In this article, Simon McCarthy-Jones (HtV team member) reviews Emily’s Voices, a thought-provoking memoir which recounts Emily’s struggle with voice-hearing and her journey through the mental health system. Simon is an Associate Professor in Clinical Psychology and Neuropsychology at Trinity College Dublin, and author of the recent book Can’t You Hear Them? The Science and Significance of Hearing Voices.
Emily’s Voices is a memoir by Emily Knoll. The title refers to the voices that this eloquent young author hears, which others cannot. To me, the book appears to have four aims. First, to communicate what the often misunderstood phenomenon of ‘hearing voices’ is (and is not) like, in the author’s own experience. Second, to describe why this experience was problematic for the author (which has as much to do with other’s reactions as it does the voices themselves). Third, to delve into the author’s past to flag factors that may have contributed to the development of her voice-hearing. And, finally, to communicate a much needed message of hope by telling the author’s own experience of recovery, including the transformation of her identity from ‘service-user’ to professional researcher.
The book is well written, well structured, reflective and offers a wide range of insights. It is not weighed down by academic jargon, but is clearly and powerfully written in the author’s own voice and is a pleasure to read.
The book is split into three parts. Part one (~50 pages) involves the author describing her childhood. Emily curates her past to include aspects of her childhood that it appears the reader is meant to suspect are of potential relevance to her later development of voice-hearing. These include emotional neglect, being forced to suppress emotions (“I learned to hold in my emotions”, “I did my best to push the feeling down deep inside me”) and creating a split-off inner world (“I started to develop an internal world that split me off from those around me, in a way that I had designed to give me protection and comfort”). However, the author does not put forward an explicit theory as to what led to her coming to hear voices.
Part two describes Emily’s descent into voice-hearing (she only reports one fleeting experience of voice-hearing in part one). She moves to London as a young woman and it is in the ensuing stress and isolation that voice-hearing proper starts. Emily embeds the descriptions of her voices in the context of her life at the time. As a result, when describing what the voices say, the reader can see how these often reflect her own fears. Emily also brings us closer into the experience by describing what the voices sound like, and the effects they have on her. Given my own personal research interests, I would have appreciated even more detailed descriptions to help me understand more about what Emily’s voices were like. This part of the book also describes her (generally unsatisfactory) experiences of traditional psychiatric and psychological treatments at this time.
The final part of the book describes Emily’s ascent. She encounters alternative approaches to voice-hearing, finds new sources of support, and returns to higher education. Through the Hearing Voices Network she is introduced to the idea of talking with her voices, rather than just telling them to shut up. She also encounters the idea of voice-hearing as a potentially positive experience and something to be proud of. She has helpful encounters with psychiatrists and psychologists, as well as with colleagues and friends. A new psychotherapist introduces her to the idea that the voices are parts of her own self and gives her someone she can talk to about the stresses she faces. Emily is able to use her own experiences and interest in voice-hearing to embark on a successful research career,
The book ends just after her beloved Gran dies. At the funeral Emily tells herself what she will now do with her life and vows to “enjoy my life, like Granny enjoyed hers”. We are then updated as to what she has achieved since, and her continuing learnings, fears and hopes for the future. The end of the book is a beginning, and a hopeful one.
A number of inter-related themes in the book jumped out at me; fear and the need for safety, isolation and the need for love and understanding. Late in the book, Emily describes her childhood as one of “long-term neglect”. Indeed, throughout there is a poignant sense of a child desperate for love and security, but who fails (to various degrees) to get this from her father, mother, brother and grandparents. As an adolescent struggling with voice-hearing, Emily again manifests a core need for love and safety. She shows how psychiatric wards can spectacularly fail to provide this most basic and urgent human need.
However, the theme which struck me most strongly was control. Experiences of lacking control flood the book. There is an absent father whose appearance/disappearance Emily cannot not control (despite her attempts to, including a poignant and memorable effort involving a pink pillowcase). There is irregular access to loving grandparents as a child, access which she cannot not control but which others, such as social workers and her mother, can. She wishes for a friend’s sense of control when it comes to eating. She resents her grandmother’s control of food when Emily develops bulimia. Again and again describes the stress of not having control.
Indeed, when Emily recounts her first experience of voice-hearing, aged 13, even the voice is trying to control her. After being discharged from hospital, having been admitted for anorexia, her Mum gives her a creamy lasagne. Emily then hears a loud female voice, like that of one of the doctors from the hospital, saying “You have to eat it. You know that”. Emily relates this voice to the control she felt her doctor had over her, whilst admitted, and still has over her at home where she is under instruction not to lose more weight.
