In 2016, shortly after participating in a CACREP-accredited graduate program for clinical psychological counseling, I heard outside the classroom of an international human rights movement centered around the experience of "hearing voices" – what would it be? called auditory-verbal hallucinations in clinical mental health situations. The movement includes people with unusual perceptions, often referred to as psychosis.
I slowly got to know the movement through an introductory workshop, a three-day training for group leaders, participating in online and personal groups for one year and reading the literature on the subject. Most recently, I traveled to the 11th World Hearing Voices Congress in Montreal, where I could shake hands with one of the movement's founders, the Dutch psychiatrist Marius Romme, and hear him speak.
With this article I would like to familiarize the consultants with the Hearing Voices movement and related international networks of recovery groups. I believe the Hearing Voices movement is in line with the values and ethical principles of the American Counseling Association.
History and current development of the movement
The Hearing Voices movement began in Europe in the 1980s when a patient confronted Romme because of the limitations in mental health care. Why, asked the patient, was it okay for Rummy to believe in a god whom he could not see or hear, but was wrong for her, the patient, to believe in voices that she really heard? To learn more about the listening experience and help his patient, Romme had the woman tell the story on television and asked other speech listeners to contact him. About 550 reached out.
Remarkably, many of the people who heard voices did not need clinical help. Vanessa Beavan, John Read and Claire Cartwright wrote in the Journal of Mental Health in 2011 after researching the literature that it was safe to say that one in ten people in the general population would hear voices. Romme finally compared psychiatric treatment to eliminate voice hearing with conversion therapy for sexual orientation.
How did he come to this conclusion? By accepting the reality of the voices rather than just checking them off as a symptom to be treated, Romme was able to learn a lot more about their origin and meaning, and find ways to help his patients. He discovered that voices were often a reaction to problems in life, such as bullying or abuse, that the person could not cope with. In other words, there was a relationship between the voices and the person's life story.
The Hearing Voices Networks (HVN) are the network of community groups that emerged from the Hearing Voices movement. In early March, the Hearing Voices Network USA listed 119 groups on its national website. At the World Hearing Voices Congress I attended, it was reported that Brazil has grown rapidly to 35 groups in recent years, while the Canadian province of Quebec started with one group in 2007 and now has 35 groups. The majority of the groups are in Europe, where the Hearing Voices movement began.
The groups developed when people with hearing experiences grew tired of not being heard and were classified as mentally disturbed. They were also frustrated with the compulsive nature of the often ineffective treatments. People with experience that could be called psychosis in the clinical setting can meet in these groups and examine their experience in rooms that are free of clinical judgment. When a clinician brings a person to join a Hearing Voices group, the clinician is often asked to wait outside or in another room while the speaker is present. Members of these networks believe in the freedom of speech listeners to interpret their experiences as they see fit. The key to this approach is that individuals are heard in strange, non-judgmental ways when describing their experiences.
People discover that profound healing can occur if they are listened to in this way. Eleanor Longden's TED lecture entitled "The Voices in My Head" is a great introduction to this approach. Longden describes how changing her perspective on hearing voices – from a disorder to be treated to meaningful experiences if only one could open their metaphorical envelope – led to a major developmental shift that allowed her to make peace with her experience.
Treatment alternatives
I am firmly convinced that the Hearing Voices movement is in line with the ACA values. ACA has a rich tradition of promoting social justice, respecting diversity and promoting the value, dignity, potential and uniqueness of people. In clinical practice, consultants work to promote the ethical principle of customer autonomy and the right of customers to control the direction of their treatment and life. This endeavor is realized with all sorts of mental health problems, but experiences that could be called psychosis are generally approached differently in the US mental health system, which may indicate a blind spot in mental health.
Contrary to the ACA values that I learned in my first semester at the graduate school, I became increasingly concerned when I learned about advisory roles that conflicted with these values. The two roles of providing psychoeducation and monitoring medication compliance were specifically related to psychosis. This includes instructing the client in the medical model, explaining that hearing voices and other unusual experiences are symptoms of a brain disease process, claiming that symptoms have no personal value or meaning to be investigated, and teaching that treatment should be to try to stop this disease process. In this approach, psychoeducation is essentially used to impose a certain value or framework on the client's experience of hearing voices.
The American Psychiatric Association established the medical model when it was founded in 1844 and wrote in its journal at the time: "We regard madness as a chronic brain disease …" This is the lens and the approach that the organization has chosen and supported with evidence. Of course, the medical model is useful for some people, and many useful treatments have been derived from it. However, there are other people who prefer alternative social or development models and lenses that are more in line with ACA values.
A 2017 report by the United Nations Human Rights Council concluded that one of the obstacles to mental health and well-being was the lack of free and informed consent. Specifically: “In order for the consent to be valid, it should be given voluntarily and on the basis of complete information on the type, consequences, benefits and risks of the treatment, associated damage and the availability of alternatives. ”
The availability and awareness of alternatives and complementary approaches can be a key element that requires some work. It is important for consultants to identify innovative approaches that comply with ACA's ethical principles for customer autonomy and non-defectiveness, or to avoid measures that cause harm. I believe that the Hearing Voices movement is such a promising innovative approach, in which evidence is published in scientific journals and books, including Living With Voices: 50 Stories of Recovery, by Romme and colleagues (2009).
A development model
In contrast to the medical model, consultants rely heavily on a development model of customer concerns. The Hearing Voices movement comes very strongly from a development perspective and fully recognizes that voices are often a reaction to problems in life. After Romme and colleagues found out that 70% of adults had voice trauma or conflict, they examined 80 children who heard voices and published the results in 2004 in the International Journal of Social Welfare. They found that 75% of the children had voices about circumstances they felt powerless about.
