Hearing Voices Movement

Hearing Voices Movement is a philosophical trend in how people who hear voices are viewed. It was begun by Marius Romme, a professor of Social psychiatry at the University of Limburg in Maastricht, the Netherlands and Sandra Escher, a science journalist, who began this work after being challenged by a voice hearer as to why they could not accept the reality of her voice hearing experience. They advocate an approach of using techniques employed by those who have successfully coped with their voices. This can include acceptance and negotiation with the voices.

The movement
The Hearing Voices movement can be said to have been established in 1987, by Professor Marius Romme, a social psychiatrist and Sandra Escher, a science journalist, both from the Netherlands, with the formation of an organisation for voice hearers and others interested in this phenomenon, entitled Stichting Weerklank (Foundation Resonance). In 1988 an organisation was also established in England, with the active support of Marius Romme (James, 2001) entitled The Hearing Voices Network. In the following years, further networks have been established in other European countries including Italy, Finland (1995), Wales, Scotland, Switzerland, Sweden, Austria, Germany (1998), Norway & Denmark; and also in other parts of the world including Japan (1996), Israel, New Zealand, Australia and most recently the USA (2006).

In 1997 a meeting of voice hearers and mental health workers was held in Maastricht, Netherlands to discuss developing the further promotion and research into the issue of voice hearing. The meeting decided to create a formal organisational structure to provide administrative and co-ordinating support to the wide variety of initiatives in the different involved countries. The new network was called INTERVOICE (The International Network for Training, Education and Research into Hearing voices).

INTERVOICE holds annual steering group meetings, encourages and supports exchanges and visits between member countries and the translation and publication of books and other literature on the subject of hearing voices. In 2006 INTERVOICE set up a website and in 2007 was incorporated as a not for profit company under UK law. The president of INTERVOICE is Professor Marius Romme.

INTERVOICE is supported by people who hear voices, relative and friends and mental health professionals including nurses, psychiatrists and psychologists. INTERVOICE members assert that the most important factor in the success of their approach is the importance placed on the personal engagement of the people involved, meaning that all participants are considered an expert of their own experience. They see each other first as people, secondly as equal partners and thirdly as all having different but mutually valuable expertise to offer. This can either be through direct experience of hearing voices or having worked with voice hearers (and/or wanting to).

INTERVOICE is critical of psychiatry in relation to the way the profession generally understands and treats people who hear voices and holds that their research has led them to the position that schizophrenia is an unscientific and unhelpful hypothesis which should be abandoned,  (Romme, 2006).

The Hearing Voices movement regards itself as being a post-psychiatric, (Bracken, 2005 and Stastny/Peter Lehmann, 2007) organisation, positioning itself outside of the mental health world in recognition that voices, in their view, are an aspect of human differentness, rather than a mental health problem and that, as with homosexuality (also regarded by psychiatry in recent times as an illness), one of the main issues is about human rights. Therefore by changing the way society perceives the experience, they believe, psychiatry, as it did with homosexuality, will follow.

The Hearing Voices movement is also seeking more holistic health solutions to problematic and overwhelming voices that cause mental distress then what it regards as the generally reductionist, disease based model offered by mainstream psychiatry. Based on their research they hold the opinion that many people successfully live with their voices and that in themselves voices are not the problem. For this reason they are prepared to accept a range of explanations offered by people who hear voices including spiritual ones and assert that recovery (see recovery model) from overwhelming voices can be achieved by seeking to understand the meaning of the voices to the voice hearer.

A detailed and neutral account of the significance of the Hearing Voice Movement entitled "Can You Live With the Voices in Your Head?" was published in the New York Times Magazine in 2007, the author Daniel B. Smith noted that the movements "brief against psychiatry can be boiled down to two core positions. The first is that many more people hear voices, and hear many more kinds of voices, than is usually assumed. The second is that auditory hallucination — or “voice-hearing,” H.V.N.’s more neutral preference — should be thought of not as a pathological phenomenon in need of eradication but as a meaningful, interpretable experience, intimately linked to a hearer’s life story and, more commonly than not, to unresolved personal traumas."

