General points about Making Sense of Voices Approach:
\nThat it is not seen as an alternative, but rather the only view: p2
\nUse of the word \"real\" is very much in the sense in which it is used in narrative. People encouraged that their voices are real, but later also encourage to accept them as part of themselves, and originating in themselves. In contrast they view the attitude of mnay mental health professionals as \"regarding voices not as a source of information, but as a sign of a 'non-existent' reality.\" p 4 Another example of this (p13) is a description from a voice hearer who showed that \"accepting my voices as real\" lead to a conciousness of \"ownership\" of the voices and that she then \"stopped looking for a cause outside myself\". This is the opposite of the concern that MH practitioners have about the word \"real\" - they tend to believe that if a service user is allowed to believe that they are real then they will not be able to stop looking for a cause outside of themselves. The strategy to help a person who believes that he is hearing the voice of the Queen is to try to persude him that he cannot be, that it is a hallucination. It would be thought that if one agreed that yes, the voice is really there that this would lead the person into ever more delusional explanations.
\n\"...getting rid of voices is neither necessary nor important\" p7
\nThey take as a starting point that hearing voices is not in itself pathological. p8
\nMaybe could show how the whole description that Romme and Escher have created is a description under which the action of recovery is possible.
\np26 The necessary thing is not to get rid of the voices but rather to change one's relationship to them
\npp36 -37 Shows how he (Romme) has come to view schizophrenia, borderline PD, dissociative dissorder and depression as four ways in which people may respond to hearing voices. Also obsessions may develop., or mania. He does say that this is not his attempt to create and alternative diagnostic system, but one is left with the sense that he needs people to be hearing voices to be able to make sense of their experience. And while for many that may be true, what about those for whom it just is not - one can have delusions without hearing voices, or borderline PD without hearing voices. This gives rise to a pressure to find the voices as a means to work with a person, and a pressure to find undisclosed voices. There may even be a pressure to suggest to someone that unusual thoughts ought to be interpreted as hearing voices, even if they are not being interpreted that way currently. It all points again to the possibility that Romme thinks there is a law-like relationship between trauma and voices, and that there are true meanings to these experiences, rather than narrative expanations to the self and reasons rather than truths.Do we need a special understanding about voices, or a special understanding about the self? The impression is very much that voices, rough on by trauma, are primary to to self disturbance (although not exclusively)
\np 39 \"...when a voice hearer recognises the voice he/she hears as the voice of a deceased person, when asked about where the voice is coming from they will say, ' the voice is coming from so and so'; they don't say that this is the cause of the voice-hearing experience.\" This suggests a helpful divide between reconising that a voice is real and that they genuinely are from others - it might be part of why professionals are so worried about saying that the voice is real.
\np40 Cites a lit review Reid et al (2005) in which 180 studies show that hallucinations are strongly linked to childhood abuse. Romme: \"...it becomes clear that traumatic experiences play an imortant causal part in people developing voice-hearing expeiences.\" The question is, what kind of a cause is this? Is it a law like relationship or a narrative explanation? If the latter, then that is good news, as re-authorship becomes a distinct possibility.
\np47 \"Most voice hearers who have recovered are quite clear about the causal relationship between their voices and their traumatic experiences.\" Law like again. And then again, if what has occured is re-authorship, then of course that is what they now say - and why they now have an authored self - but it still does not mean that there was a truth relationship there. Why make this point? Not because trying to accuse Romme of replaceing the quasi-science of psychiatry with another quasi-science, but because if we can establish that it is the narrative self that has the problem rather than it being the voice that is the problem, then we can hope to look to a new model for mental health which goes beyond those who hear voices.
\nP54 Once again describes the relationship between life-events and hearing voices, and there is definitely more of an emphasis on events than interpretation.
\npage 63 Describes the relationship between voices and voice hearer as a metaphor. The suggestion is that for most voice hearers it takes some time to learn to understand these metaphors. This clearly links to authorship. P 71 embellishes: \"\"...we have tried to demonstrate that voices might metaphorically express the relationship that exists between what the voices tell the voice hearer, and the voice hearers emotions connected to various situations; memories, experience of trauma, and so on. These metaphors are very instructive in learning about the problems that lie at the roots of the voice-hearing experience.\" - this difinitely suggests an emphasis on voices as being the primary problem, not a sign of a deeper problem of self.
\n\n
The primacy of phenomenology
\n\"Mental health care should start from the experience of the voice hearer\" p4
\np 25 Explicitly says that diagnosng someone with schizophrenia is harmful - because it \"...alienates the voice-hearer from their experience...\" it removes their agency by making them \"...a passive victim of disease....\" They also say that it destroys the possibility of a helpful relationship between professional and voice hearer.
\n\n
\n
Examples which describe a narrative self
\np59 The use of the word 'construct' is considerably more like narrative than law-like relationships.
\n\n
Examples which are like the \"externalising\" of Narrative Therapy
\np 12: \"...at my first hearing voices group [a fellow voice hearer] asked me if I heard voices. When I replied that I did, she told me that they were real. It doesn't sound like much but that one sentence has been a compass showing me the direction I needed to travel and underpinning my belief in the recovery process.\" (Ron Coleman)
\nAgency is seen to follow externalising - page 16-17 shifting the balance of power.
\nExamples which are like the descovering of unique outcomes of narrative therapy, or the undermining of the dominant narrative:
\n\n
p7: \"Many of the fifty people kept their voices but changed their relationship in a way that the relationship became helpful.... All got rid of the distress from their voices because they changed their relationship with them.\"
\np 17:\" I realised that the only power the voices had was the power I gave them\". This also makes one think of a process asdescribed by Sass and Parnass, where the onset of the voices could be characterised by an increasing sence of them as entities in themselves, a sort of disauthoring,
\n\n
\n
p22 describes someone who begins to recognise: I am nobody, that's what has happened to me. Who I am is my voices.
