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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.
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:
- 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.
- 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.
- People who cope better also differed in terms of the kinds of strategies they adopted to manage their voices and its personal impact.
- 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)
- 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.
- 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 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 voices(s), and the consequent re-empowerment of the person.
Alternative to medical model
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).
- Further, there is a range of secondary problems, and withdrawal affects associated with both traditional and atypical antipsychotics (Tarrier 1999).
- Moreover, there are significant issues to do with compliance, largely as a result of the point above, despite the technological advances in drug administration.
- 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).
- 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).
- 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).
- 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.
- 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
- 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 has focussed 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.
The recent developments in the scientific and psychological literature and reported here and elsewhere provides strong support for the suggestion that experiences traditionally viewed simply as by-products of illness processes are amenable to significant moderation through informed psychological and self-help interventions. Within this, the role of peer support, shared talking and self-resourcing, are of particular importance through the longer-term process of recovery.
To conclude, the core concept promoted by Professor Marius Romme, Sandra Escher (2000) and the wider membership of the hearing voices movement is that hearing voices is, in it self, not a sign of illness but a signal that there are problems, often emotionally overwhelming problems, that need to be solved or coped with.
The position of the hearing voices movement can be summarised as follows:
- Hearing Voices Network
- Hearing Voices Network
- Interpretation of Schizophrenia (book)
- Ross Institute for Psychological Trauma
- Trauma model of mental disorders
- P.Baker (2000); OpenMind (103) May-June p14-15.
- R. Bentall et al. (1988) Sensory deception: towards a scientific analysis of hallucinations. Croom Helm, London.
- R.Bentall (1990) Reconstructing Schizophrenia.
- M. Birchwood; A Meaden; P. Trower; P. Gilbert; J. Plaistow; (2000); Psychological Medicine. Vol 30(2) 337-44.
- M. Boyle (1990) Schizophrenia: a scientific delusion. (RKP).
- B.P.S. Recent advances in understanding mental illness and psychotic experiences: (June, 2000) B.P.S. Publication.
- P. Brown (1994) Understanding the inner voices. New Scientist 9 July 26-31.
- P. Chadwick, M. Birchwood, & P. Trower (1996) Cognitive Therapy for delusions, voices and Paranoia. Wiley.
- P. Chadwick & M. Birchwood (1994) The omnipotence of voices. A cognitive approach to auditory hallucinations. Br Jo of Psychiat, 164, 190-201.
- L. Clarke (1998) Nursing Times: 94 (4) Mar p28-9.
- L. Clarke (1995). Nursing Times. 91 (31) 2 Aug.
- R. Coleman & M. Smith (1997) Working with Voices. Handsell Pub.
- A. David & J. Cuttings. (1993) The Neuropsychology of Schizophrenia. Earlbaum, London.
- D. Fowler et al (1995) Cognitive Behaviour Therapy for Psychosis Wiley
- P. Garety et al (1994). Cognitive behavioural therapy for drug resistant psychosis. Br Jo of Med Psychol, 67, 259-271.
- G. Haddock & P. Slade (1996) Cognitive Behavioural interventions with Psychotic Disorders. Routledge.
- P.J. Martin (2000). J Psychiatr Ment Health Nurs Apr 7 (2) 135-41pp
- S. McNally & J. Goldberg (1997) Natural cognitive coping strategies in schizophrenia. Br Jo of med Psychol 70, 159-167
- P. Thomas; I Leudar (2000). Voices of reason, voices of insanity; Studies of verbal hallucinations. Francis/Routledge.
- M. Romme et al. (1999). Cognitive therapy with psychosis and auditory hallucinations. - TIJDSCHR-PSYCHIATR 41/5 (277-286).
- M. Romme & S. Escher. (1994) Accepting Voices. MIND publications .
- M. Romme & S. Escher. (1989) Hearing Voices. Schizo Bull. vol. 15 no2, pp.209-216
- M. Romme. Nursing Times 94 (9) 4 March.
- J. Strauss (1994) The person with Schizophrenia as a Person: Approaches to the Subjective and Complex. Br Jo of Psychiat (1994) 164, 103-107.
- WHO. The World Health Report (Geneva, 1999).
- National Services Framework for Mental Health; Modern Standards & Service Model (DoH, 1999)
- T. Wykes; A. M. Parr; S. Landau (1999). Br J Psychiatry Aug 175 180-5.
