The Beginning of Hearing Voices Group in an Allopathic Hospital
It was not an easy feat. As with any new project, I required approval from the program director and hospital administration. I am very fortunate to work under a very open-minded program director who is dedicated to her patients and program enhancement. At the time of my proposal, the program director gave me the approval to establish the Hearing Voices Group (HVG) once approved by the hospital administration. After much deliberation it was finally approved. Groups were to begin as soon as we were trained by the HVN. However, many, if not most, of the team members were apprehensive of the philosophy and effectiveness of the project ( for more information on HVN please click on booklet).
Seasoned staff indoctrinated and practicing the medical model paradigm were not able to grasp that the change of language does not delude the patient from his experience, but strengthens his self-determination to heal. In other words, the tension with indoctrinated staff is that schizophrenics need to know that his or her reality is just not real and medication is the only way to live a normal life in society. The HVG assents to the individual’s etiological belief of non-ordinary states of the mind’s origin and validation. Integration comes through validation and self-determination.
Introducing new paradigms to a set belief system is challenging for any unorthodox clinician. The unorthodox practitioner must possess an open mind, along with an ability to think outside the biochemical box, and a drive to be a compassionate nonconformist with a healthy state of presence within a rigid allopathic subject-object system. For most in the conformist system, placating the overt behavior is superior, quicker, and requires less effort than delving into and understanding the seed of human pain. As a system nonconformist, with a strong belief in the social work core values and oath , the team’s reaction and dismay did not dissuade me from moving forward with the HVG in the APH program.
The First Hearing Voices Group
The prototypical exploratory group was initiated with the APH (Adult Partial Hospital) patients. APH is a heterogeneous group of individuals with diverse overt behaviors, backgrounds, ages, gender, history of inpatient hospitalizations, and exposure to the allopathic treatment of mental illness. Due to the nature of the APH group, not all patients have a history or experience hearing voices, seeing visions, or any other ESP (extrasensory perception). Thus, the language had to be customized to accommodate each patient and their unique experiences. For example, the language had to be adjusted for individuals experiencing depression and anxiety, without, hearing voices or seeing visions. Most recipients responded well, but, the best response was professed by the voice hearers who were able to express themselves freely without judgment. As group facilitator, I tended to change the member’s language from the pathologized and stigmatized auditory or visual hallucinations to voice hearing and/or seeing visions or having extrasensory perceptions.
For example:
Ed comes to the program with a long history of hospitalizations for his bizarre behavior and command voices. Throughout his initial assessments he was said to display peculiar behaviors and observed to be noncomplaint. During rounds his treatment coordinator presented Ed as inappropriate for the program not only due to his history, but also, for what she witnessed during the assessment phase and briefly in groups. It must be mentioned that Ed has a heavy accent which at times is difficult to understand and despite the amount of medication he is on, still laughs and responds to his voices. Many of his peers dismissed Ed due to his accent, loose associations, and behaviors. During the first HVG with him, the group was discussing extrasensory perceptions. As I explained what it was, Ed was quietly sitting in the corner of the room. Suddenly, he exclaims that what he and his fellow voice hearers experience is all about differing perception. Both the other facilitator and myself validated his perceptual experience and encouraged him to continue explaining. I translated for the group as Ed freely spoke of his voices, how the beings attached to voices appear, and the troubles caused by the voices. Modelled by the group facilitators, his peers integrated Ed into the group and since that time, Ed’s demeanor, motivation, and participation shifted to a healthier one.
The group material and experiential exercises are inclusive of coping skills, mindfulness, body scan meditations, caring for self, accepting and negotiating with the voices, visions and/or thoughts, but, most importantly changing the language from the disease model to an ordinarily standard one.
To assess the efficiency of the HVG, the Program Director and myself devised an anonymous survey for the patients to fill out (hearing-voices-survey-1). On the day we gave out the surveys, the group was of only eleven members. Each one completed the form. Please click on hearing-voices-group-survey-responses to read a summary of group member responses. The responses were favorable of the group. The group content assisted voice hearers and individuals who do not have that experience.
The Start of a New Beginning
I continue to lead the HVG with a favorable response from the patients, Program Director, and administration. The most important is that the participants have a safe place to
express their experiences. There is a challenge and caveat to the HVG in the hospital. Most, if not, all participants are indoctrinated into the disease model and still believe that they have a biochemical deficiency. Due to the prevailing mental illness paradigm, the group members are placed on medication for their ESP and voice-hearing experiences. As the HVG facilitator, I do not encourage anyone to discontinue the medication cognizant of the detrimental effects to their physical and mental health. The main functionality of the group is to foster techniques to deal with a spiritual crisis (Grof, 1989), normalize the experience of ESP and nonordinary states of consciousness, and shift the neurobiological and psychiatric illness identity and embodiment (Conrad & Barker, 2010) from both the recipient and the clinician to a self determined holistic way of thinking.
