Last updated 11/06/2007

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A radical report argues schizophrenics should listen to the voices they hear – not drown them out with drugs

Wendy Moore, Sunday May 21, 2000, The Observer

Alan Leader has been hearing voices since he was 15. The first time it happened he was in a television shop. He had been upset by images of starving children in Biafra. Now a voice coming from a TV was telling him the famine was his fault, that somehow he was to blame. ‘I felt completely bazooka-ed by it,’ he recalls. For a year he told no one, afraid of the stigma attached, while the voices grew increasingly distressing. Eventually he was diagnosed as a schizophrenic, spent the next 15 years in and out of psychiatric units, and was put on long-term medication in an effort to staunch the noises in his head. He still hears voices. There are five in all: two are aggressive and often argue with each other, while the others make trivial comments about wallpaper patterns or car number plates. But Leader, 47, who lives in north London, has been out of psychiatric care and off medication for more than 10 years. He has a full-time job, working in mental health services to help others with similar experiences. He has learned to live with his voices and, by accepting them, to control them. ‘I wouldn’t know what to do without them now. They are part of me,’ he says.

The idea that voice -hearing can be an acceptable, even enriching, experience is anathema to conventional psychiatrists – and may well strike fear in the minds of the general public, which is used to headlines shrieking that voices ‘ordered’ someone to kill. Mainstream psychiatrists regard hearing voices as simply a symptom of mental illness, typically schizophrenia, which must be eliminated by medication at all costs. They argue that prolonged exposure to voices is dangerous and strongly discourage discussing what voices say for fear of legitimising them. Nonetheless, the approach of teaching people who hear voices to control the whispers in their ears is fast gathering pace within the NHS. The method was pioneered by a Dutch psychiatrist, Professor Marius Romme, and his journalist partner, Sandra Escher, after they discovered voice-hearers in the late 80s who had never undergone psychiatric treatment and who lived quite happily with their voices. They drew on historical research which throws up a distinguished list of people who claimed to have heard voices, including Socrates, Galileo, Pythagoras and Joan of Arc. Often, the Dutch researchers found, voices begin in childhood. People whose families are more tolerant then are more likely to cope with them in later life. Romme and Escher came to the radical conclusion that hearing voices in itself is not a problem – it is the individual’s and society’s inability to cope with the phenomenon that causes distress – and set out to teach coping techniques to voice-hearers. Their work has spawned self-help movements in Holland and the UK – the Hearing Voices Network now boasts 80 groups – and challenges the very roots of modern psychiatry.

Next month, Romme and Escher visit Britain to run a training course for the mental-health charity Mind, which will teach health professionals in the NHS their controversial techniques. Their latest book, outlining their methods, is published by Mind this summer. Alan Leader first tried the Romme/Escher approach after meeting the pair in the early 90s. Medication had never fully worked for him – although he does not rule out using it again if necessary – and left him overweight, shaking and tired. Now he keeps the voices firmly under control by allowing them a set time every day – between 6pm and 7pm – when they can chatter uninterrupted, avoiding situations that might trigger them at other times, and working on detaching himself from them. He imagines the two argumentative voices as the moaning old men in The Muppet Show. ‘I would rather live with them and feel alive,’ he says, ‘than be medicated up to the eyeballs and emotionally dead.’ Others are also using the techniques to live in harmony with their voices. Ron Coleman was 25 when he heard his first voice: it was that of a priest, who had abused him at 11, telling him he should burn in hell. His first reaction was to ‘get bladdered’. But as the voice grew more persistent, he drank more, lost his job and his house. He spent six of the next nine years in psychiatric units, where he was forcibly medicated and underwent 40 bouts of ECT. Nothing dimmed the voices – the drugs don’t work for a sizeable minority – until he met Romme and Escher and tried their approach. It was the first time anyone had attempted to make sense of what his voices were saying. ‘For me it was very much about the fact that I hadn’t dealt with certain issues,’ he says. Now Coleman, 41, who lives in Gloucester, hears seven voices but controls them sufficiently to work full time as a freelance trainer in mental health care. He has taken no medication for seven years.

