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Avoidance of Voices Can Be as Problematic as Listening Too Much

In the system of mental health “care” which is dominant today, “hearing voices” is conceptualized as an illness, and so the goal is seen to be minimizing such experiences.  Even talking about the voices is usually discouraged.  Mental health practitioners show no interest in the voices other than to find out whether they are still present: if they are, drug dosages are increased or changed in the hopes of dampening or eliminating them.  If the person continues to hear voices despite often massive drugging, then distraction methods are usually the only coping idea that is suggested.  Anything is done to avoid actually listening to, or being curious about, the voices.

It certainly is true that listening too much to voices can cause extreme problems.  Voices can order people to harm themselves or others, or say things which could crush, or conversely cause a grandiose inflation of, self esteem.  If the person obeys the voices or believes them, or even if the person just gets pre-occupied by them or caught up in them enough to be distressed by them, damage can result.

But sometimes the opposite of one mistake is just another kind of mistake:  it is becoming obvious that the avoidance of voices is just as much a mistake as is listening too much to them.

One problem that occurs when people chronically avoid the voice hearing experience is that they never learn how to handle it.  An even more serious problem is that the methods people use to avoid the voice hearing experience actually weaken the person, so that they become less able to handle the voice when they encounter it anyway despite their best efforts at avoidance.

Consider the effect of chronic use of antipsychotic medications.  These drugs do sometimes cause voices to disappear, or at least become less prominent.  But they do so by weakening a person’s ability to care about things:  they are essentially indifference drugs.  They weaken a person’s ability to have strong opinions, a strong personal voice.  They induce a kind of passivity, and it has long been noted that a person under their influence has fewer spontaneous interests, but is still capable of responding to the ideas or suggestions of others.

The problem with the above is that if a person is ever going to face the voices and work things out, the person needs personal strength, or the very thing being dampened by the drugs, in order to do so.  If a voice orders a person to kill themselves, it is very important that the person have strong ideas about the importance of continuing to live, so that the person can reject the suggestion.  A person made passive by a drug is actually less capable of resisting suggestions made by voices that persist despite the drug.  Unfortunately, this passivity is currently usually seen as just an aspect of the person’s “mental illness” and as proof the person cannot handle hearing voices, and the need for even more medication to try and suppress the voice.

(This is not to say that cautious use of medication can never be helpful, for example when a person does not yet have skills needed to face voices and when “listening too much’ would lead to disaster.  But such use should be sparing, and as temporary as possible, if the person is to get a chance to really learn to face the voices and the issues behind them.)

Distraction, when it is overused, has the same problem.  Consider a person who always distracts herself from her worries, rather than face them.  Such a person never learns that there are ways to face the worries effectively, and the worries themselves tend to get worse due to being neglected.  The same problem occurs when distraction is overused when coping with voices.  As one voice hearer I know put it, “voices are personifications of issues you don’t want to deal with.”  Failing to deal with the issues makes the issue seem more pressing which in turn actually strengthens the voice, while the person never learns to feel strong enough to face the voice or to work through the issues the voice talks about.

While always avoiding the voices keeps the voice hearer stuck in being incompetent to deal with voices, the mental health system suffers the same effect when it’s only strategy is encouraging drugging and avoidance.  Mental health professionals fail to learn anything that helps them understand voices:  instead they are taught simply to categorize them as illness, and to suggest drugs and distraction.  Since they never study the experience or what can be done about it, they feel incompetent to suggest anything else, and then their allegiance to the illness model grows even stronger since it is the illness model that says “there is nothing more to know here, the voices are just a result of something “wrong” in this person’s brain…..”

Fortunately, new models of how to cope with voices are emerging, mostly due to the efforts of the Hearing Voices movement, which is an alliance of voice hearers and people who have been really willing to listen to their experiences.

In the new models, changing the relationship with voices, rather than eliminating them, is the aim.  The fact that many people hear voices without problem, or even find that their life is enriched by hearing voices, is highlighted.  People learn to deliberately listen to voices some of the time, and to mostly refuse to listen to them at other times, so that the voices are neither avoided nor experienced as overwhelming.

One of the trickier issues is to learn to discover the issues the voices are about, and to reconnect with parts of the person’s psyche and experience that the voice represents.  The problem is that voices are often best understood an integrated by not taking them literally.  That is, a voice that says “kill your mother” may eventually best be understood as meaning something like “you need to find a way to reduce your mother’s dominance in your life.”

