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Making Sense of Psychotic Experiences Making sense of psychotic experiences Citation for published version (APA): Escher, A. D. M. A. C. (2005). Making sense of psychotic experiences. s.n.]. https://doi.org/10.26481/dis.20050519ae Document status and date: Published: 01/01/2005 DOI: 10.26481/dis.20050519ae Document Version: Publisher's PDF, also known as Version of record Please check the document version of this publication: • A submitted manuscript is the version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Link to publication General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license above, please follow below link for the End User Agreement: www.umlib.nl/taverne-license Take down policy If you believe that this document breaches copyright please contact us at: [email protected] providing details and we will investigate your claim. Download date: 10 Oct. 2021 MAKING SENSE OF PSYCHOTIC EXPERIENCES PROEFSCHRIFT ter verkrijging van de graad van doctor aan de universiteit Maastricht op gezag van de Rector Magnificus, Prof.mr.G.P.M.F.Mols volgens het besluit van het college van Decanen in het openbaar te verdedigen op donderdag 19 mei 2005 om 14.00 uur door Alexandre, Dorothée, Marie, Adrienne, Charlotte Escher Promotoren Prof. dr. J.J.van Os Prof. dr. M.A.J. Romme Co-promotor Dr. Ph.A.E.G.Delespaul Beoordelingscommissie Prof. dr. M. de Vries (voorzitter) Prof. dr. R.P. Bentall (University of Manchester) Prof. dr. J. Jolles Prof. dr. H. Katchnig (Universitätsklinik für Psychiatrie, Wien) Prof. dr. M. M.W. Richartz ISBN - 9056812181 M.C. Escher's "Relativity" 2005 The M.C. Escher Company - the Nethetherlands. All rights reserved. The studies described in this thesis were carried out at the department of Psychiatry and Neuropsychology, Maastricht University in cooperation with the RIAGG, Maastricht department of Social Psychiatric Services (SPD) . The first years they were funded by the Praevention fund, later by ZON. Aan Marius, Diederik en Rutger Contents Introduction: The development of the hearing voices studies 7 Chapter 1: Hearing voices and its historical course 19 Chapter 2 : Hearing voices 37 Chapter 3: Coping with voices: an emancipatory approach 49 Chapter 4: Independent course of childhood auditory hallucinations: a sequential 3-year follow-up study 57 Chapter 5: Formation of delusional ideation in adolescents hearing voices: a prospective study 69 Chapter 6: Coping defence and depression in adolescents hearing voices. 79 Chapter 7: Determinants of outcome in the pathways through care for children hearing voices 91 Chapter 8: Maastricht Interview with a child hearing voices: interview and frequencies 109 Chapter 9 : Stimmenhören bei Kindern 125 Chapter 10 : Trauma and hearing voices 133 Chapter 11: Epilogue 159 Chapter 12: Summary 165 Samenvatting 179 Chapter 13: Dankwoord 195 Curriculum vitae 205 Chapter 14: Publications 209 Appendix 215 Introduction The development of the hearing voices studies 7 8 Introduction This study will give evidence that the experience of hearing voices must be seen in a broader context than individual psychopathology. The restricted view that hearing voices is a symptom of an illness has become disabling for all people with this experience, both for patients as well as for people who can cope well with their voices and use the experience positively. The generally accepted but restricted view of voices as symptoms creates a taboo that reduces the freedom of people to talk about their experience, because it is all too readily assumed to be a sign of mental illness. This study is part of a programme that promotes the acceptance of voice hearing. The primary aim of this approach is to make explicit the relationship between individual history and the voices; to take the experience out of the realm of psychopathology and put it into the context of people’s life-problems and their personal philosophy (Romme & Escher, 1989, 1993, 1996; Romme, 1996; Pennings et al. 1996; Honig et al. 1998). In this thesis a research study is presented in which 80 children who hear voices were followed up over a period of 3 years. The experience itself was explored, alongside the relation with the life-history, factors influencing the continuity of this experience and the effectiveness of care. Evidence of the negative attitude towards voice hearing Hearing voices in West European societies is mostly associated with psychopathology, a belief that is specifically held by psychiatric professionals