On the Frontline with Voices

A Grassroots Handbook for Voice-Hearers, Carers and Clinicians

Keith Butler

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9781138040328
• eBook ISBN: 9781351705967
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

This is a jargon-free, user-friendly resource for voice-hearers and their carers, as well as the clinicians and groups who support them both. It offers a new and practical way of looking at voice-hearing as well as a host of practical strategies to assist in recovery. The resource is built around three core sections. Each of the sections speaks directly to voice-hearers, clinicians and carers, in turn. The style and content addresses each group's individual needs in terms appropriate to them and schools them in how to deal with voices from their particular perspective.  The core aim is to provide these three groups with practical techniques they can use on a daily basis. The resource offers a proactive, practical and client-centred framework that is designed to reduce anxiety and increase the likelihood of learning new ways to deal with voices. Keith Butler is a consultant clinical psychologist and an associate fellow of the BPS (British Psychological Society). He was a key player in the development of the Buckinghamshire Early Intervention Service (BEIS) and occupied the position of clinical lead in the BEIS for its first 6 years up to his retirement at the end of 2010.

Chapter 1
Approaching the problem of voices

The Western view of hearing voices - commonly referred to as auditory hallucinations in the mental health world - has for many years been embedded in psychiatry. In other words, descriptions of cause were only presented as biological. Consequently, the chief recommendation for treatment has until recently been biological. Medication is given to a patient without the patient really understanding how it works, and therefore being unable to regulate or participate as an equal in the treatment process.

Generally, although the causes are recognised as being complex, models used have presented a somewhat iinear picture of cause, effect and treatment. This may be adequate for many medical problems but in matters relating to how people are dealing with thoughts and feelings and the behavioural outcome within the complexities of society there needs to be more thinking in terms of systems. Key issues relating to, for example, the influence of challenging social pressures in the genesis and maintenance of the problem have not been factored into the description. Consequently, the need to intervene in these areas has been underplayed.

Thus, we can say that finding the cause of complex mental health issues is not simple because it is usually multifaceted.

Susan Jeffers (1991) has a noteworthy approach to the problem of cause:

But does it really matter where our self doubts come from? I believe not. It is not my approach to analyze the whys and wherefores of troublesome areas of the mind. It is often impossible to figure out what the actual causes of negative patterns are, and even if we did know, the knowing does not necessarily change them. I believe that if something is troubling you, simply start from where you are and take the necessary action to change it.

(Jeffers, 1991,18)

Among others, it is this multifaceted quality of the problem of cause that draws in a psychosocial approach². Decades of crusading to get recognition of psycho-social explanations has eventually born fruit. This innovation has made it easier to describe voice-hearing to people who hear troublesome voices in an understandable way and also to provide them with the tools that they can use on a daily, hourly or even minute-by-minute basis to deal with their voices. In this way, control and power is placed back into their hands.

I therefore want to introduce you to a way of seeing voices that has helped many people move towards an ordinary life where voices may still be present but have become minimally or no longer troublesome to them.

I will be drawing on some key approaches and also strategies that my voice-hearing clients have taught me in individual, group and family therapy settings.

The key target is the inherent power dynamic that plays out chiefly within the relationship the voice-hearer has with their voices.

To make a beginning, I would like you to start thinking like a commander in the army. Before action is taken, a good commander will gather intelligence about the enemy by trying to understand them. At first, this will be an overall picture, and later the commander will try to understand the specifics of the enemy, such as how they fight and what their strong points and weak points are. Having this information at hand allows the astute commander to draw on a variety of techniques and strategies to counteract attack or intrusion.

It is similarly important for people who have to deal with troublesome voices - the voice-hearer, the carer and the clinicians - to adopt a strategic attitude in attempting to overcome voices. They will soon also realise that they will be entering the world of interpretations and meanings that are attached to the experience. This then is perhaps a good place to start.

1.1 A few words about meaning

The various meanings that we place on all our experiences are reflected in the descriptions we attach to them. Some people may say that a ride on a roller coaster is fantastic; others may say that it was horrible. It is the same roller coaster but experienced differently by different people. Thus, it has different meanings to different people and so people respond to it in different ways.

It is quite usual that the meanings each of us attaches to experiences may stay with us for many years, if not our whole lives. For instance, when you hear the word 'apple', what sort of things come into your mind? The sort of things that come into my mind are: eat, bake, sweet, sour, hard, throw, rotten, worms, red, green, skin, bitter, tree, my first apple, primary school, teacher and Snow White. Memories associated with these particular words come to the surface.

Thus, around almost every word we know or experience we have had there is a halo of personal interpretations, meanings, memories and associations that influence how we see the object - in this case 'apple' (see Figure 1). This then colours the way we behave towards the object - in this case, what we have named 'apple'.

Figure 1 Personal interpretations and meanings

As you can see, there are a lot of memories and experiences locked up for me in this single word 'apple', and so it is for everyone. In other words, if I was blindfolded and given something to taste and it tasted somewhat sour but also had some sweetness, had a bit of a tough bitter skin and a particular smell, I would probably identify it as 'apple'.

What about words like 'father', 'family' or 'dog'? What memories and meanings would then come up for each of us? The only thing we can really say is that they would probably be quite different for each of us.

