Getting into the recovery position; Listening to
and working with the psychiatric “voices” we can
and cannot hear.
Dr David Cameron PhD, CPsychol and Psychotherapist
Threshold, Richmond Fellowship NI Ltd
&
Patrick McGowan Service – User Consultant, Health Service
Executive and Dublin City University School of Nursing
 The right to, without censorship, speak
freely or seek, receive and input
information or ideas, regardless of the
medium, a basic human right constituted
and protected under Article 19 of the
Universal Declaration of Human Rights.
An oppressive regime
In circumstances where voices are
oppressed, silenced or go unheard,
autonomy, agency and citizenship are
forfeited, the truth remains
suppressed or undiscovered and the
human spirit is crushed.
Finding your voice in the
psychiatric system
“People have always heard voices. Hearing
voices was what spiritual and artistic people
did and it was perfectly normal. But now,
people who hear voices are simply labelled as
"mad". What has happened to inner voices:
have they changed or is it society that has
undergone a transformation”.
(Press release, Inter-voice, 2006)
Discrimination
 4- 5% of the general “normal” population hear voices
at any given time (Shevlin et al., 2007)
 The vast majority will never be in contact with
psychiatric services.
 Two thirds do not find the experience unduly distressing
(Romme, 2009).
 84% of voice hearers are needlessly discriminated
against because of the 16% whose experiences are
possibly indicative of a genuine illness (Romme, 2010).
These bizarre experiences
are being caused by your
illness schizophrenia
We can diagnose you with the
illness called schizophrenia
because you have these
bizarre experiences
Circular
logic
How do you know
that I have an
illness called
Schizophrenia?
Ah right ????
Passive listeners
 If this relational dynamic is internalized to
critically self-scrutinise it produces a specific style
of subjectivity “governmentality” (Foucault, 1979)
creating compliant or good “patients” (Roberts &
Wolfson, 2004).
 This once a schizophrenic always a schizophrenic
strap-line although not supported by long-term
follow-up studies (Harrison et al., 2001; Calabrese & Corrigan, 2005)
results in negative stereotyping, discrimination,
social exclusion and self-stigmatisation, the
aberrant and synergistic precursors for a career of
dependency and chronic psychiatric disability
which, effectively destroys any real hope of
recovery (Harding, 1987).
Active listeners
 Psychiatric voice hearers who reject the native
language of biological psychiatry and resist having
their "voices" subjugated as the incomprehensible
ramblings of a “broken brain", risk being accused
of lacking insight, which paradoxically is often
taken as further evidence that they are suffering
from a “treatment resistant” mental illness (Thomas &
Bracken, 2004).
Treatment resistant
 For these voice hearers, service - users the
language of psychiatry is experienced as a
powerful, oppressive and malevolent voice
which, paradoxically can compound and
accentuate the distress of the very "voice"
psychiatry is charged with silencing (Walsh &
Boyle, 2009).
The unspoken unspeakable
 Several large-scale research studies have found
that for many, hallucinatory or sensori-motor
experiences are related to early traumaticvictimisation experiences, not least childhood
physical and childhood sexual abuse (Read & Ross, 2003;
Read et al., 2003, 2005; Whitfield et al., 2005; Geekie, 2004; Janssen et al., 2004;
Spauwen et al., 2006; Shevlin et al., 2007).
Perhaps a more sensible
approach would be to simply
tune in the TV.. Privileging and
“working collaboratively with
the service-users frame of
reference, whether he / she sees
the experience primarily as
medical, psychological or even
spiritual phenomenon” (British
Psychological Society, 2000, p. 59)
Tuning in
Talk not just tablets
• Many service users are alarmed
that psychiatrists, mental health
and allied professionals are not
willing to listen to or help them
understand and make meaning of
their experiences in terms of
social, cultural and relational
contexts (Birchwood et al 2000; Faulkner &
Layzell, 2000; Rose, 2001; Vaughn et al., 2004;
Chandler & Hayward, 2009; Romme et al., 2009;
Dilks, 2010).
• Meaning making is an especially
empowering experience (Chandler &
Hayward, 2009; Dilks, 2010) while
"biomedical [or other
reductionist] interpretations are
limited at best unhelpful and at
worst harmful" (Thomas and Bracken,
2004, p. 361).
