Voice-hearing: What does the future hold?’ Wolfson Gallery, Palace Green Library Durham University 5 November 2016, 10 am – 4 pm
Earlier this month we marked the opening of our exhibition Hearing Voices: suffering, inspiration and the everyday with a day-long event on ‘Voice-hearing: What does the future hold?’ Open to anyone with an interest in voice-hearing or Hearing the Voice research, the event was attended by over eighty experts by experience, mental health professionals, academic researchers and students. It was fantastic to see such a great turnout, and we’d like to thank everyone who attended for joining us to explore future direction in voice-hearing research, clinical practice, activism, peer support and the international Hearing Voices Movement.
HtV collaborator Rachel Waddingham opened the day with a complex and compelling vision of the future, which explored some of the issues she is currently wrestling with both in a personal capacity and as Chair of Intervoice. Rai urged us to consider the strengths and limitations of trauma-based models for understanding voices, particularly the narratives that such models do and do not sanction. She also called for more safe spaces and sanctuaries in mental health services, greater diversity and inclusivity in the communities that form around voice-hearing, and a society that is founded on openness, empathy, understanding and respect for each other’s experiences.
Rai’s talk is available to listen to as a podcast here.
Professor Marius Romme
The remainder of the day included a panel discussion on ‘Durham Perspectives’, which featured contributions from Charles Fernyhough (Project Director, Hearing the Voice), Guy Dodgson (Northumberland, Tyne and Wear NHS Foundation Trust), Roz Austin and Nicola Armstrong, as well as a public lecture from Marius Romme and Sandra Escher, the founders of the Hearing Voices Movement. In the afternoon session, we divided into smaller groups for a more focused discussion around some of the issues raised in the formal presentations. These included our project’s plans for Integrated Voices – a major new online resource for the treatment and management of distressing voices which Hearing the Voice will be developing over the next few years. We also discussed ways to reduce stigma (particularly in the workplace), and how to ensure that research and voice-hearing networks involve and are accessible to people from diverse backgrounds, including those who live well with their voices in the absence of any need for psychiatric care.
The Hearing the Voice team is grateful to everyone who shared their ideas, knowledge and expertise in this public forum. If you couldn’t make it, we hope you will be able to visit Hearing Voices: suffering, inspiration and the everyday and join us at some of the other events in the exhibition’s linked programme in the future. Full details of the guided tours, discussion events, public lectures and film screenings that surround the exhibition can be found here.
Hearing Voices: suffering, inspiration and the everyday is currently installed in Durham’s Palace Green Library until 26 February 2016. More information about the exhibition, including podcasts featuring interviews with HtV researchers, interactive presentations and links to articles and further resources, is available on the exhibition website.
If you would like to arrange a group visit to the exhibition for a hearing voices or unusual experiences group, please get in touch with us via email.
Dr Peter Moseley, our postdoctoral research associate in psychology, reviews a recent special issue on hallucinations in the Journal of Consciousness Studies.
The Journal of Consciousness Studies has a new special issue, on the subject of hallucinations. There are eight journal articles, four of which are written by philosophers, and four by psychologists. Unfortunately, these articles aren’t available to read freely online so I’ve produced a brief summary of the special issue below for those interested.
Firstly, it should be noted that the issue uses a pretty broad definition of ‘hallucination’. So, this doesn’t just include voice hearing, but also hearing other noises, visions, and any other sensory experience in the absence of an external stimuli. We recognize that the term ‘hallucination’ may not be the preferred term and may seem un-necessarily pathologizing, but since it is used in the special issue, we’ll stick with it for this blog post.
A common theme of the issue is that our current understanding of hallucinations is limited by a number of factors; in their introductory editorial, Riccardi and Laroi argue that our current psychological models of hallucinations are not fine-grained enough to account for the wide variety in the phenomenology of hallucinations, and fail to integrate cultural, social, biographical or clinical factors, despite it is clear that these are of crucial importance. They argue that our models are also too static to adequately capture a phenomenon such as hallucinations, which are usually very complex, and change over time.
This viewpoint is elaborated on by Raballo’s paper in the issue, which argues that a combination of neuroscientific (‘what’s going on in the brain?’) and phenomenological (‘what is it like to experience?’) approaches may be the best way forward. Belveaux, Cermolacce and Jardri also address this issue, suggesting that these two approaches could be combined to address the question of whether hallucinations can truly be seen to fall on a continuum of severity, or a continuum of need-for-care.
