Journal of Social Work http://jsw.sagepub.com/ Listening to voice hearers Bob Sapey and Peter Bullimore Journal of Social Work published online 21 February 2013 DOI: 10.1177/1468017312475278 The online version of this article can be found at: http://jsw.sagepub.com/content/early/2013/02/19/1468017312475278 Published by: http://www.sagepublications.com Additional services and information for Journal of Social Work can be found at: Email Alerts: http://jsw.sagepub.com/cgi/alerts Subscriptions: http://jsw.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav >> OnlineFirst Version of Record - Feb 21, 2013 What is This? Downloaded from jsw.sagepub.com at Curtin University Library on May 18, 2013 XML Template (2013) [13.2.2013–2:50pm] [1–17] //blrnas3/cenpro/ApplicationFiles/Journals/SAGE/3B2/JSWJ/Vol00000/130045/APPFile/SG- JSWJ130045.3d (JSW) [INVALID Stage] Article Journal of Social Work 0(0) 1–17 ! The Author(s) 2013 Listening to voice hearers Reprints and permissions: sagepub.co.uk/journalsPermissions.nav Bob Sapey DOI: 10.1177/1468017312475278 Lancaster University, UK jsw.sagepub.com Peter Bullimore Asylum Associates, Sheffield, UK Abstract Summary: This article considers what the Hearing Voices Network can offer to mental health social work. It combines an extensive literature review of voice hearing by Bob Sapey and the expertise by experience of Peter Bullimore who runs a peer support group for voice hearers. Findings: The re-framing of auditory hallucinations as voice hearing has significantly changed the way many voice hearers have been able to understand their experience. This new approach to working with voices was developed at the University of Maastricht, principally by social psychiatrist Marius Romme. By moving away from bio- logical explanations of brain disease to psychological understandings of emotions, Romme and his colleagues have found ways of helping people cope with voices, rather than trying to get rid of them through medication. This has led to a network of voice hearing groups throughout the world. There is much of what happens in these groups and within the social psychiatric responses known as the Maastricht approach that can be practiced by social workers. Applications: The Maastricht approach to working with voices challenges the basis of pharmacological responses to psychosis and moves beyond anti-psychiatry by offering positive alternatives to the current biomedical treatment of schizophrenia. This approach can be undertaken by experts by experience and mental health professionals. We describe these approaches and argue that in adopting them, social workers can help voice hearers cope both with the content of their voices and the stigmatising responses to being diagnosed with schizophrenia. Keywords Maastricht approach, mental health, social work, social work practice, critical social work, trauma, voice hearing Corresponding author: Bob Sapey, Department of Applied Social Science, Bowland North, Lancaster University, Lancaster LA1 4YN, UK. Email: [email protected] Downloaded from jsw.sagepub.com at Curtin University Library on May 18, 2013 XML Template (2013) [13.2.2013–2:50pm] [1–17] //blrnas3/cenpro/ApplicationFiles/Journals/SAGE/3B2/JSWJ/Vol00000/130045/APPFile/SG- JSWJ130045.3d (JSW) [INVALID Stage] 2 Journal of Social Work 0(0) Introduction The Hearing Voices Network (HVN) was formed in Holland in 1987 and a year later in England; it now includes more than 180 groups throughout the UK. The HVN aims to respect the ways in which individuals understand their own experi- ences of voices and unlike biomedical psychiatry, it does not label people as schizo- phrenic or treat their voices as hallucinations. Instead, HVN groups offer support by providing voice hearers with the space to talk freely about the issues which they feel affect them. HVN groups have contributed to a growing body of knowledge that the voices people hear, along with other unusual experiences that are usually referred to as psychosis, are in fact emotional and psychological responses to life experiences, particularly childhood abuse, bullying and poverty. However, viewing the experience of voice hearing as real rather than as a hallucination caused by an illness, contradicts and rejects the biomedical approach that has dominated psych- iatry for more than a century. It therefore provides a significant challenge to med- ical practice and to other occupational groups which work within the mental health system, including social work. In this article, we argue that the ways of working with voices used within the Hearing Voices Network, could be used by social workers to help voice hearers cope both with the content of their voices and the stigmatising responses to being diagnosed with schizophrenia. This article is based upon an extensive review of the literature on voice hearing undertaken by Bob Sapey and it draws on the experience of Peter Bullimore, of voice hearing and running a hearing voices group. Reimagining voice hearing While social workers have long been encouraged to adopt social approaches to