\nExamples which are like ownership or authorship from B and B
\np14 Gives a number of ways in which voices become recognised as meaningful, including recognising the person who is speaking, because of their characteristics, because of what triggers the voices, because of tthe emotions or the \"demons\" they represent. These are all described as ways in which the voices become \"personal\". Very similar to Bortolotti and Broome saying that what makes a thoght my thought my thought is supporting it with reasons. So, it seems that what is true of thought insertion is no less true for hearing voices.
\nTwo other poitns spin off here: 1. that once again it is not THE reason but a \"reasonable\" reason. 2. What does this all add to the idea of \"auditory hallucinations\"? It makes the problem not one of perception but of authorship... at least, the idea that the delusions or other disturbance is secondary to a perceptual problem does not seem to fit anymore.
\np15: many examples which are authorship - worth quoting one or two.
\np20: \"I realised they spoke nonsense and systematically closed them out, and started to concentrate on my own thoughts\". They managed to split the voices away from themselves and then test them for reasonableness.
\nEscher, page 58 - 53. Accepting the voices - covers \"accepting that the voices are real\" , which is probably closest to externalising from White, accepting that the voices \"belong to you\" and are \"part of your life history\" which is really like authorship. However, Escher claims that it is not an expressed aim of MSofV to get people to accept that the voices originate from the hearer. She says that only some come to this concluson and that for others the idea angers them. In other words, it is unimportant for recovery to gain an understanding of voices as un-authored thoughts. Perhaps it is more difficult to support them with reasons if they are also viewed as another kind of thought. Perhaps it is more difficult to externalise them also, making them into an entity to reason. Escher re-states that a person is not allowed to accept their voices under a disease model. Looking at this from B&B we might say that one cannot gain ownership and authorship over a thought one is not allowed to have.
\np89 Seems very significant \"From the moment Caroline had rejected them, they had started to fight her\". It is a key part of MSofV that it is in \"running away\" from the voices and their meaning that progress is stalled. They refer to this as the \"startle\" phase, and in their view it is here that MH services get people stuck. This \"rejection\" seems to have something to do with both externalising and authorship - it is somehow the opposite of both. So how is externalising so different to rejection?
\n\n
Examples of checks and balances from Gillet:
\nIt is clear that meeting others who experience voices as real and also the relationship with the therapist are important in recovery (p 10 and indemic in the therpeutic process). There seems to be a strong sense in which the role of others provides the Gillet's \"checks and balances\" which are required to narrate a reasoned self.
\np60 (good summary of how the voices become storied): \"There are... voice hearers who do not describe a clear relationship between voices and life history, although these account for other seven of the stories in this book. There might be a reason for this: fo example, it could feel too treatening, or the person might see the issue as too private to discuss or it might not have become clear to them, a situation we often see with emotional neglect. greater awareness helps the voice hearer to understand the experience in relation to what has happened in his or her life rather than hanging on to the idea of a debilitating biological illness. In seventy to eighty per cent of cases voice hearing is undoubtedly a reaction to actual social problems, based on the traumatic vulnerability of the individual. The identity, content, characteristics of the voices and their history of origin might indicate whom they represent, whilst the history, content and triggers might show what problems they represent. Sometimes collaborative imagination is needed in order to find the 'who' behind the voices.\"
\np62: \"Breaking the code is not the individual activity of the professional but a collaboration between the voice hearer and the professional, or even between the voice hearer and a group when the construct is conducted in a group. In such a grop, other voice hearers and professionals generate associations that can be very relevant for the individual in understanding the meaning of their voices. Experienced voice hearers can be of great support in this process and can act as professional helpers\".
\nThe promotion of voice hearing groups (p81)
\n\n
\n
Examples which are like dimished self-affection (dimished sense of being a subject of awareness or agency) from Sass and Parnass
\nRecovery described by Mrs Hutton as \"I have the feeling to be who I am\", p3
\n\n
Examples which are like hyper-reflexivity (forms of exagerated or alienating self conciousness) from Sass and Parnas
\n\n
\n
p 26 A criticism of the mainstream diagnostic approach is that \"...voice hearers are not helped to detect the relationship between their voices and what has happened in their lives...\" Is this evidence that Romme and Escher think that there is a law-like relationship between trauma and voices? They are looking for truths not reasons!
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This seems to have suggested to him that there must be some special virtue in the technical forms in which mathematical demonstrations are made. In this, however, Spinoza--as every modern critic admits--was mistaken. Mathematics and philosophy are, to be sure, allied in that both involve, on the one hand, insight, and, on the other hand, reflection. But mathematics with its restricted subject-matter is likely to differ, in method, from philosophy with its unhampered range; and Spinoza's choice, among mathematical methods, of the deductive procedure of Euclidean geometry is especially unfortunate, since it obscures the fact that his system rests, after all, on immediate observation. This unfortunate setting of his doctrine is responsible, indeed, for the most frequent misinterpretation of it: the charge that Spinoza's definitions and axioms are far from self-evident, that on the contrary he summarizes his beliefs, without establishing them, in his introductory definitions, and that he then, with great show of logic, elaborately proves them by propositions based on these very definitions. This criticism, as will appear in the following sketch of Spinoza's system, is not justified by his teaching, but it is readily explained by the misleading frame in which his doctrine is set. Even Spinoza must have realized at times that his method hampered him, for he adds to each Part of his \"Ethics\" a Preface or an Appendix or both, and in most of these, as well as in very many of his letters, he sets forth his meaning in direct and forcible fashion. To the analysis of his teaching it is necessary now to turn. This chapter attempts to give both an exposition of Spinoza's teaching, and a critical consideration of his arguments and their conclusions. 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