‘Inner Voices’: Hearing the Voice in the Guardian

Hearing the Voice is delighted to draw our readers’ attention to ‘Inner Voices’ – a series of blog posts and short articles on voice-hearing and related issues published online by the Guardian.

Written by Hearing the Voice researchers, the articles in the series explore the scientific, philosophical and literary aspects of hearing voices.  Topics covered include the latest research into voice-hearing in people who do not have a psychiatric diagnosis, the neural mechanisms underlying ordinary inner speech and experiences of hearing voices, as well as the representation of voices and inner speech in literary works such as Virginia Woolf’s Mrs Dalloway, Hilary Mantell’s Beyond Black and Samuel Beckett’s Ohio Impromptu, among other issues.

The series also contains the interim findings of the “Writers’ Inner Voices” project – a qualitative study of literary creativity, designed to explore the complex ways in which writers experience the voices, presence and agency of the characters and people they bring to life.

The ‘Inner Voices’ series is available in full here.

In order of publication, the Hearing the Voice posts are:

Hearing the Voice would like to thank the Edinburgh International Book Festival and the editors of Guardian Books and Guardian Science  for making the series possible, and providing us with such a fantastic opportunity to reach new audiences and engage the public in our research.

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Job Opportunity: London Hearing Voices Projects Manager (21 hours per week)

London Hearing Voices Projects Manager rsz_lhvn_logo
(21 hours per week)
NJC SCP 32-34, £30,656-£32,255
(£18,393 – £19,352 for 21 hours per week
)

Aim: To manage all aspects of Mind in Camden’s Hearing Voices Projects and undertake one-to-one, group and development work alongside service users.We are seeking a motivated and experienced individual to take responsibility for the overall management of our innovative London-wide Hearing Voices Projects. To be successful in this role, you need to have an in-depth understanding of the Hearing Voices Movement and the role of peer support groups within this. You will have experience of supervising or mentoring staff/volunteers, and have the skills necessary to build a strong and effective team.

With the confidence and organisational skills necessary to take the lead on busy and diverse projects, on the cutting edge of the Hearing Voices Movement, you will be required to engage with a wide range of stakeholders (from the adult mental health, prison, forensic and youth sectors). As such, this role is best suited to someone who is flexible enough to modify their approach to suit the situation. We are looking for someone with strong facilitation skills who is able to deliver and design training that communicates the values of the Hearing Voices Network clearly and accessibly.

As well as having responsibility for the overall management of the projects, including supervising staff/volunteers and ensuring we meet targets agreed with funders, you will also be required to undertake direct development work when necessary. This could include facilitating Hearing Voices Groups within a prison setting and, as such, it is important that you have experience in the adult mental health sector and supporting vulnerable people. Prior experience of working with people who have been in prison or forensic services is not essential, but a real willingness to do this is.

We particularly welcome applications from people who have lived experience of voices or visions and are able to use this experience to inform, and enhance, their work.

Previous applicants need not apply.

Closing date: 20 October, 3pm.

Interviews: Wednesday 29 October and Wednesday 5th November.

For more information and application forms, please see the job advertisement on the Mind in Camden website

 

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Dawn Edge on ‘The “Schizophrenia Epidemic” among African Caribbeans in the UK’, Joint Special Interest Group for Psychosis, Durham, 24 September 2014, 5.30-7pm

Durham University and Tees, Esk and Wear Valleys NHS Foundation Trust Joint Special Interest Group for Psychosis (JSIGP) is open to all staff working in either the Trust or University.  However, it will be of particular interest to those staff working in ‘psychosis services’ or who are involved in research within the field. A warm welcome is also extended to any service users who would like to attend. The group meets on a regular basis to discuss a wide range of topics and speakers.

The next meeting, featuring a presentation by Dr Dawn Edge (University of Manchester) on ‘The “Schizophrenia Epidemic” among African Caribbeans in the UK: Exploring Causes and Potential Solutions’, will be held on Wednesday September 24th 2014 from 5.30 – 7PM in the Joachim Room, College of St Hild and St Bede, Durham University (30 on this map).