Movement history
Baker (2000) in OpenMind in an overview of the challenging new research and practise initiatives, developing across Europe, charts the progress made from a view of voice hearing as bizarre and dangerous towards a recognition of voices as real, meaningful, and related to peoples' lives. This recognises that the experience can be overwhelming and deeply distressing, but also, that the attempt to understand their meaning can be part of a solution.

Leudar and Thomas
In a recent book, Leudar and Thomas (2000): voices of reason, voices of insanity, review almost 3,000 years of voice-hearing history, including that of Socrates, Schreber, and Janet's patient 'Marcelle', amongst others, to show how we have moved the experience from a socially valued context to a pathologised and denigrated one. Foucault has argued that this process can generally arise when a minority perspective is at variance with dominant social norms and beliefs.

Romme and Escher
The work of Romme and Escher (1989, 90, 91, 92, '94, '97, '98, '99) provides a much needed theoretical framework for these new initiatives, and provides much of the impetus for the self-help movement in recent years. They demonstrate:


 * 1) Not everyone who hears voices becomes a patient. Over a third of 400 voice hearers in Holland had not had any contact with Psychiatric services. These people either described themselves as being able to cope with their voices and/or described their voices as life enhancing.
 * 2) Romme cites demographic research including studies by A. Y. Tien, (1991) and Eaton W.W. et al 1991) indicating that hearing voices in itself is not a symptom of an illness, but is apparent in 2 - 4 % of the population (some research gives higher estimates) and even more (about 8%) have peculiar personal convictions, aka delusions, and do so without being ill. His own research has provided further verification of this.
 * 3) Comparisons between people. People who cope well with their voices and those who did not show clear differences in terms of the nature of the relationship they had with their voices.
 * 4) People who cope better also differed in terms of the kinds of strategies they adopted to manage their voices and its personal impact.
 * 5) 70% of voice hearers reported that their voices had begun after a severe traumatic or intensely emotional event, such as an accident, divorce or bereavement, sexual or physical abuse, love affairs, or pregnancy. In a recent study, Romme et al (1998) found that the onset of voice hearing amongst a 'patient' group was preceded by either a traumatic event or an event that activated the memory of an earlier trauma. There was a high association with abuse. These findings are being substantiated further in an on-going study with voice hearing amongst children (Escher, 2001)
 * 6) Some people who hear voices, regardless of being able to cope with this or not, may have a burning need to construct a personal understanding for their experiences and to talk to others about it without being 'written off' as mad.
 * 7) A long-term developmental process of psychological adjustment was identified by surveying the considerable range of experience and the negotiation methods that people reported

Romme, (1991, '98) has developed this appoach with several studies showing that hearing voices can be associated with memories of emotionally 'undigested' events, usually connected with key relationships.

Romme et al, (1999) find that these important connections can be addressed using CBT and self-help methods.

Romme describes a 3 phase model of recovery.
 * Startling. Initial confusion; emotional chaos, fear, helplessness and psychological turmoil.
 * Organization. The need to find meaning, arrive at some understanding and acceptance. The development of ways of coping and accommodating voices in everyday living. This task may take months or years and is marked by the attempt to enter into active negotiation with the voice(s).
 * Stabilisation. The establishment of equilibrium, and accommodation, with the voice(s), and the consequent re-empowerment of the person.

Alternative to medical model
The Hearing Voices movement reflects significant disenchantment with the medical model, and the practises of Mental Health services through much of the Western World.

Brown et al (1998) finds that 23% of people diagnosed with a psychotic illness experience positive symptoms that are resistant to medication. Indeed, only a minority, roughly 35% obtain significant benefits from drug treatment (Romme 1999).