Both Dokic and Piazza, meanwhile, take on the problem of whether a hallucination (e.g., seeing a mug on the table in front of you that isn’t really there) is precisely the same as a ‘true’ perception of a mug on the table in front you. If so, what does this mean about the fallibility of typical perception? Taking a different tack, Nanay asks whether hallucinations and mental imagery can be seen as the same kind of mental states, concluding that the evidence suggests that there is, at least, a substantial common denominator between the two.
Collerton and colleagues discuss visual hallucinations in a number of different groups – healthy individuals, individuals with eye disease, individuals with Parkinson’s disease, and individuals with Lewy Body dementia. They outline some key differences between visual hallucinations in these groups and voice hearing; for example, emotional state seems to play a much less important role in visual hallucinations than it does for voice hearing. However, Collerton et al. argue that we should not view visual hallucinations as an ‘aberrant’ symptom of disease, but instead a ‘price for maintaining a higher degree of functionality than would otherwise be possible’.
Finally, Hearing the Voice’s own Ben Alderson-Day and Charles Fernyhough ask whether auditory verbal hallucinations (hearing voices) are irreducibly social in nature, concluding that standard psychological models of voice hearing would be improved upon by acknowledging the importance of social aspects of voice hearing. They outline ways that speech and language processes involved in voice hearing also involve socially important information, arguing that the social characteristics of voice hearing can be explained without appealing to completely separate cognitive systems.
Taking the issues raised by these papers, Riccardi and Laroi make a number of recommendations for the field of hallucinations research. Firstly, we should integrate data from multiple different pathologies (rather than simply focusing on people with a diagnosis of schizophrenia), as well as working with people with no diagnosis. Rather than just focusing on hallucinations in the auditory modality, researchers should also focus on other modalities such as vision, but also smell, taste, and feelings of presence – which are understudied areas. Further, researchers should expand their research beyond neurobiology, to include social and cultural factors that may be important in hallucinations. Finally, they propose that a crucial area going forward will be to research the ‘developmental profile’ of different forms of hallucinations; that is, how (if at all) do they change over time, both at onset and throughout the lifespan?
These recommendations very much align with our research goals at Hearing the Voice. Our aim is to combine as many different perspectives as possible in order to provide a better understanding of the experience of hearing voices, and to draw on insights from the personal, clinical, scientific, literary, cultural and political spheres.
Marco Bernini, our core member in Durham’s Department of English, reflects on the recent Amazon Echo UK commercial in this blog post. Marco directs our attention to the implications of personifying voices in technology.
A few days ago Amazon released in the UK another piece of technology that we probably don’t need, yet which many will be hankering to have before long. It’s called Amazon Echo, and it’s a black or white cylinder with speakers, microphones, motherboard, and so on. Crucially, it also has a voice and, to spare you even this little Christening effort, a name: Alexa.
As you can see in the somehow troubling UK advertising video (Why doesn’t he know the name of the band in his own Saturday playlist?), Alexa’s voice does more than just echo your own voice (it wouldn’t be worth the price, better go screaming at the mountains for that): she echoes your desires. She can turn your lights on, read you a book, play you some music, tell you the weather forecast and much more (but not too much). In the U.S. version, she can also help spelling words or help you learn how to spell.
If she had consciousness, however, or a basic awareness of her cultural context, Alexa would realise she’s not exactly the new game in town. In fact she’s just the latest addition to a long list of eminent voicy technological partners that have being populating fictional and real worlds for the past 50 years. From visionary cinema (Kubrick’s Hal 9000 being paradigmatic) to average television (Knight Rider’s KITT); from disturbing toys (1980’s Hasbro’s Furby, now alas back to the market) to New Age expensive mobile tech (Apple’s Siri – the only one of these, interestingly, without a fixed gender, which changes as you change nationality), all these voices share a common feature: they have been created to be more than just voices. Starting with their proper names, all are designed to be personified by their users.
The intentionality of engineers and screenwriters in the design of these more or less intelligent voices is only part – and probably not the more interesting part – of the story. In fact, their success relies on a shared skill in which human beings still seem to beat computers: the easiness in, and flair for, attributing agency, emotions, intentions, beliefs (shortly, some kind of consciousness) to inanimate objects and disembodied voices.
