Last updated 29/06/2007

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Marius Romme in this new article, considers five questions about the importance of changing your relationship with the voices. Based on interviews with 50 voice hearers who have recovered from the distress caused by their voices.

by Professor Marius Romme

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Ron Coleman is the best known voice hearer to have recovered from the distress caused by his voices. He has written a beautiful book about recovery “Recovery an alien concept”. It is personal and political. He describes his personal recovery and describes a lot of important issues in the recovery journey. After having read it, my trouble was how to remember what is said and how to use this information when supporting people who are trying to overcome the distress caused by their voices.

Over the last few years we have assembled the recovery stories of 50 people for an anthology soon to be published. But here to, I have had the same problem with my ambition to describe the process of the recovery of these 50 people.

How to remember what is important in the recovery process?

When you read these stories you become very impressed by the struggle these people have gone through. You become enthusiastic about the many different ways in which they succeeded in taking back their power and have started to live their own lives and rather than the lives of their voices.

Living your own life is after all the purpose of recovery.

But when you have read these stories what do you do with the information?

As a voice hearer it might be not so difficult because you can look for identification with some of the people who wrote their stories and to identify with what you recognize and then try to use what is used by these fellow voice hearers. But as a professional you are rather at loss as what to do with all this information.

I therefore formulated 9 questions in order to organise the information written up in these 50 stories and I will discuss five of them in this paper (because in papers you also have to organize information and necessarily reduce information).

I therefore will accentuate the importance of changing the relationship with the voices and will give an overview of the steps taken in the recovery process next time.

These are the five questions:

1) What does the voice hearer say about the roots of their hearing voices experience?

2) What kind of influences has psychiatric care had on his/her recovery?

3) What does the voice hearer say about the importance of accepting the voices in his/her recovery?

4) What do voice hearers say about the relationship between the voices and the person’s life?

5) How did V.H. change their relationship with their voices to overcome their distress?

The first question about the roots of hearing voices: As far as the roots of the hearing voices experience are concerned in these 50 stories, most people tell about how they experienced trauma. Most frequently, sexual and physical abuse was seen as the cause of the voice hearing experience.

Like Sue said: “I have perceived my voice as that of the abuser when I was a child”

And Helen: “I see them as post traumatic after effects of the abuse”.

Or Flore: “With me there was no confusion, I recognised the voice as the abuser”

As well as Mien: “I started hearing voices when I was 7, that was the time time the sexual abuse by the curate started”.

As a second frequent traumatic background we hear stories about “long-time emotional neglect”. With emotional neglect we see that the person has:+

not learned to express emotions;

was punished when emotional;

was treated without love and support, but mostly criticized

Like Ami says: “We should keep our emotions to ourselves”.

Or we hear from people about being belittled and over long periods being told they are no good, like with Frank: “My second mother was very aggressive with me, the children from the second marriage have had a better time, I was simply guilty of everything”.

Or emotionally neglected like Helen: “Throughout my childhood my father made me feel more like an object rather than a human being. He never provided any sort of love, kindness or support”.
With emotional neglect the person arrives at adolescence without a clear identity and becomes vulnerable in adulthood when staying on ones own, where emotions are inevitably part of daily life. One has become vulnerable for the perception “of” – and - the coping “with” emotions.

Another trauma that has a great impact is long-term experience of being “bullied” at school. We read from Johnny´s interview: “My childhood and family life was happy and secure but the bullying seemed to be carried on by the voices”.

From Karina we hear: “The strongest and most negative voices came from the people I used to go to school with, I was bullied at school and a lot of the content came from this time, it was like I was carrying the past voices around with me”.

We also read about hearing voices related to threatening living conditions as Mieke told us: “I start hearing voices when I get into a situation where I felt really threatened with my ability to subsist."
Also Gina felt threatened: “I lost my job and when my boy friend left I had to stay all on my own in my flat. I became very anxious, because there were drug dealers at the corridors and someone had caused a fire in a nearby flat”.

We read about rejection as a child as with:

Debra: “Over the years I was to gain by subterfuge, snippets of information regarding my adoption which added to my sense of loss, betrayal and rejection, as well as undermining my self-esteem. I was to discover that I had been sent back to the adoption agency by one couple as it was believed that I was defective in some way and was possibly brain damaged.”

Then there are, I think, the most dramatic mishaps when rather “normal adolescent problems” of insecurity, accompanied with hearing voices are taken for the expression of mental illness (Eleanor; Stewart; Antje and Sasja – see below), then this is diagnosed as schizophrenia and treated as an illness with neuroleptics as the only option available. Medication instead of being helpful and supportive with their issues of insecurity - and - instead of helping the person with their development, actually causes more difficulties.

Eleanor said: “I was 18 when I went to University. I’d never been away from home before. I was quite naïve. The group I got into were very hedonistic, very outgoing. I was accruing a massive debt. I was torn between following their path and feeling that I ought to be working hard. It was around that time this voice turned up, it was like the voice was, or I was, reprimanding myself. Then I made the fatal mistake of mentioning this to one of my friends She was horrified and so I came to be referred to a psychiatrist. I was admitted to hospital and treatment meant drug therapy. It was all undermining my sense of self.”

Antje who told us: “I was 17 when I started to hear three voices. I had just started living on my own and changed schools. I went to a special science school were we concentrated on mathematics. I then had real difficulties with mathematics I had had never before. I sat at my desk for three hours one day not knowing were to start when I heard a clear voice saying: .”you are stupid” "When some years later she opened up it was immediately seen as psychosis and treated only with medication. This disrupted her life totally.

