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How do we explain Joan of Arc's experience of receiving messages from God telling her to fight the English army? Why do sports competitors talk to themselves when pushing to improve their performance? There are some golfers who even talk to their golf ball! You've heard people say that talking to yourself is the first sign of madness'. Or is it? I've just read a review of a new book about explanations of hearing and responding to voices called 'The Voices Within' by Charles Fernyhough, which got me thinking about how we interpret voice hearing. The book examines lots of research and explanations as to why people might talk to themselves. You can find out more about the book at the author’s website: http://www.charlesfernyhough.com/tvw.html
Hearing voices can be interpreted as a hallucinatory experience, that is experiencing something for which there is no obvious stimulation, and so hearing voices is an auditory hallucination which some people answer back– and is recorded in diagnostic classifications as one symptom of schizophrenia. So going back to Joan of Arc, if she told people today what she had experienced she might have been diagnosed with a mental illness instead of being burnt at the stake (but of course later made a saint). You see there's a lot of history to responding to voices, and it’s probably only relatively recently that medicine has had such a major role in assessing its causes, rather than religious or spiritual explanations.
There are lots of other modern explanations of voices before we jump to illness explanations, isolation, sensory deprivation, deafness, stress – all of these can be causes. Marius Romme one of the founders of the Hearing Voices movement talks of voices experienced by people diagnosed with schizophrenia as a reaction to unresolved problems in the person’s life. His movement has been helpful to many voice hearers in coping with voices.
So how do we respond to someone who hears voices and responds to them? Assessment of these is important, because we don’t want to jump to diagnoses of psychotic disorder if there are other explanations. Assessment isn’t just about causes ( mental health or other causes) but it’s also about impact on the person.
- Are the voices distressing or encouraging?
- Are they having a harmful impact on the person’s life and their interaction with others around them? Has the person developed any coping strategies?
- Are the voices present all the time, or are can the person keep a diary of when the voices occur?
These are the questions that can be most helpful in working with someone who hears voices.
David Beckingham – QCS Expert Mental Health Contributor