‘dependency’?
Services discharge people by the thousands because of cuts to services, but staff will say it’s to prevent ‘dependency’. Everything is short term now, and where support does work often users appreciate fairly low levels of support. Now it’s revolving door by another method – hit the deck – get some response and then out asap, then only go back if in crisis.
I know people who have used services for 40 years, I wouldn’t view them as dependent, anymore than I would view a diabetic patient of 40 years as dependent, or my own physical condition which requires lifelong checks. So long term physical health support is ok, but in mental health it’s ‘dependency’ [putting aside how useful they are].
We ALL depend on other people, few of us are islands. ‘Dependency’ is not the exclusive preserve of a medical model of care.
Report comment
Both Yoga, and Tai-Chi were mentioned above, as being VERY helpful…. Yoga works with “prana”, which is “breath energy”, and the “asanas”, or poses. It’s about the stillnesses of the poses, and breath work. Tai-Chi works with “chi”, which can be a bit trickier, and subtler to define, but it’s a good start to think of it as the physical, electro-chemical energy of the 4 human nervous systems, muscles, bones, etc…. Also, Tai-Chi is about “moving Chi”, “collecting Chi”, “releasing Chi”, working with “Chi”
The stillness and breath-work of Yoga, combined with the movements and Chi work of Tai-Chi,
WILL QUICKLY PROVE LIBERATING and WONDERFULLY BEAUTIFUL…..
There’s little that’s better for ANY “psych patient”, than Yoga, AND Tai-Chi!….
But remember, it doesn’t work, if YOU don’t do it!…. >GRIN <….
Report comment