 * 1) Further, there is a range of secondary problems and withdrawal affects associated with both traditional and atypical antipsychotics (Tarrier 1999).
 * 2) Moreover, there are significant issues to do with compliance, largely as a result of the point above, despite the technological advances in drug administration.
 * 3) The complexity of people's experience. It is a highly personal experience. In addition, emotional problems e.g. depression, anxiety are found in 25-40% of those diagnosed with psychosis (Johnstone et al, 1991) and the risk of suicide is increasingly recognised (Briera, 1996).
 * 4) Apart from the issue of medical effectiveness, 'getting better' must be as much a personal process, to do with the nature of the experience, as a medical one (Boyle, 1990).
 * 5) Many service users have a negative experience of mental health services because they are discouraged from talking about their voices as these are seen solely as symptoms of psychiatric illness (Romme, 1997).
 * 6) Slade and Bentall (1988) conclude that the failure to attend to hallucinatory experiences or and have the opportunity for dialogue about them is likely to have the effect of helping to maintain them.
 * 7) Romme (1991) describes several case stories to show how the acceptance or non-acceptance of voice hearing is socially and culturally determined, which can influence the outcome of treatment with people diagnosed with 'schizophrenia'. Baker (1995) describes several 'case' stories to show how the acceptance, or its lack, is socially and culturally determined which can influence the outcome of treatment with people diagnosed with 'schizophrenia'. Baker (1995) suggests that the extent to which nurses accept the experience of people they believe to have psychotic disorders has an effect on the extent to which they can discuss it with them
 * 8) Martin (2000) describes the creation of an environment conducive to discussing the experience. Such strategies do not demand textbook answers, but emerge from service users living, in a supported way, with the experience of voice hearing. i.e. Common-sense methods

Increasingly, in acknowledgement of the methodological weaknesses, poor prognostic power, symptomatic variability and general weaknesses inherent in the diagnostic validity of the term 'Schizophrenia', the psychological literature has increasingly tended to focus on specific or discrete symptoms or aspects associated with it (Bentall, 1990).

Thus, there has been a rapid growth in research investigating theory and treatment of strange beliefs, attention and concentration deficits, self-esteem, family processes (such as the Expressed Emotion literature), to mention but a few, as well as 'voices'. In addition, recent developments in the theory and treatment of post-traumatic stress disorder and dissociative conditions offer new understandings emphasising the close links between severe trauma in earlier life and voice hearing subsequently along with other potentially very disabling psychological symptoms. Romme et al, for example report that the disability incurred by hearing voices is associated with previous trauma and abuse, in some way (Romme et al, 1998). Similarly, in a follow-up study (Romme et al, 1999) find that these important connections can be effectively addressed clinically using a mixture of psychological therapy and self-help methods.

Romme and Escher (2000) have developed a method they call "Making sense of voices" to explore the problems in the life of the voice hearer that lie at the roots of the hearing voices experience. This approach was adopted as a consequence of the results of the studies they carried out, that they claimed, showed that to hearing voices, in it self, is not a symptom of an illness, but in most people is a reaction to severe traumatic experiences that made the person powerless, and are in effect, a kind of survival strategy.

Recent work
Recent work has focused on beliefs about voices in addition to the voices themselves. Chadwick, Birchwood and Trower (1996), Chadwick et al (1996) and Bentall (1994) have proposed a number of psychological theories for understanding the experience of hearing voices and the beliefs associated with them. Chadwick and Birchwood, 1997) reported marked reductions in voice hearing, and associated distress based on their cognitive model.

In an intriguing study, Birchwood et al (2000) found close parallels between the experience of subordination by voices and the experience of subordination and marginalisation in social relationships generally. This suggests that distress arising from voices may not only be linked to voice characteristics but also social and interpersonal beliefs based on life experience.

A range of other psychological and psychosocial treatment approaches are also reported in the literature. In Slade and Bentall (1988) a number of psychological strategies and the evidence supporting their efficacy are reported in terms of distress and anxiety reduction as well as in the frequency and/or intensity of the voice hearing experience.

