# When the past is present: the multiple meanings of ?hearing voices?



## Harebells (May 19, 2017)

*When the past is present: the multiple meanings of ‘hearing voices’*
by Simon McCarthy-Jones, _The Irish Times_
April 26, 2017

_*Experiencing multiple childhood traumas is  associated with voice-hearing to an extent comparable to the association  of smoking with lung cancer*_

What does it mean when someone is  “hearing voices”? It has been seen as a sign of the divine and a symptom  of illness. For much of the 20th century it was tightly tethered to  schizophrenia. Yet a new perspective has emerged. This has proposed  alternative meanings and causes for voice-hearing, and is developing  innovative ways to help hearers. This approach has been driven by people  who hear voices themselves.

Today, within psychiatry,  distressing voice-hearing is predominantly seen through a biomedical  lens. It has been deemed “a symptom of brain disease just like  blindness”. This is nothing new. If we asked the Ancient Greeks about  hallucinations, their reply would not be all Greek to us. They would say  voice-hearing is caused by a chemical imbalance that should in turn be  treated by other chemicals, albeit ones with unpleasant side-effects.  Two thousand years later, only the names of the chemicals have changed.

The problem with a biomedical  approach is not that there aren’t brain changes associated with  voice-hearing. There are. Much research, including my own, has found  evidence of this. Neither is the problem that this approach can’t help  people. It can. Antipsychotics can be of great help and can save lives.

The first problem with this  account is its tendency to not look beyond biology. It assumes it is  unproblematic that only 0.3 per cent of schizophrenia research has  investigated the role that child abuse may play in its development. It  also attempts to sneak by us the assumption that biological changes  demand biological solutions. It assumes new medications are needed,  rather than new meanings.

A further problem is it equates  the elimination of voices with recovery. This assumes voices don’t have  important messages for the hearer. Furthermore, if the drugs don’t work,  and for many people they don’t, it may be assumed little else can be  done (although one should never simply stop taking antipsychotics;  coming off these without medical advice can be dangerous).

Finally, it shuts the door to the  expertise of voice-hearers by assuming the activity of their brains and  genes can tell us vastly more than their act of telling their story. All  these assumptions have been questioned by the Hearing Voices Movement  (HVM), an organisation led by voice-hearers and supported by academics,  mental health professionals, family members, and others. Although there  are indeed valuable things that people cannot tell us and that only  magnets and centrifuges can reveal, it has emerged that without the  context of a person’s life, centrifuges may only spin lies and magnets  repel, not attract, truth.


_Many voice-hearers have found that the hands of the past are clearly working their voices. This past has often been traumatic_ 
​
An exorcist once rhetorically  asked me what else could explain vile and vitriolic voices, if not the  devil. We do not have to look far for an answer. “It was clumsily done,”  wrote Samuel Beckett in The Unnamable, “you could see the  ventriloquist.” Similarly, many voice-hearers in the HVM have found that  the hands of the past are clearly working their voices. This past has  often been traumatic.

Formal research has now caught up  with the insights of voice-hearers. We now know voice-hearing is  strongly associated with child abuse. A 2012 study of the general  population found that experiencing multiple childhood traumas was  associated with voice-hearing to an extent comparable to the association  of smoking with lung cancer. This bears repeating. Experiencing  multiple childhood traumas is associated with voice-hearing to an extent  comparable to the association of smoking with lung cancer. Other  studies have since estimated that if we eliminated five specific types  of child abuse we would prevent a third of cases of psychosis. The  imbalance that many voice-hearers experience is not best understood as  being one of chemicals, but one of power.

Given that traumatic life-events  cause brain changes, one could suggest voice-hearing is a sign of a  brain disease caused by trauma, and promptly return to biomedical  remedies. Instead, the HVM has suggested that voices may profitably be  listened to and decoded, rather than just suppressed. To do this it has  developed tools such as the Maastricht Interview. Through this, voices  can come to be recognised as misunderstood messengers. A voice telling  the hearer to kill themselves could be understood as a very badly  communicated suggestion that one needs to make significant changes in  one’s life, or as a call for acknowledgement of pain.

Eleanor Longden describes how she  compassionately spoke to one of her voices, saying “You represent awful  things that have happened to me, and have carried all the memories and  emotion because I couldn’t bear to acknowledge them myself. All I’ve  done in return is criticize and attack you. It must have been really  hard to be so vilified and misunderstood.” After a long pause, one of  the voices responded: “Yes. Thank you.” If this approach could make  apparently nasty voices nicer this would be a major breakthrough, as the  strongest predictor as to whether a voice-hearing person will enter  psychiatric services is if they hear nasty voices. Formal trials of the  Maastricht Interview are now underway.


_There is no one reason people hear voices, and there is no one answer.  There is, however, only one place to start, and that is with listening_ 
​
Hamlet knew there was something  rotten in Denmark, because a phantom appeared and told him so. Many  phantom voices are telling us the same thing. We should already be aware  of the extent of the problem of child abuse in society. However, there  is a need for greater awareness of the potential mental (and physical)  health consequences of such abuse. It was once said that rape is a  problem with no name. This is wrong. It is a problem with many names,  but these exist in a psychiatric hall of mirrors, most of which never  actually name it. We need to acknowledge that diverse disorders,  including schizophrenia, bipolar disorder, borderline personality  disorder, depression, anxiety, and anorexia may all, in some cases at  least, have their roots in experiences of child abuse. We have become  better at identifying child abuse, we now need to be better at  recognising its potential effects, including voice-hearing.

Of course, not everyone who hears  voices does so due to child abuse. There are many routes to  voice-hearing, and also many ways to cope with it. Some people simply  want their voices stopped. New ways to do this are needed. I have just  received funding from the US-based Brain & Behavior Research  Foundation to trial neurofeedback for voice-hearing, in collaboration  with Dr Michael Keane’s Dublin-based Actualise neurofeedback clinic.  This will test if training voice-hearers to control the activity of  their brain can quieten or eliminate their voices. Yet other people will  want to dive deeper into their voices to try and learn from them.  HVM-based Maastricht Approach Centres have been opened in the UK to  facilitate this, and training in this approach is being delivered across  Ireland.

There is no one reason people hear  voices, and there is no one answer. There is, however, only one place  to start, and that is with listening.

_Dr. Simon McCarthy-Jones is an Associate Professor in the Department of Psychiatry at Trinity College Dublin, Ireland. *Can't You Hear Them?* is published by Jessica Kingsley Publishers._


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## forgetmenot (May 19, 2017)

If it is a chemical imbalance of the brain then one would think the voices would be constant i don't know. 

  Sometimes for some the voices tend to come only under extreme stress and then leave again just as quickly as it came and to them the voice is real they heard it only to be told no one had said anything or they can see themselves no one is around to have said it.

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I like the statement new meaning is needed not new medication  new meaning to what is happening.


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## MHealthJo (May 21, 2017)

Wow, this is amazing information. I have read very little in this field.... thanks so much for sharing this!


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