Professor's research gives hope to those who hear voices.

Professor of Psychology Gail Hornstein

By Emily Harrison Weir

Mount Holyoke College Professor of Psychology Gail Hornstein understands the skeptics. She, too, once doubted that a revolutionary technique she now champions could help those who hear voices. Psychiatrists have long believed that people who experience what they call "auditory hallucinations" suffer from schizophrenia, an incurable mental illness that can only get worse over time.

But an experience in a London treatment center changed Hornstein's mind. She described one aggressive-looking woman who seemed heavily drugged suddenly transforming into "another person" when she joined a peer support group run by the Hearing Voices Network.

"To my astonishment—and violating everything I'd learned in 25 or 30 years as a psychologist—the woman 'woke up,' made insightful, empathetic comments to others about their experiences, and was an active, involved member of the group," said Hornstein. "That was when I realized that something really powerful was going on."

Exploring this simple but radical approach has become the focus of her work.

New hope for the "incurable."

Hornstein says people who hear voices are typically urged to ignore or bury the voices with psychiatric drugs. But if those methods fail, traditional psychiatry is at a loss.

Ever since that revelatory day in London 15 years ago, Hornstein has worked with Hearing Voices, using a new approach that has helped many left behind by other treatments.

The Foundation for Excellence in Mental Health Care has awarded a $250,000 grant that will enable Hornstein and her colleagues to expand a network of peer support groups for those who hear voices. A portion of the grant will go to the Western Massachusetts Recovery Learning Community (RLC) to train facilitators who will guide participants in helping one another understand and learn how to cope with the voices.

The grant will be used first to train more facilitators and start additional peer support groups. Once there is a network large enough to study, Hornstein will hire Mount Holyoke students and alumnae to investigate precisely how and why the approach is so helpful to so many distressed people.

Hornstein has helped train some 200 facilitators over the past six years, and—with her colleagues at the peer-run RLC—has made Western Massachusetts a hub of Hearing Voices Network activity. Of the 55 groups in the United States, seven are in the area.

Forging a path to acceptance.

This approach argues that hearing voices, in itself, is not a symptom of psychosis, but "an understandable response, often to traumatic situations, that can be interpreted, understood, and coped with."

"The most important thing Hearing Voices groups do is encourage the person to ask, 'Why are the voices there? What are they saying and why?' " said Hornstein.

She has observed or led hundreds of such peer support sessions, and says frightening, dictatorial voices can be combatted the same way as schoolyard bullies—by confronting the belief. Doing that, she says, can "transform the fear into understanding and then empowerment."

"And, unlike some other types of intervention in psychiatry, if it doesn't work, this does no harm," Hornstein said. "And most of the time, strikingly, it works."

The Hearing Voices approach is well established and accepted in at least 30 countries on five continents, but is little known in the United States. Here, it has been met with skepticism and some hostility, Hornstein said, adding that the key to changing that is producing research explaining clearly how it works.

Her 2009 book Agnes's Jacket: A Psychologist's Search for the Meanings of Madness talks about her realization that listening to patients' own accounts of their experiences is key to alleviating their suffering. "Madness is more code than chemistry," she has said. "If we want to understand, we need translators—native speakers, not just brain scans."