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The Coalition of Behavioral Health Agencies, Inc. Coalition Briefs
An electronic newsletter of the Coalition's Center for Rehabilitation and Recovery

Elizabeth Saenger, PhD, Editor and Writer
No. 111-2, January 2015

The Center for Rehabilitation and Recovery provides assistance to the New York City mental health provider community through expert trainings, focused technical assistance, evaluation, information dissemination and special projects.

Supporting Voice Hearers in Their Recovery

Tami Gatta, RDT, LCAT

The Hearing Voices Movement is continuing to take root in the United States, as voice hearers and allied professionals seek opportunities for empowerment within the voice hearing/vision seeing experience. While there is no definitive way to provide support, there are several ways to create an environment conducive to healthy exploration together.

  • Accept that the voices are real. Voice hearers are frequently asked to dismiss their senses and interpretations of stimuli. Such demands can make individuals distrust themselves and doubt their ability to work towards recovery. It also arouses significant defenses. Start off by making it clear you accept the reality of the experiences being described. This quickly lends itself to the potential for deeper work. 
  • Work creatively. The experiences of voice hearers can be challenging to articulate. Oftentimes, the voices themselves express anger at being discussed openly. Think outside the box. Allow people to explore using the creative arts, which can create a healthy distance through metaphor. Consider making masks of the voices. Encourage role plays to practice meaningful dialogue, assertiveness, and boundary setting. Ask if certain music feels reflective of the voice hearing experience. Many individuals frustrated by a lack of words to express themselves are able to communicate through creative means. 
  • Look for patterns together. There is something to be said for picking up on patterns in voice hearing. Do the voices get louder after specific types of interactions? Can they be connected to triggering places? Pinpointing patterns can be extremely empowering. It makes the experiences less random, and suggests that there are real reasons why the voices surface. As patterns in voice hearing emerge, so do options for coping skills. Someone who notices that the voices are present on subways, or after speaking to a specific relative, can prepare for voices beforehand. Such observations also offer opportunities for discussion about how voices and visions can serve as important markers of external distress. 
  • Don’t assume silence is preferable. Not all voice hearing is negative. There are voices that are soothing, encouraging, and appealing. Some voices evoke feelings of connectedness. Traditionally, mental health services have emphasized a vision of recovery that eliminates the presence of voices altogether. Yet many voice hearers do not want to lose contact with their voices. Check in, and get a better sense of what individuals are hoping for in relation to their voices and visions. If getting rid of them is the goal, acknowledge that this may or may not happen, and explore feelings about this uncertainty. If not, discuss the benefits the voices offer. Either way, focus on shifting the relationship between the voices and voice hearer so the person has a renewed sense of control. 
  • Find community. Many voice hearers believe they are alone in their experience. They feel isolated, and uncertain as to whom they can trust with their stories. In working with voice hearers, I repeatedly notice group participants express relief at being able to speak with others who see visions or hear voices. Self-help groups in the Hearing Voices Movement, located in the community and led by individuals with lived experience, are becoming more numerous in America. Encourage your clients to consider trying groups that offer the chance to speak openly and socialize with other voice hearers.  

In short, regardless of whether you have lived experience, you can support people who hear voices or see visions by validating their experiences, helping them make meaning out of them, and reducing their isolation.   

Tami Gatta, RDT, LCAT, a privately practicing drama therapist, consults to those developing services for voice hearers. She also works as the Hearing Voices Group Developer, and within the hospital diversion program, at Community Access. She can be reached at tami.gatta@gmail.com.

Recommended Resources on Hearing Voices

Understanding Psychosis and Schizophrenia provides a broad framework for understanding hearing voices as a personal and social phenomenon. It covers the nature of psychosis, offers insights into support techniques, suggests research and prevention efforts, and more. The 180-page, free online text is primarily by clinical psychologists, but also people with relevant lived experience in the United Kingdom, where the Hearing Voices movement originated.

Hearing Voices NYC lists local groups and contacts, and provides a list of voice hearing materials available for lending at the Jefferson Market library in Greenwich Village.

Hearing Voices Network USA connects voice hearers and allies across the country.

Intervoice (the International Network for Training, Education and Research into Hearing Voices) has updated information on publications, training opportunities, and global conferences. 

The Maastricht Interview has adult and child versions of a questionnaire about voice hearing created by the founder of the Hearing Voices Movement.

Eleanor Longden’s moving story on TED talks captures the spirit of the hearing voices movement though personal narrative.

Working with Voices—Victim to Victor (approximately $15) Written by voice hearers, this supportive 2006 workbook offers a guide to exploring voices alone or with others.

How to Reduce Stigma: A Lesson from the Japanese

Steven R. Anderson

Critics have long contended that diagnostic labels cause or intensify mental illness stigma. To them, terms like schizophrenia, bipolar disorder, borderline personality disorder, and other diagnoses do as much harm as good. They label individuals for life, perpetuating the negative attitudes that researchers have identified as harmful. Yet as the 2013 update to the Diagnostic and Statistical Manual (DSM) attests, diagnostic labels are useful for categorizing and documenting mental illness—not to mention receiving insurance coverage—and will likely be here for the foreseeable future.

Given this reality, is there anything in the naming of mental illness itself that can reduce stigma? Surprisingly, yes. In 2002, the Japanese Society of Psychiatry and Neurology decided to change the previous term for schizophrenia, seishin bunretsu byo (“mind-split disease”) to a new term, togo shittcho sho (“integration disorder”). Studies found that many psychiatrists never informed their patients of their diagnosis when they had to use the old “mind-split disease” terminology.

With the name change, however, this changed.  A 2005 study found that physicians were significantly more likely to discuss the diagnosis with their patients using the new term, reducing the stigmatizing culture of silence that had dominated the diagnosis of schizophrenia in Japan.   

Bleuler coined “schizophrenia” (literally “split mind,” from the Greek) to describe the fragmented thinking he observed in his patients. Despite this, the term is used in everyday language to denote a “split mind” or “multiple personality,” neither of which accurately describes schizophrenia.  This inaccurate, but common, usage contributes to the significant stigma that individuals with schizophrenia face.

Why haven’t the United States and other Western nations followed the lead of Japan in updating a problematic term? When it comes to diagnostic labels, at stake is more than just a name.

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The opinions expressed in RECOVERe-works do not necessarily reflect the views of the Coalition of Behavioral Health Agencies.

To subscribe or unsubscribe to RECOVERe-works, a free publication of the Center for Rehabilitation and Recovery at the Coalition, please email esaenger@coalitionny.org.

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