The personification of voices in general, and synthesised voices in particular, can be considered as the outcome of a more primary cognitive faculty of human beings: the ability to anthropomorphize. Neurosciences and Psychology are still exploring this strange aptness and impulse humans have to transform an interaction with inanimate objects, machines, and voices into some sort of interpersonal relation.
Literature, on the other hand, has a long tradition of stories relying on this faculty. From Abbott’s Victorian novel Flatland in which we are asked to empathise with geometric figures to Aesope’s classic tales in which we are attributing to talking animals a human consciousness to make sense of the story. In contemporary cinema, think only of the scene from American Beauty’s: nobody in the audience had any difficulty in understanding what is meaningful (and touching) in the recorded movement of a flying shopping bag.
One way of explaining (and maybe it’s even an evolutionary explanation) this anthropomorphizing capacity would be therefore to say that it serves our rational understanding. Following an influential idea by the literary theorist Jonathan Culler, we can say that we anthropomorphize to “naturalise” what we experience, in so doing bringing the unfamiliar “within our ken.” However, this explanation falls short when it comes to explaining the undeniable need we seem to have to bring things alive, to pull a consciousness out of a voice. Besides, sometimes we are not in control of this faculty, and we can hardly limit ourselves to bare perceptions without imbuing objects, natural elements, voices with some strong or weak intention, attitude, mindset: shortly, a personality.
Importantly, these qualities are not properties of the object but relational propertiesemerging in the interaction we have with objects, nature, animals and voices. They have a personality for us; they have an attitude towards us. For instance, as does the character in Proust’s Swann’s Way, we can perceive the “hostility of the violet curtains and of the insolent indifference of a clock.” As Marcel does here with curtains and clocks, we are constantly anthropomorphizing and personifying, either consciously or unconsciously, in order to enable a relationship with us.
We can see, then, that artificially intelligent voices such as Alexa are designed actively to trigger our flair for personification. Ideally, this should reach the point of forgetting it is us attributing a sort of consciousness where none in fact is: to ignore that the intentions and desires we perceive as being of the voice for us, are simply ours. In this sense, Alexa indeed does echo something: our need for a company; our hunger for interaction.
Even in a foreseeable future where designs and technological possibilities will be sophisticated enough to make AI voices concretely grow and learn, their very existence will still testify for, and rely on, our flair for personification and desire for dialogical interaction. This scenario is beautifully represented by Spike Jonze’s 2014 movie Her – a film which is a treatise on how essential, mysterious, and exquisitely human is the need of someone to talk to.
‘Her: A Spike Jonze Love Story’
Set in a near future, Her is the story of the relationship between Theodore (Joachim Phoenix) and the voice of his operative system, Samantha (Scarlett Johansson). `Even before activating the AI voice of Samantha, Theodore is already doing a job which demonstrates his capacity for personification. Theodore puts himself in the mind of his clients in order to write letters for them. By gathering information from few pictures, he has to pretend to be another person – a complex task that requires creating, inferring, intuiting other people’s inner mindsets. He has to blend his voice with the imagined voices of his clients as persons. Interestingly, we watch him not writing, but dictating to a computer the text of the letters.
Yet in his private life, Theodore is alone (and lonely) after a broken marriage. Until he sees the advertising of a future version of Alexa, which promises something that is “an intuitive entity that listens to you, understands you, and knows you. It’s not just an operating system; it’s a consciousness.” But the OS has no body, just a voice. Once set up, from the beginning this voice becomes, however, much more. Here is the very first conversation Theodore has with the OS (with critical annotations from the original screenplay):
FEMALE OS VOICE
(cheerful and casual)
Hello, I’m here.
FEMALE OS VOICE
Hi, how are you doing?
(unsure how to interact)
I’m well. How is everything with you?
FEMALE OS VOICE
Pretty good, actually. It’s really
nice to meet you.
Triggers for, and telltale signs of, personification are already in place. The cheerfulness and casual tone of the voice are instantly providing Theodore with information for inferring some kind of personality (and discarding others). The voice’s reply, in fact, is not droning a neutral short answer: instead, she keeps surprising Theodore with a relaxed attitude and syntax, which suggests a sort of reflective self-consciousness (“actually”) and pleasure in conversing (“really”).
In brief, the way Samantha speaks betrays traces not just of what she thinks or feels, but also of how she thinks and sees the world. Cognitive linguists have been calling these audible or readable signs of mentality that are detectable in the way we use language our “mind style.” However, Samantha’s “mindstyle” would be a dead letter if there were no Theodore interpreting and increasingly constructing a consciousness out of her AI voice.