Stewart: “I started hearing voices when I was 14, I had a very difficult time. My parents were in the process of splitting up, at the same time two grand parents passed away, I also was being bullied by the head boy and I had been hacking into computers at school, some one else got the blame and was expelled from school, I felt very guilty, but unable to own up. I didn´t tell anybody. I stopped going to school just telling them I was not feeling well”. Stewart ended up in psychiatry where he went down hill because hearing voices only induces drug treatment without exploring what had happened to cause them.

This brings me to the second question. What are the influences of the traditional psychiatric care? They are more or less horror stories that we read. Intelligent capable people come in to the hands of a psychiatrist and are mentally broken down by medication and a system that leaves no hope for the future. A future painted as a life-long sentence of medication and no perspectives to realize ones capacities. This is most sad with the life stories that started with adolescent problems.

As with Stewart who told us: “I was only fifteen then. I got a diagnosis of schizophrenia and different professionals: nurses, social workers, psychologists and psychiatrists all gave the same sort of message time and time again: my prospects for the future were not great, I shouldn’t have expectations about school or work or having relationships”.

And like we read from the story of Antje: “Every time, when I was released from hospital and went back to normal life, there was this reduction of possibilities in my life. Nearly ten years later I was not interested in anything any more”.

We read about this kind of negative influence with practically every one who comes in to the hands of traditional psychiatry, where medicalisation of hearing voices breaks the person down. From all the stories it becomes clear that those who recovered did this outside the psychiatric system and found somebody who opened another perspective on hearing voices for them. However it is also good to read that these 50 people found other possibilities and they also regularly found them with professionals in mental health care, even with psychiatrists. I am happy that so many found open minded professionals, but sad that there are still so few. It is crystal clear from all these stories that the traditional approach has nothing to offer in the sense of recovery and is even very harmful for the development of the person involved. As far as the third question accepting voices is concerned a most important step seems to be that ones self, but also others, accept that they are real, and that others look at them with a perspective of the possibilities there are to cope with them. Therefore self help groups are very important and/or a more optimistic friend or professional, or a book like “Accepting Voices” to start the process of the possibility of recovery for oneself can have an important influence.

Like Ami said after reading “Accepting voices”: “This made the experience concrete and not mystifying. A process of building up was described, giving hope”

Or Eleanor when she says: “Pat Bracken ( an English psychiatrist) told me, this is just a normal experience. There is a context to it and a meaning. I started reading about this and thought whoa ‘may be I can be a part of this’”. So, accepting is not concretely accepting everything of the voices as they are perceived, but is the beginning of looking differently at them; normalising them; being with many others who hear voices; creating hope and opening personal possibilities.

Accepting your voices and accepting yourself

Accepting starts in the way in which one changes one thoughts about once voices. Instead of interpreting them as a sign of madness, learn to see them as a possibility to cope with and as a meaningful experience.

Accepting ends with accepting one self as Jeanette says: “I had to recognize myself and especially to accept myself. "

Or Sasja: “You realize the consequences of hearing voices much later. You have to also change yourself, whether you like it or not. I don’t like changing. Now I am more philosophical, but before I wanted to control everything. I now accept myself much more”. So accepting starts with accepting the reality of the voices and ends with accepting the reality of yourself as you are.

Changing the relationship with your voices also becomes part of the recovery process. In the beginning the voices are often seen as almighty and as being right,

LikeDaan, who says “I thought I was bad because the voices called me all sorts of names. Later I realized that the voices were related to the physical abuse I´d experienced, because they have the characteristics of those people who abused me. Then I perceived that the voices became more or less intruding depending on the situation I was in. They become bad when there are conflicts in the house” . So they become a kind of mirror of the living situation.

Or Eleanor “I began slowly to realize that yes he is a demon, but he was a personal demon. His demonic aspects were the unaccepted aspects of myself image”. Or Sue “the relationship with my voices has always been related to suppressed emotions. Whenever I have experienced traumatic experiences in my life, my voices seemed stronger” Or Mien “the ugly voice told me, the sexual abuse was a punishment, because I was lazy and stupid. But in the psychotherapy I got more insight in myself. I understood that voices have everything to do with how I feel myself”

Or Antje “It took me a quite a while to see the relationship between my voices and my life, so I realized that when I was angry and did not express my anger the voices became angry at me.”

Or Debra “I realized that the only power the voices had, was the power I gave them”.

How did these voice hearers manage to change their relationship with the voices.

It seems very important in the recovery process to change the relationship with ones voices and therefore I will give some examples of how voice hearers, in many different ways, managed to change their relationship with their voices.

Antje says: “A shaman therapist taught me to talk friendly and slowly to my voices and ask them to go to the place they belong. After three or four weeks, talking three or four times a day to the voices in this friendly slow way, they slowed down an became quieter. This made it possible to let the voices I heard for so many years vanish”.

Andreas says: “I realized that the continuous chain of hatred in the relationship between me and my voices needed a break through. Only when I acknowledged that many things the voices were telling me were true I became able to forgive them. Only when I asked the angry voices to forgive me, I became less depressed.”

Debra says: “I decided that everything I was doing so far was not working for me so doing the exact opposite made sense to me. First I changed my attitude towards them instead of bowing to their every whim; I embraced them as friends and welcomed their intrusions greeting them with kindness and respect. I then approached the voices as I would approach any relationship and began to put parameters around how and when they could contact me. I also began exploring other areas of my life and discovered what role the voices played ìn my life: “the need to feel connected to someone a need to belong”.

Eleanor says: “I realized that the fear I felt had created this vicious circle of avoidance and isolation. I tentatively began to test out what the voices claimed. Having realized he had not much power. I asked well were he is coming from. He is not coming from outside he can’t be. It can only be from me. The contempt and loathing he is expressing actually reflects how I feel about my self”

Ami says: “My relationship with my voices changed when I learned to see them as a signal of my problems when I learned to react positive to them. When said to me “look at her what a disaster” I looked in the mirror and thought they are right “I should dress properly”. From a negative influence it became a stimulus”.

