Laura Zera

Stories to Connect Cultures

You and Mental Health: Countering the Pathology View of Hearing Voices

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There’s a t-shirt–you may have seen it– that says, “I do whatever the voices in my head tell me to do.” My guess is that the person who decided that particular expression should be screen printed on cotton had never experienced auditory hallucinations, just as the person who came up with the “Kiss me, I’m Irish” t-shirt was probably Latvian.

Voice to earWe quip about hearing voices because we don’t think it’s normal. You’ll never see a t-shirt that says, “I respond when asked a question,” or “I sleep laying down.” If we’ve never heard voices, though, then who are we to deem it (and damn it) as abnormal?

In my last mental health post, I wrote about empowering the mental health consumer by engaging them and their families more meaningfully in decisions around their treatment protocol. When working with those who deal with psychosis, however, if we pathologize the experience of hearing voices, we’ve instantly set boundaries on the discussion–and attached a certain stigma–as we dive into contemplation of ways to eradicate the voices.

A different philosophy bears consideration. Started 26 years ago as the Hearing Voices Movement and now operating as INTERVOICE, it holds that voice hearers can develop their own personal narrative around the experience, including tools for accepting and coping with the voices. Instead of labeling voice hearing as abnormal, it applies recognition of voices as meaningful and related to the hearers’ lives, possibly even linked to unresolved trauma or a difficult event. Thus, an environment is created where voice hearers are encouraged to talk about their experiences without shame and stigma.

The approach is supportive and respectful. The result is empowerment.

While many voice hearers are leading the way in changing perceptions around voice hearing (take the wonderful Eleanor Longden, for example), I’m also thinking about this with a more all-encompassing mental health shift in mind. Movement toward more meaningful mental health care, for any symptoms and illnesses, require that we approach with an open mind and suspension of some of our usual labels for what’s normal and what’s not. Stay human-focused. Try new things. Engage in deep dialogue with mental health consumers to come up with new policies. And then, one happy day, the t-shirt designers will have to respond to a savvy market and retire some of their classics.

 

What do you think about this philosophy? And are there any risks or other considerations that I’ve missed?

 

You and Mental Health: Empower the Consumer

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‘Empowerment’ is one of those words whose meaning can lose impact over time and with overuse. Or when you use it like this: “Let me reach out to my team and see if we can ignite our value proposition in a way that will empower them and help us achieve our organizational goal of scalability.” Do you gloss over when you read or hear stuff like that, or, like me, hear the voice of Charlie Brown’s teacher in your head?

Recently, two readers left brilliant comments on my blog post regarding involuntary outpatient treatment that reminded me why empowerment should never become cliché, no matter how often it is used in corporate speak or marketing materials or annual reports. It’s not cliché, nor is it easy, which is perhaps why we gloss over it and take shortcuts that will produce quicker results, even when we know we could get better results if we waited longer, and, yes, invested more.

In their insightful responses, both Marcy and Jill brought the discussion back to be one of meaningful care instead of forced treatment. This isn’t to say that involuntary outpatient treatment doesn’t have a place in the conversation, but rather, if we focus on building resources around something like that, it’s like saying, “Well, the car dealer sold us a lemon with an oil leak, but that’s okay, we can just keep adding a quart of oil to the engine after every 100 miles and it’ll keep going.”

What about the car dealer? And is it just that car dealer, or is there a culture—of expediency, of profit, of apathy or whatever—that has sprung up in the automobile industry and trickled out into all the car dealer tributaries? (Note: I mean no offense to car dealers and my own experience with them has generally been very positive!)

Thinking about what path leads to more meaningful treatment for people with mental illness, it seems to me that we need to go back and look at where the cracks and gaps in the mental health system start, and to make sure that forced outpatient treatment isn’t our version of accepting a car with an oil leak.

We don’t want to keep driving that car, just barely maintaining it until we’ve run it into the ground. We need a system that empowers mental health consumers—in a real way, not a corporate-speak way—so that they are able to advocate for their needs and fully participate in their own care, as Marcy and Jill suggested. And the vision would be that if mental health care were delivered in a more meaningful way, mental health consumers wouldn’t reach the crisis states that lead to forced treatment in the first place.

Why is empowerment so vital? It’s human nature that we invest more of ourselves in something when we’re given a role to play in the process and decisions. Just think of anything that you’ve ever worked on at a job, and what aspects of your work made you put skin in the game for one thing and not another.

I do hope that some of you guys will post references and links to organizations who participate in models for treatment delivery that engages the consumer.

In the meantime, here are a few resources from which I’ve taken inspiration.