Dawn Edge is a Senior Lecturer in the ‘Centre for New Treatments & Understanding in Mental Health’ (CeNTrUM) at The University of Manchester.  Her research emanates from a passion to reduce inequalities in access, care and treatment for mental health problems experienced by underserved communities. In addition to her academic post, Dawn is a Non-Executive Director of an NHS Mental Health & Social Care Trust and has worked with the Big Life Group to establish an inner-city Free School, which is committed to fostering pupils and parents’ well-being and resilience.

Abstract: African Caribbeans in the UK have the highest prevalence of schizophrenia, most difficult relationships with mental health services and greatest persistent inequalities in care of all ethnic groups.¹ Although rates of schizophrenia in the Caribbean are similar to those among White British people,² African Caribbeans in the UK are 9 times more likely to be diagnosed with schizophrenia. Paradoxically, they are often labelled ‘hard-to-reach’ by services reporting low levels of engagement and delayed access to treatment; resulting in a vicious circle of negative care pathways, coercive treatment, poorer outcomes, fear and avoidance of mental health services.³ Given the personal, social and political cost of the over-representation of African Caribbeans in the most coercive part of the mental healthcare spectrum, it is intriguing that so little emphasis has been placed on developing more effective interventions.

In this seminar, Dawn will explore the on-going debates about the factors that might account for the so-called ‘schizophrenia epidemic’ among people of Caribbean origin in the UK and will consider whether it is possible to take it out of the ‘too difficult to do’ box.

Places are limited for this event.  To reserve a place, please fill in our online registration form.

Service users and their families and friends who attend meetings of the Joint Special Interest Group for Psychosis can receive an honorarium of £20 plus travelling expenses.  For more information and to obtain the relevant claim forms, please contact Valentina Short.

If you would like to receive information about future JSIGP meetings via email, please sign up to the JSIGP mailing list.

References
1.  Morgan, C., et al., First episode psychosis and ethnicity: initial findings from the AESOP study. World Psychiatry, 2006. 5(1): p. 40-46.
2.  Mahy, G., et al., First-contact incidence rate of schizophrenia on Barbados. British Journal of Psychiatry, 1999. 175: p. 28-33.
3. Keating, F., et al., Breaking the circles of fear: A review of the relationship between mental health services and African and Caribbean communities. 2002, The Sainsbury Centre for Mental Health: London.

 

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Time 2 Change: bARTer, BALTIC Centre for Contemporary Art, 8 September – 19 October 2014

Screen Shot 2014-09-04 at 12.08.42Time 2 Change: bARTer
Monday 8 September – Sunday 19 October 2014
Level 2 Quay Gallery, BALTIC Centre for Contemporary Art

Launchpad, in partnership with BALTIC Centre for Contemporary Art, is delighted to present bARTer – an exhibition of work by artists with lived-experience of mental illness from two regional charities, Newcastle & Gateshead Art Studio (NAGAS) and North Tyneside Art Studio (NTAS).

The exhibition aims to instigate meaningful interaction and dialogue with the public around perceptions of mental health.

The planning, design and curation of the programme was led by 30 NAGAS and NTAS artists, working with Baltic Artist Lesley Rose in a series of seven workshops.  The result is an exhibition of the artists’ work, exploring ideas, perceptions and conversations around mental health.

bARTer opens on Monday 8 September 2014 at BALTIC Centre for Contemporary Art, Gateshead, NE8 3BA and runs until Sunday 19 October 2014.

NAGAS provides an innovative range of creative services directed at improving and enhancing the quality of life, health and social integration of its members.

NTAS is an award-winning organisation based in North Shields that has been using art and creative activities as a mechanism to transform the lives of people experiencing mental health problems since 1991.

Launchpad works to redress the balance, and offers the chance for anyone who uses mental health services in Newcastle to have their voice heard by the people who run these services.

The bARTer project is funded by Time to Change, England’s biggest programme to end the stigma and discrimination faced by people with mental health problems. The programme is run by the charities Mind and Rethink Mental Illness, and funded by the Department of Health, Comic Relief and the Big Lottery Fund. 