Sue says: “I accepted my voices as real. Once I did that my relationship changed. I stopped looking for a cause outside myself. I looked for solutions in myself. I reclaimed my personal power” Flore writes: “Before I listened to the voice and just did what he said, I learned that I had my own opinion, my own mind. I did not have to follow the voice."

Gina: "I have learned to ask them questions and they appeared to be talking about the things I was thinking about. They told me things that were true. I could not afford such a high rent I could not stay there”. Hannelore “I started to remember the time I heard voices before I got into the psychiatric care and how I managed to cope with them”.

Mien: “From my psychotherapist I learned how to cope with my voices. He told me I was not mad but that they were related to my past. That it is a rather normal experience you can talk about with others. Those voices express what has or is happening to me”.

Stewart: “After I set my self up as a self employed worker, my relationship with my voices changed, I think because my self esteem started to rise. Work gave me a purpose”.

Jeanette B: “One day my voices told me I had gone to far, I should be punished. I would die the coming night and fall into the hands of the devil. Although I was very afraid, I fell asleep and woke up still alive. This was a turning point I realized they spoke nonsense and since then I systematically closed them out, I started to concentrate on my own thoughts. Every thing I did I thought about like: “laying the table, I thought this is a fork this is a knife” etc. This gave me control. It took me five years before I had banned them for 100% of the time, but I got rid of them. “

You see that the ways people changes their relationship is very different but it seems quite an essential prerequisite to recover from the distress with voices.

Changing the relationship seems to become possible with the insight into and the changing nature of the power relationship between the person and the voices. The recognition that the person him/herself gives power to the voices and with the starting of the process of taking back power, it also becomes possible to change the relationship with the voices By either becoming friendlier and therefore less dependant on the voices or by the recognition that what the voices are saying has a value for the person However, a third possibility seems to be to back the full power of the voices.

We see the first two solutions of changing the relationship from a negative one into a positive one less often with people with sexual abuse as the originating trauma. With them we see less of a positive relationship, but a growing independence, becoming less a victim, taking back power by realising they have their own mind to make decisions with, finding solutions in themselves, living their own life. In both situations there are preliminary needs like: one needs to accept the voices as a reality; learn to talk about them with others; find support, not being mad; looking for their role in your life; testing the power of the voices and taking back power; making choices in starting to live your own life; using voices as a helping hand but not living their life as you originally might have interpreted them.

In his book Recovery an alien concept Ron Coleman has described five steps in this process like:

1.“Others” to show you and to help you find another way and to be able to talk with about your voices.
2.“Developing one self” in relation to what has happened to you, working through shame and guilt and building up self-esteem. Learning to recognize your needs resulting in emotional self-acceptance; growing out of the victim role and developing self awareness and develop ingyour self-worth again in social roles.
3.“Taking ownership” because nobody else can own once experience and it is only the voice hearer who has the experienceof their voices. In the 50 stories people seldom told us about ownership, but describe what they learnt about understanding the connection between their voices and their personal position in life and how they learned to use this to their benefit.
4.“Taking back power” is described in the 50 stories after testing the power of the voices and discovering that the voices have no more power then the voice hearer is giving them, which then leads to changes in the relationship with the voices. In the 50 stories more attention is given to changing the relationship with the voices then is done in Ron’s book.
5.“Making choices” is done by the persons in the stories by taking up social roles extending social contacts and then building up their self-worth again

When a person develops more insight into the relationships between the voices and themselves, the voice hearers often say that during the recovery process the voices change from pathological into functional ones. They more or less mirror the persons way of being, feeling good or bad about themselves and about their lives, living in conditions they feel safe with or threatened with. The way a person feels and functions is also the basis of a persons changing mental health condition and the voices give expression of that. In the recovery process voice hearers often learn first about the relationship between the voices and their past life experiences. Later they learn from the interaction with their voices and about the interaction of the voices with their daily lives in the here and now. Firstly, this involves the relationship with the trauma they have endured, and then later the relationship with their way of being in the world of today. As a professional you can’t hurry this process, you can only support this process - but it is the process of the voice hearer developing themselves. You can’t go more quickly then the pace at which the voice hearer develops. However, it is a broader development then coping with voices, it is also coping with life, growing, building up safer relationships and living conditions, developing the self and being the real owner of the voices, something that Ron Coleman has described very well.

Conclusion

The more the process of recovery develops, the more the relationship with the voices become functional, instead of pathological.

They become the mirrors of the soul and well being; a reflection of ones mental health.

This article based on a speech given at the Hearing Voices Congress, Copenhagen, Denmark 31 May 2007

The Independent on Sunday, 18/03/2007: Mental Health Special edition

Mental health special edition edited by guest editor, Rufus May, mental health activist and INTERVOICE member and contributions from INTERVOICE members, Peter Bullimore (Sheffield Hearing voices Network and founder of the Paranoia Network) and Prof Phil Thomas (psychiatrist).

Rufus says:
Sunday's Independent on Sunday Review magazine: "The journey through 'mental elf' problems can be a spiritual process. A time of crisis, reflection and regeneration. In this special issue we look at the whole mental health continuum, how people have dealt with and transcended their difficulties and gone on to make a contribution to life. People who have been silenced are reclaiming their voices and hopefully this will lead to radical change in how we listen and respond to madness. Many thanks", Rufus May Guest Editor

The mad doctor: The extraordinary story of Dr Rufus May, the former psychiatric patient
At the age of 18, Rufus May was diagnosed as an incurable schizophrenic and locked up in a psychiatric hospital. Now, he is a respected psychologist and a passionate campaigner on mental health issues. He is also the guest editor of this special issue. Here, he tells his extraordinary tale

Now we're talking: Tales of breakdown and recovery
These brave people have dared to break one of society's greatest - and unhealthiest - taboos, by speaking openly about their mental health issues. From well-known figures coping with stress and breakdowns, to lesser-known pioneers finding remarkable ways to overcome sometimes extreme and terrifying psychological difficulties, their stories are here to inspire...

