Bargaining with the voices in our heads

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    Karen Taylor and Ron Coleman lead a workshop on hearing voices in Philadelphia. Participants traveled from as far away as Wisconsin and Florida to attend. (Kimberly Paynter/for The Pulse)

    Karen Taylor and Ron Coleman lead a workshop on hearing voices in Philadelphia. Participants traveled from as far away as Wisconsin and Florida to attend. (Kimberly Paynter/for The Pulse)

    New treatments for a stigmatized group of patients emerge.

    Berta Britz hid the voices she’s heard for a long time, spending years in and out of hospitals and on disability.

    “One of the most common things they say is, ‘You belong in flames. Stab the eyes and slash the arms. Crash the car. All that you touch is tainted.'” Britz, a petite, middle-aged woman who wears small frameless glasses, has a diagnosis of schizophrenia. But she said the medications she takes “never turned the voices off.”

    Around 75 percent of people with schizophrenia report hearing voices, and it is a symptom long associated with this and other serious mental illnesses. But not everyone who hears voices that other people don’t has a mental illness. Now, momentum is growing for a movement that reframes how “voice-hearers”—the term used by people in the movement to describe themselves—get treated.

    The World Hearing Voices Movement was started by Dutch psychiatrists Marius Romme and Sandra Escher. Their research demonstrated that hearing voices does not necessarily correlate with a psychiatric diagnosis. Their other findings also defied prevailing medical treatment of voice-hearing. Romm and Escher discovered that in 70 percent of voice-hearing cases, the voices are related to past trauma.

    People who tell their doctors that they hear voices might be told to ignore them, have their medications upped, or even told to wear headphones to drown the voices out, said Mark Salzer, a psychologist and Director of the Collaborative on Community Inclusion of Individuals with Psychiatric Disabilities at Temple University. In other words, “There’s no way you could possibly do anything in your life while you’re still hearing voices so we need to medicate, medicate, medicate,” said Salzer.

    So putting trauma—not pathology—at the root of voice-hearing is a helpful change, said Salzer. The other benefit of the world hearing voices movement? “Bringing people together for peer support,” said Salzer. The movement encourages voice-hearers to start their own local support chapters, and it’s been instrumental in raising awareness of alternative treatments to hearing voices.

    Talking, not just medicating

    “I was taught not to talk to people about their voices,” said Karen Taylor, a mental health nurse from the United Kingdom. “It would be bad, a horrible thing would happen to the person.” Taylor runs a mental health non-profit called Working to Recovery in Scotland with her husband, Ron Coleman, a voices hearer.

    Taylor doesn’t believe that any more. She and Coleman teach peer supporters and health care professionals how to talk to people about their voices. In particular, they use something called a “voices profile” to get people to describe each voice and how it might relate to their life. “This is in conjunction with hearing the person’s story,” said Taylor. She said hearing the person’s story—and working on corresponding trauma—can help people live with their voices.

    Talking about voices can also encourage other evidence-based practices for managing voice-hearing, like reality-testing. This means “calling out” the voices on their threats and acknowledging where their power to disrupt or hurt comes from. “If I tell my voices to do the dishes, the dishes don’t get done,” said Berta Britz. “In the physical world they don’t have power, the only power is what I’ve given them.”

    The lessons of the hearing voices movement have been life-changing for people like Britz. She now bargains with her voices, promising to talk with them 20 or 30 minutes each night in exchange for not intruding during the day. “By setting up boundaries, I changed the relationship to them having all of the power and my having none, to both of us having some power,” said Britz. While one entirely negative voices remains, she said the others have become less negative and even supportive. Now, “I have one who will sometimes tell a joke,” she said.

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