Alternative To Medical Model
The Hearing Voices Movement reflects significant disenchantment with the medical model and the practises of mental health services through much of the Western World.
Brown et al. (1998) finds that 23% of people diagnosed with a psychotic illness experience positive symptoms that are resistant to medication. It has been reported that only a minority (roughly 35%) obtain significant benefits from antipsychotic drug treatment. Further, there is a range of secondary problems and withdrawal effects associated with both traditional and atypical antipsychotic drugs.
The movement also focuses on the complexity of the experience of hearing voices. In addition, emotional problems (such as depression and anxiety) are found in 25–40% of those diagnosed with psychosis, and the risk of suicide is increasingly recognised.
Apart from the issue of medical effectiveness, 'getting better' must be as much a personal process, to do with the nature of the experience, as a medical one. Many service users have reported negative experiences of mental health services because they are discouraged from talking about their voices as these are seen solely as symptoms of psychiatric illness.
Slade and Bentall (1988) conclude that the failure to attend to hallucinatory experiences and/or have the opportunity for dialogue about them is likely to have the effect of helping to maintain them.
Romme (1991) describes several case stories to show how the acceptance or non-acceptance of voice hearing is socially and culturally determined, which can influence the outcome of treatment with people diagnosed with schizophrenia. Baker (1995) suggests that the extent to which nurses accept the experience of people they believe to have psychotic disorders has an effect on the extent to which they can discuss it with them. Martin (2000) describes the creation of an environment conducive to discussing the experience. Such strategies do not demand textbook answers, but emerge from service users living, in a supported way, with the experience of voice hearing.
Increasingly, in acknowledgement of the methodological weaknesses, poor prognostic power, symptomatic variability and general weaknesses inherent in the diagnostic validity of the term schizophrenia, the psychological literature has increasingly tended to focus on specific or discrete symptoms or aspects associated with it.
Thus, there has been a rapid growth in research investigating theory and treatment of strange beliefs, attention and concentration deficits, self-esteem, family processes (such as the Expressed Emotion literature), to mention but a few, as well as 'voices'. In addition, recent developments in the theory and treatment of post-traumatic stress disorder and dissociative conditions offer new understandings emphasising the close links between severe trauma in earlier life and voice hearing subsequently along with other potentially very disabling psychological symptoms. Romme et al., for example report that the disability incurred by hearing voices is associated with previous trauma and abuse, in some way (Romme et al., 1998). Similarly, in a follow-up study (Romme et al., 1999) find that these important connections can be effectively addressed clinically using a mixture of psychological therapy and self-help methods.
Romme and Escher (2000) have developed a method they call "Making sense of voices" to explore the problems in the life of the voice hearer that lie at the roots of the hearing voices experience. This approach was adopted as a consequence of the results of the studies they carried out, that they claimed, showed that to hearing voices, in itself, is not a symptom of an illness, but in most people is a reaction to severe traumatic experiences that made the person powerless, and are in effect, a kind of survival strategy.
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