Screen Shot 2014-09-04 at 12.55.25

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Review of ‘You Are Not Alone’ by Roz Oates, Edinburgh International Book Festival, 17 August 2014

Roz Oates, a doctoral student in Durham’s Centre for Medical Humanities and Department of Geography, who is also part of the ‘Hearing the Voice’ research team, writes:

On Sunday 17 August I attended a presentation called ‘You are not alone’ at the Edinburgh International Book Festival. Nicola Morgan, Donna Conner and Dawn McNiff, authors who have written about voice-hearing or visions, discussed how they have presented these issues in books written for young people. The event was held as part of the wider ‘Conversations with Ourselves’ programme, funded by the Wellcome Trust, which the ‘Hearing the Voice’ research team at Durham University was a key partner in. I was drawn to the event, as I have previously worked as a tutor teaching young people, and I wondered how these authors had presented the challenging topic of voice-hearing in a way that is accessible to a young audience. I am also aware of the lack of first-person narratives of psychosis written by teenagers, and I was interested to learn how authors had imagined and dramatized the experience of voice-hearing. I hoped that I would hear descriptions of voice-hearing that seemed realistic, and that the young person would be shown to grow with the experience, in a way where they could better cope with it.

Nicola Morgan, an established authority on the teenage brain has written The Teenage Guide to Stress. She explained that this book grew out of a survey of the different stresses that teenagers experience, such as those associated with exams or relationships. She pointed out that adolescent stresses are different to those which adults’ experience. Morgan read an excerpt from the end of her book, when a teenager explains that now she is able to cope with stress, as she wants to help other teenagers realise that this is possible. Morgan pointed out that in a supportive family, a teenager feels able to have emotional outbursts, and in this way can release emotions. However, in a non-supportive family, the young person takes on the role of the adult. Morgan suggested that for teenagers who face trauma or pressure, and find themselves troubled with unusual experiences, such as hearing a voice, it is important for them to find the right person to talk to. In this way they will discover that they are not alone. The Chair for the panel discussion, Lorna MacDonald, said that for the young person feeling that they are not alone is an important first step to getting help.

All of the authors emphasised that it is important not to pathologise the voice-hearing experience, as this may stop a young person from seeking help. Hearing voices or having visions does not necessarily mean that a young person has an illness. Ben Alderson-Day has recently written a post on voice-hearing in people who do not have psychosis or any other particular mental health problem. (If you’ve missed it, it’s still up here.) As Morgan suggested, besides people with schizophrenia, 1% of people will hear a voice when no-one is there. In the cases of both protagonists considered in Donna Conner’s Skinny and Dawn McNiff’s Little Celeste, the unusual experiences were triggered by difficult events, and it is important for the young people concerned to work through their emotional issues. Donna Conner, the author of Skinny, follows an overweight teenage girl, Ever Davies, who hears a vicious and undermining voice, which she calls Skinny. Her voice is linked to her very low self-esteem, and the bullying that she experiences at school because she is morbidly obese. Conner candidly related her exploration in this book to her own experience of hearing an inner, critical voice telling her that she needed to lose weight, before she had weight loss surgery. As Conner said, ‘everyone has a skinny’, in the sense that most people have something that they feel insecure about.

McNiff in Little Celeste describes how her protagonist, a child called Shelley finds a baby on her bed. Shelley is about to go to secondary school, and she feels abandoned by her Mum, who is distressed because her boyfriend has recently left her. For Shelley, the baby feels like a real baby. The baby grows into a toddler and shrinks again. By looking after the baby, Shelley learns to soothe and calm herself. McNiff said that she is interested in how the imagination heals. McNiff pointed out that it is very difficult for Shelley to have her own needs fulfilled. Shelley learns through caring for the needs of the baby. However, once Shelley starts to stick up for herself, she ends up not needing the baby.

In a discussion among the panel after the authors’ individual presentations, Morgan said that ‘I firmly believe the more we understand about how we react, that is the best way towards understanding mental health’. Morgan suggested that this place of understanding is crucial, for hopefully the young person can discuss what is on their mind before they are under such pressure that they begin to hear a stressed, negative voice. As Lorna MacDonald pointed out, stress can manifest itself in different ways, and she pointed out that some young people start to hear voices and see visions that are not there. Donna Connor made the helpful point that ‘the worst bully of all is the one that lives between your own two ears’. Therefore, the overall message communicated to the audience by the different authors was that young people need to feel that they can ask for help, as receiving support can make a real difference. As Morgan pointed out, talking therapy works better if it is started earlier.