Psychological warfare: What's the best way to treat mental health problems?
Mental-health experts are fighting over how best to treat emotional distress, and our minds are their battleground. Dr Cecilia d'Felice looks at the competing factions and asks, who will emerge victorious?

Is there a link between madness and creativity?
Many illustrious thinkers and poets, including Shakespeare, have believed that genius is only a step away from insanity. John Walsh goes in search of evidence in our contemporary culture

The day I lost it: Confessions of a killer
When someone in the grip of mental illness commits murder, the true story is often lost in a tide of sensationalism. In this extraordinarily frank account, 'Jimmy Smith' recalls the breakdown that led him to take his own mother's life, and its shattering aftermath

Last updated 11/06/2007

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Published: Independent, 18 March 2007

At the age of 18, Rufus May was diagnosed as an incurable schizophrenic and locked up in a psychiatric hospital. Now, he is a respected psychologist and a passionate campaigner on mental health issues. He is also the guest editor of this special issue. Here, he tells his extraordinary tale

When I was aged 18, I witnessed first hand how society's approach to mental health wasn't working. I was admitted to Hackney hospital - a psychiatric hospital - and told that I could not leave. On the verge of adulthood, and feeling lost after my girlfriend had left me, I had invested in a spiritual search for guidance. The messages I picked up from the Bible convinced me I had a mission. Seeking to discover what my mission was, I slowly deduced that I was quite possibly an apprentice spy for the British secret service. I was eventually admitted to hospital when I became convinced that I had a gadget in my chest that was being used to control my actions.

Psychiatric hospital was like another world entirely. Queues for the medication trolley punctuated the boredom and general sense of hopelessness. Any resistance to the regime was quashed by forcible restraints and powerful injections. Many friends felt too scared to visit me.

That experience coupled with being given a diagnosis of schizophrenia made me feel like a social outcast. When my parents were told my condition was probably genetically inherited, the die seemed irrevocably cast. Ward rounds felt like elaborate religious rituals conducted by the consultant psychiatrist, with an audience of medical students and student nurses observing, while my insanity was confirmed and long-term drug treatment prophesied. I found the medication made me feel empty and soulless; I could not think past considering my basic needs. The drugs made me physically weaker and affected my hormones so I became impotent.

I was concerned about this. However, to the outside world, because of the mind-numbing effects of the drugs, I was less focussed on my spy and spiritual beliefs. The doctors pronounced that I was responding well to the medication. I was determined to stop taking the tablets and injections as soon as I could find other ways of staying calm and centred.

The majority of fellow patients were revolving-door patients. I myself was told I'd be back. It was true: I was readmitted twice before I managed to escape the role of mentally ill regular customer. But I was luckier than most: as well as my parents visiting me daily, a close friend came back from selling pots and pans to US servicemen in Germany and began visiting me daily too. I started to pick up on her belief that this breakdown, or whatever it was I was having, was something I could get over.

When I was 12 years old, I had witnessed my mother make a strong recovery from a disabling brain haemorrhage, so instinctively I knew that I could turn my life around with the right support. So I decided not to believe in the doctor's wisdom and planned to get a job as soon as I left hospital. While I was still in hospital, I started going to churches and community centres offering to do voluntary work. Although I must have seemed a bit odd, I found many kind people who were willing to give me tasks to do and slowly I started to rebuild some social skills.

When a friend and fellow patient, Celine, took her own life after being heavily over-medicated, it became a turning point for me. It was a Caribbean funeral and hundreds of people turned up for it. It contrasted strongly with the absence of support she had had when she had been alive and hearing abusive voices from her past.

I realised then that I had found a cause that needed no delusions to support it. Like Celine, I had gone through the strange process of being talked to as if I was not there, of professionals trying to suppress my odd and disturbing behaviour with drugs without trying to understand why I was acting as I was. No one seemed willing to think what was it like to walk in my shoes.

We, as a society, were making people madder and maybe I could do something about changing that. What if I could make a different kind of come-back to the psychiatric ward, as a mental health professional? Then perhaps, in Trojan horse style, I could help dismantle the myths of the psychiatric hierarchy. The more I thought about this, the more I realised I would have to keep my former identity as a psychiatric patient strictly under-cover.

When a junior psychologist informally questioned my diagnosis of schizophrenia, suggesting I had had a temporary psychotic episode instead, it made me think maybe psychology was a way of doing things differently. So my mission was becoming clearer: I would train as a psychologist. I knew I needed to sort myself out to some extent before attempting this journey.

My first job, straight out of psychiatric hospital, was working as a night security guard in north London's Highgate Cemetery. I now think that patrolling the heavily wooded grounds in the dark was a deeply therapeutic activity. With no time to daydream, I had to stay aware and face my fears of the dark and the unknown. I also think just walking in close proximity to nature was a very healing process.

It was during this time that I successfully came off my psychiatric medication, against doctors' advice. I then spent several years doing a range of jobs and learning creative ways to express myself, using dance and drama. I shifted my focus from thinking about myself to trying to help others, while making sure I looked after my mind and body. I used the outdoor gym on Parliament Hill, sport and breathing exercises as natural ways to manage my moods. I was careful to avoid unreliable or abusive friends and stick with people who had stuck by me. Studying sociology helped me understand the wider structures of society, demystifying such things as the class system and power relations between men and women.

