Hearing the Voices of Others
Anna Tickle
When I became an assistant psychologist in a psychiatric unit, I had little idea of what my day-to-day role would entail. Upon arrival, I quickly realised that the team I was joining had not previously included a psychologist and they were uncertain about what my role might be. This meant that the situation I found myself immersed in was somewhat tentative and would require working with the team to explore the possibilities. Here, I will focus on just one of those possibilities, which came to fruition and proved to be an unrivalled learning experience in my professional life to date: providing a group experience for people who hear voices. I have changed the names of those involved in order to protect their identities.
I was very fortunate that my line manager, Daphne, was happy to share her extensive experience and knowledge with me but also had the confidence to allow me to learn from my own practice. This allowed me to feel supported but not over-protected or stifled in any way, despite my inexperience. It was Daphne who suggested that I could establish and run the group. The opportunity to work with people who hear voices caught my interest, perhaps because of my own lack of knowledge and curiosity about the phenomena. I was immediately engaged because I wanted to find out more about people’s experiences of hearing voices and how they might be supported in coping with the resulting distress. My curiosity drove my initial motivation to engage with the challenge and my investigations perpetuated further interest.
The first task was to research why people might hear voices, how the experience might affect them, and whether there was anything that I could offer individuals who might join the group. I was sensitive that being asked to run a group suggested that I had something valuable to provide and yet I had no previous experience to support this. The group was not positioned as a joint endeavour of learning, but as a therapeutic process being provided by professionals for people who required support to cope with experiences that caused them acute emotional distress. I felt that this placed pressure on me to do everything possible to validate my position. This was in fact pressure that I placed upon myself, because of a feeling that I would be somehow exposed as fraudulent if I had not acquired extensive knowledge about the topic that would bring us together. It was the pressure to learn, within a limited period, which led to me immersing myself in the situation.
As I researched the phenomena of voice hearing, I discovered that I held assumptions I had not been conscious of. I found myself constantly surprised by what I read, despite knowing nothing about the subject to begin with. I learned of the examples of famous people who it is claimed heard voices, including Socrates, Joan of Arc, Mahatma Ghandi. This led me to consider that ‘voice-hearing’ might be constructed as a spiritual or religious experience or as a sign of mental health difficulties. Learning that the Xhosa of South Africa train people who hear voices to become healers suggested that there could be positive explanations and responses to experiences that seem so far removed from Westernised medical conceptualisations. This increased my curiosity and I wanted to include these thoughts into the content of the group, in the hope that this might spark inquisitiveness in group members and broaden their thinking about the experience of hearing voices.
Fortunately, Daphne supported this approach and encouraged me to include such ideas in the material of the group sessions. This carried with it some risk. I imagined scenarios in which group members would argue that such examples were irrelevant to their own distressing experiences, which were commonly constructed by their psychiatrists as symptoms of mental illness that should be treated by neuroleptic medication. These concerns proved to be unfounded as group members expressed interest in the variety of different explanations for hearing voices that are found in different cultures around the world. Their receptiveness was a lesson to me that it can be valuable to challenge dominant discourses by considering much broader perspectives.
Daphne and myself interviewed all of the potential group members. Their stories were fascinating, a blend of tragic circumstance and astounding resilience that had helped each of them to cope with voices and images that persecuted them relentlessly. For some, the voices were within their head and for others they were external. Voices could have strong identities and even fight with one another with such fury that the person hearing them found it impossible to hear their own thoughts. “Don’t eat that you fat bitch”, Lisa’s voice would tell her. She knew it was her father, despite having never met him. For a long time Stewart had seen visions of himself hanging from a beam in the barn outside his house. His wife had chained and padlocked the doors of the barn but the voice would tell him “It will be okay, you’ve got the keys now”. During some nights he would lie frozen in bed for hours because he could hear somebody calling his name. Dan’s voices began when he was a child. They had been a comfort and helped him to cope when his father crept into his room at night to violate him. As the years went on the voices changed, telling him to hurt himself and others. The scars running down his cheeks served as evidence of their power. Standing at a bus stop was at times impossible because Dan was so tormented by the voices’ claim that everybody around him thought he was a paedophile. Hearing each person’s story opened my mind to experiences so far removed from my own that I had to learn to suspend disbelief in order to accept that people could learn to cope with such distress. This increased my sense of pressure and the size of the challenge that was to offer something that might be useful for each of the group members.