Voice-hearing experiences are fairly common and are not necessarily in themselves a cause for concern.  However, if you hear voices and these experiences continue to cause significant distress or interfere with your relationships or daily activities, you should seek the advice of your GP or family doctor and seek other sources of sympathetic support.  In the UK, the Hearing Voices Network offers information, support and understanding to people who hear voices.  Voice Collective also provides excellent online resources, peer support groups and creative workshops designed specifically for young people who experience voices and visions and their families and carers.  Many people find it helpful to engage with other people who hear voices.  If you live in Scotland or the North-East of England are are looking for a support group in the region, you might find it useful to consult our interactive map of peer support groups, which contains the contact details, times and locations of many Hearing Voices groups, including those specifically for adolescents and young adults.

 

 

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‘Talking to the Voices in Our Heads’ by Sam Wilkinson and Felicity Dreamer

In a recent piece for the Guardian’s Inner Voices series, Dr Sam Wilkinson (Postdoctoral Research Associate in Philosophy, Hearing the Voice) and Dr Felicity Dreamer (Postdoctoral Research Associate on the Language and Mental Health Project) write:

Somebody hears a voice, but nobody is speaking. It seems reasonable to assume that there is something going on in the head of this person that is similar to what is going on in the head of somebody actually hearing someone speak. The challenge is to explain why this is happening in the absence of a speaker.

One popular strategy is to explain it in terms of someone’s ordinary “inner speech” somehow becoming “loud”. This will explain why somebody has an auditory, and specifically verbal, experience in the absence of sound waves hitting their eardrum. However, it does not explain why so many cases of voice hearing are perceived to come from another speaker.

Perhaps we need to think outside the box. Perhaps we should not focus on sounds and how hearing works, but rather on communication and how that works. There are a number of reasons not to focus on audition. One is that some voice-hearers describe an experience of “soundless voices”. For example, one participant in a recent study told us: “It’s hard to describe how I could ‘hear’ a voice that wasn’t auditory; but the words used and the emotions they contained were completely clear, distinct and unmistakeable, maybe even more so than if I had heard them aurally.”

Another is that “voices” are also experienced by congenitally deaf people. Jo Atkinson, a researcher in London, has done very important work correcting the “audio-centrism” of mainstream clinical perspectives on voice-hearing. She has shown that deaf voice-hearers experience vague visual imagery like being addressed in sign-language, or of disembodied lips. At other times they see text. But they do not have auditory experiences at all.

What has been overlooked is an aspect of how we normally perceive speech. The usual conditions of someone speaking, and one’s understanding them, do not only involve the sounds that they make, but also what they intend to communicate. The study of communication is the territory of pragmatics, the branch of linguistics that studies utterances rather than sentences. Utterances are sentences used in context, at a particular moment and place, by a particular person.

It is important to recognise that a voice-hearing experience is the experience of a spoken utterance, not a sentence. So on hearing an utterance, a hearer will automatically interpret its meaning. It is this interpretation process that might be able to explain why there so often is a speaker (eg a person, a demon, or a god) behind the voice. In order to interpret the meaning of an utterance, a hearer must consider the intentions behind its use at that moment. In fact, some theorists in pragmatics argue that you can never get any meaning out of an utterance without attributing some kind of intention. And intentions are never free-floating: they are always the intentions of someone (or something with a mind).

A voice-hearer might hear the utterance “He is a loser”. Without knowing whom the speaker is referring to, the hearer can’t know what is meant by that utterance. And yet it seems that voice-hearers generally know who is being referred to in their voices, and what the voices mean. This suggests that the voice-hearer takes there to be a speaker behind the voice, with an intention to communicate.

Within this approach, where voice-hearing experiences are primarily viewed as communicative rather than auditory, it becomes less surprising that the voice is taken to come from a speaker, since this is a necessary dimension of all communication.

This points us in fruitful therapeutic directions. It indicates that therapies shouldn’t solely focus on getting the voice, the auditory experience, to simply go away, but instead aim to change the voice-hearer’s relationship towards the voice (the speaker). Two recent therapies are in keeping with this. In one, voice-dialoguing, a therapist encourages the voice-hearer to repeat what the voice says so that the therapist can “converse” with it. In another, avatar therapy, the voice-hearer is encouraged to build an avatar – a visual representation of the voice – with which they can interact as though it were a real person. Both have shown promising results.

This article was originally published here in the Guardian’s ‘Notes and Theories’ science blog on 26 August 2014.

