This is one of my favourite slides that I use in talks I do. The idea expressed by Ron Coleman is for me the heartbeat of what Hearing Voices approach is about.
Hearing voices is not – as some think – just a new name for a diagnostic term. Rather, “hearing voices” is, firstly, an attempt to find and use simple, accessible and descriptive language of shared human experience. Calling something like “auditory hallucination” might leave you believing you’re in on some sciencey secret society with secret, all-knowing knowledge, but you’ve only to hear people tie themselves in knots, talking of “false hallucinations”, “pseudo hallucinations” etc to realize they really know knob-all with knobs on.
Hearing voices is not a perfect term – I don’t just hear voices I see and feel things and smell things and other stuff too – many of us do. It is though simple and blessedly free of the self-referential tied-up-in-knots language of logic and pseudo-science. better, it supposes no knowing, no theory of “causation”, no judgements on whether a person’s experience is real or not, or socially acceptable or not, and focuses instead on what we might experience – we hear voices.
And believe me , it leads some to question their own ideas assumptions and definitions: many ask me “can you tell me if what I experience is hear voices”.
Hearing voices as approach
But hearing voices is also an approach [or a whole bunch of approaches ] – in which, mostly, we accept.
We accept that whatever a person experiences is real – and we do so without regard for whether we share in that experience.
The voices are real
There is no assumption of broken-ness, deficiency nor illness, no assumption that we know better what is happening, no assumption that we know better what a person needs do. We do not assume we can fix the problem.
Accepting that we don’t know is the best place from which we can learn.
Emancipatory for Voice Hearers
Accepting that people hear voices and that doing so is part of human experience is to say that whether you hear voices or not then you are like me: not some alien species, not some genetic mutation with a chemical deficiency, not some broken, dangerous individual- but merely someone just like me.
hearing voices as human diversity
If we regard hearing voices as simply a human variation – just another aspect of diversity- then that will change our whole approach. Diversity is not only about what we can see- different height, eye colour, skin colour. Nor is it only about different culture, different language, different food, dance and customs and traditions .
Diversity also includes invisible differences – the diversity of internal experiences. My experience is different from yours as yours is different from any and every person you will meet.
We each have a unique experience of moving through the world, because we are each unique. Paradoxically, we are also as much the same was we are different. One thing at least that we have in common is that we are each unique, with our own unique experience.
Hearing voices is just one of the ways we can experience the world. It is something that occurs in all cultures and is understood in different ways – in many it is highly valued as a gift, one that may sometimes be difficult to bear perhaps, but a gift.
In some cultures we have opted for the understanding that only trained experts can know, and that if a person hears voices then they must be ill and that illness must be “shitzophrenia” whatever that is – there is no consensus even amongst those who do believe.
Yet even the experts’ own diagnostic manual [DSM] includes fifty diagnoses for which hearing voices is a “symptom” [DSM IV-TR version] . This is all to say nothing of the medical conditions for which there are reliable diagnostic tests that can give rise to a person hearing voices – for example: fever, epilepsy, certain brain cancers, taking recreational drugs and even beginning to take psychiatric medication.
Still further, it ignores that many people might experience hear voices around distressing events and at trying times like the loss of a loved one. For example, a study in Wales showed that almost 50% of people in long-term marriages heard, saw, or otherwise sensed the presence of their spouse after they were deceased.
Is this a medical problem? If hearing voices means a person has “shitzophrenia” then surely marriage is a reliable cause of shitzophrenia?
Clearly this is ridiculous – hearing voices is much better, more usefully understood simply as a human experience that can be troubling.
The kind of assumption that regards any experience of hearing voices as a disorder called “shitzophrenia” is exactly the kind of thing that in CBT or other cognitive therapies would regard as “automatic thinking” and in need of therapy to modify it.
pain in the ass
So what of persecutory voices? or voices that simply score high the pain-in-the-ass scale?
Research shows that more than 70% of people who hear voices that talk in a persecutory, negative, violent or oppressive manner have themselves experienced adverse, violent or oppressive events. These can include incidents of abuse, violence, torture, war, bullying, belittling, adverse childhood events but also simply a stressed environment in which its difficult for a person to express themselves. For some people it might be that they were tied down, isolated and forced to recieve psychiatric treatment. It is not true of everyone’s experience but it is common for people who have these experiences to make the connection that the voices they hear – who they sound like, the words they use, etc, are often connected with those difficult experiences.
It makes simple sense that experiences like this can leave a person trapped in the terror of the moment that has since passed.
We commonly understand the concept of flashback as a reliving of difficult past events. Is it really too much a stretch to also understand that hearing violent, persecutory voices can too be a kind of flashback experience? I now understand that when I have that experience it is exactly what is going on and understanding that helps me heal.
Obviously hearing a voice or voices like this is going to be difficult experience. In hearing voices approach we offer that understanding but also the hope that we can learn to act to change our own experience.
simple does not mean easy
It is bloody hard and takes practice, maybe support and even intensive help but it is in concept very simple…
- whatever we experience is real
- we can find and learn ways of making even our most troubling experience less troubling.
- even the most difficult voices can be understood as having some useful information for us.
- regardless of what the voices might say, we always get to choose what we do
- like people, voices can change
- we can learn to change the relationship we have with anything that we might experience – even the most difficult voices .
