Dr. Simon McCarthy-Jones’s book – Can’t You Hear Them? The Science and Significance of Hearing Voices – does a very thorough job of evaluating a litany of ‘clinical’ hypotheses formulating the ’cause’ of voices. There must be about fifty hypotheses and the summary is basically that none of them provide a good answer. The issue to me is that both psychiatry and psychology are limited by their own frames of reference: – Psychiatry: By declaring mental health issues to have physical origins (the frame of reference) – the inevitable result is that the explanation will be some sort of brain dysfunction causing unusual cognition (delusion), mood disorder (relationship to self such as depression), mania/paranoia (relationship to world) and behavior (irrational, because voice hearers act from a different understanding). If we disagree, we lack insight. – Psychology: Makes the assumption that the cause ‘must be’ something in our personal history, which translates to the presence/absence of unusual stimuli (trauma or neglect); the presence/absence of needed relationships (absent parent, abusive family member); the presence/absence of conditions necessary to proper development; or some issue of identity/personality (because voices have different identities). If we disagree, we are dissociating from or ‘something must have happened before you can remember’ or ‘memories are often suppressed’ and if we dig around enough we will find something causal. Psychiatry calls the stimuli ‘hallucinations’ and gives no meaning at all to the content. Most (not all) models in psychology are more likely to use the term ‘voices’ which implies they have meaning… but since what voices say does not make sense in everyday frames of reference, so to make that work content has to ‘representative of something that happened’. Clearly, both of these are following the flow of their frame of reference and not the evidence of or in in the stimuli. Both professions are selecting evidence (ignoring stuff that matters in the experience) and force fitting it to the professional frame of reference. Dysfunction in brain and/or mind. And corroborating effectiveness amongst themselves. Forgive me for expecting psychiatry and psychology to be coherent with each other, before I entrust either with dabbling in my mental or physical wellbeing. I have done an excellent job by ignoring most of what both have to say on the topic. Both are missing the point in that neither has a coherent explanation of HOW their explanation will lead to the production of stimuli that: – Are always RECOGNIZED as external (not just perceived as) – That have their own cognition (imagine the complexity of brain signalling involved) and adopt a different point of view from a different frame of reference than our own to – Present and sustain an alternate view of ‘reality’ in real time, despite our cognitive rejection or acceptance of what they say To make sense of our experience in a clinical frame of reference, it has to describe how the brain has derived ADDITIONAL functionality (separate cognitive entities) acting independently in parallel to MY everyday cognitive function. If your argument is ‘it must be trauma’ you have to add coherent explanations for: – HOW my trauma produces this additional functionality but not Joe’s trauma (i.e. why am I susceptible, but not Joe with similar trauma) and – HOW exactly my brain has suppressed that trauma, because it would be good to know, so that I can suppress ‘voices’, which are the trauma in my case Both psychiatry and psychology make assumptions about what (hallucination to be dismissed/’voice’ that needs to be heard) and why (brain/mind dysfunction) – without bothering to explain the how or fully understanding the what = nature of the stimuli. I am a little more optimistic about ‘researchers’ which extends to many more frames of reference. I have attended several conferences where you see far broader approaches than what we experience in clinical delivery models. What we really need is a better understanding of the nature of the stimuli, the phenomenology… from which we can show that our cognitive, mood and behavioral responses are ordinary.