Making Sense of Psychotic Experiences

 (thesis)

Escher’s thesis is mainly comprised of nine previously published papers. The papers as well as the introduction, the epilogue, and the two summaries (one in English, one in Dutch) all say pretty much the same thing, so the book is enormously repetitive. The exception is the first chapter, which attempts to illustrate that the association of voice-hearing with insanity is a recent historical development. Chapter 13 is eight pages of acknowledgements and a one-page biographical sketch of Escher.

Although Escher and her constant co-author, Romme, insist that hearing voices should not be seen as psychopathology or mental illness, in this thesis they do not question the concept of mental illness in general. Nor do they refrain from psychiatric jargon. For instance, they interchange the term “hearing voices” with terms like “psychoses” and even “psychotic disorders.” They endorse psycho-education, yet speak of a therapeutic process, not an educational process. The casual reader would not notice that they are talking about a phenomenon which they claim is not mental illness. Their reasons may be that to have papers published in professional journals and command the attention of physicians, not to mention attain a PhD, one has to play the game according to the scientistic rules. Their previous book, Accepting Voices, makes a more sincere effort to take voice hearing out of the medical atmosphere.

Below I summarize Escher’s thesis without the medical trappings and repetition:

Marius Romme MD PhD, now retired, began working as a psychiatrist during the psychedelic sixties. He considers himself a social psychiatrist. Escher, having studied journalism at university, became involved with psychiatry – and with Romme – in the nineteen-eighties after taking a job at the mental health service, helping co-workers write articles.

In 1987, frustrated by his inability to help a patient cope with hearing voices, Romme decided to enlist the help of other voice-hearers. He and his patient appeared on a popular Dutch television talk show and invited voice-hearers to contact them. Around 750 (on a population at the time of about 14 million) did. After first interviewing them on the telephone, Romme and Escher sent out 450 questionnaires. The responses to the questionnaires provided the information for the study. Romme and Escher also organized a conference for voice-hearers. It was their first contact with voice-hearers who were not psychiatric patients and functioned well in their daily lives.

As about 10% of the responders reported first hearing voices in childhood, Romme and Escher became interested in children who hear voices. Again they appeared on national television, this time asking specifically for child and adolescent voice-hearers or their parents to contact them. There were approximately 500 responses. For this second study, the questionnaire was adapted for children by a child psychologist. The children, most of whom were actually adolescents, did not fill in the questionnaires themselves, but were visited in their homes and asked the questions by interviewers who recorded their answers. This study lasted three years, during the course of which the participants were interviewed at most four times.

Romme and Escher found that most people who report hearing voices function normally. They cope with their voices, and some people even enjoy or derive comfort from them. They do not seek psychiatric care. The minority who do seek psychiatric care are the ones who cannot cope with the voices they hear. In these people, the voices are frequent, nagging, and/or domineering. In about 70% of these non-copers, the onset of the voices, or the onset of the trouble coping with them, can be linked to traumatic events or situations over which they felt powerless, such as: the death of a loved one; (parents’) divorce; moving house; losing a job; unrequited love; troubles at school; being bullied at school; sexual molestation; hospitalization; or a handicap. Some of the events were physical, including brain trauma at birth and from an (automobile?) accident, and anesthesia. In one case a girl began hearing voices at age 12 after her boyfriend had given her drugs and allowed his friends to sexually molest her. (Romme and Escher seem to attribute the voices to the abuse, not the drugs. This is interesting, because I have heard firsthand of people beginning to hear voices after taking psychiatric drugs.)

No relationship at all was found between professional mental health care and coping with voices. People who do not seek psychiatric care, or discontinue it out of dissatisfaction, are at least as likely to learn to cope with their voices as people who remain in psychiatry. Among the children interviewed, 60% spontaneously stopped hearing voices during the course of the study. Sometimes removing a stressful situation, such as transferring a child out of a school with an unpleasant teacher, heralded an end to the voice-hearing. Other times simply maturing seemed to do the trick. Psychiatric drugs are often unsuccessful in hushing the voices, and when they do, a high price is paid in deterioration of body and mind.

Biopsychiatry cannot help people cope with hearing voices. On the contrary, biopsychiatrists make coping harder by reinforcing the taboo on voice-hearing and prohibiting exploration of what the voices are saying. What is helpful to voice-hearers is not diagnosis and drugs, but learning that they can resist the voices, talk back to them, let them know that the voices aren’t the boss. Learning to cope with voices is empowering, psychiatry is disempowering.

Romme and Escher have also founded peer support groups for voice-hearers. Although this thesis does not reflect it, they have made an invaluable contribution to helping people who have trouble coping with the voices they hear. I wish to use this opportunity to express my admiration for their accomplishments.