On Thursday 8th March, I was lucky enough to be speaking at a really interesting conference hosted by Norfolk and Suffolk NHS Foundation Trust. Giving Psychosis A Voice 2 brought together a line up of speakers that I would pay to see, so to be asked to present alongside some of the great and the good was a real honour for me. Whilst I was a bit nervous preparing to speak in front of some of the people who have inspired me over the last decade, I was pleased to be challenged to push myself to say something fresh and interesting.
The day itself passed in a whirlwind. The organisers worked hard to fit in lots of speakers – meaning I’m still processing and thinking through the range of perspectives on offer. However, here are some of my initial thoughts and memories.
You can see the presentations, yourself, by checking out this website: www.smhp.nhs.uk/conference/GivingPsychosisaVoice2.aspx
Jacqui Dillon: Living With Voices
Jacqui launched the conference with an inspiring talk sharing the Hearing Voices Network’s approach to voice-hearing. Using the ‘Living With Voices’ as a base, she explained how that people’s life narratives and published research make it clear that adverse life experiences are at the root of difficult voice-hearing experiences. She advocated a new approach to understanding voices and ‘psychosis’ that ditches the old them/well us/ill dichotomy, but embraces a continuum where extreme experiences result in extraordinary reactions. Personally, this view makes a lot of sense to me. Whether someone who has been traumatised, victimised, excluded or invalidated hears voices, has extremes of mood or struggles with their emotions – to me it’s the same thing. We are all reacting understandably to very real events in our lives.
Phil’s presentation, for me, was memorable precisely because it was very human. He shared some of his thoughts about working alongside people who experience distressing realities – suggesting that we don’t need new models, but simply need to rediscover ways of being alongside people and truly listening to them.
Robin is a consultant psychiatrist and the head of the new schizophrenia commission. Given the radical and trauma focused line up, I was interested to hear how his presentation worked alongside this. After all, if we all say the same thing and spend our lives agreeing with one another it would be a very boring world. His presentation was interesting – acknowledging that we have moved on from the idea that schizophrenia is simply a genetically based illness that is fundamentally different from ‘normality’.
Robin suggested that psychosis is, in part, about salience. The idea is that someone experiencing psychosis will, because of the excess of dopamine in their brains, will experiences things as meaningful and important when they are not. They will, understandably, seek to make links between these experiences and create beliefs to explain them. Neuroleptic medication reduces this so called ‘aberrant’ salience, but CBT is then needed to help people make sense of the beliefs that they have already constructed.
Whilst I can see where this perspective is coming from, I think it has a number of important flaws. It’s one thing to explain how something happens mechanically – but quite another to understand WHY. Focusing on the biology risks stripping psychosis of its sense.
Lucy Johnstone: Formulation as a Radical Alternative to Diagnosis
I first heard about Lucy Johnstone when reading her book ‘User and Abusers of Psychiatry’. At the time I was stuck in a cycle of need/rejection with the psychiatric services and her book helped me develop a different understanding of my situation. I was interested to hear her perspective as, in my experience, the formulations used in mainstream CBT psychology can be (for want of a better word) formulaic.
As expected, Lucy had a really sensible take on all this. She deconstructed biological psychiatry’s diagnostic approach as one which magically turns problems into illnesses and strips them of meanings. Her alternative formulation based approach felt both human and helpful. For me, most importantly, I liked that she articulated my concerns about the blending of this approach with biological psychiatry. The stress vulnerability model, whilst seemingly a step forward, has always deeply concerned me too.
Rufus May: Using Creativity To Manage Extreme States
After a very intense morning, I really welcomed the energy in Rufus’s presentation. He had the whole audience engaged in ‘Brain Gym’ and other activities that can help ground, distract or calm someone in an altered state. Whilst the combination of poetry, reflections and activities was refreshing – the stand out tip for me was the use of puppets. The idea is to use puppets to represent voices or aspects of self. For example, I might create a finger puppet to represent one of the voices I’m struggling to communicate with/deal with. I might create another which either represents a positive/helpful voice or a wise aspect of my self. Role playing and externalising a conversation using puppets, to me, feels less intense than Voice Dialogue. It’s simply a creative technique to help someone find positive ways of communicating with the voices they hear. I’ve since used it with a few people that I’ve worked with – thanks Rufus!
Rachel Waddingham: Sense, Interrupted
Over the years I’ve had many different ways of making sense of my experiences (inner and outer). Monsters, alien experiments, government conspiracies, biological illness and dissociation. Of all of these, only the biological illness (schizophrenia/schizoaffective disorder) was imposed on me by others. Interestingly, it is the only explanation that is unrelated to my experience of trauma (by both obscuring it and making it irrelevant). In my talk, I explained the sense in some of my overwhelming beliefs and reframed them as understandable steps in my journey to make sense of the bad things that have happened to me. The diagnosis of schizophrenia, given at a time when I was extremely vulnerable and looking for answers, effectively hijacked this. I then went on to share some thoughts on the implications for this on the way we work with people in extreme states of distress.
Eleanor Longden: Making Sense of Voices
Eleanor, currently studying for her PhD, deconstructed traditional western psychiatric understandings of voice hearing. Using her own experiences alongside the latest research, she clearly demonstrated that voices are understandable and related to the person’s life experiences. There’s not much more I can say about this as everything she said made perfect sense – it just saddens me that this approach is still so radical. It’s essentially a human understanding of a human experience – yet psychiatry seems skilled at complicating and dehumanising things. Let’s bring the sense back!
Dirk Corstens: Talking With Voices
Dirk explained the theory behind Voice Dialogue – a technique where a facilitator respectfully speaks to someone’s voices with the goal of increasing awareness and understanding. Framing voices as dissociative experiences, Voice Dialogue is a powerful technique that – for some – can produce a turning point. Dirk is currently researching the effectiveness of Voice Dialogue, so I’m looking forward to hearing what has been found.
Dirk shared two recent examples from his work. The first one showed that opening up the potential for Voice Dialogue with someone can be powerful in itself. We heard how Marion, someone who felt unable to communicate with a very powerful and distressing voice, recognised that she did indeed communicate with her voice when it refused to take part in Voice Dialogue with Dirk. That the voice said ‘no’ in reply to a question she asked it was a real step forward. She was also able to start to question why the voices didn’t want to do this – was it afraid? was it really that powerful? Dirk’s second example showed how dialoguing can help someone change the way they view a voice. We heard how this technique helped Ian see that his angry voice was actually trying to support him (but doing it in an unhelpful way).