Publications/articles by Professor Marius Romme and Sandra Escher et al:
Romme, M.A.J. & Escher, A.D.M.A.C.: Hearing Voices (1989) Schizophrenia Bulletin 15 (2): 209 - 216
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
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 Psychiatr Scand. 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
Falloon I.R.H. and Talbot R.E. (1981) Persistent auditory hallucinations: coping mechanisms and implications for management, Psychological Medicine, No.11, pp. 329-339
John Freedland (1995), Hearing is believing, The Guardian (UK Newspaper), April 22
Mike Grierson (1991), A Report on the Manchester Hearing Voices Conference November 1990 Hearing Voices Network
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;
G. Haddock, P. Slade: Empowering people who hear voices in cognitive behavioral interventions with psychotic disorders, Routledge, London (1996)
Heery M. W. (1989), Inner Voice Experiences: an exploratory study of 30 cases Journal of Transpersonal Psychiatry, vol. 21, no. 1, pp. 73-82
Doug Holmes Ph.D, Hearing Voices: Hillary, Angels, and O.J. to the Voice-Producing Brain Shenandoah Psychology Press, email@example.com , 15 February, 1999
Adam James (2001), Raising our Voices: History of the Voice hearing movement, Handsell UK
J. Jaynes: The origin of consciousness and the breakdown of the bicameral mind: (1976) Houghton Mifflin, Boston
Leudar and P. Thomas: Guidelines for Establishing Pragmatic Aspects of Voices - Voice Hearer Talk (1994) Manchester: Department of Psychology, University of Manchester
I Leudar, P Thomas and M. Johnston: Self Repair for in dialogues of schizophrenics: effects of hallucinations and negative symptoms, (1992) Brain and Language 43: 487 - 511
I Leudar, P. Thomas and M. Johnston: Self monitoring in speech production: effects of verbal hallucinations and negative symptoms (1994) Psychological Medicine
I Leudar, P. Thomas, D. McNally and A. Glinsky: What can voices do with words? Pragmatics of verbal hallucinations (1997)Psychological Medicine
Ivan Leudar and Philip Thomas: 'Voices of Reason, Voices of Insanity - Studies of Verbal Hallucinations' (2000) published by Routledge/Psychological Press.
Lineham T., (1993), Hearing is Believing, New Satatesman and Society, 26.3.93, pp.18-19 Lockhart A. R. (1975)
Mary's Dog is an Ear Mother: Listening to the Voices of Psychosis, Psychological Perspectives Vol. 6, No 2, pp.144-160
Miller L.J., O'Connor R.N & DiPasquale T., (1993), Patients' Attitudes Toward Hallucinations American Journal of Psychiatry, Vol. 150, no.4, pp. 584-588
Posey T.B. and Losch M.E. (1984), Auditory hallucinations of hearing voices in 375 normal subjects Imagination, Cognition and Personality, vol 3, no.2, pp. 99-113
Rector and Seeman (1992) Auditory Hallucinations in Women and Men, Schizophrenia Research, vol 7, pp. 233- 236
T.R. Sarbin (1990), Towards the Obsolescence of the Schizophrenia Hypothesis, The Journal of Mind and Behaviour, vol. 11. No.3/4, pp. 259-283
Siegel, Ronald: Fire in the Brain: Clinical Tales of Hallucination Dutton Books New York 1992 Sidgewick H.A. (1894)Report on the census of hallucinations, Proceedings of the Society of Psychical Research, No. 26, pp. 25-394
Slade P.D. (1993) Models of Hallucination: from theory to practice in David, A..S and Cutting, J. (Eds.) The Neuropsychology of Schizophrenia; Earlbaum, London
Slade P.D and Bentall R.P. (1988) Sensory Deception; towards a scientific analysis of hallucinations Croom Helm, London
G. Lynn Stephens, George Graham , When Self-Consciousness Breaks: Alien Voices and Inserted Thoughts (Philosophical Pychopathology Series) by Hardcover - 200 pages (May 2000) Bradford Books; ISBN 0-262-19437-6 Tarrier N., Harwood S., Yusupoff L., Beckett R. & Baker A. (1990), Coping Strategy Enhancement (CSE): Method of Treating Residual Schizophrenic Symptoms Behavioural Psychotherapy, No.18, pp. 283-293
Tien A.Y. (1991) Distributions of hallucinations in the population Social Psychiatry and Psychiatric Epidemiology, No.26, pp. 287-292
Tiihonen, Hari, Naukkarinen, Rimon, Jousimaki and Kajola (1992) Modified Activity of Human Auditory Cortex during Auditory Hallucinations, American Journal of Psychiatry, vol. 149, No.2, pp. 225-257
John Watkins: Hearing voices - A Common Human Experience: published in 1998 by Hill of Content Publishing, Melbourne, Australia, ISBN 0-85572-288-6
Yusopoff and Tarrier N. (1996) Coping strategy enhancement for persistent hallucinations and delusions, pp. 86-103, in Cognitive, Behavioural Interventions with Psychotic Disorders, Routledge, London Therapy, Eds. Haddock G. and Slade P
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