working in mental health services, they often remain a weak partner in health trusts and are in danger of losing their identity (Nathan & Webber, 2010). Although Carter (2004) has made the argument very strongly that social workers could adopt the approaches used by the Hearing Voices Network, recent textbooks aimed at introducing social work students to mental health practice present a confused picture in terms of social approaches. Golightley gives it scant attention, describing schizophrenia as a disorder which is treated, but not cured with medi- cation that ‘can dramatically correct serious and abnormal [emphasis added] phe- nomena such as hallucinations and delusions’ (2008, p. 29). Gould (2010) is more circumspect about the merits of medication, but does not present any alternative to the biomedical construct of schizophrenia as a way of understanding voices. Karban (2011) explains the biomedical model, its criticisms and alternatives, but while clearly favouring a social approach she seems to envisage it existing alongside the biomedical model. On the other hand, Coppock and Dunn (2010) explain why the biomedical model is problematic and encourage social workers to adopt a social model that privileges the experiences of people with mental distress rather than Downloaded from jsw.sagepub.com at Curtin University Library on May 18, 2013 XML Template (2013) [13.2.2013–2:50pm] [1–17] //blrnas3/cenpro/ApplicationFiles/Journals/SAGE/3B2/JSWJ/Vol00000/130045/APPFile/SG- JSWJ130045.3d (JSW) [INVALID Stage] Sapey and Bullimore 3 medicine. Their concern about the use of medication is reflected in their description of compulsory treatment in the community as a mental health control, not a mental health service. Tew (2011) is the one writer who seems to embrace the HVN approach of empowering voice hearers by valuing the way people define their experience of voices. He argues that: An important message from people with lived experience is that we should not always see unusual mental experiences as inherently ‘bad’ and in need of eradication – as has been the implication of a biomedical approach. (Tew, 2011, p. 27) He incorporates this understanding into the construction of an alternative social approach to working with mental distress, which challenges the continued hegem- ony of the biomedical approach. The HVN treats voice hearing as a real experience, not a hallucination. However people construct their experience, as aliens, God, a devil, a dead relative or a symptom of an illness, they are accepted as real and something to be worked with, rather than eradicated. The breakthrough in accepting voices in this way came in the 1980s when Marius Romme, a psychiatrist at the University of Maastricht, and his partner Sandra Escher, a science journalist, plus other col- leagues, found that many more people heard voices than was previously thought, but about one-third of them did not find this to be a problem and so were not in contact with any of the psychiatric services (Romme, Honig, Noorthoorn, & Escher, 1992). Voice hearers who did not cope with their voices were twice as likely to be receiving psychiatric care. Romme found that in his psychiatric prac- tice, if he accepted the reality of people’s voices rather than viewing them as hal- lucinations, he was able to find out much more about their origin and meaning, and so develop more effective ways of helping people. ...voices are expressing emotions, and these emotions are those the voice hearer experienced as the result of the traumatic situation. The recovery process is one of turning points in the relationship with the voices, with the person becoming more powerful and independent ...It doesn’t make sense to attempt to cure signals of prob- lems, and it’s not an approach that is particularly successful either because the trau- matic background is not recognised and the emotions involved are not coped with. (Romme, 2009a, p. 9) Romme and Escher (2000) are critical of the Kraepelinian1 construct of psychosis as caused by illnesses and criticise Kraepelin’s methods and assumptions, which continue to inform psychiatry. They point out that his observations took place in clinical settings and did not include people who were not in receipt of treatment; that he thought the distress was a result of one specific disease rather than as a response to the voices. Because of the latter he assumed the cause was organic and ignored his patents’ life experiences. On the other hand, their own work, which has been developing over the past 25 years, has increasingly valued the personal Downloaded from jsw.sagepub.com at Curtin University Library on May 18, 2013 XML Template (2013) [13.2.2013–2:50pm] [1–17] //blrnas3/cenpro/ApplicationFiles/Journals/SAGE/3B2/JSWJ/Vol00000/130045/APPFile/SG- JSWJ130045.3d (JSW) [INVALID Stage] 4 Journal of Social Work 0(0) testimony of voice hearers. Traditionally this type of evidence has been rejected or at least serious devalued in the world of randomised controlled trials, although it has had a stronger place in social work practice (Gould, 2006).