who interpret these experiences as a symptom of an illness. Also linked to this view is the belief that listening to the content of voices increases the hearer’s undesirable fixation on this ´unreal´ world, the voices being regarded as unreal because they cannot be heard by anyone other than the voice hearer. Thus the psychiatric assumptions about the individual with this experience cannot be very optimistic, and indeed hearing voices is mostly associated with the diagnosis of schizophrenia, a poor prognoses (cessation of the voice hearing experience), a life long experience of illness and not being fully in control of oneself. Blom (2003) describes how strong this believe is embedded. ‘Schizophrenia is acknowledged to be one of the most serious and disabling disorders that plague humankind. According to the World health Organisation, it ranks among the ten leading causes of disability worldwide. It effects about one per cent of all human beings, most 9 in the prime of life, interrupting their further development, breaking up families and marriages, ruining their careers, and causing one out of ten people with the diagnosis to commit suicide, It may be impossible to rank various kind of suffering, but schizophrenia is certainly one of the worst human afflictions’ (Blom , 2003. p. 10) This negative set of beliefs connected to voice hearing has become rooted not only in psychiatric practice but in public opinion as well, despite research such as Bleuler (1978), Huber et al. (1975), Harding (1986) and Ciompi (1980) and ‘user’ (of psychiatric services) literature (de Jong, 1997; Coleman, 1996; O´Hagan, 1993; Read & Reynolds, 1996) contradicting this idea showing that people do recover from ‘schizophrenia’). Recently psychiatric opinion has become more openly divided, with some expert opinion asserting that the disease ‘schizophrenia’ is of questionable scientific validity (van Praag,1993; Bentall,1990; Boyle,1990; Hoofdakker, 1995; Jenner et al., 1993; Ross & Pam, 1995; Thomas, 1997; Blom, 2003; van Os & McKenna, 2003). None of the implications of these challenging studies have so far been taken into account in the organisation of mainstream mental health services. Public opinion parallels psychiatric belief, and this can be illustrated by looking at media reporting. Leudar and Thomas (2000) conducted research about the way newspapers report on hearing voices. They concluded that: ‘The tie between hearing voices, mental illness and violence was a major recurrent theme in the British newspapers between 1993 and 1996.’ (p.151). It is not only the believed association with violence that is harmful, but the use of this kind of information is even more alarming. ‘We have seen how Members of Parliament used cases of people with mental illness who committed violent deeds to justify their arguments and the need for legislative change, and these cases were composed by journalists using the phenomenon of hearing voices. In journalists’ writing, hearing voices was typically (but not exclusively) presented as a symptom of mental illness and a concomitant of unreasoned violence’(Leudar and Thomas, 2000. p. 172). 10 Acceptance of this general view about voices inevitably extends to popular literature, for example in general reference books and encyclopaedias such as Routledge (2000) and the Winkler Prince (2002), in which hearing voices is explained as evidence of either ‘schizophrenia’ or ‘borderline’ or a cantata (a medieval kind of singing). There appears to be no room for normality despite many epidemiological studies (Sidgewick, 1898; Posey & Losch, 1983-84; Bentall & Slade, 1985; Posey, 1986; Tien, 1991; Eaton et al., 1991; Barret & Etheridge, 1992; Bijl et al. 1998) showing that about two to four percent of the general population hear voices with the characteristics of auditory hallucinations. These studies suggest that about one third of these people take a course of action that leads to seeking help. Most voice hearers therefore do not take a course of action where their experience comes to be regarded formally as an illness. These relatively simple to understand research findings cannot be found in information that is available for the general public, including the media and popular art forms. There is no acceptance of any other view about voices than to regard them as abnormal, undesirable and unacceptable. Western European societies attitude toward voice hearing makes the open admission and discussion of such experiences taboo.
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