Listening to those who hear voices.

Gail Hornstein

By Keely Savoie

Twenty years ago it was revolutionary: enabling the people who hear distressing voices to speak about the experience, rather than trying to silence the voices they hear. But this approach has proven transformative, both for people who hear voices and for the field of psychology itself.

The radical technique debuted with the founding of the Hearing Voices Network (HVN), an international collaboration of voice-hearers, mental health professionals, and family members who are working to change the approach to helping people who experience what psychiatrists call auditory hallucinations. Its approach has led to the founding of hundreds of peer-support groups for voice-hearers. The method has steadily gained credibility and now is used around the world, but it still lags in the United States.

Gail Hornstein, a professor of psychology and education at Mount Holyoke College, and Jacqui Dillon, the national chair of the HVN in England, intend to to change that. The two are advisors to the Hearing Voices Research and Development Fund at the Foundation for Excellence in Mental Health Care. Working with their colleagues at the peer-run Western Massachusetts Recovery Learning Community, they have begun an initiative aimed at researching what contributes to the success of the HVN method and to spreading the approach to communities around the United States.  

Unknown reasons

No one knows why up to 11 percent of the world’s population hears voices. Some of those individuals receive psychiatric diagnoses and treatment, while others live ordinary lives in the greater population. Regardless of the underlying causes, psychiatric treatment for decades focused on stopping the voices, most often with medication. That approach misses an opportunity to learn anything about the phenomenon, said Hornstein who was recently interviewed about her work in Psychology Today.

Hornstein is the author of Agnes’s Jacket: A Psychologist’s Search for Meanings in Madness. For 20 years she has been collecting, teaching, and writing about narratives of “madness” that are written in the first-person. She believes that much information is lost when patients’ lived experiences are discounted.

“If you take seriously what people have to say about their own anomalous experiences, you will actually come to a very different understanding of what they mean,” she said. “Once you take them seriously, you start to question some taken-for-granted parts of mainstream psychological theory.”

In the United States, psychiatric diagnoses are based on the Diagnostic and Statistical Manual of Mental Disorders, created by the American Psychiatric Association, which classifies mental disorders by clustering symptoms. Diagnoses can vary from doctor to doctor. Broad diagnoses can obscure individual experience, and lead to overmedication and societal alienation, Hornstein said.

The World Health Organization conducted two worldwide studies in the 1990s that showed that patients diagnosed with schizophrenia fare better in developing countries than in the developed world. The difference may be due to the fact that  in developing countries, patients are less likely to be on long-term medication and more likely to be cared for and treated at home within their communities.

A different path

Silencing the voices heard by individuals can also have the unintended effect of making the hearers’ lived experiences more terrifying, Hornstein said. Moreover, not all voices are bad or threatening. Some are comforting, encouraging, even protective.

“While medication works in some cases, often it only makes the voices feel farther away, or quiets them to an barely discernable murmur,” she said. “It’s as if someone’s whispering, but you can’t make out what they are saying. And sometimes that can be even more frightening.”

Instead of muting those voices, allowing the people who hear distressing voices to talk about their experiences in a nonmedical setting has the power to give those people greater control of their lives. In turn, it can transform their experiences from frightening and painful to something that can be understood, acknowledged, and managed. Hornstein has personally witnessed this transformation on countless occasions.

“It’s extremely moving to see people—many of whom have been patients in the mental health system for 20 years or more and who have never been helped by even heavy doses of medication—to have their lives transformed by participation in a hearing-voices peer-support group,” Hornstein said. It’s incredibly inspiring.” .

Spreading success

The Hearing Voices Research and Development Fund has concentrated over the past year on training new facilitators across the United States for these peer-support groups so that they can be established in more locations. The fund’s goal is to build regional networks where HVN'’s approach can become a viable alternative in this country, as it is in so many other parts of the globe.

The fund is  also beginning to research specifically how the HVN peer-support-group model is able to transform the lives of voice-hearers, so as to be able to more easily replicate its success.

In June, Hornstein will travel to the Aspen Ideas Festival as a Spotlight speaker to share her insights and ideas.

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