In each concept, for example, father, dog and even apple, we would have some good memories and meanings and some bad memories and meanings. Whatever the case, every time I see or hear someone who, for instance, reminds me of my rather, it is quite likely that some of the meanings I attached to that person would come up.

Thus, when any one of us experiences something, one of the first steps our mind takes is to try to make sense of that thing - the 'What is it?', 'Where does it come from?' and so on set of questions pops up. If we cannot immediately make sense of it, our minds still have to try to answer these questions anyway, simply because we do not easily live in a world that is full of questions and strange, unknown experiences. Further, if you do not know what you are experiencing, it is very difficult to know how to respond to it.

So, if I do not know what it is that I am seeing or hearing, I will probably classify it as something closest to what I already know - like the saying: 'if it looks like a duck, sounds like a duck, and walks like a duck, it probably is a duck.' What follows then is that I would interact with this thing as if it is a duck. But with voices it is not that simple. One of my clients illustrated this by reporting that his one voice sounded like his father, but that his father would never say those kinds of things to him.

The meanings that voice-hearers attach to their voices play a big role in the way they experience them and thus in the way that they deal with them.

1.2 Understanding voices: the overall picture

There are many ways to try to understand what voices are so that they can be dealt with in a way that has the least impact on the person's life. As mentioned, the traditional way derives from a medical approach in which voices are described as having biological roots. The most common explanation I have come across is that they are part of a brain disease, in which there is a 'chemical imbalance in the brain'. In order to address this view, the hearing of voices is classified as being part of an illness. Consequently, people become medical patients and are given medication as the first-line treatment.

For me as a psychologist, it does not matter what voices 'really' are. In other words, questions like 'Are voices just caused by a bunch of chemicals or is there some part of the brain that needs to be treated in some way?' are largely irrelevant because there are few current treatments in those domains that offer a life similar to the one had before the person heard voices. What matters in the long run is having a way of dealing with them so that the person can get on with the business of living as soon as possible.

There is another very important issue that has to do with what voices are. Ihe dividing line between voices in the clinical sense and other voice-like experiences is very thin. There are some who will no doubt be able to stick a glossy label on what I am about to describe, however this personal experience is hugely troublesome and it affects my behaviour at times. The clever label I have heard it called is 'imposterism'.

Some say that it is more common in girls, but there is a percentage of guys that experience it as well.

My imposterism goes something like this. I do not experience a voice as such but, at the lowest end of the scale, I experience a groundless sense of guilt and culpability when I see a police car. At the rough end of the spectrum with certain experiences, I have intense self-condemning thoughts that may be triggered by the situation or that may arise completely out of the blue.

They confront me like a prosecuting barrister with a string of accusations of misrepresenting facts as well as myself, hence the word 'imposterism'. There is a strong feeling that my guilty secret will be discovered and that there will be severe consequences. I have no guilty secret that I know of. However, once on a roll this process is relentless. It can actually cause me to start talking in a defensive way.I almost messed up an important job interview when this process kicked off during the interview. But these are not voices, simply because I do not actually hear a voice; they are thoughts and fear responses and I can fairly easily work out what life events are triggering them.

For the voice-hearer, on the other hand, voices are the worst kind of nightmare. They are experienced just as real as when two people are talking to each other. For the voice-hearer the personal origin of their voices is obscure and, as such, an explanation is not readily available. Being thus shrouded in mystery also grants the voice power. Later, you will see that this cloak of mystery is also one of the targets that can be fruitfully attacked.

They subjugate the voice-hearer to a bombardment of criticism, threats and abuse, the likes of which those who have never experienced hearing a voice(s) can barely understand. I could only get an impression of it after many years of work with voice-hearers.

Voices often corne at unexpected times, causing the person to feel startled (see section 1.2). They will find themselves waiting for their voices, even when they start learning how to deal with them. After hearing voices constantly for more than 20 years, one voice-hearer described the cessation of voice-hearing as if 'part of his brain was missing'.

When voices arrive, either as if coming from a distance or by gatecrashing a voice-hearer's thoughts, one by one or all together, the interruption is instant and total. The effect is a bloodless coup in which the person may become instantly and totally overwhelmed. I have seen a client move from productive involvement in a group to being reduced to a sweating, helpless person literally within a minute, for no reason apparent to anyone else in the group. He asked to be left alone for a while and the group continued. Several minutes later he emerged from his battle saying that he had applied the strategies that he had learned and with great effort and tenacity he had reduced his voices to a bearable level. In those few minutes he had overcome his voices.

The person who hears voices easily becomes extremely fearful of them. Often they may feel that they have to obey them and that the voices may never be challenged.

A person who hears voices often believes that their voices are all powerful.

Sometimes it seems that some voice-hearers make a sort of devil's pact with their voices, believing that if they do what the voices ask, they will be left alone. Of course, the anticipated result does not happen. Further, although the voices break this silent contract repeatedly, the voice-hearer may well still believe that it will work sometime. It never does.

One very important issue about voices and emotions is that voices se...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of Figures
• Introduction
• 1. Approaching the problem of voices
• 2. For voice-hearers
• 3. For clinicians
• 4. For carers and family
• 5. In conclusion
• Appendices
• References
• Index