Psychiatry and Hearing Voices: A Dialogue With Eleanor Longden

This could be one of my most important blogs. It is an attempt to find common ground between psychiatry and the Hearing Voices Movement (HVM)-a growing international grassroots effort to help people find meaning in their troubling experiences.

The dialogue began when Eleanor Longden gave a wonderful TED Talk (The Voices in my Head), viewed nearly a million times since its release last month. The editors at Huffington Post then asked me to comment on her talk (Psychiatry and Recovery: Finding Common Ground and Joining Forces).

I was enormously impressed by Ms Longden and have always looked favorably on the HVM, but did express the concern that some viewers who really need psychiatric medicine might misinterpret her talk as an invitation to stop taking it. There has since been a productive back and forth on the relationship between psychiatry and recovery. See the Open Letter to me from members and supporters of Intervoice, the organizational body of the HVM and my response.

Along the way, Eleanor and I began an enjoyable email correspondence that made clear to both of us how like-minded we are. Here are her thoughts and my summary of our agreements:

Ms Longden: As Allen says, there is considerable overlap in our perspectives, and Intervoice respects and supports his work in highlighting the dangers of over-diagnosis and over-medication.

Many Intervoice members receive support from mental health services, and we have always encouraged respectful partnerships and alliance with mental health professionals of all disciplines (for example, the co-founder of the HVM, and the current Chair of Intervoice, are both psychiatrists). And I personally discovered the HVM via an extremely creative, empathic psychiatrist whose patient I was at the time.

Intervoice likewise recognizes that many people find medication helpful and advocates for informed choice following honest, open discussions between patients and prescribers about the benefits and limitations of psychiatric drugs. Essentially, we support people to find solutions that are meaningful and useful for them, and our emphasis is on propagating choice and good information.

Clearly, people have been helped as well as harmed by mental health treatment, and while we critique and question the practice of some psychiatrists, we have never located ourselves as an “anti-psychiatry” movement.

Intervoice does, however, object to reductionistic biomedical mindsets, especially in our approach to voice-hearing. While we acknowledge that hearing voices can cause extreme distress, we consider it a meaningful experience that can be explored and understood (an opportunity for learning and psychological growth, even if the lessons are painful and difficult) rather than just a pathological symptom devoid of context.

We emphasize research that locates voice-hearing (and other classic indications of psychosis) as the result of life conflicts and difficulties. Correspondingly, we question the dominance of therapeutic practices derived solely from biomedical models.

What I endured so disastrously was the application of a reductionistic biomedical model that is practiced in numerous hospitals in the Western world. Voice-hearing was seen as a meaningless symptom of disease-leading to coercive, overzealous prescription practices, the privileging of biology over psychosocial circumstances, and the overstating of medication’s effectiveness whilst minimizing both its limitations, and the hazards of long-term use.

Intervoice’s approach is not a therapeutic model. At its heart, it is about solidarity and social justice. It emphasizes the right of individuals to hold their own beliefs about their experiences and recognizes that, whatever their cause, these are personally meaningful. We believe in the possibility for positive coping, whole-life recovery, and learning to listen to voices without torment and distress. No one is ‘too ill’ to benefit.

We use diverse strategies to promote change, including self-help groups, recovery and coping models, psychosocial formulation, social/political activism, narrative approaches, and sharing hopeful, positive information. Just like traditional psychiatric models, Intervoice’s approach does not suit or appeal to everyone. We see that every recovery story is unique, and never advocate for restrictive, “one-size-fits-all” policies.

What we emphasize is something often missing in mainstream mental health: choice. We believe that people are experts in their own experience; that meaning should not be coercively imposed by outsiders. Those who are distressed by what’s happening to them should be treated as active partners in seeking solutions.

For example, people who come to voice-hearing self-help groups endorse a broad range of explanatory frameworks for the voices they hear. We support people to make sense of what’s happening to them, listen to their stories, explore what their beliefs mean to them, and offer support and input in working towards healing and recovery; but no one is told their beliefs are “wrong,” and no one is turned away.

Too often, these choices are withheld in traditional services. A final, crucial aim of Intervoice is supporting people to have positive identities as voice-hearers.

In mental health there are groups perceived as great medical organizations, or great therapy organizations, or organizations excelling in research. To me, Intervoice and the HVM it represents, is a great humanitarian organization, reaching out across the world.

I first encountered it as a traumatized, demoralized patient, and through it discovered aspirations that transcended notions of ‘cure’: to envisage and enact a society that understands and respects voice-hearing, which supports the needs of those who hear voices, that values and protects their citizenship, and which promotes a liberating space to feel pride, dignity, empowerment, and a voice that can be heard.

Thanks, Eleanor. We are in complete agreement on all the following points:

•We both believe there is no one size fits all way to understand and deal with hearing voices.
•We both agree that medication prescribed appropriately and collaboratively can be necessary and helpful for some people; and when prescribed inappropriately can be excessive and harmful for others.
•We both agree that voices (just like dreams) are meaningful experiences that are informative about both internal psychological conflicts and external life stresses - and are not just a pathological symptom devoid of context.
•We both believe in the value of individual resilience and fortitude in listening to, learning about, and coping with voices.
•We both believe in hope, courage, and that no one is ‘too ill to benefit.'
•We both believe that treatment relationships should be collaborative partnerships.
•We both believe in the important role Intervoice has played in supporting those who are struggling with voices.
•We both believe that psychiatry done poorly follows a narrow biomedical reductionism, while psychiatry done well benefits from an inclusive and humanitarian model that integrates biological, psychological, and social factors.
•We both believe in active advocacy for those who are badly under-served, unsupported, and stigmatized in so many parts of the world.

This exchange has been a great pleasure and I hope contributes in some small way to greater interaction and synergy among all of us who are trying to do our part to relieve emotional and mental suffering.