Critical Values Based Practice Network

C-VBP-N

Understanding Voices

Written by Steven Coles on . Posted in Clinical Psychology Bite-Size

Understanding Voices

Issue 12 – March 2009

Author: Steven Coles (steven.coles@nottshc.nhs.uk)

Key points

  • There are a number of ways to make sense of the experience of hearing voices
  • For some people and cultures hearing voices is viewed as a gift
  • The experience of voice hearing is shaped by a person’s social world and personal history

 Implications for practice

  • Voice hearers could be supported by staff to make sense of their experiences
  • Assisting someone in their social world may help them with distressing voices
  • Information and peer support from hearing voices groups can be invaluable 
The dominant way of understanding hearing voices in mental health services is seeing it as a manifestation of a mental illness (often assumed to be biological in origin). However, for several years a number of voice hearers, alongside some academic and clinicians have challenged the dominance of this biomedical model and have advocated for space for alternative perspectives1.

Meaningful Explanations: What does Society Offer? 1,2,3

Within a biomedical model, a sharp divide is often drawn between normal and abnormal experiences with hearing voices fitting into the latter category. However, extensive evidence shows a continuum between these two poles. For example 10 to 15 per cent of the normal population has heard a voice (or hallucination) at some point in their life. Whilst some people are distressed by hearing voices, others find it a positive and helpful experience. What is defined as normal is culturally determined and within some communities hearing voices is considered a spiritual gift. The types of explanations that society and communities offer to those who experience hearing voices are likely to influence a voice hearer’s experience and distress. For people who hear voices, Western society in the main provides the dominant understanding of “mental illness” or “schizophrenia”. This model has many negative associations and assumptions (often unfounded), such as the assumption of a chronic and negative outcome, societal stigma and fear, and the need for expert and often coercive medical treatment. The lack of alternative explanatory frameworks can leave people either accepting the medical model and its negative connotations, or rejecting this viewpoint. Rejection of the medical model leaves voice hearers the considerable task of making sense of their experiences without the support of a more positive and accepted societal framework. This is where groups run by people who hear voices (such as the hearing voices network) have tried to fill the gap. Such groups offer space and respect to voice hearers’ explanations, and solidarity and acceptance by a peer group.

Power and the Social Environment

Research into voice hearers’ relationship with their voice(s) has highlighted the importance of power 1,4. Those who feel less powerful in relationship to their voices are more likely to experience low mood and greater distress. How a person feels in relationship to others and society in general is mirrored in how a voice hearer relates to their voice. Feeling disempowered in society appears to drive a person’s sense of powerlessness in their relationship with their voice. This again highlights that hearing voices is not solely an individual problem, but one very much shaped by a person’s social environment. People can be disempowered by many factors in their current and past social world e.g. difficulties with housing, lack of social support, living in a deprived neighbourhood5. A person’s early environment is also one factor that can shape a person so that they either feel cared for and looked after, or alternatively feel threatened and powerless6. Therefore someone who hears voices and has experienced a disempowering early environment (e.g. child abuse) is likely to relate to their voices in a disempowered manner (such a person may also have had positive experiences in their world that enables them to cope better). Research has also found that child abuse is related to mental health difficulties and experiencing voices7. Overall, it seems abuse can be one factor that shapes a person’s sense of and actual power in the world, influences the occurrence of hearing voices, and negatively shapes the power dynamic between voice hearer and voice. 

Practice

For staff working with a voice hearer it will be important to support the person to help make sense of their experiences. This would entail sensitively discussing how a person understands and copes with their voice or voices. It would helpful for staff to be open to understanding the experience of voice hearing from a wide range of perspectives, not solely from the standpoint of ‘mental illness’. Provision of information about the large number of people (and famous people) who hear voices can also help to normalise a person’s experience. However, for some people discussing their experiences might be too difficult and this should also be respected. In such circumstances (as for most voice hearers) assisting with difficulties in a person’s social world is likely to help them to feel more able to cope and manage their voices. Voice hearing groups and communities have often led the way in new understandings, support and coping with hearing voices. The Hearing Voices Network and Intervoice can be invaluable resources for people and provide information on coping with voices. Hearing voices groups can allow space for people who hear voices to share there experiences, gain ideas for coping and experience support and solidarity from people with ‘similar’ experiences. 

REFERENCES

  1. Romme, M. & Escher, S. (1993). Accepting voices. London: Mind Publications.
  2. British Psychological Society. (2000). Recent advances in understanding mental illness and psychoticexperiences. A report by the British Psychological Society Division of Clinical Psychology. Leicester: British Psychological Society. Free Download: www.understandingpsychosis.com
  3. Tien, A. Y. (1991). Distributions of hallucinations in the population. Social Psychiatry and Psychiatric Epidemiology, 26, 287 – 292.
  4. Birchwood, M., Gilbert, P., Gilbert, J., Trower, P., Meaden, A., Hay, J., Murray, E. & Miles, J. N. V. (2004). Interpersonal and role related schema influence the relationship with the dominant ‘voice’ in schizophrenia: A comparison of three models. Psychological Medicine, 34, 1571 – 1580.
  5. Hagan, T. & Smail, D. (1997) Power-mapping – I. Background and basic methodology. Journal of Community and Applied Social Psychology, 7, 257-267.
  6. Gilbert, P. (1992). Depression: The evolution of powerlessness. Hove: Lawrence Erlbaum
  7. Fairbank, S. & Coles S. (2008). Childhood trauma and ‘psychosis’. Clinical Psychology Bite-Size, 7.
Website:          Intervoice (International community for hearing voices) http://voices.schublade.org/about Hearing Voices Network (UK) www.hearing-voices.org/index.htm

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