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.
