Definition
The Hearing Voices Network is an service user organization that centers around the idea that hearing voices is not in itself a pathology, but rather an experience (Styron, Utter, and Davidson, 2017). The HVN views voice hearing as a response to trauma and focuses on lessening distress associated with voice hearing and increasing perceived self efficacy, rather than attempting to minimize the experience of the voices themselves.
In the practice of modern psychiatry, voice hearers are diagnosed with schizophrenia. (Patel, 2014). Schizophrenia is a mental health diagnosis used to describe people who experience hallucinations, disordered thinking, or impaired cognition. Modern psychiatry holds the belief that voice hearing has a neurobiological basis, specifically related to neurotransmission. Because schizophrenia is conceptualized as a pathology, a diagnosis of schizophrenia is usually accompanied by recommendations of treatment in the form of psychotherapy and antipsychotic medication (Patel, 2014). According to their website, the HVN was founded both to explore alternate causes of voice hearing as well as offering additional strategies for living as a voice hearer when medication is unhelpful (“About HVN”). The model the HVN promotes for coping with voice hearing involves examination of the content of the voices, and exploration of the basis of this content within the voice hearer’s experiences.
The HVN clearly states that that it does not provide “treatment” for voice hearers, instead it offers support through self help ideology and social validation. Another major focus of the HVN is decreasing social stigma around people who hear voices through advocacy. (Styron, Utter, and Davidson, 2017).
The HVN is a relatively new movement and information about it has been primarily spread through first person accounts of experiences of voice hearing and the HVN (Styron, Utter, and Davidson, 2017). One such example is a Ted Talk by Psychologist and voice hearer Eleanor Longden (This talk can be found here: https://www.ted.com/talks/eleanor_longden_the_voices_in_my_head). The activities of the HVN primarily consist of advocacy work on behalf of voice hearers and social support through hearing voices peer support groups (Styron, Utter, and Davidson, 2017). In addition, two approaches for helping voice hearers make sense of their experiences have been developed through the HVN, these approaches are The Maastricht Hearing Voices Interview and “Talking With Voices”, and are discussed in more detail below (Styron, Utter, and Davidson, 2017).
While the HVN distinguishes itself from traditional psychological perspectives on voice hearing, it supports the use by individuals of traditional psychological approaches to coping with voices, including medication and traditional psychotherapeutic approaches (Styron, Utter, and Davidson, 2017). In addition, the two HVN based approaches discussed above, share many techniques in common with traditional therapeutic approaches. In particular, most techniques for coping with voice hearing involve engaging with the voices in order to better understand “the nature of the voices and their content” (Styron, Utter, and Davidson, 2017). One of the HVN based approaches is The Maastricht Hearing Voices Interview, which leads voice hearers through a set of steps during which the voice hearer and a therapist collect information related to the content, origin, and impact of the voices on the voice hearer’s life. This process followed by a collaboration with the therapist that explores possible interpretations of that individual’s voice hearing experience and strategies for coping with the more difficult aspects of voice hearing. The other HVN based approach is the “Talking with Voices” approach, in which a therapist asks questions directly to the voices with the goal of collecting the same information as The Maastricht Hearing Voices Interview does. The therapist then develops a profile of the voices so that the voice hearer can begin to address the relevance of the voices’ content in their lives. A review of traditional therapeutic approaches as well as HVN approaches to coping with voice hearing can be found here: https://link.springer.com/content/pdf/10.1007%2Fs11126-017-9491-1.pdf.
Research on the efficacy of the HVN support groups and approaches is very limited and primarily anecdotal. (Styron, Utter, and Davidson, 2017). Styron, Utter, and Davidson review the studies conducted before 2017 on HVN and report that studies found that most participants reported positive outcomes as a result of the HVN support groups, particularly in improving social relationships. This review also pointed out that the studies found that significant variation in how the individual groups were run (2017). A more recent study by Longden, Read, and Dillon found positive associations between HVN group attendance and perceptions of social support and self efficacy (2017).
Because all studies on the HVN thus far have been qualitative and conducted on participants who are simultaneously receiving psychological or psychiatric treatment, definitive conclusions can not be drawn about the efficacy of the HVN support groups compared to the traditional therapeutic approaches (Longden, Read, and Dillon, 2017).
Historical Context
While there are some historical examples of hearing voices being treated as a meaningful experience, in the 21st century, hearing voices has primarily been viewed through a medical model which considers voice hearing to be a pathological symptom of Schizophrenia or an associated mental illness (Suri, 2011). The prominent medical model views Schizophrenia as a biological illness and thus prioritizes medication over other methods of understanding or coping with the experience of hearing voices (Suri, 2011). However, such medications often carry severe side effects (Muench and Hamer, 2010). In addition, the diagnosis of schizophrenia carries a high degree of societal stigma that can be damaging and socially isolating for people who hear voices (Ruddle, Mason, and Wykes, 2011). A study by Angermeyer and Matschinger (2003) concluded that the negative impacts of the Schizophrenia label were greater than the positive impacts. Participants in the study associated the label of Schizophrenia with dangerousness and would experience fear and a desire to distance themselves from the voice hearer. The study can be found here: http://onlinelibrary.wiley.com/doi/10.1034/j.1600-0447.2003.00150.x/full. The HVN emerged in 1987 in response to the limited and stigmatizing medical understandings of the experience of hearing voices and has been growing as a movement ever since (Styron, Utter, and Davidson, 2017).
