Alternative Care for Those Who Hear Voices

Drawing by E. Wagele

Drawing by E. Wagele

Supporting the severely mentally ill is difficult. In many cases treatments haven’t worked or haven’t worked well. About three quarters of people put on a medication for psychosis stop taking it within 18 months because of side effects or other issues. Sufferers may end up homeless or in prison. When hospitalization, therapy and medications haven’t succeeded, some have turned to support groups, such as the Hearing Voices Network in Holyoke, Mass., and Open Dialogue at Advocates in Framingham, Mass.

Benedict Carey wrote about this movement in the New York Times, August 8 2016 (“An Alternative Form of Mental Health Care Gains a Foothold”): “At a time when Congress is debating measures to extend the reach of mainstream psychiatry — particularly to the severely psychotic — an alternative kind of mental health care is taking root that is very much anti-mainstream. It is largely nonmedical, focused on holistic recovery rather than symptom treatment. It’s increasingly accessible through an assortment of in-home services, residential centers and groups like the voices network… in which members help one another understand each voice as a metaphor, rather than try to extinguish it… Psychiatry’s critics are mounting a sustained, broadly based effort to provide people with practical options, rather than solely alleging abuses like overmedication and involuntary restraint.”

Carey uses the example of Carolyn White, who hears voices in her head. She felt hopeless. The drugs made her feel worse. “Some of the voices inside Ms. White’s head have been a lifelong comfort, as protective as a favorite aunt. It was the others — ‘you’re nothing, they’re out to get you, to kill you’ — that led her down a rabbit hole of failed treatments and over a decade of hospitalizations, therapy and medications, all aimed at silencing those internal threats.

“At a support group for so-called voice-hearers she allowed other members of the group to address the voice directly: ‘After I thought about it, I realized that the voice valued my safety, wanted me to be respected and better supported by others,’ said Ms. White, 34, who, since that session in late 2014, has become a leader in a growing alliance of such groups, called the Hearing Voices Network, or HVN.

“Dr. Chris Gordon, who directs Open Dialogue, calls the alternative approaches a ‘collaborative pathway to recovery and a paradigm shift in care.’ The Open Dialogue approach involves a team of mental health specialists who visit homes and discuss the crisis with the affected person — without resorting to diagnostic labels or medication, at least in the beginning. Some psychiatrists are wary, they say, given that medication can be life-changing for many people with mental problems, and rigorous research on these alternatives is scarce. ‘I would advise anyone to be carefully evaluated by a psychiatrist with expertise in treating psychotic disorders before embarking on any such alternative programs,’ said Dr. Ronald Pies, a professor of psychiatry at SUNY Upstate University, in Syracuse. ‘Many, though not all, patients with acute psychotic symptoms are too seriously ill to do without immediate medication, and lack the family support that those programs generally rely on.’”

How It Works

The group meetings, guided by a person who hears voices, sometimes accompanied by a facilitator, are open to family members but closed to the news media. No one uses the word “patient” or refers to the sessions as “treatment.” American hearing voices groups have tripled over the past several years, to more than 80 groups in 21 states.

The Carey article concludes: “Not everyone benefits from airing their voices, therapists say. The pain and confusion those internal messages cause can overwhelm any effort to understand or engage. ‘People will come to our program because they’re determined not to be on medication,’ said Dr. Gordon, the medical director of Advocates. ‘But that’s not always possible. The idea is to give people as many options as we can, to allow them to come up with their own self-management program.’”

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