Psychosis as a personal crisis: an experienced based approach
Few times in the history of Psychiatry has there been revealing events, initiatives
or observations that have unexpectedly impacted the professionals and users and
significantly influenced the subsequent course of the knowledge and practice of this
The “non-restraint” of York Retreat with William Tuke has been one of these.
This example spread to many other public and private institutions that renounced the
chains and restraints of the patients, demonstrating how the relationships inside the
asylum improved with knowledge and affect, with more humanitarian communication
with the patients and more interest in understanding their problems. The incidences that
led to the physical restraint of the insane were, to a large degree, a consequence of the
relationships and attitudes towards them.
The rediscovery of the voice hearers by Marius Romme and Sandra Escher and
the Hearing Voices Movement have the same historic value. As did the “non-restraint,”
this is provoking the same astonishment among professional and users as well as a similar
dynamics of incredulity, acceptance, enthusiasm, skepticism, opposition or distrust. And
as occurred with the “non-restraint,” we should also not be surprised that the Hearing
Voices Movement is making its way, little by little, into the social history of psychiatry,
surrounded by other merely descriptive practices, that do not take into account the
bibliographic data of the patient and that are quite simplistic and comfortable, such as the
purely empirical and indefinite drug monotherapies, without any criteria or limits, or the
other more brutal practices that still exist, such as electroshock, that want to end the
voices, even at the cost of destroying the mind.
More than twenty years ago, Marius Romme and Sandra Escher discovered that
which had been hidden and ignored for almost two hundred years by descriptive asylum
Psychiatry - that there were many persons who heard voices and who had not received,
nor sought, nor required medical care. Through a Dutch television program, and then in
the organization of a series of specific meetings, they entered into contact with persons
who heard voices, carried out normal lives, and who did not feel the need to make the
voices disappear. They accepted them and could cope with them. They heard voices, but
had never needed psychiatric help. On the contrary, they considered that their voices
enriched their lives.
Epidemiological research in the general population has demonstrated that hearing
voices is not rare among normal, mentally healthy persons, even in Western society.
Some large scale studies have revealed the existence of hallucinatory experiences in
more than 10% of the persons and of auditory hallucinations in more than 2% of them.
Hearing voices, and even more so in childhood where this number is four or five times
greater, is a special, but not rare, experience.
A good number of persons who hear voices are capable of coexisting well with
them and they consider them an essentially positive experience since the voices are, for
them, a source of advice when they listen to them with critical judgment and they adapt
to them. Those who can cope with their voices, in general, have developed their own
individual response and are distinguished by their ability to maintain the sense of their
The problem does not consist so much in the presence of the voices but rather in
their ability to cope with them. For those who hear voices and cannot cope with them
satisfactorily, the impact is very negative, since they affect their social life, mental
processes and freedom of action. The authors of this magnificent book maintain that this
is because the voices they hear confront questions that are fundamental for them and are a
reaction, either to frustrated aspirations, to a serious trauma or to other situations that they
have not been able to resolve and in whose presence they feel impotent. The voices, they
say, will remain until the problem is solved or there is a change of attitude towards them.
As the persons try to fight against them, the voices become more bothersome.
Consequently, this fight occupies the central place, so that the implicit message of the
voices is lost. The persons who seek psychiatric help, experience the voices as a negative
experience, possibly because of the nature and difficulty of their underlying problems.
What has the traditional descriptive psychiatry offered for the last two hundred
years? A triple pirouette of arrogance and ignorance, that initially considered these
persons as alienated, then as brain-damaged, and finally it stopped listening to them. It
redefined the voices on an exclusively pathological basis as auditory hallucinations, a
symptomatic paradigm of diagnostic labels, such as schizophrenia or psychosis, with the
free presumption of a still-undemonstrated underlying brain disorder. And what is even
worse, it condemned these persons to silence, because it maintained a priori that the
voices had no meaning, that they were noises from a damaged brain machinery that were
not worth listening to. Therefore, the professionals of the traditional descriptive
Psychiatry did not listen to them. Perhaps they asked about the form of the voices,
believing that their formal aspects would be the pathway that would lead them to the
brain disorder. However, they were not interested at all in the content of the voices, what
these voices were saying to these persons that were hearing them, and that was exactly
what was most important to the patients.
Institutions such as Psychiatry are created thanks to dominant ideologies that
redefine reality and their adequate approach. The institutional processes and interactions
by which asylum psychiatry interpreted the voices in a historic moment to firmly embrace
scientific positivism and materialism of the brain disorder and abandon any religious or
magic trace from previous periods, was a mistake, one which was still followed by most
even after the development of psychoanalysis.
This was a mistake with serious consequences that spread to the diagnosis, image
and stigma of insanity to all those who, with whatever frequency, intensity and attitude,
had this subjective experience of hearing voices at some time in their lives, that now
became painfully marked, obstructed and hidden in a wall of silence forever.
This wall has began to fall with the work of Marius Romme and Sandra Escher
and with the Hearing Voices Movement, which, in only twenty years, has spread to
many countries from Holland to the United Kingdom, and to Denmark, Sweden,
Norway, Italy, Australia, New Zealand, the United States, Germany, Austria, Palestine,
Canada, Finland, Ireland, Switzerland, Greece and Japan, etc. There are countries, such
as the United Kingdom, which has almost 200 groups, and there is growing activity as
can be seen at www.intervoiceonline.org and in the different chapters of this book,
which is an essential text to understand the historic meaning of this innovating
perspective and practice in the understanding and help of persons who hear voices and
suffer because they cannot satisfactorily cope with them.
The authors of the present book have drawn those hearing subjective voices out
of their objective, external, social and psychiatric silence. Furthermore, they have taught
all of those who are trying to help them that the voices appear, remain and have a
meaning in the lives of these persons, their difficulties, traumas and unresolved
problems. They also teach us all that the voices speak to them about themselves, their
identity, crises and lives; that these voices are a part of their mind that they do not
recognize as being their own, that they refer to significant introjections that reappear as
persons, metaphors or reference groups who give consolation, support, guidance,
criticism, reproach or memories of painful events experienced or hidden, rejected or
repressed aspects of them.
This book presents a new vision for the health care professionals and a
reconstructive task in their work with those who hear voices, teaching them to listen to
them, understand them in their biographic dynamics, to make a commitment in the
resolution of the unsolved disorders and traumas experienced, in the change of their
own attitudes towards their voices and in their own responsibility and role in their
Historic and epidemiologic knowledge provides a different perspective to the
hearing of voices among the possible human experiences and especially to
understanding them and not disqualifying them. In the entire book, there is a laudable
effort to free the voice hearers from the social silence and stigma, promoting their
participation in self-help groups and forums with other persons who experience or have
lived through similar experiences. For this reason, this book is also fundamental for the
persons who hear voices, for their family and friends. It is also essential for any person
interested in this innovating therapeutic avant-gardism, because in addition to it, the
Hearing Voices Movement is a social liberation movement.
MANUEL GONZÁLEZ DE CHÁVEZ
Professor and Chief of the Psychiatry Service of General University Hospital
Gregorio Marañón. Complutense University. Madrid. (Spain)
Former President of International Society for the Psychological Treatment of
Schizophrenia and other Psychoses