Making Sense of Psychotic Experiences
reviewed by Mira de Vries
Escher’s thesis is mainly comprised of nine previously published
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
with insanity is a recent historical development. Chapter 13 is eight
acknowledgements and a
one-page biographical sketch of Escher.
Although Escher and her constant co-author, Romme
, insist that
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
published in professional journals and command the attention of
physicians, not to mention attain a PhD, one has to play the game
the scientistic rules. Their previous book, Accepting
, 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
during the psychedelic sixties. He considers himself a social
psychiatrist. Escher, having studied journalism at university, became
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
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
for voice-hearers. It was their first contact with voice-hearers who
were not psychiatric patients and functioned well in their daily
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
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
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
who have trouble coping with the voices they hear. I wish to use this
opportunity to express my admiration for their accomplishments.
We thank Dr. Escher
for the complimentary copy of her thesis.
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