Sue Mayhew, who is 36 and lives in Gloucestershire, has also come to terms with her voices and even believes they saved her life. She first suffered a breakdown when she was 19 after losing a baby in a cot death. It was during a second breakdown that she first heard them. She was about to throw herself off a multi-storey car park when a chorus of voices – she thought of them then as angels – pulled her back. The third breakdown occurred just after the birth of her daughter, now nine, but since then she has had no more psychiatric episodes. She still hears voices occasionally, and takes low-dose medication to diminish them, but treats them as she would background noise in a pub, picking them up or ignoring them as she pleases. Mayhew believes psychiatrists should be more open-minded towards voices. ‘I think it is about time they started to listen to their patients and have a bit more humility when it comes to admitting that they don’t know everything they claim to know about the manifestations of the human psyche.’

But the whole approach rings alarm bells for Dr Cosmo Hallstrom, consultant psychiatrist at the private Charter Clinic in London, and a member of the public education committee of the Royal College of Psychiatrists. He finds the idea of training NHS staff in the Dutch methods ‘scary’. ‘We spend an awful lot of time trying to persuade people to have treatment. For someone to come along and say, “Live with your voices” is not very helpful,’ he says. ‘I think untreated schizophrenia is dangerous, and the longer you delay treatment, the worse the outcome.’ Yet Dr Phil Taylor, a consultant psychiatrist in Bradford, believes that suppressing people’s voices with drugs is even more dangerous. He has been successfully helping patients in Bradford to accept their voices for 10 years – including people who are seriously disturbed – and teaches the method to medical and nursing students. Although he still prescribes medication for patients, the aim is to calm, rather than eliminate, their voices, so they can then discuss them and – eventually – learn to live with them. ‘I don’t think voices are necessarily signs of mental illness,’ he says. ‘For some people, the experience is brought about by intense distress, and that tends to get them into contact with mental health services.’

Incidents of people hearing voices have been documented for more than 2,000 years, says Dr Taylor, who has co-written a book, Voices of Reason, Voices of Insanity (Routledge, £15.99), which analyses the phenomenon throughout history.

Socrates heard a ‘daemon’ which advised him where to walk, while Galileo heard the voice of his dead daughter, it reveals. Only recently has the hearing of voices been interpreted as a sign of mental illness, while in some cultures the experience is revered. When children of the Xhosa people in southern Africa hear voices, they are trained as healers, the book notes. Dr Taylor believes that more people here would admit to hearing voices, too, but for the social taboo. His research shows that voices rarely give orders; most are actually mundane. People who blame violent acts on their voices are still responsible for their own actions, he argues. In fact, violence is rarely associated with schizophrenia. The number of homicides committed by people with a mental illness has stayed at the same low level for 10 years, while total homicides have risen. And while orthodox psychiatrists still object to the new approach, there are signs of growing sympathy in the NHS for more flexibility towards hearing voices. Professor Julian Leff, of the Institute of Psychiatry, thinks that there has been ‘a sea change in attitudes towards this experience. As studies reveal how common voice-hearing really is, it can no longer be regarded as “abnormal”.’ One sign of acceptance, he says, is the growth in treating schizophrenia with cognitive behavioural therapy, where psychologists discuss with patients what their voices say and gently challenge them – although this is still rarely available on the NHS.

The vast majority of people who hear voices today are still treated by psychiatrists who refuse to discuss what the voices say. Professor Leff believes that ‘if a person experiencing voices doesn’t find them difficult to live with, and isn’t impelled towards dangerous acts like suicide or homicide by them, who are we to say that they should be got rid of?’

http://observer.guardian.co.uk/life/story/0,,223194,00.html#article_continue

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From Wikipedia, the free encyclopedia

An hallucination may occur to a normal person in state of good mental and physical health, even in the apparent absence of a transient trigger factor such as fatigue, intoxication or sensory deprivation.

