To position our chapter, we would like you to understand that our studies have focused on the experience of ‘Voices and Visions’ as people perceive them. As a consequence, we use their language and, for example, never talk about ‘hallucinations’ but rather about ‘hearing voices’. In psychiatry, the word ‘hallucination’ is easily equated to a symptom of an illness. Although recent reviews about hallucinations acknowledge that they occur in healthy people (Aleman & Larøi, 2008), in psychiatric practice, voice hearers still come up against an unjustified psycho-pathological way of thinking...
To position our chapter, we would like you to understand that our studies have focused on the experience of ‘Voices and Visions’ as people perceive them. As a consequence, we use their language and, for example, never talk about ‘hallucinations’ but rather about ‘hearing voices’. In psychiatry, the word ‘hallucination’ is easily equated to a symptom of an illness. Although recent reviews about hallucinations acknowledge that they occur in healthy people (Aleman & Larøi, 2008), in psychiatric practice, voice hearers still come up against an unjustified psycho-pathological way of thinking (Romme et al., 2009). Several epidemiological population surveys show that about 4% of the population experience voices and only a relatively small group is hindered by these experiences. Tien (1991) found that only about one-third suffer from them and are in need of some form of help. Van Os et al. (2001) showed that a far smaller part could indeed have fitted within the psychosis categories of the DSM.
Based on epidemiological studies, we work with the assumption that hearing voices, as such, is not a psycho-pathological phenomenon or a symptom of an illness, but rather a human variation in coping with emotions. Voices per se are a normal human reaction to trauma or stressful circumstances. However, it is the inability to cope with traumatic experiences and voices that might lead to illness. It is therefore up to the voice hearer to undertake a journey in which his/her experience is the starting point.
In this chapter, we would like to discuss the theoretical background behind our approach, how we gather information about the experience itself, how this information is used in a psychological formulation of the person's problems, what voice hearers themselves tell us about their recovery, and how all this information can be used in a therapy plan.
Our theoretical background stems from social psychiatry, which is a science that studies mental health problems in the context of their socio-emotional background. We were familiar with the fact that many mental problems are reactive patterns to socio-emotional problems in daily life and/or problems in the person's past and his/her upbringing. In our first study in 1987 (Romme & Escher, 1987), we already found a high percentage (70%) of trauma at the onset of voice hearing. By studying the experience more intensively, it became clear that this phenomenon is mostly a reactive pattern to very troublesome life experiences such as trauma or emotional neglect. This idea has more recently been acknowledged in many studies. Read et al. (2005) reviewed 180 studies and concluded that ‘psychosis can be a reaction to traumatic experiences given the prevalence of such experiences in people with psychosis and the links to the form and content of psychotic experiences’. In this overview, there are several studies in which it also becomes clear that traumatic experiences are more prevalent in people with a history of serious mental illness like schizophrenia and manic-depressive psychosis than in the normal population (Mueser et al., 1998). There are also some studies in which traumatic experiences are shown to be of causal importance with hallucinations (Spauwen et al., 2006).
When linking life stories and voices, we feel in tune with the work of Watkins (2008) who wrote about hearing voices as a human variation, and White (1996) who developed a method he called ‘Re-authoring lives’. White describes quite clearly the relationship between people's voice hearing and their life story and shows that voice hearers can gradually retake ownership of their lives when they learn about this relationship. This opinion is confirmed by the voice hearer Coleman (1997) who also describes the relationship between his voices and his life story in his process of recovery. He reports how in learning to cope with the traumatic experiences that were at the roots of his voice hearing experience, he was able to recover from the distress caused by his voices. It enabled him to take control of his life again.
Over the years, we have interviewed over 350 voice hearers within five different studies (Romme & Escher 1989, 1993; Romme, 1996; Escher, 2005; Romme et al., 2009). In three of these studies, we compared voice hearers who were patients with those who never received care. In all of these studies, in about 70 to 80% of the voice hearers who became patients, their voices were related to endured and mostly long-term serious problems in their lives, which they experienced as traumatic. In our studies, we focused on the links between the kind of trauma and emotions involved and the characteristics of the voices. In particular, we specifically observed the importance of focusing on the experience itself in order to enable people to learn to cope with their voices, to accept them, and to stimulate the voice hearer to learn to cope with the problems that lay at their roots. This means coping with the memories of traumatic experiences and distorted emotions that are the consequence of these. Voices in patients must be seen as a signal of problems but should certainly not be the only point of interest in the mental healthcare of voice hearers. Although it is often thought that our research population was highly selective, the study of comparing ‘healthy voice hearers’ with ‘patient voice hearers’ (Romme, 1996; Honig et al., 1998) was done with voice hearers who were still in hospital or only in the care of an out-patient department for chronic psychiatric patients with a background of psychosis and hospitalization. They were willing to talk about their voices because we were really interested in their experience and they did not risk getting more medication or encounter any further negative approaches when talking about their voices. The same applies to many people taking part in the recovery study (Romme et al., 2009), these people suffered many years of rather senseless hospitalization and treatment with medication. Also a number of the children in the children's study had ‘suffered’ psychiatric treatment (Escher et al., 2004).
Chapter. 12075 words.
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