Psychiatric Rehabilitation Association

Living with Hearing Voices

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PsyR Connections 2012 Issue 3
September 5, 2012

Leah Rokeach, LCSW

Hearing voices has long been associated as one of the most characteristic symptoms of schizophrenia. Hearing voices is a frightening experience; voices can be intrusive and disturbing in various ways. Voices can be threatening, commanding the person to hurt others or hurt himself/herself. These voices cause great distress, and because of the negative content of the voices, the voices become a source of fear and embarrassment. Another painful consequence for most people who hear voices is the feeling that they have little or no control over the voices. Research shows many people continue to hear voices even after prolonged use of medication.

Ms. S is 31 years old and has been hearing voices for the past 10 years. The voices come almost every day and they tell her she is a failure, she will never amount to anything, and no one likes her nor respects her. Ms. S was diagnosed with schizophrenia at the age of 21. She was told she had a disease of the brain and would need to take medication the rest of her life. However, nothing changed for Ms. S after being on medication; she continues to hear the voices. She was hospitalized a few times, especially when the voices commanded that she kill herself. She describes the voices as very powerful. The voices have control over her life and she cannot function, she cannot have friends, she cannot work, nor can she go back to school. She reports that the “the voices are tormenting me” and she is embarrassed to tell anyone about the voices, so she spends most of her days at home alone.

Most people who hear voices feel the same powerlessness against the voices as Ms. S does: they are in distress, feel hopeless, and believe the voices control their lives. When people start to hear voices, they are diagnosed with psychosis, and told, just like Ms. S was told, that the voices are caused by a disease of the brain. They are told that just like someone who has diabetes, they will have to take medication for the rest of their lives. Some are also told they cannot go back to school or work. This medical model focuses on symptoms and illness, which causes a sense of hopelessness, despair, and loss of dreams and goals. While no one can guarantee recovery from mental illness and distressing psychotic symptoms, everyone deserves to hear that such a recovery is possible. There are many people who cope with voices and lead healthy and productive lives. There are many stories of people who recovered, living with their voices, and some of these voice hearers are no longer on medication.

The Hearing Voices Approach that has helped people who hear voices recover and move on with their lives is based on the work by Marius Romme, a psychiatrist in the Netherlands, and his life, Sandra Escher, a psychologist. Marius and Sandra started the Hearing Voices Movement in 1987 in England, after being challenged by a voice hearer as to why they could not accept the reality of her voice hearing experience. Hearing Voices is an organization whose membership includes voice hearers who have recovered and lead meaningful lives while continuing to hear voices. The organization has helped countless voice hearers gain ascendancy over the negative impact of their voice hearing experience. Many Hearing Voices Network organizations have been established in other European countries, Australia, and recently, in the USA.

There are two central principles in the Hearing Voices approach:

  • 1. Voices are real.
  • 2. Voice hearers can change the relationship with their voices.

Acknowledging the voices are real is certainly a radical departure from the way mental health professionals usually treat individuals who hear voices. People who hear voices are usually told they are hallucinating (the voice or voices are not real), and taking the medication is the only way the voices will be eliminated. We see that very often medication by itself does not eliminate the voices. However, once a voice hearer learns to accept that voices are real, it can open the door for constructive discussions on how to make sense of the voice hearing experience. The more we can help voice hearers understand the voices and the issues the voices represent, the easier it will be to deal with them. Also, finding out more about the voices makes them less mysterious and therefore, less scary.

The Hearing Voices approach proposes that the voices by themselves may not be the problem, rather the relationship that people have with their voices and the power and influence that voices have in a person’s life may be the problem. The focus of the Hearing Voices approach is to alleviate distress. This includes talking directly to the voices and negotiating with them: asking them what they want, offering to set a time for talking if they leave them alone, and most important, talking to them with respect. Talking to the voices usually reduces the power of the voices and the voices calm down; the voices become quieter or become friendly voices.

Ms. S was initially resistant to start therapy. She felt helpless and hopeless about her future. She thought of herself as a schizophrenic rather than a human being diagnosed with schizophrenia. She was very surprised and became quite excited when she read the recovery stories from members of the Hearing Voices Network. She said, “This is the first time someone told me about recovery, about the possibility of leading a better quality life.”

Ms. S is learning the Hearing Voices approach to accept the voices as real, she is developing more and more curiosity about the voices, and she is learning how to listen to her voices and try to understand what they mean. She is learning the various coping techniques and steps that are helping her change her relationship with her voices. Ms. S has made remarkable progress on her journey to recovery. She is less frightened by the voices and has started to take some control over her voices. Her psychiatrist reduced some of her medications, so she is able to focus and she is more alert. Ms. S also joined a voice hearing group and she is working in a doctor’s office for a few hours a week where she helps the receptionist at the front desk.

It is time for mental health professionals to open up to some of the new approaches to voice hearing. The Hearing Voices approach proponents believe that if we do not envision psychiatric disability as a life sentence, we will increase the chances that people with a psychiatric disability diagnosis will discover their own resilience. This is a profound insight that offers hope and inspiration to those individuals who have been diagnosed.

About the Author: Leah Rokeach, LCSW has a private practice in Brooklyn NY. She specializes in working with people who are diagnosed with a psychiatric disability. She can be reached by email, or by phone at (917) 670-7148.

David Batty, Making Sense of the Voices, Society Guardian, (November, 2001).
Jessica Aranella, PhD, Just Accept It: The Voices are Real, Behavioral Healthcare (August 9, 2012).
Romme, M. & Escher, S. Making Sense of Voices: A Guide for Mental Health Professionals Working with Voice Hearers, London Mind Publications (1993).
Ron Coleman & Mik Smith, Working with Voices II: Victim to Victor, P&P Press LTD (2007).
Rufus May, Talking with Voices,
Rufus May, Changing the Power Relationship with Your Voices,
Stone, H. & Stone S. Embracing Ourselves: The Voice Dialogue Training Manual, Nataraj Publishing (1993).
T.M. Luhrmann, Living with Voices, The American Scholar, Summer Edition (2012).