It is not yet widely recognised that hallucinatory experiences are not merely the prerogative of the insane, or normal people in abnormal states such as sensory deprivation, fever or drug intoxication, but that they occur spontaneously in a significant proportion of the normal population, when in good health and not undergoing particular stress or other abnormal circumstance.

The evidence for this statement has been accumulating for more than a century. Studies of hallucinatory experience in the sane go back to 1886 and the early work of the Society for Psychical Research (Gurney et al, 1886; Sidgwick et al, 1894), which suggested approximately 10% of the population had experienced at least one hallucinatory episode in the course of their life. More recent studies have validated these findings; the precise incidence found varies with the nature of the episode and the criteria of ‘hallucination’ adopted, but the basic finding is now well-supported (see Slade and Bentall, 1988, pp.68-76 for a review).

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Last updated 11/06/2007

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Head to head:

Is hearing voices a sign of mental illness?

Two psychologists debate the issue: TONY DAVID says yes, IVAN LEUDAR disagrees.

Most people believe that ‘hearing voices’ is a clear sign of mental illness, but this may not be the case.

In a discussion in The Psychologist magazine, published on Tuesday 1 May 2001, Ivan Leudar, of the University of Manchester, argues that hearing voices is not in itself a sign of madness, and that such experiences should be judged as sane or insane in terms of their consequences for life.

He refers to visionaries from the past such as Joan of Arc, claiming that in the present day, ‘the very fact of hearing voices becomes a cause of mental distress, and this is because of the meaning of the experience in our culture, which is grounded in psychiatry.’

Leudar also points out that the media usually associate hearing voices with violence, even though most people who have psychotic experiences are not dangerous.

The psychiatrist Professor Anthony David of the Institute of Psychiatry, London, points out that, ‘a voice-hearer who is not in any distress, who lives a fruitful and productive life according to commonsense criteria, would never even enter the arena in which the possibility of mental illness was up for discussion.’

Admitting that hallucinations may be a source of inspiration or spiritual guidance, David says this is no reason to abandon the search for the biology, physiology and biochemistry of such phenomena (along with their historical and cultural context).

A report, Recent advances in understanding mental illness and psychotic experiences, was published last year by The British Psychological Society. Recent advances in understanding mental illness and psychotic experiences, ISBN 1 85433 333 X, Cost £15, cheque payable to the Division of Clinical Psychology (including postage and packing) from The British Psychological Society, 48 Princess Road East, Leicester LE1 7DR, or the document can be downloaded from the web, address www.understandingpsychosis.com.

Extract:

IVAN LEUDAR

LET me start by proposing the terms of the debate. I do not accept that auditory and verbal hallucinations must be studied only as hallucinations. The term ‘hallucination ’ implies an intrinsic confusion – something subjective is wrongly experienced as ‘real’ – but in fact most voice hearers are not confused in this way. Even before we investigate the experience, the term tinges it with a logically intrinsic pathology where there may be none. The term ‘ hallucination ’also implies that the (social and personal) dilemma is always whether the experience is private and psychological , as opposed to objective and social. This is simply not the case. The question we are to debate is meant to elicit controversy, and it does; but I am not sure it is one to bring out what is most interesting about ‘hallucinatory’ voices. The questions I like are, for instance, ‘Does everybody take hallucinations to be a sign of insanity?’ or ‘ Was hearing voices always a sign of insanity?’; and the answers to these are clearly ‘no’. One should ask what exactly these experiences have indicated, t o who m , and on what grounds. Psychiatry is not in a privileged position here.

Why were these experiences always noticeable and controversial , historically speaking? Not always on the grounds of their intrinsic pathology and confusedness. One historical debate was held by the French Societé édico-Psychologique in 1855. The debate was essentially about how to distinguish hallucinations of the insane from those of artists , visionaries and more ordinary others, but this turned out surprisingly difficult. The comparisons we re made in terms of (i) control over the experiences , (ii) confusing imagination and memories for perceptions, and (iii) confusing private experiences with the shared public ones.