Perspectives
The HVN has been considered controversial because it provides an ideology for voice hearing that diverges from that of the prominent medical model (Styron, Utter, and Davidson, 2017). Although the HVN does not rebuke use of traditional psychological approaches for coping with voice hearing, some critics have indicated that through the HVN’s reframing of the experience of hearing voices, it understates the beneficial aspects of medication as a coping strategy for voice hearing (Styron, Utter, and Davidson, 2017).
Further critiques of the HVN have focused on the fact that almost all participants in the HVN support groups have at some time or are simultaneously receiving other types of psychological and psychiatric assistance (Styron, Utter, and Davidson, 2017). This has led to questions about whether participants in support groups are hindered by the lack of representation of voice hearers who are not psychological or psychiatric patients (Styron, Utter, and Davidson, 2017).
Connection to Politics of Health
Peter Conrad explained that medicalization consists of “defining a problem in medical terms, usually as an illness or disorder, or using medical intervention to treat it” (2005). One area where medicalization is particularly visible is in psychiatry. He pointed out that, since the 1980s, there has been a shift in psychiatry from using psychotherapy to treat mental illness, to using more technologically driven therapies, particularly medication (Conrad, 2005). These shifting principles in ideology and treatment of mental illness are particularly important in considering what options are available to people for coping with mental illness. For example, insurance companies will often cover medication as a treatment for mental illness, but not psychotherapy (Conrad, 2005). Conrad explained that medicalization can lead to individualization of social issues (Conrad 1992).
The HVN, while it is not against psychiatry, does not view hearing voices as a symptom of underlying brain dysfunction (Styron, Utter, and Davidson, 2017). Rather, the HVN views hearing voices as having a “protective or positive function” (Styron, Utter, and Davidson, 2017) in coping with external circumstances, such as trauma. While the HVN believes that medication and psychotherapy can be useful as a supplemental way of coping with voice hearing. However, the work of the HVN diverges from the work of traditional psychological strategies for managing voice hearers in that it identifies itself as a social movement. In contrast to medicalized approaches of managing people who hear voices, which focus on individual “pathology”, the HVN externalizes the issues surrounding people who hear voices, and focuses on “social advocacy, emphasizing the roles of peer support, trauma, and the need to normalize the experience of voice hearing” (Styron, Utter, and Davidson, 2017). This process of shifting the ideology around voice hearing from a medical model to a social one is an example of demedicalization (Conrad, 1992). by By choosing to focus on the external and social circumstances around people who hear voices, the HVN provides a perspective that contrasts the prevalent medicalized perspective on this experience.
Citations
Angermeyer, M., & Matschinger, H. (2003). The stigma of mental illness: effects of labelling on public attitudes towards people with mental disorder. Acta Psychiatrica Scandiavica,108(4), 304-309. doi:10.1034/j.1600-0447.2003.00150.x
Conrad, P. (1992). Medicalization and Social Control. Annual Review of Sociology, 18(1), 209-232. doi:10.1146/annurev.soc.18.1.209
Conrad, P. (2005). The Shifting Engines of Medicalization. Journal of Health and Social Behavior,46(1), 3-14. doi:10.1177/002214650504600102
“About HVN.” Hearing Voices Network, www.hearing-voices.org/about-us/.
Longden, E. (2013, February) Eleanor Longden: The Voices In My Head [Video File]. Retrieved from https://www.ted.com/talks/eleanor_longden_the_voices_in_my_head
Muench, J., MD, MPH, & Hamer, A., PharmD, BCPP. (2010). Adverse Effects of Antipsychotic Medications. American Family Physician,18(5), 617-622.
Patel, K., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia. Pharmacy and Therapeutics,39(9), 638-645. Retrieved February 2, 2018.
Ruddle, A., Mason, O., & Wykes, T. (2011). A review of hearing voices groups: Evidence and mechanisms of change. Clinical Psychology Review,31(5), 757-766. doi:10.1016/j.cpr.2011.03.010
Styron, T., Utter, L., & Davidson, L. (2017). The hearing voices network: initial lessons and future directions for mental health professionals and Systems of Care. Psychiatric Quarterly,88(4), 769-785. doi:10.1007/s11126-017-9491-1
Suri, R. (2011). Making Sense of Voices: An Exploration of Meaningfulness in Auditory Hallucinations in Schizophrenia. Journal of Humanistic Psychology,51(2), 152-171. doi:10.1177/0022167810373394
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