The group was to run for twelve sessions, and I expected that it would take time for the members to build trust and feel comfortable to share with each other. As a starting point, we worked together to set the rules for the group. This gave an insight into the needs of the group members, but also their level of sensitivity and kindness towards each other. Although the group felt awkward initially, it was clear that the members had respect for each other and were willing to embark on a journey together in the hope of finding new ways to manage the voices that they heard. For one member, Martin, the situation was overwhelming. He believed abuse during childhood and years of illicit drug use had led to his worries that other people were talking about him. This, together with the voices he heard, had destroyed any confidence to be in social situations. Martin asked to go to the toilet during the first session but did not return. He was embarrassed when I contacted him after the group, but we worked through this and thought about what might be useful to him. The group situation had felt threatening and Martin was unable to return. Instead, we agreed to meet separately each week but follow the work of the group. We did so over the next three months and Martin attended the entirety of every session. As we progressed, he developed new ways of coping with the voices’ challenges to his confidence and he experimented with new social situations. The pinnacle of his achievements was being able to attend a charity ball that he expected his voices would force him to leave early. He enjoyed it so much that he remained until the end and told me about it with such excitement and pride that I had the sense of it being a truly momentous occasion. Had we allowed Martin to leave the group without exploring ways of working that might be better suited to him, Martin might not have achieved his new-found confidence This taught me that being adaptable can enable ways of persisting with situations that would be easy to abandon. I think that this also reflects that through preparation for the group I had developed a sense that I might have something to offer that was worth persisting with. This gave me the confidence to suggest to Martin that we could find another way of working together.
As the weeks passed, the group members became more comfortable with each other and we worked together to think about their understanding of their experiences and how they managed their distress. The accounts that group members told were so absorbing that listening to them could not have been anything other than an immersive experience. Being able to hear what was being said without expressing shock or disbelief helped me to guide the group through the therapeutic process. This could be challenging at times, not because I did not believe individual accounts, but because I found it hard to believe that people can be so resilient to such testing experiences. I found myself able to learn from watching Daphne, who always listened sincerely with calm body language and empathic expressions. Of equal importance was what I learned from the members of the group, who attended completely, never disputing what was said. While I was the mental health professional with little experience, they were all experts by experience. Learning to learn from them was crucial and is something that I hope will serve me well throughout my career.
There were times when the group felt uncomfortable. This was perhaps inevitable given that we were discussing such sensitive concerns among a people for whom paranoia, anxiety and depression had been a part of everyday life for many years. I had to be able to contain anxieties felt by the group, such as when Dan said that the voice was telling him to tear out people’s jugular veins with his teeth. The look of anguish in his eyes made it seem that this was a possibility but the group worked together to support Dan rather than express fear or abandon him after he shared his most perturbing thoughts. At times we had to offer reassurances that the group was not being filmed or recorded and we had to adapt the work so that some individuals did not have to write anything down, for fear that it might be used against them. As I had found with Martin, learning to be flexible and adaptive helped the group to run more smoothly. I also learned to position myself not as the expert, but as a facilitator who could help the group members to learn from each other. This relieved me of some of the pressure I had felt before the group had begun, so that I was less concerned with imparting knowledge and could make myself more emotionally available to the group.
There was never any question about whether I would persist with the group, as it was my job to do so. Despite this, my motivation increased as I found each session more rewarding than the last. What was most interesting for me was that each of the group members seemed receptive to the group was an immersive learning experience. As I watched them return each week to persist in their quest for a better understanding or more control of their experiences, I was driven to continue to both help them to learn and to learn from them. The experience broadened my thinking in ways that I can apply to many situations. I anticipate that its memory will stay with me forever.
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