Some argued that hallucinations we re inconsistent with reason, and that visionaries such as Socrates or Joan of Arc we re mentally ill simply because they had them and acted on them. Others disagreed and distinguished physiological from pathological hallucinations. The former we re seen as reasonable – relevant and sensible in content and appropriate emotionally, providing proper grounds for actions. The lesson is to judge hearing voices (and other such experiences) according to whether they are reasonable, and in terms of their consequences for life: in other words, pragmatically.

A second relevant debate concerned the visions of St Teresa of Avila. Her autobiography detailing them in support of her religious practices was examined by the Inquisition, who clearly distrusted visions. They declared that one should be very careful before granting sainthood on their grounds , but they did not see them as signs of insanity. Visions could be categorised as ‘mere imagination’, as ‘the work of the enemy of mankind’ and as messages from ‘the angel of light’; and the assignment into a category was a matter of their consistency with theological dogma and consequences for life.

What I would suggest then is that hearing voices (and the experiences we may cat ego rise as hallucinations) should be judged as sane or insane in terms of their consequences for life. They are not in themselves signs of madness, any more than, s ay, thinking and remembering; even though some people can have bizarre and false memories, and some people think delusional thoughts. The madness of some hallucinations is in their involuntariness, delirious content, falsity, childish terror of the hallucinator: in other words, nothing specific to hallucinating. Epidemiological research implies that hallucinations are not necessarily concomitants of insanity but may happen to people without any psychiatric problems.

My own work implies that hearing voices is intrinsically rather mundane in content and not necessarily deluded or deluding. There is a problem though. We always have experiences under a description, never just the bare experiences. It is possible that hearing voices under the description ‘a hallucination’ and ‘a symptom’ is not so much an indication of mental illness as a cause of psychological distress.

The Psychologist , Volume 14, Part 5 (May 2001) For full debate download article here

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Researchers: Elisa Gatiss, Robert Dudley, Bryony McGregor, and Mark Freeston. Doctorate of Clinical Psychology, University of Newcastle Upon Tyne. UK.

Hallucinations and voice hearing have been traditionally associated with severe psychiatric illness. However, recent research has provided some evidence that auditory hallucinations are a normal psychological phenomenon commonly experienced in both ‘normal’ and clinical populations (eg Romme & Escher, 1996; Slade & Bentall, 1988). This has resulted in a shift in attitude towards voices and voice hearers; the mere presence of a voice per se is not considered to be the problem, rather it is the individual appraisal of, or meaning attributed to the voice that is important. Furthermore, studies have indicated that the experience of hearing voices can be positive in both those with psychosis (eg Chadwick & Birchwood, 1994; Johns et al., 2002) and evangelical Christians (Davies et al., 2001).

Recent advances in cognitive behaviour therapy for psychosis have led to the development of models to enhance psychological understanding and treatment of distressing auditory hallucinations (Morrison, 2001). However, there is an absence of research into people with psychosis who are not overtly distressed by their voices. The work that has been undertaken by Max Birchwood and colleagues found that voices perceived to be benevolent tend to be engaged, while those seen as malevolent are resisted. A comprehensive description and greater understanding of the psychological mechanisms underpinning the experience of positive voices we feel could lead to the development of a ‘normal’ model of auditory hallucinations. Such understanding could enable us to work more effectively with people with negative voices by highlighting potential therapeutic techniques, normalising the experience of hearing voices and fostering hope.

Owing to this interest in the experience of voices in the absence of distress we set out to discover what are the distinctive features of positive experiences of auditory hallucinations in people with psychosis who experience both positive and negative voices. In essence, we wanted to know what makes one voice seem positively and another seem negative.