While none of this is easy, more and more people are taking this journey, and many are writing about it quite eloquently.  One example is Rachel Waddingham.  Rachel hid from her voices, using drugs and distraction, for 9 years before hearing the stories of others in the Hearing Voices Network convinced her to try another approach that led to her recovery.  As she puts it,

Through a combination of luck, the kindness of others and my own, not inconsequential, stubborn streak, I have finally ditched the psychiatric labels and see myself as a survivor. I manage a London-wide mental health project, am an independent trainer, speak at conferences, take part in committees and live a life that I truly love. I no longer take neuroleptic medication, and choose to live with alongside my experiences.

Rachel has her own blog, and she has also shared her experiences recently on a new website run by the Hearing Voices Network of the UK.  Rachel writes very clearly about how to be curious about and communicate with even voices that seem stubbornly uninterested in communication and dialogue.  For example she writes that:

When I finally felt ready to open up the lines of communication with The Three, The Three weren’t so eager to reciprocate. I remember talking internally with them, asking them who they were, why they were with me and what they were trying to tell me. I tried to be as respectful and open as the Voice Dialogue method suggested, but still The Three carried on talking as if I wasn’t there.

Initially this lack of response discouraged me. I felt a bit like a failure – even my own voices didn’t think I was important enough to talk to. Still, I persevered and tried to reassure myself that it takes time to change a relationship that has been running in the same way for over a decade.

The Three still haven’t talked directly to me, but I am now much more skilled in the art of the one sided conversation. For the first six months or so, I tried to ask them direct questions with no luck. Recognising I needed to change tack, I instead responded to what they were saying. I reasoned that some people, especially those who have a point to press, are more engaged when you talk with them about things they are interested in than your own agenda.

When The Three talked of there being gas on the tube and that I was being poisoned, I simply stated (as calmly as possible) ‘Thank you for reminding me I don’t feel safe. There have been lots of times in the past where I haven’t been safe, but I’m ok here at the moment. The other people on here don’t smell gas, and they are not afraid. There’s nothing here to be scared of’. This wasn’t a magic trick, and The Three didn’t suddenly skip off into the sunset. They carried on talking over me. I felt safer, though, and – in time – The Three started to respond to this approach and became quieter and less insistent.

Rachel’s full post is very much worth reading, I suggest you check it out.

With more articles like hers, and with the leadership of the Hearing Voices Network, and of groups like the International Society for Psychological and Social Approaches to Psychosis (ISPS) of which she and I are both members, I’m hoping that we can shift to a mental health system that supports a balanced approach to voices rather than the current mode of drugging and running away from them.



2 comments… add one
  • For whatever its worth one of my own attempts to understand the voice hearing experience:

    People who mostly hear the kind of voices they want to hear may eventually lose their ability to hear these voices because they are able to reveal a verbal illusion (1) while some people who mostly hear the kind of voices they want to avoid learn to sometimes avoid the kind of voices they hear by paying more attention to what they are able to hear objectively (2) …

    1.) Extinction: The occurrences of a conditioned response will eventually decrease or disappear when a conditioned reinforcer (un-patterned noise) no longer is paired with a primary reinforcer (information)!

    2.) People who consistently avoid the event they fear will continue to expect a fearfull event (phobia) and people who frequently are able to avoid the voices they hear by revealing a mismatch will continue to expect to hear the voices they are trying to avoid! To continue to expect to hear the voices you are able to avoid by revealing a verbal illusion may generate negative symptoms like poverty of speech, affective flattening and avolition and to continue to expect to hear the voices you are trying to avoid will generate the voices you are trying to avoid whenever you are unable to reveal a verbal illusion… (Conditioned avoidance response (CAR) is a test with predective validity for antipsychotic efficacy … )

    “Non-clinical populations usually experience voices with a neutral or even positive emotional content” and avoidance may result in negative symptoms, disorganization or a tendency to interpret environmental or tinnitus-like sounds of a very low volume…

    An already stigmatized experience can be connected to some of what characterize an even more stigmatized illness, but most people who hear auditory hallucinations do not meet the diagnostic criteria for schizophrenia!


    Post subject: Speech perception and some symptoms of schizophrenia

    Stefan Andersson

  • Conditioned avoidance response (CAR) is a test with predective validity for antipsychotic efficacy and negative symptoms are very hard to treat… (Negative symptoms like poverty of speech, affective flattening and avolition may depend on that you in avoidance WERE able to reveal a mismatch… )

    Stefan Andersson


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