Full day working with voices workshop Hearing Voices a Common Human Experience NFAO NW Regional Meeting 24 th November 2009 Peter Bullimore Hearing Voices Network Asylum Associates 450 people who heard voices responded 300 were unable to cope 150 accepted their voices and could cope with them Hearing voices in psychiatry Is hearing voices in itself a psychiatric condition? Does it indicate the presence of a specific disorder? Do certain characteristics of hearing voices indicate certain disorders? There are quite a few voice-hearers who cannot be diagnosed with a psychiatric diagnosis when using an appropriate diagnostic instrument. The number of such people in the general population is even higher that those voicehearers who can be diagnosed with a psychiatric disorder. Hearing voices is found in many different conditions. When it appears as part of a complex of symptoms diagnosed in schizophrenia, the complex consists partly of hearing voices as a reaction to a serious event or identity which cannot be coped with, and partly of a secondary reaction, to an inability to deal with the voices. In other words the whole complex of schizophrenia symptoms does not have to be the consequence of illness. Hearing voices is a very personal experience, differing from person to person in terms of what the voices say, and the life events and ideals that provoke them. When analysed properly, the relationship between the voices and the life-history can show that the voices make sense when looking at the circumstances in life which provoked them. 1
Crazy theories Cats cause schizophrenia Rape seed Pollution Thrush Core concept of a new approach to hearing voices Hearing voices in itself is not a sign of a mental illness, but a sign of a problem. Masturbation Pink spot Red spot Stilettos Becoming a patient is due to the inability to cope with voices and underlying problems. Chlamydia In our society there are more healthy people hearing voices, than there are ill people hearing voices. Voices are messengers that sometimes bring awful messages. Hearing voices is apparent in healthy people. The Startling Phase The focus of helping at this stage should be the reduction of anxiety through anxiety management techniques. Medication may be useful at this time in helping to reduce anxiety. Help must be given with full recognition and acceptance of the actual voice hearing experience of the person. The next step is to seek possible ways of gaining control over the voices. It is important to foster a sense of security by showing amongst other things, emotional involvement and by taking careful note of events and their timings. Contact with other voice hearers during this phase can be valuable in reassuring people that they are not alone. In due course one should try to bring some fundamental order to the person s daily routine. It is important for friends and family to be supportive rather than critical at this stage. 2
Organisational Phase When the initial anxiety and confusion has been reduced or temporarily suspended it is possible to concentrate on organising the voices and the hearer s relationship with them. During this stage detailed attention is paid to such issues as; Analysis of the possible significance of the voices to the hearer with the regard to both past and present. This can be done through an exploration of the hearer s history. The meaning of the voices in the person s daily life. The influence of the family s attitude to the voices. Accompanying symptoms of dissociation or emotional repression. And/or any symptoms suggesting a delayed development of the self. Particular circumstances under which the voices are heard. What they have to say. The nature of any triggers and accompanying perceptions. Attention will be paid to the social position of the person, her or his degree of dependence, the necessary social provisions, and the available opportunities to develop and present a full identity as someone who hears voices. Starting points HOUSING BEING BELIEVED JOB SELF-CONFIDENCE SELF-ESTEEM SELF-BELIEF The Stabilisation Phase In this phase, the focus is primarily on expanding knowledge and developing the personality through the use of various therapies. This is the period when people have begun to learn to live in balance with their voices, the voices are seen as being a part of the person. The relationship with the voices is more reasonable, they have a more positive influence and become less controlling, but people can choose to follow their advice if they want to. In this phase people are less anxious about their voices. 3
