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Lecture, given to the International Conference "Dignity and Recovery" at the University College Cork, run by the Cork Advocacy Network, Ireland, 11 February 2005; in: Journal of Critical Psychology, Counselling and Psychotherapy (U.K.), Vol. 6 (2006), No. 1, pp. 23-25. Powerpoint presentation

Hannelore Klafki

Making Common Sense of Voices

Many historically important people claimed to have heard voices that acted as their inspiration: Socrates, Moses, Mohammed, Joan of Arc, Teresa of Avila, Carl Jung, Anthony Hopkins and Ghandi. Today there are still 3 to 5 per cent who hear voices and many of them cope well with their voices—without psychiatric intervention.

It has been known for some time that a high percentage of the general population experience brief and occasional voices, particularly at times of bereavement, divorce and separation. This is also the case for people in extreme circumstances, for instance, 80 per cent of those who have endured torture hear voices during their ordeal (Amnesty International) and the phenomenon is also seen amongst long-distance yachtsmen (Bennett, 1972). In cases like these, there is no evidence of the presence of mental illness—indeed, often quite the contrary.

Nevertheless psychiatrists neglect these facts and they still regard hearing voices as auditory hallucinations and in many cases (80 per cent) as a symptom of "schizophrenia." Traditionally, the usual treatment for hearing voices is to administer psychiatric drugs for the reduction of delusions and hallucinations, but not everyone responds well to this treatment. Up to 50 per cent of people with a diagnosis of schizophrenia still hear voices when treated with medication.

Psychiatrists have many theories about what may cause voices, many of them presume that it is part of a psychosis and that it might be caused by some kind of genetic flaw. Generally though, it is presumed that there is not a lot an individual can do for themselves to cope with the voices. Professionals are taught not to talk to voice hearers about the content of their voice experience as this is thought to be "buying in" to the patients delusions and not helpful. Most often professionals will seek to distract the voice hearer from their voices. This is not a helpful approach. To be told that the voices are just a symptom of an illness, when those voices are as real to you as anything else in the physical world is very disempowering. Often voice hearers try to discuss their voices with members of the medical profession. They want to discuss what the voices say and the significance of the voices, but they are told voices are just a symptom of illness, to be ignored as best they may. However, they do hear voices that talk about things deeply relevant and meaningful to them. How can they believe that these voices are part of an illness and of no more significance than a sore throat? In an environment where there is active discouragement to talk about the voices from the medical advisors, they are being asked to accept that their own experiences are not relevant.

The same happened to me. They told me I have a psychiatric disorder and I received 6 different diagnoses and I received different treatments according to the diagnosis I had at the time. For 10 years I took medication because I didn`t trust myself. I was a victim of the voices and of the psychiatric system. My recovery began the moment I dared to talk about my voices. I began looking back over my life. My admission to hospital was the result of a complex interaction of factors. One of the factors is to hear voices and another is about the physical abuse and violence. The voices were undoubtedly a reaction to these unhealthy circumstances. Why was I never asked about my circumstances? Why did no one ever ask: 'What are the voices talking about? Do you hear a man or a woman? Do you know the triggers of your voices?' Such obvious questions are not usually asked in psychiatry. In psychiatry it is important to establish a diagnosis. And once this diagnosis is found, it automatically provides answers to all questions. From that moment on, everything you say and do is regarded as a logical manifestation of the diagnosed disorder.

I started fighting against this interpretation because I no longer wanted what mental health care professionals offered me. I met more and more voice hearers and we had many meetings and discussions. The main result of these discussions among us was that we needed to empower ourselves. There is no one else, who will do it for us.

Finally we founded the German Hearing Voices Network which offers self-help groups, conferences and trainings in how to understand voices and how to cope with voices. It is Important to understand the different modes of expressions used by most of us to describe and account for our experiences, as well as the language spoken by the voices themselves. There is often a world of symbols and feelings involved; for example, a voice might speak of light and dark when expressing love and aggression. We try to encourage voice hearer to meet other people with similar experiences and to read about hearing voices, in order to help overcome isolation and taboo.

The training is primarily offered to users, ex-users and survivors of psychiatry and people threatened by forced psychiatric treatment; and which is also open to their supporters and interested workers in the psychiatric field. Training is offered not only on how to cope with voices but also on such issues as: self-help, alternatives to psychiatry, how to deal with psychiatric drugs, empowerment and much more.

Now the improvement in individuals who are encouraged to talk about their voices—instead of the suppression by synthetic chemicals—becomes more apparent, and health professionals learn to understand that the key to understand voices is within the content of the voices. The message of the network is: the fact that you hear voices is not the problem; it is the way you deal with them. And hearing voices in its own is not a sign of mental illness.

Our attention moves from mental illness, symptoms and passivity to recovery, possibilities and directing our own lives, but we also take the initiative in the area of recovery, empowerment and expertise by experience. Collectively, in the user movement, it raises our consciousness. We claim the authorship on our own subjectivity. The concept of recovery is a powerful one. Recovery is a concept that allows us to develop expertise by experience. This gives us the opportunity to overcome our patient-identity without ignoring its reality. Talking about the voices and working on recovery with others is a political matter. I believe that mental health care users can help and support each other in their recovery to a far greater extent than is currently the case.

Only learning from each others knowledge, gained from our own experiences over so many years, will enable us to develop concepts through which we can express ourselves. Concepts from within which we can say: 'that is how it is, this is who I am, and that is of help to me.' Our ideas are not only of value to us. They also offer the possibility for professionals to learn to speak in a new language. A language that both users and professionals understand.

Thank you very much for your attention.

Hannelore Klafki is a founding-member of the German Netzwerk Stimmenhoeren (Hearing-Voices-Network) and was Chair of this Network for seven years. Since 2003, she is a board-member of the German Bundesverband Psychiatrie-Erfahrener (Federal Association of [ex-] users and survivors of psychiatry). And she is a trainer for (ex-) users and survivors of psychiatry and their friends and supporting relatives as well as interested workers in the psychiatric system; she offers training on topics of how to deal with hearing voices, on the topic of self-help, empowerment and alternatives to psychiatry. More about Hannelore Klafki

Hannelore Klafki died on Sept. 4, 2005