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So, what's wrong with hearing voices?

December 14, 2011

At a New York City forum some 50 professionals and consumers considered two unusual but important questions: “How unusual is it to hear voices?” and “What can I do about it?” The forum brought information about a growing international organization, the Hearing Voices Network that embarked on a nationwide training effort early in 2011, hoping to train voice-hearers how to create and facilitate HVN groups across the United States.

The session was presented by two voice-hearers, Daniel Hazen, executive director of Voices of the Heart, Inc. and Oryx Cohen, Technical Assistance Director for the National Empowerment Center, who began the session by “de-pathologizing” so-called “extreme” experiences that include not only hearing voices, but seeing things, feeling things (e.g., feeling that one’s observations are unusually powerful or unique), or smelling things that are not detectable by others.

Cohen explained that these phenomena, which are often regarded by psychiatry as textbook symptoms of mental illness or psychosis, reportedly affect up to one in 10 people at some point in their lives, making an individual’s likelihood of experiencing them “about as common as being left handed.”

The speakers also debunked another common legend about the voices themselves; that they are frightening, violent, or destructive in nature. Many voices are experienced as positive and, although the onset of such voices is sometimes triggered by a traumatic event, the speakers pointed out that the majority of voices have a benign catalyst.

“The most common circumstance in which people say that they have come to hear voices is after the death of a loved one, when they feel that they are hearing that voice again,” said Cohen, adding that for many of these hearers, “that voice is experienced as a very reassuring thing.”

HVN, which developed around work led by Dutch professional Marius Romme and voice hearer Patsy Hage some 25 years ago, has since grown to encompass hundreds of chapters worldwide, including 160 in England. The group’s mission is to gather and share, nonjudgmentally, among those who hear voices or experience other extreme phenomena.

Among HVN’s major goals are to “de-pathologize” voice hearing and other extreme phenomena through group sessions that are facilitated by specially trained, voice-hearing peers, said Hazen. The sessions are strictly nonjudgmental in nature, combining listening, sharing and exchange between the peers who share their experiences, insights, and personal strategies for living with their voices. Another goal, Hazen added, is to “redefine our relationship with psychiatry,” which typically regards voice-hearing as a symptom of psychosis that should be feared, ignored, or medicated.

Based on the experiences and research of its early adherents, HVN’s mission and training holds that voice hearing and other extreme phenomena are real individual experiences that ought first to be explored and understood, then managed when possible in benign ways, often with the help of cognitive strategies that may be discovered or shared by the individual in the HVN group or individual therapy.

The idea that trained peers (typically two peers, or a peer/professional team act as group facilitators) could safely lead individuals within a group to share, then explore their voices or experiences proved to be too much for one attendee. This self-described cognitive researcher termed HVN’s group sharing “potentially dangerous” for those whose voices were experienced as evil, harmful, or suicidal. He asserted that individual therapy, guided by a professional, was the only safe course.

Cohen disagreed, countering that “It’s better for hearers to talk about their experience with others.” Bolstered by the security and support of the group, Cohen said, “The hearer can come to the conclusion that he or she does not have to listen to the voice. If [a hearer] doesn’t talk about it,” he asserted, “it can be much more dangerous for the hearer to just feel that he or she is going to act on it.”

Autonomy and non-judgmental support are among a strict set of guidelines outlined in a charter for HVN groups. Hazen explained that in actual HVN peer groups, individuals who share their voices or experiences generally learn coping skills or strategies as others recall similar experiences and reflect on how they felt and responded.

“It’s a real learning experience,” said Cohen. “You have to be willing to sit on the edge of your seat and be uncomfortable with it.”

A growing body of research points to three distinct stages of voice-hearing:

  1. Startling phase—In this phase, the hearer is often startled or frightened by the experience, yet also interested or curious. In this phase, the speakers said that “going to a group can really reduce the anxiety when this occurs.”
     
  2. Organization phase—After accepting the reality of the experience, hearers in the second phase try to make sense of the voice(s), organize it, and look for its meaning or antecedents.
     
  3. Stabilization phase—The third phase is characterized by greater calm, acceptance, and recognition of the experience. The voices don’t go away, and, in many cases, the hearers find that they do not want them to go away. The hearer remains in a stable relationship with his voice(s) or experiences and often learns or discovers approaches that help to address or manage the voices more comfortably.

Among the more common strategies used by hearers to deal with voices heard at unwelcome or inconvenient times involves “putting off” the voice by “making a date” or “asking if it would come back/call back later,” presumably when the hearer has more time or ability to listen. Another very common strategy is to treat ones voices with calm and courtesy, as though each was an unexpected, but temporary guest.

The notion that peer-led groups might help voice-hearers to tame and better live with their voices was, in the words of one local psychiatrist, “liberating.” The psychiatrist added that he found the autonomy offered by the HVN approach “extremely helpful” and a “welcome alternative” to the “paternalistic and sometimes even unethical” means advocated by some in psychiatry for treatment of whose who experience voices or other extreme phenomena.

The ability of many voice-hearers to live with their experiences without recourse to the mental health system, along with the experiences of those who emerge from the HVN process with the abilty to better live with their voices, “calls into question why we ‘pathologize’ these experiences in the first place,” said Hazen. In fact, Marius Romme, the Dutch professional who first studied the phenomenon, rejects the idea of “mental illness” in favor of the theory that voice-hearing is an expression of trauma or other personal problems in the life of the hearer.

Voice hearers who want to locate HVN groups or receive facilitation training, as well as behavioral health professionals or organizations interested in supporting the formation of local groups can learn more by visiting Voices of the Heart (link) or joining the “Hearing Voices Network USA” page on Facebook.

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