And Theodore is so effective (and so eager and necessitous) in personifying Samantha’s voice that he soon falls in love with her. This third-person pronoun significantly gives a title to the movie. The movie could have been easily titled, Samantha. Instead, the chosen title situates the film from the perspective of Theodore who, starting from a mere unnamed disembodied voice, gives her more than just a name (which actually Samantha gives to her-Self), but a personality. He is able to simulate a full-blown consciousness out of the voice he hears in the earphone he wears now everyday and everywhere. In other words, the pronoun here relates not to a person, but to a personifying process.
The story has a clever ending that I won’t spoil. Yet the movie’s real subject is, in my opinion, the enigmatic, desperate, dignified, primordial flair (and proneness) humans have for personifying the world in order to communicate, be listened to, be understood, be cared for or loved.
This starving for a dialogue and a relation, probably and paradoxically, propels also our constant chatting to ourselves in our heads with our inner voices. By the same token, there can be possible links between our inclination to personify the world and experiences widely regarded as being out of the ordinary, such as auditory-verbal hallucinations. The latter can be considered as distressing personifications, showing how this fundamental human ability can go wrong and fall beyond our control.
In this light, futuristic AI voices such Samantha (or Alexa) seem to rely on a core, primitive, and mysterious human flair which science is still far from understanding in all its complex ramifications. And if today Alexa’s voice can answer a lot of questions, she will be stalling at the more interesting of them: “Alexa, why do I need your company?” Which, incidentally, is spelled C.O.M…
 Culler, J.  2002. Structuralist Poetics: Structuralism, Linguistics and the Study of Literature. New York: Routledge, 157.
 Proust, M. In Search of Lost Time Vol 1: Swann’s Way. London: Vintage, 7.
Do you hear voices or have other unusual experiences and live in the North-East of England? Do you have an idea for a public dialogue event, film screening or panel discussion that explores voice-hearing from a personal, political, cultural or spiritual perspective? If so, Hearing the Voice would love to hear from you.
We are currently producing a major exhibition on voice-hearing – Hearing Voices: suffering, inspiration and the everyday – that will take place at Durham’s Palace Green Library from 5 November 2016 to 27 February 2017. The exhibition will explore voice-hearing from personal, scientific, historical, literary and theological perspectives, and investigate different facets of the experience of hearing voices through original artworks, artefacts and narratives from the medieval to modern periods. It will also be accompanied by a linked programme of public events that will include creative workshops, public lectures, panel discussions and events for young people.
As we are now just starting to plan the events programme that accompanies the exhibition, we would like to extend a warm invitation to voice-hearers, their families and carers from the area to join us for a meeting at the Learning Centre inDurham’s Palace Green Library on 15 September 2016 from 3.30-5pm to discuss ideas. All proposals are welcome, and we’d particularly like to hear suggestions for events related to the themes of the exhibition.
If you’re interested in attending, please let us know by registering here. We hope you can make it – we would be delighted to have your valuable contribution.
If travel is an issue for you or you have any other questions or concerns, please email us and we’ll explore ways to make it possible for you to attend. If you can’t make it and you’d like to contribute a suggestion, please get in touch and let us know.
Bringing together people with lived experience of psychosis, clinicians and researchers to present research, theory and practice on the topic of stigma, the purpose of this conference was to raise awareness of how societal and internalised stigma affects the lives of people who experience psychosis. Some of the highlights from the event include the keynote address by Professor Patrick Corrigan (Illinois Institute of Technology, US), who described how the stigma of mental illness is similar to that of racism and homophobia. He advised that ‘you can’t change stereotypes, but you can challenge prejudice’. Corrigan noted that the biggest public concerns are that the public think that the mentally ill are ‘dangerous’, ‘weak’, and they ‘choose to be this way’. He said that the stigma of mental illness means that people may be alienated from faith communities. They may have worse educational opportunities, poor housing, and less access to health care.