The importance of respecting and supporting voice hearers' own capacity to develop their own understandings and personal coping resources has been emerging in recent years (Warnes et al 1996). In a single case study, Davies (1999) was able to demonstrate the value of a diagological approach, which supported the voice-hearers own development of a meaningful and helpful personal narrative. McNally and Goldberg (1997), as has Romme and Escher (1994, '98) emphasised the importance of the individuals own coping resources and beliefs in developing effective intervention strategies. They identified a variety of ways in which 'self-talk' and other naturalistic coping strategies can be actively deployed towards managing voices and related experiences. Warnes (1996, '99) discusses the value of interventions that maximises and supports the person's own experience of control of their experience.

Researchers are also seeking to discover what are the distinctive features of positive experiences (including pleasurable ones) of auditory hallucinations in people with psychosis who experience both positive and negative voices - and - amongst people in the "normal" population, Sanjuan J et al (2004), Gatiss et al (2005), Beavan (2006), Campbell (2006, Thornton (2007). Beavans research, for instance, found nearly half the people who heard voices said their hallucinations were mostly friendly or helpful.

Summary
The position of the hearing voices movement can be summarised as follows:

Hearing voice is in itself not a sign of mental illness Hearing voices is experienced by a great many people, without becoming ill. Hearing voices is related to problems in life history. To recover from the distress caused, the person has to learn to cope with their voices and the original problems that lie at the root of the experience

Publications

 * By Marius Romme, Sandra Escher, et al.

15 (2): 209 - 216
 * Romme, M.A.J. & Escher, A.D.M.A.C.: Hearing Voices (1989) Schizophrenia Bulletin
 * Romme, M.A.J. & Escher, A.D.M.A.C. (1989). Effects of mutual contacts from people with auditory hallucinations. Perspectief no 3, 37-43, July 1989
 * Romme, M.A.J. & Escher, A.D.M.A.C. (1990). Heard but not seen. Open Mind No 49, 16-18,
 * Romme, M.A.J. & Escher, A.D.M.A.C. (1991). Sense in voices. Open Mind 53, The mental health magazine, 9 November
 * Romme, M.A.J. & Escher, A.D.M.A.C. (1991).Undire le Voci. Spazi della Menten nr. 8, December 1991 p 3-9
 * Romme, M.A.J., Honig, A., Noorthoorn, O., Escher, A.D.M.A.C. (1991) Coping with voices: an emancipatory approach. British Journal of Psychiatry 161, 99-103
 * M. Romme, A. Honig, E. O. Noorthorn & S. Escher: Coping with hearing voices: an emanciapatory approach (1992) British Journal of Psychiatry
 * Marius Romme and Sandra Escher: (Eds.), Accepting Voices (1993, second edition 1998), 258 pages, MIND Publications, London.
 * Marius Romme and Sandra Escher: (Eds) Understanding voices: coping with auditory hallucinations and confusing realities (1996) First published by
 * Rijksuniversitiet Maastricht, Limburg, Holland and also new English edition, Handsell Publications
 * Marius Romme and Sandra Escher: Making Sense of Voices - A guide for professionals who work with voice hearers: (2000) MIND Publications