I was reminded of the prejudice against the subject of mental illness when a right-on community centre refused to support me and a group of amateur drama students putting on a play about a nervous breakdown. Nevertheless, from drama classes I learnt the art of re-inventing oneself through improvisation. I will always remember how one of my drama teachers impressed upon us all the message that "this life is not a rehearsal". My confidence in acting was to become useful over the next 10 years of carework and psychology training, where I chose to keep quiet about my previous role as a psychiatric patient, to avoid the possibility of discrimination.

For me, the dividing line between the mentally ill and the sane was more a question of social boundaries than actuality. I had found some very mad people in hospital very helpful and some of the so-called "well" nurses quite bullying and hostile, it suggested to me that to some extent madness was in eyes of the beholder. I also knew that my own madness had been meaningful; for example, my fantasies about being a spy had given my life meaning and my search for a spying mission was a metaphoric search for a meaningful quest in my life.

My training as a psychologist in the early 1990s, coincided with a time when psychology as a profession was beginning to interest itself in trying to understand and work with madness, an area which was usually associated with the more medical, drug-prescribing profession of psychiatry. For the past 10 years I have been working as a psychologist covering a broad range of mental-health problems. I know that to really help someone who is deeply suffering or confused, we need to be very creative and offer a wide range of resources.

In Bradford we have self-help groups where people are encouraged to help others as well as themselves. We also create spaces where for example art, spirituality and physical relaxation can be explored in a number of different ways. We have Tai Chi classes, dance classes and African art classes, as well as political and cultural discussion groups. If people hear troubling voices, I want to understand these beings that haunt them. I will sometimes communicate directly with the voices and try to facilitate a peace process between the voices and the person hearing them.

I must be living proof that people can resist so-called command hallucinations, because initially many voices feel threatened by me and tell the voice hearer to attack me. I am still unscathed, which is a strong testimony to the fact that people who hear voices can learn to resist the most bullying and aggressive of them. So instead of encouraging people to suppress their experiences, which I think generally makes them worse, I try to assist people to face their demons in their own time.

Is society any madder than 20 years ago when I was in hospital? It seems to me that some things are getting worse and some things are getting better. People are getting bolder in talking about their experiences of distress and madness. This is refreshing; the status quo, in which well-meaning professionals and charity heads are the only experts, is starting to be challenged. Britain is a leading light in this consciousness raising, where people are coming out more and more about their experiences of emotional distress. Consequently, a broader range of ideas and approaches to what helps us heal troubled minds is being listened to.

At the same time, the might of the pharmaceutical industry is stronger than ever before; drug companies are ruthlessly promoting the simplistic and misleading "chemical imbalance" theory of mental distress, while marketing our discontent as diagnosable medical illnesses. In the US, they have been very successful, with roughly 10 per cent of women taking anti-depressants and an astonishing 10 per cent of children being treated for ADHD with the amphetamine derivative Ritalin. Each year in this country, prescription rates rise for psychiatric medication.

While I am not against all use of mind-altering drugs, this trend is worrying. I think that when drugs appear to work, the main effect is that of masking a patient's problems, but as soon as you remove them the problems bounce back, often with a little more oomph due to the fact they have been artificially suppressed. You also need more and more of the drug to achieve the same effect, because our brains build up a resistance to all mood-altering substances. We are then likely to experience the more negative effects of the medication and develop a dependence.

So drugs are limited in their usefulness and are perhaps best used as a last resort and for short periods of time. This is not going to be popular in the board rooms of Big Pharma, the Big Brother of mental health. But if we are going to make progress in our quest for healthier communities, we are going to have to limit the pharmaceutical industry's influence on how we understand our minds and approach the recovery process.

Last updated 11/06/2007

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Taken from the preface to "Recovery an Alien Concept", available to purchase from P&P Press

I was brought up in a working class Roman Catholic family and like many boys my age I went through my religious phase in my eleventh year of life. I went to see our parish priest and told him that I wanted to become a priest. Our parish priest at this time was getting on in years and was one of the old school having said more masses in Latin than in English. He was also without doubt a man of God who saw himself as a shepherd and us as his flock. When one among his flock stated they wanted to become a priest, he took them seriously. He took my desire to become a priest seriously and once a week I met with him and two other boys who had also stated a desire to enter the priesthood. In these weekly meeting we would discuss further the teachings of the church, the role of the priest and whether we thought our calling to the priesthood was real. After one such discussion one of the boys stopped coming as he felt he was not being called but was trying to please his family. The two of us that remained were undeterred and continued on with our instruction, fully committed to the idea that some day we would become priests.

These were happy days for me, I was preparing to serve God and I had all the enthusiasm an eleven-year old could muster for my coming tasks. The day that changed my life started the same as any other I went to school and after school I headed for the chapel house for instruction. The housekeeper answered the door, she was near to tears as she told us our parish priest had taken seriously ill earlier in the day, although he survived he was never to return to the parish. (I often wonder what would have happened had he never became ill. Would I now be a priest?) Shortly after this happened a new parish priest arrived, (I will call him Adrian) at first everything was business as usual and I soon relaxed into my normal routine. The next three months went by without incident as far as I was concerned though I noticed that a lot of the altar boys were leaving service before they normally would age wise.

