Culture as Medicine Day2 for 2012: Hearing Voices

Today I gave the keynote address at the International Healing Voices Conference in Melbourne.   The conference was organized by Voices Vic (for Victoria, the state in which Melbourne lies).   Speakers came from around the world -- Ron Coleman (who started the Hearing Voices Network in the U.K.); a woman from Auckland, New Zealand; Eleanor, a young woman/psychologist/voice hearer from Australia, and more.   Unlike most mental health conference, where the attendees are mostly practitioners of various kinds, this conference was mostly "patients".   And was it different!   The energy was so upbeat!   The conference was all about hope and recovery.   People told inspiring story after story of being severely mentally ill and recovering to the point of becoming a practicing psychologist, for example.   I'll start with Eleanor's story.

By all appearances Eleanor was an aspiring young psychologist.   She could have help her own at any professional meeting.   She was attractive, articulate, well-dressed, well-spoken -- the kind of graduate any psychology program would be proud to proclaim.   However, once upon a time, she had been a patient in the mental health system.   She heard voices that tortured her.   Once she tried to drill a hole in her head to let the voice out.   She wasn't trying to harm herself.   She just really believed that the voice would leave if it had an exit pathway.   Her longest hospitalization had been for 5 months and she had more of them than she could count or remember.   She had connected with the Hearing Voices Movement and had learned how to manage her voices.   Slowly but surely the positive voices gained sway over the negative voices.   Eventually her mind became more peaceful and she was able to return to her University studies.   She could concentrate and learn again and went on to complete a doctorate in clinical psychology and to become a licensed psychologist.

As so many people have told me, Eleanor reported that the medications only made her worse.   The drugs didn't touch the voices.   They just made her completely unable to think.   Being unable to think prevented her from doing the cognitive therapy she needed to do to learn how to manage the voices.   Being unable to think left her in complete misery.   Eleanor told us that she wasn't against medication or anything that helped people.   She would have been happy to take a drug that worked.   However, she said, "I'm against forcing people to take drugs that don't work and make them worse and prevent them from working through the problem."   For that she received a standing ovation from the audience.   I was impressed.   This was not an anti-psychiatry group.   This was a group of pro-active consumers demanding realism of outcome.   They were angry with a mental health system which pretended to help when it didn't and actually made them worse.

However, I have gone ahead of myself.   The conference began with a welcome from its organizer, a woman named Indigo, who also heard voices.   Then the "Welcome to Country" was given by an aboriginal man from the people who originally inhabited the area that is now known as Melbourne.   He played an amazing concert on a digeridoo that he had made.   Then, to my surprise, a North American aboriginal man came out to dance.   He was Ojibway from Minnesota.   The music started and to my surprise it was a Lakota song.   He didn't dance.   He waited and waited.   Then he looked at Indigo puzzled.   "You put on the wrong song," he said.   He went to the podium and clicked the correct song on the computer.   Ojibway words filled the room instead of the Lakota.   I had known that song and was singing along.   However, I knew Ojibway wouldn't dance necessarily to Lakota.   That's been a rivalry for hundreds of years.   In 1420, the Lakota attempted to defeat the Ojibway in the area around Thunder Bay, Ontario.   The Lakota suffered a miserable defeat.   I'm reminded of that every time I visit Thunder Bay.

Next came the official welcome and address from the Chair of the Agency funding Voices Vic, which was delivered by a man named Quinn from Prahan Mission.   To my surprise, our host, Tony Gee, had worked with Quinn in the past at other agencies.   Tony is the Chair of Life Is ". Foundation, which is one of the collaborators in our Australian Cross Cultural Exchange.   Life Is" has a mission of preventing suicide and assisting those left behind by a suicide to heal.   Then came my talk.   I'm going to share what I had to say, but first more observations from the conference.

The strong indigenous presence also contributed to making this a different kind of conference than others I have attended.   We heard often that aboriginal healers were not afraid of voices.   Hearing voices is normal and honored in the aboriginal community.   One hears the voices of the ancestors, the voices of spirits, the voices of the animals and of nature.   To be a voice hearer is a privilege and an honor.   Aboriginal elders were present from diverse parts of Australia to share how they assisted people who heard frightening and terrifying voices.

All this converged on the subject of my talk -- that hearing voices is an ordinary human experience that we all have.   What's different is the spin we put on the voices and the voices to which we give our attention.   I showed brain imaging slides for "hearing voices", "people with the diagnosis of schizophrenia who were not at the moment hearing voices, and so called "normal controls".   I joked with the audience about not knowing where they could have found a room full of normal people, since they were so rare.   The imaging studies suggested that the only difference was in the frontal lobes.   The frontal lobes are what we use to make up stories about our voices.   One story is that these are just our own thoughts.   Then we call those people with intrusive and disturbing thoughts "OCD".   We spare them the psychosis diagnosis because they know the thoughts are their own despite their disturbing and even terrifying nature.   In other stories, the Voices are Ascended Masters trying to take over one's mind for the purpose of eternal punishment.   In the indigenous story, some of these voices are the whispters of the ancestors, some of them come from the spirits, and one's job is to listen carefully to all the voices and practice discernment.   An elder told us never do anything a voice tells you to do if it will hurt you or someone else.   Good spirits wouldn't tell you to hurt anyone or hurt yourself.   They're funny and they make you feel good.   My suggestion is that hearing voices isn't abnormal and isn't even worthy of treatment or diagnosis.   Instead, people suffer due to the stories they create or absorb about what the voices mean and who they are and also for being fixated on negative voices that criticize, castigate, berate, wheedle, and excoriate their listener. I suggested that this tendency to focus on the negative voices is related to painful life experiences which was in keeping with Eleanor's talk (came after mine) in which she reported that people who experience trauma are 46 times more likely to receive a psychotic diagnosis than those who don't.   Eleanor's trauma was being raped and molested repetitively in a day care center run by pedophiles.   She told us her home life otherwise was atraumatic and that her parents had been loving and warm, but she had had no way to express her traumatic experiences since they occurred when she was so young and they just kept building inside of her like a pressure cooker ready to explode which she finally did during her second year at college.

I suggested that the work with voices was to make sure all voices are heard and none are necessarily more privileged than others even when those inner voices match the broader messages of the dominant culture.   I introduced Bakhtin, Hermans, and dialogical self theory to the group.   The Russian, Mikhail Bakhtin, is easily one of my favorite philosophers.   In one often quoted passage, he described the mind as a room filled with a cacophony of polyphonous voices, each arguing with the other, each trying to achieve ascendency, some forming shifting coalitions to win out over others (sounds like the U.S. Congress to me!).   He thought Doestoevsky had done the best job describing the mind in this manner, especially in Crime and Punishment, in the way in which Raskolnikov's mind is presented.

Hermans and his colleagues have taken this further into a mature psychological theory which matches the concepts of social constructionism and critical constructivism.   The mind consists of many "me's".   Each "me" emerges to manage a particular relationship and collection of stories related to that relationship.     More about this tomorrow!