“The “madman” as defined by
others, is part of society’s cultural
heritage. Whether “madness” is
explained by religious authorities
as demonic possession, by secular
authorities as disturbance of the
public order or by medical
authorities as “mental-illness” the
mad themselves have remained
largely voiceless” (Chamberlin, 1990, p. 323)
Discovering or recovering a voice
 These voices, no longer satisfied with or muffled by a
dominant illness saturated model are vigorously
reverberating from within a recovery oriented
movement.
 A synchronised symphony of concerted and coherent
voices united in reasonably demanding that they are
listened to in the design, implementation and
evaluation of mental health service provision .
From maintenance to recovery
 This voice is beginning to speak a liberating
language that is shifting the emphasis from
maintenance to recovery, entering into open
and honest dialogue with the voices,
personal experiences and narratives of
psychiatric voice hearers.
Prioritising the preference of the
service user
 Service users are clearly telling mental health and
allied professionals what they want:
 A humane response to what is a largely human predicament,
one which does not simply interpret “voices” whether audible
or inaudible as indicative of an illness .
 Voices which must be liberated not subjugated or silenced .
 A shared belief in the fundamental human right to interpret
their experiences in a way which is meaningful and personally
empowering .
 A shift in emphasis from maintenance to recovery supported
by a broad choice of alternative interventions not least those
designed and delivered by service users that is experts by
experience.
Getting into the recovery position
 Recovery must be self-defined and self-directed by the
ideographic narratives of those who own and are living
the experience.
 Equally, because recovery defined from this
perspective assumes a sufficient level of “interpretative
agency” which, hitherto, may have been undermined
by prescriptive paternalistic interventions that have
candidly dismissed the value or validity of the
contextual interpretation of the service – user’s
experience this agency may have to be first discovered
not recovered. (Chandler & Hayward, 2009)
From unsafe certainty to safe
uncertainty
 Crucially for the professional the radical dimension is an
open “willingness to collaborate with experiential worlds
that may disconcert your own” (Chandler & Hayward, 2009, p. 8)
 This means moving from the prescriptive solution focused
position of “unsafe certainty” which, is unreceptive to
individual difference and supports or rigidly defends risk
adverse practices to a position of “safe uncertainty”
founded on the belief that “uncertainty is part of the
human condition” (Mason, 1993).
 From this perspective “the less curious we are the more we
understand too quickly, leading to a position of premature
certainty” (Mason, 1993).
Authoritative doubt
 This does not mean haphazardly abandoning or
undermining knowledge and expertise but rather
holding them together with uncertainty,
foregrounding safety, attending to the variables that
can be reasonably managed but recognising that it is
impossible to account for and cover every eventuality.
 In the asymmetrical power relations of the mental
health system if effective peer collaboration is to
become more than an aspiration professionals must
take up the position of authoritative doubt.
Coercion and duty of care
 Feeling threatened compounded by an absence of
hope and low expectations of change produces a toxic
combination that results in
 Unchallenged paternalism (“duty of care”).
 High use of coercion (46,770 compulsory detentions in
2004/5 in England).
 The prescriptive imposition of misconceived
explanatory models whether recovery oriented or
otherwise to “improve insight” eroding hope and
colluding with chronicity (Roberts & Wolfson, 2004)
To be buried alive
Linguistic lobotomy
 Mental health and allied professionals, therefore,
must avoid the less obvious but equally
disempowering and disabling linguistic lobotomy
which, severs ownership of the experience from
the person owning the experience, as well as
denying them their own attempts to make
meaning of these experiences (Bracken & Thomas, 2005).
Getting into the recovery position
 For the person in recovery this means accepting
that nobody is going to recover for you.
 For the mental health-allied professional it means
relinquishing the omnipotent but delusional belief
that recovery is something which can be either
prescribed or colonised according to the dominant
yet misconceived theoretical presuppositions of
our time.
Radical collaboration
 “Recovery [is and must be based on radical
collaboration it] is not a gift from Doctors but the
responsibility of us all… We [service users –
survivors]must become confident in our own
abilities to change our lives: we must give up being
reliant on others doing everything for us. We need
to start doing things for ourselves. We must have
confidence to give up being ill so we can start
becoming recovered” (Coleman, 1999).
Thank you for listening