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‘Hearing voices allowed Charles Dickens to create extraordinary fictional worlds’ – by Peter Garratt

In a recent piece for the Guardian’s Inner Voices series, Lecturer in English Studies and participating researcher in the Hearing the Voice Project Dr Peter Garratt writes:

Evelyn Waugh’s A Handful of Dust (1934) ends with its protagonist, Tony Last, trapped in the Brazilian jungle by his captor, Mr Todd, who compels him to read aloud the complete works of Charles Dickens, in sequence, over and over, without end – or escape. It’s a fantastically dark conceit: the great Victorian novelist as the sadist’s accomplice. It also links Dickens to the possibility that there is something potentially oppressive, even imprisoning, in experiencing the human voice. Voices, it suggests, may tyrannise the mind.

Waugh linked Dickens elsewhere with hearing voices. In The Ordeal of Gilbert Pinfold (1957), most notably, the middle-aged writer Pinfold suffers an acute mental crisis while at sea, repeatedly hearing the thrum of human voices coming from the ship’s pipes. Or so he assumes: in fact, these voices are persistent, imaginary, and unsolicited – that is, auditory verbal hallucinations, seemingly related to Pinfold’s dependency on alcohol and sedatives (Waugh wrote from first-hand experience). The voices follow Pinfold around wherever he wanders on the ship, causing increasing perturbation. And the ship’s captain has the unmistakably Dickensian name Steerforth (after James Steerforth in David Copperfield, another sadistic master).

Most modern readers may feel instinctively that literary experience has much in common with the act of overhearing. Reading fiction is a process of allowing characters’ voices to sound in the inner ear, and absorbing the imagined noise they make (magically cued by curls of ink on a page). It’s common to think of writers, too, building fictional worlds through voices, as if creativity begins as a subtle internal overhearing. The analogy between imagining and hearing certainly runs deep in our myths of culture. Inspiration, that theory of composition at once ancient, Romantic, and modern, tells us that creativity ignites by admitting some mysterious other voice into the writer’s flow of being. To write means having one’s voice disrupted, taken over, rendered by another. Dickens believed this, too.

Later in his career, Dickens’s vocal impersonations of his own characters gave this truth a theatrical form: the public reading tour. Although wisdom has it that “doing” the different voices of his cherished characters hastened his death, no other Victorian could match him for celebrity, earnings, and sheer vocal artistry. The Victorians craved the author’s multiple voices: between 1853 and his death in 1870, Dickens performed about 470 times. “Amid all the variety of ‘readings’, those of Mr Charles Dickens stand alone,” beamed the Times in 1868. Edgar Johnson, his first post-Freudian biographer, wrote in the 1950s: “It was [always] more than a reading; it was an extraordinary exhibition of acting that seized upon its auditors with a mesmeric possession.”

Hearing voices and inventing character were also indivisible aspects of his creativity. Dickens understood his astonishing writing practice as the summoning of voices. “Every word said by his characters was distinctly heard by him,” one critic stressed in 1872. Dickens himself considered his novels to come from some autonomous source beyond volition, as he wrote to his friend John Forster: “when I sit down to my book, some beneficent power shows it all to me, and tempts me to be interested, and I don’t invent it – really do not – but see it, and write it down”. How literally he meant this is hard to judge. But allowing in unsolicited presences was central to his self-understanding as a writer. Mrs Gamp, the disreputable nurse from Martin Chuzzlewit, intruded repeatedly on Dickens when he was writing that novel, “whispering to him in the most inopportune places – sometimes even in church – that he was compelled to fight her off by force”, as the American writer JM Peebles later put it.

Like mesmerism, which he took up, illusion and hallucination were topics of serious interest to Dickens. An essay of 1857, My Ghosts, published in his own journal Household Words, explored these fragile mental states. And his fiction features unanchored voices, such as in his 1866 Christmas story The Signal-Man, which begins with the sudden intrusion of an unidentified voice bellowing “Halloa!” out of nowhere. Members of the international hearing voices movement today argue that voices represent a part of the person that wants to be heard and acknowledged. Whether modern theories help us to better understand Dickens, or vice versa, seems unclear. But he was an exemplary source of voices, as both a writer and performer, in ways that should ask us to consider how we culturally frame literary creativity, inner speech and audition, and unusual mental experience.

This article was originally published here in the Guardian’s Books blog on 22 August 2014.

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