Corrigan pointed out that ‘1 out of 4 people have a mental illness, but you don’t know about it, because people are in the closet’. With schizophrenia or psychosis the stigma is even greater. When you consider that 1% of the population in the UK has a schizophrenia diagnosis, this means that there are 694,684 people living with stigma. Corrigan argued that under certain circumstances almost anyone can hear a voice. Examples that he gave included: a recent bereavement, trauma, solitary confinement, sleep deprivation, use of certain drugs, high fever, and someone being on the verge of sleeping or waking. Corrigan suggested that living in recovery does not mean being symptom free, and he gave examples of famous people who hear voices, which include Brian Wilson from The Beach Boys, Anthony Hopkins, and the late Nobel prize-winner Mathematician, John Nash. Corrigan reflected that ‘if people came out it would change the stigma enormously’. Corrigan is the author of a programme called ‘Honest, Open, Proud’, which takes individuals through a process of learning about and applying principles of self-disclosure about their mental illness and recovery. For as Corrigan noted for ‘people who were in the closet – it was horrible for their health’. Yet, ‘if you come out you don’t get a bear hug. You may be the focus of gossip for a while’. Therefore, people can benefit greatly from having support to make the self-disclosure of mental illness.
In a symposium featuring a range of presentations on overcoming internalised stigma and fostering empowerment, Rachel Waddingham, who is a freelance trainer and a trustee for the National Hearing Voices Network, spoke about her own journey to recovery from ‘psychosis’. She now understands her voices and other intense experiences to be a reaction to trauma. She said that ‘the moment we use words like symptoms, illness, delusions, it makes my life so much more difficult, especially when the words are being used by caring, nice people’, such as mental health nurses. She reflected that ‘I internalised the views of the mental health system, and was praised for my good insight’. It was a hearing voices group that gave Rachel a safe place to grow. She said: ‘I heard other people sharing their experience. They were trying to connect with each other’. Rachel has now been out of services for five years, and she feels fortunate that ‘I was able to come back to the mental health system as a survivor, and have a different relationship to it’. She said: ‘It was about discovery and reclamation. For me my story was stolen from me. The mental health system didn’t mean to collude with my abuser, but the honest truth is they did. I’m not ill. My voices are not symptoms’. I found Rachel’s story very uplifting, as she has clearly reclaimed her experiences in a way that has allowed her to develop a positive sense of self. In 2009, Rachel set up Voice Collective in Mind in Camden, a project that helps 6-18 year olds to live well with their voices. The project adopts an experiential approach, where they work with young people whatever their perspective on their voices. For example, one young person might think that their voices are linked to trauma, while another young person understands that their voice is a ghost talking to them.
Professor Graham Thornicroft, a consultant psychiatrist with the South London Maudsley Trust, argued that research suggests that for younger people it works best to challenge stigma in educational settings. He showed us the short film ‘Stand Up Kid’, which has been made by the anti-stigma campaign ‘Time To Change’ (which is available here). Thornicroft said that evaluations of the work that ‘Time to Change’ has done to reduce stigma showed that interventions worked best if there was a personal testimony given by a trained speaker who has experience of mental illness, that employed a form of social contact, such as drama or music, that the person liked.
Dr Kathy Greenwood, a psychologist based at Sussex University, said that stigma attitudes start to develop from the age of seven. She has held six focus group with children aged 7 to 11, in which cartoon animals were used who had diagnoses of obsessive-compulsive disorder or psychosis. The children were asked ‘would you be friends with this cartoon character?’ Greenwood said that children tried to make sense of the situation, as they had a desire for certainty. She found that children want and benefit from information and knowledge. For once they could ask the cartoon animal questions about their illness, they were often willing to be friends with them. Greenwood argued that children need to be educated earlier about mental illness. At present schools are waiting until adolescents are aged 14 or 15 to intervene to change attitudes about stigma, and this is too late because attitudes have already been formed. Greenwood argued that when research carried out in 2014 showed that 88% of people with mental illness were experiencing discrimination in at least one area of their life, it is important to address this.
It was helpful to find out at the conference about the cutting-edge research on stigma that is happening at different universities. The conversations at the conference led to me reflecting on why do we ‘other’ people? Why are particular groups more likely to be stigmatised than others? Who is it that is benefitting? It was clear that myth-busting the stigmatising attitudes that were held by the general public was vital, as was empowering those with psychosis to speak out about their experiences. Thornicroft reported that research showed that people with mental health problems are seen by employers as less employable than people coming out of prison with criminal records. So, I was impressed to learn that the City Mental Health Alliance is encouraging employers in businesses in London to have constructive conversations about mental illness. Hopefully initiatives such as this one will lead to those with psychosis feeling more able to speak out about their lived experience of coping with voices and other unusual experiences.