Emily’s emotions are also controlled by others, as she is forced to suppress them (“I realise that when I learned to hold in my emotions it was as if I was not allowed to show my sadness”; “this was really unfair of our mum, I did my best to push the feeling down deep inside me”). When she is taken advantage of by an employer and overworked, she can’t express anger and can’t quit as she has no money to pay her way.
As a result of being deprived of control over so many aspects of life, Emily repeatedly tries to find something she can control. This often comes at a cost. First there are rituals (“I was starting to establish rituals and ways of thinking that gave me a greater sense of control”). Second, there is control over eating, which leads into anorexia and bulimia. Obsessions and eating disorders are revealingly portrayed as attempts to get back control over one’s life, arather than as symptoms of disease.
The reader is also shown the powerful effects of the negative way that voice-hearing is portrayed in our society. Emily describes how her initial view of what hearing voices meant was shot through with hopelessness and pessimism:
“What if these voices were here to stay? In thirty years time I’d be like the grey overweight mentally ill women on the ward, who sat zonked out in front of daytime telly. This thought terrified me”
“ ‘People do recover from breakdowns’ he said, and smiled… I added ‘Not if they hear voices’ ”
Her pessimism seems to stem from her absorbing negative public perceptions, specific things said to her by mental health professionals, and a lack of positive role models. For example, Emily relates how:
“When I had been discharged from the hospital, I had been told that I had a chemical imbalance in my brain, and I needed to be on medication for the rest of my life”.
She is unable to challenge this claim as she does not have access to living evidence to refute it. She describes how:
“I didn’t know any other young person who also experienced psychosis, so I didn’t know that recovery was possible”.
When Emily does encounter positive examples of recovery, these appear to be of great help; “I felt encouraged, knowing that someone else’s struggle with their voice had ceased”. She meets a member of the Hearing Voices Network who educates others about the experience, copes well with her own voices, and tells Emily that some people welcome the voice-hearing experience. The trainer is “proud to be a voice-hearer”. Talking about the experience is a relief for Emily (“I felt guilty at asking for his help, but also relieved that my problem of hearing voices had been shared”). However, at the same time, she is still cautious of telling many others about her voice-hearing. Indeed, Emily Knoll is actually a pseudonym.
On which note, the author is happy for me to share with you that her real name is Dr Roz Austin. Roz received her Ph.D. in 2017 from Durham University. Her survivor-researcher-led-project investigated emotional aspects of the experience of hearing voices and demonstrated the significance of space and spatial metaphors in voice-hearers’ relationships with their voices.
It is to be hoped that Roz’s book is an important step to combating the stigma she encountered, through contributing to the development of a more positive, hopeful, and liberating public conversation around voice-hearing.
I very much enjoyed reading this book, thanks to the author’s well-written prose and well-told story. As I finished the book, I found myself wanting to know more about a couple of things.
First, why does the author herself think she came to hear voices? Emily relays many theories that other people put forward for why she and others hear voices (biological disturbances, trauma, split-off parts of the self, representations of one’s relationship with others) but we only get the author’s own thoughts indirectly. It would have been interesting to hear the author weigh these (and other) theories in the balance, in relation to her own experiences.
Second, I would have liked to have heard more about the points of agreement and disagreement between the author and the ideas of the Hearing Voices Movement (HVM). The author describes hearing Prof Marius Romme (one of the co-founders of the HVM) speak at a conference where we are told he “pointed out that there are links between the characteristics of voices and the problems that a voice-hearer has faced in their past”. The author reacts strongly against this:
“But many people who hear voices have never experienced a specific trauma, I thought to myself. Voice-hearing is not just about trauma! I thought how my own long-term neglect wasn’t a specific trauma” (italics in the original).
Yet we can see that the author quotes Romme as referring to “problems that a voice-hearer has faced in their past”, not as saying that such problems are limited to isolated ‘traumas’. Indeed, the author’s recounting of the problems she faced in her past suggests she may agree with some of the HVM’s ideas. For example, Romme and his partner, Dr Sandra Escher, have argued that voices can result from suppression of emotions, which Emily often describes occurring in her childhood. It would have been great to hear more on what aspects of the HVM approach did and did not resonate with Emily, and the reasons for this.
This book will undoubtedly be appreciated by a wide range of readers. This includes other people who themselves hear voices, as well as their friends and family, people researching the experience of hearing voices or clinically working with those who hear voices, as well as members of the general public who want to get a better understanding of this experience. I am glad I had the chance to read it and that Roz continues to work in this area. I suspect this will not be her last book, and I look forward to reading the next.
Emily’s Voices is available on Amazon and can be purchased here.