- as it is with people, so it is with voices
I think it’s time we focussed less attention on convincing each other that our causal theories are the best, and instead pay more attention to helping people learn how to live with troubling experiences.
This is a message of great hope – we can help each other learn how to be less affected, less distressed , less scared of ourselves and each other.
Doing so will enable more people to empower themselves with options and choices and skills. Then we might, just maybe, get better results.
If nothing else we can offer safe places for people to talk about their difficult experiences without fear of being pounced on. You may think that is not enough but it is a more hopeful step than many others we take every day.
Emancipatory for workers
Many workers, when themselves offered a safe space to talk about their experiences, will “disclose” that they feel hemmed in. Regardless of which role they find themselves in, many feel surrounded by rules, regulations, and are required to report on their every action, and spend more time reporting and less time with the people they come to work to support.
No less a source of pressure comes from the need to be seen to acculturate and assimilate with the collective: workers must surrender to the regime -the cognitive alignment that changes the neural pathways till they accept the dogma to the exclusion of all other ideas.
Yes, mental health has all the hallmarks of a quasi-religious cult: doctrine, rituals and cathedrals that reinforce and enforce. – It has moved beyond mere belief system that every human “problem” has a chemical solution.
The medications must be taken.
As a result, many workers are themselves on the edge of their own emotional crisis, often less free and moreover less well than the people for whom they get paid to care. Many workers are as zombie-fied by their jobs as the people they supply drugs to are zombie-fied by taking those drugs.
In the same way that great institution the British pub is “a system optimized for the efficient delivery of alchohol” [Billy Connolly], so have many mental health institutions have become a system for the efficient creation of zombies.
Hearing voices offers a way of understanding each other, allows workers to rediscover their humanity, remind them of their compassion and to use more parts of themselves to accept that their training is not everything and that the best way to help someone heal is to simply walk with them as they discover what works uniquely for them.
This does not discount that medicine can help some people somewhat, some of the time – merely that medicine offers only a partial understanding and that chemical intervention can play a useful part but only ever a part.
For all the power that mental health services can and often do impose upon a person -even when they deploy the full forces of state – cannot force a person heal.
However, by placing first their common basic shared humanity one person can support another in discovering for themselves what it takes to heal.
As Eleanor Longden says in her inspiring TEDtalk,
“there is no greater privilege”.
Emancipatory for family and carers
Families and carers often feel that they too are sentenced and segregated when their loved one is befallen and diagnosed with a serious mental illness. Our culture creates layers and layers of misunderstanding about voices that often traps not only people diagnosed but their families and carers too in psychological cage of fear and helplessness.
Not only that, professionals seem to lack either time, inclination or both to regard families as having any useful role beyond surveillance and ensuring compliance.
Well, that really is no way to treat families.
In a mental health system that is so heavily dominated by experts expertly extolling their expert doctrine, mere humans have little say so are reduced to minion roles. Lay-people have no expertise in understanding or “treating” a biological brain disorder so families can have no meaningful role.
The cult of imbalanced brain chemistry has spread and inexorably aims to recruit us all.
Families are psycho-educated in a process of subtle cognitive redefinition that would have us all succumb to the belief we are nothing more than our brain chemicals , wonkily imbalanced, volatile and in need of constant expert chemical correction and manipulation .
“It’s not your son/daughter, loved one its their genes/brain chemicals.”
Families are recruited as front-line agents of pharmaceutical industry: chemical compliance secret service agents. The mission, “should you choose to accept it”: 24hr surveillance to monitor symptoms and ensure compliance.
Simple indoctrination is usually most effective, in this regime it is beautifully simple.
Operational doctrine: The meds must be taken.
The script is easy to memorize: “have you taken your meds?”
In contrast, the hearing voices approach offers families and carers a broader way to understand what their loved one might be experiencing and broader role in supporting them.
There is no script – no five word mantra, and it is true that some may find this anxiety inducing: “Tell me what to do” , “tell me the right thing to say”.
Yet operating from a broader understanding allows us – forces us – to listen to a person who is struggling and what they are wrestling with within themselves and to communicate. This is very different from listening for a checklist of danger signs that signal in us a requirement to react with assertive, immediate action to prevent imminent world-ending tragedy.
from hearing to listening
True listening can be very healing – not only for the person being listened to but for the listener too.
Listening intentionally – meaning listening with the intention that the person we are listening to will feel listened to – allows us to connect as human beings. It also allows us to learn to hear and decipher the strange, cryptic and quantum clues that don’t fit easily with diagnostic assumptions. What is being communicated is complex, strange, maybe scary . This is necessarily so, since it is about very human struggle to live in and experience the world and about learning to be alive in a complex, chaotic and messy world.
As V.S. Ramachandran says:
“just because a person says something that I don’t understand it doesn’t mean its crazy – it just means I’m not smart enough to understand”
I would only add to that
Emancipatory for all
In hearing voices everyone has a role and the best one possible, too – that of being a human being first.
We have evolved to be able to connect with each other emotionally and deeply. We can connect with the deepest fears and shame inside each other and we can be human with each other.
By learning to be open to each other’s experiences we can break the isolation that a person struggling likely feels and that we might feel too.
And with that understanding we can together discover more ways that we can help, more things that might be useful to support our loved ones find their way out of that dark lonely place and find what they need to heal.
…and in that process we might feel that we too have grown and healed a little.