I was very quickly to find the reason why when after Mass one day Father Adrian asked me to come and see him in the vestry, I sauntered over without any thought as to why he wanted to see me after all he was a priest. When I arrived at the vestry Father Adrian asked me to sit down it was at this point that things started to change. He started by asking me if I had any sins that I needed to confess, when I said I did not he called me a liar and said that he needed to pray for me so that I would be forgiven. He knelt beside me and started praying aloud he was saying something about me leading him into sin and that I was evil. As he continued to pray he started moaning and groaning, I was aware that his hand was slowly moving up my leg this went on until he was touching my penis. As this continued I was aware of becoming a spectator in what was happening to me. I became aware of other things around me like the candles that were burning too brightly and his purple vestments were if anything even more purple than usual. I was there but not there those who have been abused will know what I mean, much later in my life I discovered that this is called dissociation and it is the most common form of self-preservation of those who are abused. At the time it did not feel much of a defence to me for inside I screamed at him to stop I also screamed at God for protection but either God was deaf or I never screamed loud enough because he never defended me. When it was over Adrian told me that no one would believe me if I told them what had happened. I left the vestry in a daze and never told anyone what happened that day or the many other days that it was to continue for.

I was trapped for a while within this cycle of abuse, after all who would believe me? Adrian was a priest he stood between people and God, he represented Christ on the earth, the forgiver of sins, the good shepherd. I was an eleven-year old boy, a dreamer and to say anything would brand me a liar. My relationship with this God that I thought I believed in was over. The abuse continued for a few months until I found from somewhere the strength to turn my back fully on the church and with it God. My spiritual and religious phase was over. Time has taught me that this is the pattern with abusers that they are often in positions of trust in the community and they use this position to ply their evil trade in misery and pain. Experience has taught me that the failure to deal with abuse means that the abuse will stay with you throughout your life and in many ways shape your life in terms of future relationships. This is especially true when it comes to trusting friends or life partners. This event more than any other was to shape my life or should I say illness.

If this was the only traumatic life event that I was to go through I believe that I would have survived it and got on and led a fairly normal life. As is often the case it was when I thought that I had turned a corner that life dealt me its foulest hand. As I grew up into adulthood I put the abuse behind me or so I thought and got on with the business of living, it was while I was getting on with life that I met Annabelle. I met her one Saturday night in the pub after I had been playing rugby, when I saw her I knew what love at first sight meant. Being psychotic has nothing on being in love, love is without question the true psychotic experience. Annabelle was an artist, sculpture was her main medium though also she painted and did sketching. In the short time that we were together she taught me many things, she taught me what love was, how to make love and most importantly how to love life. She also taught me to appreciate the arts such as classical music, opera and theatre. With her I began to discover a spiritual dimension to my life though I hasten to add that this was not a religious thing.

Our relationship developed quickly from the torrid passion of new lovers to the passion that consumes those who are indeed soul mates. We spent as much time as we could in each others company often we would sit up through the night talking and planning as couples do. We were planning our life together, this was normality at its best. But like all normality madness was lurking waiting its chance to pounce and consume us and then one day it did.

Like the day I met Annabelle the day our relationship ended was a Saturday, I had been playing rugby and went home with something for both of us to eat. When I got in I called to Annabelle asking her if she wanted tea or coffee, she didn't reply. I went into the living room and she was lying on the couch I asked her again and still got no reply I gave her a shake but she would not wake up. I rushed out of the house to a neighbour and asked them to phone an ambulance. They rushed her to hospital and put her on a life support machine she did not make it and three days later she was pronounced dead. Annabelle had taken her own life I never really found out why but I know that I blamed myself, I don't know why I blamed myself though it was to be many years before I stopped doing so.

When she died a large slice of me died also, I swore that never again would I get emotionally involved with anyone. Like many others I suppressed all of my emotions about Annabelle and her death. I continued on with a semblance of existence that others called life. Like the abuse I choose to pretend it never happened and like the abuse my feelings of grief and loss and hatred of the world festered inside growing and growing waiting for their chance to devour me.

The time came for my emotions to overcome me when I had an accident on the rugby pitch that put me out of the game forever. Barely weeks had passed since I was discharged from hospital (still on crutches) when I heard a voice for the first time. I was in my office waiting for the computer to deliver the results of some data I had inputted when a voice behind me said that I had done it wrong. I looked behind me but there was nobody there. I stopped what I was doing immediately, went to the pub and got drunk, I remember thinking that I was stressed and needed a break.

Within a short six months period the voice had been joined by other voices that spent most of the day screaming at me. I could not focus on my work and the only relief I got was when I had drunk myself into oblivion. Eventually my boss told me I had four weeks to get my act together. Four weeks later I was out of work, losing my home and on my way (though I didn't know it then) to my first encounter with the psychiatric services. In double quick time I became a pitiful sight with an unkempt beard, more often than not dirty clothes and more and more frequently drunk rather than sober.

Eventually I could not take any more and I phoned the Samaritans and after much talking went to see my GP. He ended the consultation with the words "I am going to arrange for you to see a specialist" fine I thought that will take a while, what a surprise I was in for. He took me out of his consulting room and asked me to wait in a small side room in the surgery a few minutes later he returned with a nurse who he told me was going to look after me while he arranged an appointment with the specialist. The only thing I remember about that wait with the nurse was how little she spoke it was as if she was frightened to be in the same room as me.

My short wait ended some three hours later when the GP returned with another man it turned out that this man was the specialist that the GP had contacted. The specialist introduced himself and told me that he was a psychiatrist and that he had come to see me since my GP was concerned about me. It was here that I went through my very first one-hour present state examination, after the interview the psychiatrist told me I was ill and it would be better if I came into hospital for a short time. I told him where to shove his hospital and fled the surgery, three days later I was dragged into the Royal Free hospital where I once again was subjected to the psychiatric interview with the conclusion that I was suffering from schizophrenia.