We interviewed 14 people who had been using psychiatric services and who experienced voices on a regular and frequent basis. In particular, these people could identify either; a ‘good’ and a ‘bad’ voice, or could experience the same voice as either positive or negative at different times. Each person was interviewed using a semi structured interview on two occasions. On one occasion they were asked about the negative voice, and the other occasion they were asked about the positive voice (the order of the interview varied and was determined by the person).

The content or frequency was not the primary difference between the voice experiences. A positive voice experience could say unpleasant things, and a negative voice could say apparently nice comments. Rather positive voices were seen to play a greater role in providing companionship, comfort and support. Positive voices were seen to be more helpful than harmful whereas negative voices were the opposite way and seen as more harmful than helpful. Negative voices were seen to be less controllable. In both negative and positive voices it was difficult to stop the voice from talking, but was easier to have a conversation with a positive voice experience. As with previous research positive voices were engaged more than resisted, and negative voices were resisted more than engaged.

We are extending this work to see how people who experience voices but who have not experienced distress (and have not been in psychiatric services) regard their positive and negative voice experiences. We feel that we could learn from their experiences, their ways of coping and help better understand how to help people who do experience distress when hearing voices.

Further details available from Elisa.Gatiss2@nhct.nhs.uk or rob.dudley@stw.nhs.uk

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We received this request in February 2006, so the research may be further advanced, see contact details for the researcher, Hannah Osborne, at the bottom of article:

Many people will hear voices at some point during their life and research has shown that some people experience their voices as positive, live rich and fulfilling lives and do not require psychiatric or psychological help. Hearing voices therefore cannot be explained by mental illness alone and clearly lies on a continuum with normality.

Commonly adopted beliefs about the nature of voices are those of a paranormal, mystical and spiritual explanation. Despite this, most research to date focuses on the negative experiences of voices and on people who feel distressed as a consequence of hearing voices.

We hope that increased understanding of the psychological features of positive experiences of hearing voices in spiritual believers will result in a more comprehensive understanding of what makes people able to deal with these kinds of experiences. Such understanding could lead to the development of ‘normal’ models of voice hearing as well as enabling therapists to work more effectively with clients who have negative experiences of voice hearing.

What can you do to help normalize the experience of voice hearing?

We are looking for people who have the following characteristics. We would like them to undertake a telephone interview exploring aspects of their voice hearing experiences:

• Your beliefs are of a paranormal, spiritual, mystical or psychic nature. • You are having both positive and negative voice hearing experiences. • You have never received any psychiatric or psychological treatment for voice hearing. • You do not use illicit drugs or anti-psychotic medication.

What does the Interview Involve?

The interview consists of two parts which may either be completed in one phone call, or time may be arranged to complete the second part another day. Each part of the interview will take approximately one hour. Some of the things that you will be asked in the interview are: to describe your voice(s), how you deal with the voices and how the experience makes you feel. The interview will be tape recorded in order to supplement the written notes that are taken by the researcher. Following the interview you will have a chance to ask any questions as well as talk off the record about any issues that have risen during the interview. Also if requested, comments during the interview may be off the record.

What are the possible disadvantages and risks of taking part?

We do not feel that there are any risks or disadvantages involved in taking part in this study. However, should you find some of the things asked in the interview difficult to talk about, the interview can be ended immediately, and time will be made to talk things through with you. In addition you will be given a contact number in the event that you experience any distress after completing the interview.

What are the possible benefits of taking part?

If we could explore features of both positive and negative experiences of hearing voices then it might be possible to use this knowledge to help people who are finding it difficult to cope better. Your account of voice hearing will help us to increase our understanding of this type of experiences and in turn, this will inform and improve psychological interventions for people who find these experiences distressing and difficult to cope with. In turn it will help to normalize the experience of hearing voices, recognize that voices can be experienced in the absence of distress and further highlight its prevalence within the general population.

If you are interested in volunteering for or finding out more about this piece of research please contact:

Hannah Osborne Assistant Psychologist South of Tyne and Wearside Mental Health Trust Monkwearmouth Hospital Sunderland SR5 INB

Email:hannah.osborne@stw.nhs.uk