Openmind 139, May/June 2006
I think the work of Marius Romme and Sandra Escher is to be applauded for opening up a world that was otherwise unexplored. It has helped to normalise and give greater status to those who hear voices - a phenomenon otherwise dismissed as a 'primary symptom of schizophrenia' and justification for most psychiatrists to lock up voice-hearers.
Romme and Escher rightly queried the classification of people who hear voices as suffering from schizophrenia. They pointed out that many people who hear voices do not use mental health services. I'm sure that many of you, when you've been profoundly tired, perhaps stressed or even bereaved, will hear a voice. It is also quite common for people to hear a voice, or voices, just before they drop off to sleep. And some who hear voices more often are not in the least distressed by them.
Romme and Escher's study also highlighted what certain psychiatrists like RD Laing and others had tried to say previously, namely that those who were somewhat 'strange' in that they mentioned the voices they heard were nonetheless intelligible if only psychiatrists took the time and trouble to understand them.
However, as usually happens when anyone puts a fairly complex case forward in a clear and easy-to-follow way, it has the potential to be misused or confused. The focus by service providers and service users on hearing voices as a discrete phenomenon is, I feel, a further dislocation of something that is already split off. To be asked, 'What coping strategies do you have to deal with your voices?' is both asking a question and answering it at the same time. After all, isn't hearing voices a coping strategy in itself?
I have heard professionals say that lots of their clients find relief in being able to talk about their voices. I think some people are truly grateful to have somebody to talk to, who seems interested in them, and in order to keep them interested they go along with daft suggestions like, 'Tell your voices you are busy and they can come back after tea.' The very idea that this could be a solution to their problem is facile in the extreme. The whole point of voices is that they are random and intrusive, otherwise they wouldn't happen.
Or they do 'research', which involves scoring from 1-10 on questions like 'How threatening are your voices?' and 'How often do you feel you have to do what your voices suggest?' This is like trying to put a mountain into a rucksack. Wouldn't it be far better to talk to the person, who might come up with a far more detailed description, instead of imposing set ideas about voice hearing and putting the client through some gruelling test. This also presupposes that all the people interviewed in this way are capable of scoring or measuring their experiences, or, indeed, are willing to talk to a stranger about something so highly personal. It's like the old advertisement: 'Tell me, Mrs Jones, which washing powder washes whiter?' 'Well, Terry, it seems to me that to afford to do these adverts you are obviously going to have to charge us more for the powder. And aren't all washing powders made by the same firm?'
If it's difficult to take into account a few people's answers to the question of which washing powder washes whiter, just think how much more complex is it to glean even the smallest grain of understanding of people who hear voices by trying to measure them. If I were to ask you, 'How would you rate on a score of 1-10 your love emotion?', would you be able to put it neatly into a box? People are not measurable in this way. They also change continuously. From when you woke up this morning to when you go to bed, you will have been through the whole gamut of moods and emotions.
Moreover, if you go to your GP nowadays and say that you are depressed to the point of wanting to take your own life, he or she is likely reply: 'Unless you hear voices or think aliens are landing in your garden I can't do anything for you.' This actually happened to someone I know. So of course some of the desperate and depressed have to say they hear voices to be taken seriously at all, because depression, which can also be life threatening, is so prevalent now that the helping agencies cannot cope with it. The fact that some people are forced to lie about their state of well-being is a true indictment of mental health services and of a society that surely has lost its way.
So concentrating on voice hearing does more for the professional than the client. What I see is another bandwagon, another fashionable intervention, where ill-equipped service providers think that they have solved the problem for the voice hearer by suggesting a strategy or two to do away with their voices, or they measure them to see which voice washes whiter.
I would contend that this is just the tip of the iceberg. Maybe I'm reacting to yet another device on the part of service providers to keep their distance from us. After all, if they concentrate on one aspect of our distress and torment, they can forget the rest and the degree to which we suffer. You could say, well that's better than nothing. But if they study the wood then they can't see the trees, and they don't admit to their clients the limitations of their help. It's like offering a person who's haemorrhaging Elastoplasts to staunch their bleeding.
I have doubts that concentrating on hallucinations alone is ever any good. It's as if the service providers in psychiatry are following the general medical practice of specialising. And that's alright if you happen to have some discrete illness with classic symptoms. But as we know, people often have complex disorders that each impacts on the other. And you can end up being sent to one 'specialist' after another, and it seems as if these 'specialists' never talk to one another. But we psychiatric patients don't want to be treated in bits. It's because we are in bits already that we come to psychiatric services. It's because we have lost ourselves that we need to be found, not in little tidy bits but as whole.
Marius Romme and Sandra Escher's books Accepting Voices(£13.99)and Making Sense of Voices (£25) are available from the Mind online shop.