Although the Hearing Voices movement recognizes a traumatic connection to the insertion of voices for the majority of people, no general causal explanation is given for the entire hearing of voices. All explanations are given room to be heard in the Hearing Voices Networks groups, including the medical model, psychological models such as voices as sub-personalities of the voice listener, spiritual beliefs that the voices are ghosts, and other possibilities.
As a side note to the development perspective of hearing voices, a new culture of Tulpamancer emerges – people who deliberately work to develop voices they call "Tulpas" to interact as friends based on an ancient Buddhist practice. A researcher at McGill University, Samuel Veissière, has performed phenomenological studies on tulip amanagers, and Tanya Luhrmann from Stanford University is working on a neuroimaging study of these people.
The book Living With Voices describes a three-phase framework for the restoration of development, which has been identified by people who have recovered from the need for hearing voices:
1) Frightened phase: Fear and the feeling of being overwhelmed dominate. Sigmund Freud wrote in The Psychopathology of Everyday Life about his experience as a voice listener while living alone in a strange city. His description of his experience was translated into English when the voice suddenly said his name.
2) Organizational phase: Interest in the experience develops and the language listener searches for further information.
3) Stabilization phase: The person regains their own potential and ability to live the life they choose.
Although this appears to be a linear process, the process can in fact be repeated every time a new voice announces itself to the speaker.
Clarifying in the Hearing Voices movement that "recovering" does not mean that the symptoms have been removed, but that the person has recovered from the need for the hearing voices. As in the not too distant past, when homosexuality was called a mental disorder, the solution is not to force people to be different from them, but to change society so that people can accept themselves when they are Experience life and love
A role for the consultant
In the US mental health system, clients who hear voices are most commonly acculturated from the perspective that their voices reflect a disease process with no inherent meaning. Once a psychiatrist identifies hearing voices as a symptom, the speech tracer's underlying trauma is often systematically ignored and invalidated. The only medical history that is asked is the family history of a mental illness to confirm the diagnosis, although the trauma history of the person could be treated in the counseling.
The Hearing Voices movement enables many voice listeners to discover relationships between their voices and their life experiences. Some voices have the tone or use the language of a bullying or childhood abuser. Voices often express difficult feelings that the listeners cannot express.
The Maastricht interview, named after the Dutch university town in which it was created, was originally a research tool developed in collaboration with voice listeners to learn more about their experiences, customers to explore their experiences. The Maastricht interview can be viewed as a voice mapping process, in which the interviewer asks the voice listener questions about the voices. Through this process, voices are discovered that serve different purposes, e.g. For example, the representation of emotions not felt, the protection of the voice earpiece or the attempt to solve loneliness or social isolation.
Questions that the Maastricht interview uses to accomplish this include:
Did you notice if the voices are there when you feel certain emotions?
Can you have a dialogue with the voices or communicate with them in any way?
Does the type or tone of the voice remind you of someone you know or knew before?
Can you describe the circumstances when you first heard them (each voice)?
Please describe your own interpretation of what is causing your experience and what your theory is about why you have this experience.
The interview with Maastricht can be found on Intervoice, the website of the International Hearing Voices Network.
The Maastricht interview contains eight specific questions that examine potential traumas that occurred in childhood at home, at school, or in the neighborhood. In addition to the counselor who makes the recovery phase easier for the client, these questions provide a validation of the client's life experience and raise awareness of unprocessed trauma that can be dealt with more effectively with counseling than in the Hearing Voices groups.
Similarities to internal family systems
In Richard Schwartz & # 39; Internal Family Systems (IFS) model, a person is born as having several different parts (such as sub-personalities), each of whom can absorb stress or trauma in life, and a core self that is not affected through trauma. The parts interact within the person, similar to how different family members interact as a system.
I asked Schwartz if the IFS model could work with people who hear voices. He told me it could. The voices can be used as part of the IFS model, and Schwartz has worked with people diagnosed with schizophrenia.
In the Hearing Voices movement, voices are seen as very interactive within the individual who hears them. Voices in the IFS model can also be viewed as parts that interact as a family system. In addition, the goal in the Hearing Voices movement is not to eliminate the voices (although this sometimes happens). Similarly, the goal at IFS is not to eliminate the individual parts of the person, but to help the person discover and release unprocessed trauma stress so that the system can live in a harmonized way. Similar to the Hearing Voices movement, in which voices are recognized as real, IFS is best carried out based on the understanding that the individual parts of a person are real and can act within the internal family system.
In a final resemblance, Romme said at the World Hearing Voices Congress that most voice hearers know the age of their voices. In his workshop, Schwartz had some participants check in with their parts and find out how old they were.
Conclusion
Romme has made comparisons between using a treatment to remove a person's voice hearing and using a treatment to change a person's sexual preference. I was impressed when I first read this comparison because at the same time I read about ACA's efforts to support bans on conversion therapy for sexual preferences. Romme repeated this comparison at the World Hearing Voices Congress.
At the beginning, I kept thinking about the extent to which people must feel when they hear voices telling them to harm themselves or others. But since then, I've met, talked to, and listened to so many people who hear voices – and who have really taken control of their lives by changing their relationship with those voices – that I am beginning to think that Rummy Is right. In my life, homosexuality was included as a diagnosable mental disorder in the diagnostic and statistical manual for mental disorders. A right-wing movement was needed to change this. The Hearing Voices movement – a movement for human rights and social justice – is in full swing with networks in 37 countries and counts.
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Laren Corrin is an advisory PhD student at the University of Southern Maine. Laren is an advocate of alternative framework conditions for psychoses and complementary wellness approaches. Contact Laren at larencorrin.com.
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