A PRESENTATION ABOUT VOICE HEARINGSally McManus andVerity StathamFriday 4th July 2014

Presenters• Work full-time at aspire, Leeds Early Intervention in

Psychosis Service• Volunteer facilitators at a Leeds Hearing Voices Group• Lived experience of psychosis and voice hearing; Interest

in psychology

GOAL & AIMS• Goal: To further or deepen your understanding of the

phenomena of voice hearing• Aims:• To give you an experiential experience of what it may be

like to hear voices• To discuss different models and ways of understanding

voices• To look at ways of coping with voices

VOICES: WHAT ARE THEY?Any thoughts?

What are voices?• Voices, sounds, music, noises• External or unknown source/mind of hearer• Psychiatry: auditory hallucination/symptom• Magical, terrifying, empowering, destructive, wonderful,

annoying, incredible, hateful, personal • Continuum, normal, everyday experience• Voice hearing as serving a purpose, the individual coping

with something

A common experience• Sleep (hypnagogic and hypnopompic )• Bereavement • Dreams• Imaginary friends (childhood)• Sensory deprivation• Hypnosis• Near death experiences• Psychedelic/drugs (LSD)• Earworms?

Statistics• Study in 1992 : 586 college students• 64% had heard own name called• 33% had heard own thoughts spoken out loud• 25% had heard own name whilst falling asleep• 11% had heard voice of absent friend• 6% had heard dead relative• 9% had heard God’s voiceBarrett and Etheridge (1992)

Statistics• Beavan, V., Read, J. & Cartwright, C. (2011) The final

prevalence estimate for voice hearing in non-clinical groups was 13%.

• Dr N Johnson completed some research at aspire in 2010-2011 and found that around half of all new referrals to aspire heard voices. Out of those who heard voices we took about half of those people onto caseload.

COPING WITH VOICES• Hearing voices groups based on work by Romme and

Escher• Psychological intervention : CBT looking at the power of

the voices and evidence for their threats/commands• Making sense of voices: why those voices saying those

things?• Headphones/talking to them• Voice Dialogue work

EXAMPLESWe will discuss these case studies later, but will tell you about them now so you have time to process.

Example 1• Female aged 25 hears voices telling her to kill herself, that she is

worthless and horrible and doesn’t deserve to live. The voices are always negative to her and have never been helpful in any way

• She believes the voice to be her deceased Grandfather who was physically violent towards her Grandmother, witnessed by her, and was verbally abusive to her in life

• She has been to church in order to seek help but has been told she is ill. She feels disillusioned about this.

• Mental health services continually tell her she is ill and needs to accept the voice as a symptom, but she finds this unhelpful

• Her main coping strategies are self harming (cutting) in order to keep herself alive and smoking cannabis which she feels relaxes her

• Where might you begin to support this woman? Referrals? Interventions? Coping strategies?

Example 2• Male aged 55 hears several voices which he has heard for

25 years. • He gained a diagnosis of Schizophrenia in the initial phase

of voice hearing when he was scared and unsettled by the experience.

• He has a history of homelessness and alcohol dependency• Now he has got used to the voices and sees them like

friends where they offer supportive advice and companionship. The voices are rarely distressing.

• He lives in supported accommodation• Thoughts on this? What support might this man need (or

not need) with the voices?

DEBRIEF

MODELS OF VOICE HEARING1. Medical – Biological Psychiatry – symptom of mental

illness / auditory hallucination 2. Psychological – result of trauma or distressing

experiences and the way these are processed by individual

3. Social – result of life events, social constructions and interactions with others

4. Spiritual – religious or transcendent experienceN.B. Is difficult to understand these models as distinct and are commonly more known as the Biopsychosocial model

1. BIOLOGICAL PSYCHIATRY• Dominant discourse in modern British society• Medicalised notion of voices as potential symptom of

psychosis/Schizophrenia• Treatment predominantly with medication (anti-psychotic)• Critical and Anti-Psychiatry movements say this view is

reductionist/without clear evidence base (no gene discovered/unclear why medication works)

2. PSYCHOLOGICAL and SOCIAL• Bad things happen to us and then we feel bad depending

on our understanding of the bad event (eg childhood sexual abuse – “its my fault”)

• Voices as a way of coping with distressing life events though voices in turn can cause distress

• Voices not predominant problem but alerting us to a problem

2. PSYCHOLOGICAL and SOCIAL• Romme and Escher began with some groundbreaking

research on voice hearing• They found that :Copers Non-Copers-feel stronger -feel weaker-more positive voices -more negative v-less commands - more commands-set more limits -not dare set limits-Listen selectively -use distraction-have more support - less support- Talk more re voices -talk less re voices

Romme and Escher• “We may therefore view the hearing of voices not solely

as a discrete individual psychological experience but as an interactional phenomenon reflecting the nature of the individuals relationship to his or her own environment, and indeed vice versa. In other words, it is not only a psychological but also a social phenomenon.”

Romme and Escher (1993) Accepting Voices p16

4. SPIRITUAL• Religious experiences where for eg a Christian may hear

God’s voice directly speaking to them. The bible references many holy figures who have the experience of hearing a voice

• Spiritual crisis (similar in presentation to psychosis at times) where a shift in an individuals beliefs can cause a crisis in emotional stability where voices can be heard

• Mediums and Spiritualists hear voices

DISCUSSIONThoughts so far……..

EXPERIENCE ACTIVITYGroups of four

Example 1

• Female aged 25 hears voices telling her to kill herself, that she is worthless and horrible and doesn’t deserve to live. The voices are always negative to her and have never been helpful in any way

• She believes the voice to be her deceased Grandfather who was physically violent towards her Grandmother, witnessed by her, and was verbally abusive to her in life

• She has been to church in order to seek help but has been told she is ill. She feels disillusioned about this.

• Mental health services continually tell her she is ill and needs to accept the voice as a symptom, but she finds this unhelpful

• Her main coping strategies are self harming (cutting) in order to keep herself alive and smoking cannabis which she feels relaxes her

• Where might you begin to support this woman? Referrals? Interventions? Coping strategies?

Example 2• Male aged 55 hears several voices which he has heard for

25 years. • He gained a diagnosis of Schizophrenia in the initial phase

of voice hearing when he was scared and unsettled by the experience.

• He has a history of homelessness and alcohol dependency• Now he has got used to the voices and sees them like

friends where they offer supportive advice and companionship. The voices are rarely distressing.

• He lives in supported accommodation• Thoughts on this? What support might this man need (or

not need) with the voices?

DISCUSSIONLearning from today: Thoughts, questions and feedback?

References• Barrett and Etheridge (1992) cited in Watkins (2008)• Beavan, V., Read, J. & Cartwright, C. (2011) The prevalence of voice-hearers

in the general population: a literature review. Journal of Mental Health• Chadwick , Birchwood and Trower (1996) Cognitive Therapy for Delusions,

Voices and Paranoia. Wiley, Chichester• Clarke I (ed) (2001) Psychosis and Spirituality: Exploring the new Frontier.

WHURR Publishers, London• Hearing Voices Network http://www.hearing-voices.org/• INTERVOICE http://www.intervoiceonline.org/• Johnson N (2011) unpublished• Romme and Escher (1993) Accepting Voices. MIND, London• Romme and Escher (2000) Making sense of Voices. MIND, London• Romme, Escher, Dillpon, Corstens and Morris (2009) Living with voices: 50

stories of recovery. PCCS books, Herefordshire• Watkins J (2008) Hearing Voices: A Common Human Experience

THANK YOU!Sally.mcmanus@commlinks.co.ukVerity.statham@commlinks.co.uk