The psychiatrist there told me that if I took medication then my voices and other symptoms would be eradicated and I would get better. He told me that the medication took about two weeks to work and in no time at all I would be back to something like my old self, he was wrong. Two weeks went by and if anything I was worse not better so I stopped taking the medication and decided to leave. This was when I discovered the real power of the system I was put on a section two of the mental health act, which held me for up to twenty-eight days against my will. A section three this is a treatment order, which allowed them not only to detain me but also to medicate me forcibly if necessary, followed the section two in quick time. This became my new way of life a constant round of illness with short periods of respite (not wellness) in the community.

Over the next ten years I was to spend six of them as an in-patient almost all of them on a section three. In this time I had nearly forty sessions of ECT, tried nearly every neuroleptic on the market and was denied psychological interventions on numerous occasions. Despite the most vigorous of treatment regimes the voices I heard remained as virulent as ever, medication gave me no respite and eventually the volume of medication I was taking was so high that I became little better than a zombie who viewed life through a legalised drug induced smog.

The system did teach me things the main one being how to be a good schizophrenic, I do believe that we learn much about how to be mentally ill in the system. Ten years were to pass before I found a way out the system by then they (the system) had created a perfect schizophrenic. Now on to recovery.

The stepping stones to recovery

Any recovery journey has a beginning, and for me the beginning was my meeting with Lindsay Cooke my support worker, it was her who encouraged me to go to the hearing voices self-help group in Manchester at the start of 1991. It was her not me who believed that a self-help group would benefit me. It was her who saw beneath my madness and into my potential, it was her faith in me that kick started my recovery and it is to her that I owe an enormous debt.

There are other essentials required for a journey to be successful; one of these is the ability to be able to navigate to your desired destination. In this I was fortunate not to have one navigator but many. In this section I will mention only five of them. The first is Anne Walton a fellow voice hearer who at my very first hearing voices group asked me if I heard voices and when I replied that I did told me that they were real. It does not sound much but that one sentence has been a compass for me showing me the direction I needed to travel and underpinning my belief in the recovery process.

The second is Mike Grierson; Mike was the person who navigated me through my first contact both with my voices and with society. He encouraged me to go out and socialise with people who had nothing to do the psychiatric system. He also took me to places like the cinema and classical concerts which reawakened my love for the arts. Mike was not only my social navigator he was also one of the people who helped me to focus on my voices in a way that allowed me to explore my experience.

The third and fourth are Terry McLaughlin and Julie Downs, Terry and Julie were my navigators back to normality, they rekindled my interest in politics and took me into their family without reservation. It was with Terry that I developed much of my early thinking around training and mental health. With Julie i developed training packages and now with my wife Karen I am continuing to develop training packages, which we use to explore the world of mental health.

My fifth person is Paul Baker another of my navigators on the road to recovery, Paul who brought the hearing voices network to the United Kingdom encouraged me to become involved in the network, then when the time was right handed over the development of voices groups to me. To all of my navigators Anne, Mike, Terry, Julie and Paul I owe my sanity.

Navigators require a map or a plan from which to navigate, and I have been fortunate for the people who were my map makers, were Patsy Hage, Marius Romme and Sandra Escher. I do not believe that these three fully understand what they have done. Little did Patsy know when she read the book by Julian Jaynes that the questions this would make her ask were going to affect so many people indeed It is because of her questions that the hearing voices network and resonance and other networks throughout the world exist today. Whether she wants it or not she has a premier place in the history of the hearing voices movement.

Sandra Escher is without doubt the person who made sure that ordinary people could understand the maps that were being made. Her ability to put across the message in language that is accessible to everyone has meant that their work has not remained in the world of academia but has been used by voice hearers from the very beginning. Sandra and Patsy have played a very important part in my recovery.

The final map maker is Marius Romme, Marius who in his own words is a traditional psychiatrist, is without doubt one of the greatest map makers who it has been my good fortune to know. When he listened to Patsy Hage and explored what she was saying it was then in my opinion he stopped being a traditional psychiatrist. When he asserted in public for the first time that hearing voices was a normal experience and that voice hearing was not to be feared he stopped being a traditional psychiatrist. When he continued his work despite being ridiculed and criticised by his peers he stopped being a traditional psychiatrist and in my opinion became a great psychiatrist.

To Patsy Sandra and Marius I only owe one thing and that is my life.

Up to this point I have mentioned nine people who have been participants in one way or another in my recovery journey and therein lies the first stepping stone to recovery; people.

If I were to name all the people who have played a part in my recovery the list would be massive. The other thing about this list would be the fact that the majority on it would not be professionals. One of my fundamental beliefs about recovery is the premise that recovery cannot and does not happen in isolation. Nor can it happen if all our relationships are based on a professional and client interaction. Recovery is by definition wholeness and no one can be whole if they are isolated from the society, in which they live and work.

For many years I had argued that there is no such thing as mental illness this has lead me into some interesting debates with people over the last few years. One of these debates was with Marius Romme, during this discussion it became clear, that Marius was not arguing a case for biological illness, what he in fact was saying was that illness could be expressed as a persons inability to function in society. This I can accept as it means that recovery is no longer a gift from doctors but the responsibility of us all.

This raises the question of whether society is prepared to take any kind of responsibility for the recovery of people with mental health problems. I am of the opinion that they will not, for in our sophisticated culture we too have bought into the notion of a biological explanation for mental health. I suppose that my expectations of society might appear to be to high, but that must be seen in the context of those societies that do accept responsibility for those amongst them who become mad.

