by Angela Carrazza
Hearing Voices Groups (HVGs), a new service for outpatients of the HSE South Lee Mental Health Services, Cork, started in the Bishopstown Library on 25th January 2013 and continues every Friday from 1pm to 2.15 pm. This is further to the success of its predecessor, which was running at Tosnú Mental Health Centre, Ballincollig, Co. Cork, and which now has been merged with the Bishopstown Group.
HVGs facilitate people with shared experience in hearing voices to come together to support one another within a confidential setting. They offer a safe haven where people who hear, see or sense things that other people don’t, can feel accepted, valued and understood. At a HVG emphasis is placed on: “Who are you?” and “What happened to you?” rather than “What is wrong with you?” They are peer support groups, in which members of the group are considered the experts of their experience. HVGs provide social support and belonging – not therapy or treatment. They offer an opportunity for people to accept and live with their experiences in a way that helps them regain hope and some control over their lives, which is outlined in the HSE’s policy document for Mental Health Services, Vision for Change. The policy also highlights the importance of the service user’s individual experience, her own understanding of her mental health issues, her recovering process, strengths, resources, values, dreams and goals. All of these are being addressed in HVGs.
The group encourages voice hearers to explore their feelings, thoughts and coping skills. Group members work together towards recovery, towards a life one wants to live, not one dictated by the voices. For a lot of people this means integrating the voices in a meaningful way into their lives. The aim is not to get rid of the voices, yet at times they may disappear through this kind of work.
As one of Cork’s HVGs’ facilitators, I have been working as an art therapist in HSE South’s Mental Health Service for the past twelve years. It has always been my belief and experience that by giving the distressed person time and a listening ear, they are able to make sense of their distress. At times it might be difficult and painful to work through underlying causes of distressing feelings, yet I believe this to be an essential part of the journey towards recovery. If as mental health professionals we want to meet a distressed person’s need, we need to place trust in the person’s narrative, and take cognisance of the metaphoric meanings that often lie hidden within psychotic beliefs and behaviours. We need to rediscover and connect with a person’s story, listen to their account and think outside the literal meaning and the illness model. It has been my experience that this will automatically bring life, energy and interest into the work with people in severe distress. In orthodox psychiatry the hearing of voices can be treated as a symptom of schizophrenia and other mental health diagnoses and the voice hearer may not be offered an opportunity to own and explore their voices in a meaningful way.
Last year I attended a course to enable me to facilitate Hearing Voices Groups (HVG), which was organised by the Catherine McAuley School of Nursing and Midwifery in University College Cork and the Critical Voices Network Ireland. This course was facilitated by Jacqui Dillon, head of the Hearing Voices Network UK (HVN UK), who is a voice hearer herself. The training’s aim was to enable those who attended to facilitate HVGs in Ireland.
Ms Dillon also delivered a keynote presentation at last November’s UCC conference of the Critical Voice Network Ireland. She gave a very powerful account of her experience and how she learned to cope with it. She still hears voices and says she now would not like to be without them. She learned to change her attitude towards them, learned to treat them with more curiosity, empathy and friendliness. Through dialogue with her voices, her negative voices became less hostile: changing her attitude to them transformed her voices from being tormentors to becoming guides and guardians. She learned to draw links between what the voices were saying, her adverse life experience, and her past and present feelings. She now values her voices as a creative, resourceful and appropriate response to severely traumatic life experiences.
In the late 1980s, Prof. Marius Romme (Professor of Social Psychiatry) and Dr. Sandra Escher (science journalist), both from the Netherlands, researched what helped people cope with their voices. Their study showed that the problem is often not the actual hearing of voices, but the person’s difficulty or inability to cope with them. They found that voice hearing is a rather common phenomenon, and that a lot of voice hearers cope well with this experience without ever using the mental health system. Romme and Escher’s research showed that at least seventy percent of voice hearers have had some traumatic event which they connect with their voices. The research illustrated that accepting one’s experience of hearing voices, communicating about this experience, having a personal explanation for the voices, and setting the voices some limits enabled voice hearers to cope better.
Romme and Escher developed ways of working with people’s voices, and did so in cooperation with voice-hearers. Romme and Escher’s approach places the person’s potentially distressing experience into centre stage. They believe that we miss the point if we just treat them as hallucinations, something that does not exist. They suggest looking beyond diagnosis and labels and that we need to validate the voices as a real influence. One’s voices can be uncomfortable, but they can hold wisdom, which can be discovered if we explore the voices and show interest in the underlying problems. This approach normalises the experience of hearing voices and helps the voice hearer become more confident in talking about their experience and in trusting that what the voices say has meaning and that it is linked to the voice hearer’s life experience, albeit often contained and communicated in metaphors. The voice hearer can experience feeling empowered by learning to own, respect and manage their experience.
Following Romme and Escher’s ground-breaking research, the Hearing Voices Movement (HVM) was founded and the first HVG were established in the UK. There are now one hundred and eighty-eight HVGs in the UK. These advocate for a radical shift in the way we understand the phenomenon of hearing voices: instead of seeing hearing voices as a sign of mental illness, we need to recognise the experience as a sign of there being underlying problems, often linked to adverse life events – and it is these problems that we need to address.
The HVM’s innovative approach of working with people who hear voices is truly inspiring, hopeful and reassuring and it reaffirms my trust in distress being meaningful. It is in a way a very simple, down- to-earth, logical approach, which places emphasis on narrative, metaphor, and on sense-making between voices, feelings, and life experience. Most importantly, it acknowledges that voice-hearing can be a significant, creative attempt to survive and cope with adverse and traumatic life experiences.
I urge my colleagues in the mental health services and indeed society in general to learn from those who hear voices and acknowledge that the voices may have helped the person hearing them to cope with and survive adverse life events. We stand to perhaps gain more from listening to them rather than by trying to extinguish them. If we fail to do so, we may risk prolonging the distress for the voice hearer.
I acknowledge the support of HVN UK, Jacqui Dillon in particular, the Critical Voices Network Ireland, and the Catherine McAuley School of Nursing and Midwifery. Hearing Voices Groups have now started in Ireland, and hopefully, over the next months and years, a Hearing Voices Network Ireland will develop nationally.
Angela Carrazza is an art therapist (MA) and a Hearing Voices Group Facilitator, with a background in social work. She has been developing the Art Therapy Service in the South Lee Mental Health Services over the past twelve years. She is a guest lecturer at UCC and CIT. Angela may be contacted at (086)7871187 or by emailing: firstname.lastname@example.org.
Corstens, D., May, R. and Longden, E. (in press). Talking With Voices. Fife: P and P Press.
Romme, M. and Escher, S. (1993) Accepting Voices. London: Mind Publications. Romme, M. and Escher, S. (2000) Making Sense of Voices. London: Mind Publications.
Romme, M., Escher, S., Dillon, J. and Corstens, D. (2009) Living with Voices: An Anthology of Fifty Stories. London: PCCS Books.
Critical Voices Network Ireland: <http://www.criticalvoicesnetwork.com>. Hearing Voices Network UK: <http://www.hearing-voices.org>. International Hearing Voices Network: <http://www.intervoiceonline.org>. Jacqui Dillon, Chairperson of the HVN UK and voice-hearer: <http://www.jacquidillon.org>.
Hearing Voices Ireland: http://www.voicesireland.com>.