The following post contains reflections on the ‘Working with voices in the NHS: dialogues and monologues’ workshop that took place at Warneford Hospital (Oxford) on 3 October 2018. This experiential workshop was affiliated with the Educational Voice-hearing Network in Oxford. Here, four of the presenters reflect on the sessions that they led for the group, which included voice-hearers, student nurses, mental health professionals, and carers.
Dr Jonathan Gadsby is a Research Fellow at Birmingham City University. He is a qualified mental health nurse, who has worked in a variety of in-patient and community settings. Jonathan writes:
My workshop attempted an introduction to some philosophy of science for voice-hearing. In order to do this, we began with a thought-experiment:
Supposing a new piece of research about voice-hearing was to be published next week in a prestigious journal. Suppose it was excellent research with a very clear outcome based on a very clear statistical power. Suppose it did not have concerning links with the pharmaceutical industry or other corporate interests. Suppose it showed a very clear link between hearing voices and biology.
Now imagine two conversations. The first takes place the next day within a Community Mental Health Team meeting. The psychiatrist comes in. She is excited. She has printed off several copies of this research. As she puts them on the table she says, ‘You see? Proof at last!’.
At the very same moment, in another part of the city, a hearing voices group is meeting. The facilitator has printed several copies of the research. Distributing them he says, ‘Proof at last!’
Psychiatrist: Proof that hearing voices is a psychiatric condition and we can look forward to better diagnosis and better, more targeted, treatments.
Hearing Voices Group Facilitator: Proof that hearing voices is a common human variation and we are normal.
The purpose of this thought-experiment was to raise the question of whether either pathology or health is inherent to the science of biology or whether it is in some way and to some extent a story about biology. Many writers have approached this subject, from Foucault to Fulford. I put it to the group that although the Hearing Voices Movement contains many different insights and ideas, to understand why it is a movement and not merely a set of approaches and principles one needs to explore these two imagined responses to that same piece of hypothetical research. My reason for deciding to approach a talk about working with voices within the NHS in this way was mainly that it is very tempting for a room with student mental health professionals, experienced mental health professionals, academics and others to imagine that they have come to learn about some new techniques to work with voice-hearers. My belief is that there is one ‘technique’ to learn above all others; how to stop pathologising people (and in this instance, their voices).
Our conversation touched on many aspects but most memorable for me was the question of whether within mental health services it could ever be enough to try to practice being non-judgemental and person-centred towards individuals, or whether one has to more openly/explicitly subvert mental health services in order to open up spaces in which voice-hearers (and others) may experience non-pathologising understandings. Is it necessary to be so confrontational, or might change be brought about in partnership with all sides? Personally I feel there is a gulf between ‘non-judgmental’ and ‘non-pathologising’ and that, given the weight of all that creates pathology within services, only direct subversion could create the necessary trust. That has been my experience. It seems to me that all answers to these questions – even the ones I prefer – are contingent upon story-telling and I’m with Arthur Frank: All stories are recipient-designed, performed for a purpose and inherently dangerous.
Mary Coaten is a PhD student with Durham University’s ‘Hearing the Voice’ research project, and works as a dance movement psychotherapist in the NHS. Mary writes:
There is increasing interest in embodied approaches to working with the experience of voice hearing.
Having worked as a dance movement psychotherapist in the NHS for many years with people who experience severe mental distress, I welcomed the opportunity to deliver this experiential workshop. The attendees consisted of people with lived experience of voice hearing, other family members, researchers and mental health students from different disciplines.
More than thirty of us met in the McInnes room at the Warneford Hospital which provided a wonderful space to move in. We began in a circle, exploring the opportunity different rhythms give for making connections with the self and others. I chose music Zimbabwean music and Bhangra because of their strong rhythms. The room very quickly became full of laughter, sound and excitement. The change in atmosphere felt palpable. I am often amazed at the immediacy of the response and the power of dance to transform and to afford possibilities for making connections.
The group were invited to try dancing with different rhythms, for example, high intensity, low intensity, abruptness, twisting, jumping and to take notice of how these rhythms impacted on their bodies.
The session continued on with breaking off in to smaller groups where there was a chance to explore the impact of movement in dyads as opposed to the larger group experience.
After the dance a lively discussion took place around the importance of rhythm in creating a sense of well-being. Some commented on the change in the atmosphere at the end of the dance, noticing how the dance can influence how we feel within ourselves but also how moving together as a group can produce changes within ourselves. There was a question about whether certain rhythms in particular were more transformative than others. I suggested that I tended to use a strong, powerful rhythm as it is considered to be an external organizer of the body and can be therefore be very unifying.
The discussion at the end inspired me to think about offering more experiential sessions in the future perhaps a day workshop.
Dr Roz Austin is the Network Lead of the Educational Voice-Hearing Network, and a Research Associate at York University. Roz writes:
My own experience of hearing voices informs my research. When I interviewed thirty voice-hearers for my survivor-researcher-led doctoral project, they shared with me some of the coping strategies that they have developed which help them. In my presentation I shared these strategies with the group. Simon found that it helped him to write poems that explore his voice, as this released his emotions. I then shared with the group how I have found fiction writing and journal-writing to be therapeutic, as the writing provides a space in which I can explore my own and others’ feelings and thoughts about hearing voices. In my book ‘Emily’s Voices’, I describe how listening to music can be a helpful strategy. Emily, the voice-hearer in my book, writes: ‘So I listened to my favourite music, and told myself that the voices were just another noise. This way the voices didn’t intrude too much, and I could keep working’.
I told the group how a recent study by Michael Silverman in The Journal of Music Therapy (2018) analysed the quantitative research in 19 studies evaluating the influence of music upon the symptoms of psychosis. Results indicated that music had proven effective in supressing and combating these symptoms, which may include hearing voices. Interestingly, classical music was found to be not as effective as non-classical music in reducing psychotic symptoms. I said that some of the voice-hearers that I had spoken to had experimented with listening to different kinds of music to see if these dampened or improved their voices. A coping strategy that Carla found helpful was to paint her voice, as this activity enabled her to mediate a different relationship with the voice where she was less frightened of it. Mary said that she practiced mindfulness when walking her dog. She considers that the anxiety that she feels is closely liked to hearing voices. Walking her dog makes it possible for her to relax.
Pauline Fair is a Co-Lead of the Educational Voice-Hearing Network. She is a former NHS staff nurse, and a Trainer with STARS (Support Training and Recovery Systems). Pauline writes:
I was asked to present at the Warneford Hospital, as a voice hearer, about my experiences of voices. My talk focused on how I built a more positive balance of power with my voices through relationships with people within a Therapeutic Community setting. I spoke about voices as a coping mechanism and how my voices could have told an emotional story, with history and meaning. I was happy to answer questions about my story and previous treatment, as well as my diagnosis.
It was so good to see lots of students from several care disciplines, contributing to discussions with carers and professionals from several disciplines.
The next meeting of the Educational Voice-Hearing Network will take place on 28 November at St Catherine’s College, Oxford University, and is titled ‘Surviving student life as a voice-hearer’. This seminar has previously been advertised on the HtV blog.