 * General


 * Christine Assiz, Heard but not seen, Independent on Sunday, 6th January 1991
 * Baker P.K (1990): I hear voices and I'm glad to!, Critical Public Health, No. 4, 1990, pp 21-27
 * Baker P.K (1995) Accepting the Inner Voices, Nursing Times, Vol. 91, No 31, 1995, pp 59-61
 * Baker P.K (1996) The Voice Inside: a practical guide to coping: Mind Publications
 * Baker PK (1996) Can you hear me, a research and practice summary, Handsell UK
 * Barret T.R and Etheridge J.B (1992) Verbal hallucinations in Normals I: People who hear voices Applied Cognitive Psychology, Vol. 6, pp. 379-387
 * Benthall R.P (1990) The illusion of Reality: a review and integration of psychological research into psychotic hallucinations, Psychological Bulletin, no. 107, pp. 82-95
 * Bentall R.P., Claridge G.S. & Slade P.D (1988), Abandoning the Concept of "Schizophrenia": Some Implications of Validity Arguments for Psychological Research into Psychotic Phenomena British Journal of Clinical Psychology, Vol.27, pp. 303-324
 * Bentall R.P., Claridge G.S. & Slade P.D (1989), The Multidimensional Nature of Schizotypal traits: A factor analytic study with normal subjects British Journal of Clinical Psychology, Vol.?
 * Benthall R.P., Haddock G. and Slade P.D (1994), Cognitive Behaviour Therapy for persistent auditory hallucinations: from theory to therapy, Behavioral Psychotherapy No. 25, pp. 51-56
 * Bentall R.P., Jackson H.J & Pilgrim D. (1988), Abandoning the concept of "schizophrenia: Some implications of validity arguments for psychological research into psychotic phenomena, British Journal of Clinical Psychology, No. 27, pp. 303 - 324
 * Bentall R.P., Kaney S & Dewey. M (1991), Paranoia and Social Reasoning: An Attribution Theory Analysis, British Journal of Clinical Psychology, No. 30, pp.13-23
 * Benthall R.P and Slade P.D. (1995) Reliability of a scale for measuring disposition towards hallucinations: a brief report, Person. Individ. Diff. Vol 6, No. 4, pp. 527-529
 * Lisa Blackman: Hearing Voices, Embodiment and Experience (2001), Free Association Books, London
 * Richard Bentall & Gillian Haddock: Cognitive behaviour therapy for persistent auditory hallucinations, (1990) Behaviour Therapy 25: 51 - 66;
 * Chadwick P.D.J. and Birchwood M.J, (1994), Challenging the omnipotence of voices: A cognitive approach to auditory hallucinations, British Journal of Psychiatry, No. 164, pp. 190-201
 * Coleman R and M. Smith: Victim to Victor: working with voices (1997) Handsell, Gloucester, UK
 * Cullberg J., (1991) Recovered versus non-recovered schizophrenic patients among those who have had intensive psychotherapy, Acta Psychiatrica Scandinavica Vol. 84, pp.242-245
 * Julie Downs, (Ed), (2001) Starting and Supporting Voices Groups: A Guide to setting up and running support groups for people who hear voices, see visions or experience tactile or other sensations. Hearing Voices Network, Manchester, England
 * Julie Downs, (Ed), (2001), Coping with Voices And Visions, A guide to helping people who Experience hearing voices, seeing visions, tactile or other Sensations, Hearing Voices Network, Manchester, England
 * B. Ensink: Confusing Realities: A study of child sexual abuse and psychiatric symptoms Amsterdam, VU University Press (1992) and also Trauma: A study of child abuse and hallucinations, in Accepting Voices Eds M. Romme and S. Escher (1993)
 * Eaton W.W., Romanoski A., Anthony J.C., Nestadt G. (1991) Screening for psychosis in the general population with a self report interview, Journal of Nervous and Mental Disease, No. 179, pp 689-693
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 * John Freedland (1995), Hearing is believing, The Guardian (UK Newspaper), April 22
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 * Haddock G., Benthall R.P and Slade P. (1996), Psychological treatments for auditory hallucinations, focussing or distraction? pp. 45-71 in Cognitive, Behavioural Interventions with Psychotic Disorders Routledge, London Therapy, Eds. Haddock G. and Slade P
 * Haddock G., Bentall R.P and Slade, P.D: Psychological treatmment of chronic auditory hallucinations: two case studies (1993) Behavioral and Cognitive Psychotherapy 21: 335 - 46;
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 * Voices - Voice Hearer Talk (1994) Manchester: Department of Psychology, University of Manchester
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