Romme and Escher say; Acceptance of the voices seems to be related to a process of the growth towards taking responsibility for one s own decisions. Always blaming others is non-productive. Or as some described it, you have to learn to think positively. Startling Phase Short term interventions promoting control over the voices Organisational Phase Engagement with the voices Cognitive Interventions Relationship with the life history Working through experiences of grief, guilt etc Stabilisation Phase Reconnecting Self-esteem Network Social Roles What this research shows is that we must accept that the voices exist. We must also accept that we cannot change the voices. They are not curable, just as you cannot cure lefthandedness-human variations are not open to cureonly to coping. Therefore to assist people to cope we should not give them therapy that does not work. We should let people decide for themselves what helps or not. It takes time for people to accept that hearing voices is something that belongs to them. Marius Romme They may be felt to occur: In the head In the ears In some other part of the body They can be internal They can be external 4
They may be: Male Female Genderless Both sexes Belong to people known to the hearer Unknown to the hearer One voice or several They may: Mumble Whisper Speak in a foreign language Be critical Be approving Tell people what to do Keep a running commentary of what the hearer is doing Repeat the person s thoughts Instruct They may: Guide Advise Be frightening Negative Unwelcome Helpful Some people feel that the voices are trying to gain control over their lives Some people may experience a loss if the voices disappear Voice profiling Voice profiling looks at who the voices are and how they influence you. The purpose of profiling is to make it clearer to yourself and others what exactly are the natures of your experiences and how they influence your life. You need to try and identify who the voices are and how they affect you. If you do not know who the voice/s are give it a name maybe one that sums it up. A voice profile is a representation of who your significant voices are and how they affect you. This helps in two ways. Firstly, when you can be clear about the identity of the voice/s you tend to feel more in control. Secondly, if people want to help you they can see from profiles what the real problems are and when you need them most. Remember profiles can change over time, for many people there are many voices, only one or two of them are usually problems, sometimes the other voices can be helpful. To start voice profiling use a I have just heard a voice check list. 5
Time Place Identity of voice What it said How you felt What you did Name of voice Gender What the voice normally says (content), any patterns i.e. time of day, is it linked to my feelings The influence of the voice, how it makes me feel and what I do in response to it. Origins, where it comes from, my explanation Coping strategies for hearing voices GIVE RECOVERY A MEANING FIND AN EXPLANATION TALK ABOUT VOICES (TO PEOPLE YOU TRUST) ACCEPTANCE TAKE INTEREST GAIN TRUST SELF EDUCATE EXPRESS ANGER (SAFELY OR PRODUCTIVELY) TRY TO REDUCE ISOLATION Coping strategies for hearing voices LEARN TO RECOGNISE BEHAVIOUR THAT ISN T PART OF THE VOICE VOICE HEARING EXPERIENCE LISTENING TO A WALKMAN/MP3 PLAYER IS IT REALLY A CONVERSATION? CHECK CONTENT OF VOICES ARE THEY TELLING YOU IT S TIME TO MOVE ON? DO SOMETHING It s difficult to listen to voices whilst doing something else- either mentally or physically Playing a video game may be helpful aggressive games can help to release tension -games requiring concentration help the voice hearer to think about something other than the voice/s CONCURRENT VERBALISATION (CONTINUOUS TALKING) This works by: -distracting the voice hearer -teaching selective listening -shows voice-hearer can begin to control response to voice -provides temporary relief You can do this by: -reading out loud (Doesn t need to be a novel-could be notices/leaflets) -stopping and naming (Useful when alone/ when difficult to have conversation) 6
SETTING TASKS BRING ON TO TAKE CONTROL SELECTIVE LISTENING NEVER ATTACK BELIEF SYSTEMS BUILD UP LIFE HISTORY ACCEPT FRAMES OF REFERENCE (SUSPEND OWN BELIEFS) BE NON-JUDGEMENTAL Coping strategies for hearing voices AGREE TO DISEMPOWER THEM ASK THEM WHY CHALLENGE DOMINATE VOICE EXERCISE WHEN POSSIBLE (Endorphin Theory) VISUALISATION IDENTIFY TRIGGERS (E.g. comments, sounds, smells) WORK WITH NOT FOR A PERSON My experience of mental Distress CHALLENGE THE VALIDTY OF THE CONTENT OF THE VOICES E.G Draw on past experiences when they said similar things REINVENT YOURSELF FOCUS ON POSITIVE VOICES (IF ANY) REMEMBER VOICES CAN T INFLICT ANY PHYSICAL PAIN ON YOU DON T BE A VICTIM: MOVE BEYOND ILLNESS MODEL Nelson Ear plug therapy Tape recorder Empty box Understanding Acceptance Recovery He will stay, Minerva, because he needs to understand, said Dumbeldore Curtly. Understanding is the first step to acceptance, and only with acceptance can there be a recovery... Harry Potter and the Goblet of Fire J.K.Rowling. Bloomsbury: London, 2000 P. 590. 7