For Example in the Aboriginal Culture when someone goes mad the whole tribe comes together to discuss what the tribe has done to cause the person to be mad. Can you imagine this happening in our cultures? I think not. When someone goes mad in our culture it is off to hospital with them. It is not a gathering of the local community that gets together to decide what is wrong with the community. It is a ward round made up of so called experts who get together often without the person concerned being present who decide both what is wrong with the client and how it will be treated. This scenario, alas all to familiar, does not hold out much chance of recovery for the client. It is an impersonal rather than a person centred way of approaching the problem. Within this scenario recovery is objective not subjective and the person is no longer a real factor in the process.

If people are the building bricks of recovery then the cornerstone must be self. I believe without reservation that the biggest hurdle we face on our journey to recovery is ourselves. Recovery requires self-confidence, self-esteem, self-awareness and self-acceptance without this recovery is not just impossible it is not worth it.

We must become confident in our own abilities to change our lives; we must give up being reliant on others doing everything for us. We need to start doing these things for ourselves. We must have the confidence to give up being ill so that we can start being recovered. We must work at raising our self esteem by becoming citizens within our own communities despite our communities if need be. We are valued members of our societies and we must recognise our value. We need to recognise our own faults the system may have created our diagnoses, but often it is ourselves who reinforce it. We need to be aware of our learned behaviour, this should be part of our old lives. We need to change those behaviours that still trap us in our roles as patients. We need to accept and be proud of who and what we are, I can honestly say my name is Ron Coleman and I am psychotic and proud. This is not a flippant statement, this is a statement of fact.

I am convinced that when we grow confident about who and what we are; we can then be confident about who and what we might become. For me these four selfs; self-confidence, self-esteem, self-awareness and self-acceptance are the second stepping stone on the road to recovery.

The third step is closely related to the second and it is rooted in our own status. I believe that we ourselves have a great deal of say in our own status. We can choose to remain victims of the system, we can choose to continue to feel sorry for ourselves, we can choose to remain the poor little ill person who requires twenty-four hour care from professionals. On the other-hand we can choose a different direction, we can choose to stop being victims and become victors, we can choose to stop feeling sorry for ourselves and start living again, we can choose to stop being the poor little ill person and start the journey of recovery. This for me is the third stepping stone choice. When we thought of ourselves as ill it was easy to let others make our choices. The recovery road however demands that we not only make our own choices but that we take responsibility for all our choices good and bad. As we make choices we will make mistakes, We must learn to see the difference between making a mistake and having a relapse. For it is the easy option to go running back to the psychiatric system when we make mistakes. Rather than face our own weaknesses we fall into the trap of blaming our biology rather than our humanity. If people are the building blocks of recovery and self is the cornerstone then choice is the mortar that holds the bricks together. There is one other stepping stone in the recovery process and that is ownership. Ownership is the key to recovery, we must learn to own our experiences whatever they are. Doctors cannot own our experiences, psychologists cannot own our experiences, nurses, social workers support workers, occupational therapists, psychotherapists, carers, and friends. Even our lovers cannot own our experiences. We must own our experiences. For it is only through owning the experience of madness can we own the recovery from madness.

The journey through madness is essentially an individual one, we can only share part of that journey with others, most of the journey is ours and ours alone. It is within ourselves that we will find the tools, strength and skills that we require to complete this journey for it is within ourselves that the journey itself takes place.

Recovery has become an alien concept, yet nothing I have talked about so far is based on rocket science, rather it is based on common sense, it is not anything new, it is merely a reiteration of a holistic view of life. We need to realise that sometimes we, all of us make things much more difficult than they need to be. It is almost as if we need life to be a rocket science that we can never understand. We seem to spend much of our time making the complexities of living even more complex through our appliance of scientific objectivity rather than exploring our lives through the simple mechanism of personal subjectivity. The time has come to have a close encounter with an alien concept it is time for recovery.

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Page updated 07/03/2008

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 INTERVOICE statement of intent

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The need to develop new kinds of interventions other than those offered by psychiatry is paramount and should be based on embracing the following:

• That the most valuable information is provided by the people experiencing psychosis. It is their perspective and experience that should have paramount importance, especially over any psychiatric theory
• It follows that those people experiencing psychosis; those who have experienced psychosis in the past; those who have been patients; those who have survived psychiatry; those who have avoided psychiatry and who have given much thought to their experiences and problems – and - to the value of psychiatric interventions should be the basis of new knowledge and practice 
• That a new way of thinking about “mental illness” is required, a conceptual leap away from professional theories to patient’s experience
• That we need to stop thinking about specific diseases such as schizophrenia etc. As these are just labels, part of a mindset and not scientifically valid. They are the mental constructs of professionals.

For a new direction for psychiatry to be realised the following issues need to be addressed:

• Symptoms psychiatry considers part of mental diseases can be reinterpreted as coping strategies and psychoses are sometimes more of a survival strategy than a disease
• The new paradigm for psychosis understands experiences, behavioural patterns and symptoms as having meaning; that behavioural patterns are coping strategies, and that causes of “symptoms” can be found in the persons’ life
• Therefore psychosis should not be the object of treatment but instead the persons’ behaviour should be interpreted as personal strategies for coping with overwhelming life experiences
• It is pointless to look for a specific cause for a specific kind of psychosis, because they are reactions to problems in life and reactions are just as unique as peoples problems are
• The psychiatry of the future would start from the premise that “symptoms” are not the effects of specific diseases, but signals of the different ways in which people come to terms with problems in life, which although serious, are common to us all

This approach will give much needed attention to the problems behind psychosis and to experiences like hearing voices and hopefully create possibilities for solutions.

It is up to the person experiencing these phenomena to determine if they wish to make the journey of self-discovery, it is their voyage and the role of mental health workers is to help them plan it and if asked to support them through it.

Based on a speech given by Professor Marius Romme in January 1999 at a conference entitled “Coping with Psychosis” held to honour of Marius’s retirement from the Maastricht Mental Health service.

 

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