Perhaps my wishes and hopes of expansion are utopian and at this time far-fetched, but, the HVG is beginning, though in its infancy stage at the hospital. It may be difficult to rapidly shift existing paradigms in a predominantly medical psychiatric model. The “seeds” of redesign are slowly planted for a new holistic era. My future goal is to present the Art of Presence and The Hearing Voices philosophy to the medical and social work students and interns , and to reconstruct the language to one of clinician-to-patient empathy, compassion, unity, and respectful interchange.
References
Featured image: Voices-in-our-head…-The-Edge-Artwork-by-thefreshdoodle
Conrad, P., & Barker, K. K. (2010). The Social Construction of Illness: Key Insights and Policy Implications. Journal of Health and Social Behavior, 51(1 Suppl), S67-S79. doi:10.1177/0022146510383495
Grof, Stanislav and Christina (eds) Spiritual Emergency: When Personal transformation Becomes a Crisis. New York: Penguin Putnam, 1989.
Hearing Voices Network Informational Booklet– http://hvna.net.au/wp-content/uploads/2013/06/Hearing-Voices-Information-Book-May-2012b.pdf
Hearing Voices Organization– http://www.hearing-voices.org/personal-experiences/barries-recovery/
Mosaicscience audiostory – https://mosaicscience.com/story/hearing-voices
Social Work Core Values– http://www.socialworkdegreeguide.com/lists/5-important-core-social-work-values/
Social Work Hippocratic Oath- http://www.wku.edu/socialwork/bsw/bsw_a_hippocratic_oath_for_socialworkers.pdf
The Art of Presence in Mental Health 
[…] The Hearing Voices Group […]
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All voices just want to be heard.
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Yes, you are right, thus, should not be silenced
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I like how you used the code of ethics as a argument 1.02 the right to self determination, I think there is a bio-chemistry aspect to hearing voices as well as the societal notions of what that means. You put in here a bias against medications, why would you say medications hurt the person mentally and physically.
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Thank you for your interesting and valid comment!
I would like to start with the code of ethics specifying the right to self determination, in this instance, of taking medication. The first thing I ask the voice hearer is if the voices or visions are harmful, destructive, and/or command type to do unhealthy behaviors to self or others. If the answer is no, such as one patient who disclosed that the voices tell him to brush his teeth, take a shower, and go for a walk, then I ask if he or she is comfortable with the voices. If the voice hearer is not comfortable then medication is suggested and I strongly suggest to practice what is covered in the HVG to deal with them. However, many voice hearers state that they like their voices for various aspects, the main one is that they keep the recipient company. If the voices are of no harm and the person wants them it would be unethical to go against the code of ethics and the state’s legality of voluntarily take medication.
However, if the person is in severe distress due to the command type of the voices and in pain with what is heard then, medication is strongly recommended. Yet, the medication can have many ethical pitfalls resulting in long term physical, emotional, and spiritual harm and injury. It is known that psychotropic medications have many side effects, the major ones are: major sedation of cognitive and bodily functions, blunt emotions, irreversible tradive dyskinesia, akathisia, severe fatigue, loss of desire, uncomfortable dry mouth, unwanted weight gain, suicidal, and sometimes homicidal ideation, and attempts. To add to the list of unhealthy side effects, not all voices are silenced with the medication. Even though the reasoning of taking the medication is for the pained person to reintegrate into society, the pained person still cannot function due to the effects of the medication on the brain and on the body, deterring them to sustain employment, have healthy relationships, and needing to deal with the stigma of taking the medication. Insomuch, many individuals who take the medication are now “policed” and scrutinized for every common behavior they display. For example, a patient came to me today and stated that he had a verbal exchange with a group peer who called him derogatory names. Both patients were evaluated by the psychiatrist, and the offended patient who became angry and upset at his offending peer, was ordered an increase of medication. Needless to say the patient felt “punished” for feeling angry at the offense. Could coping skills, mindfulness, relaxation techniques, de-escalation techniques, inner child exploration, and a present clinician to listen to his plight be introduced and used in this instance? My personal opinion is, yes. Yet, medication was used instead, fast, easy, and to the point of numbing the emotions. Thus, medication can be seen to be more of social control then to make the patient feel comfortable and integrated in the community.
If you would like more information about how the medical model (used without any other modality) can be harmful, I invite you to read the following posts:
https://the-art-of-presence.com/2016/10/17/presence-a-new-beginning-in-the-therapeutic-encounter/
https://the-art-of-presence.com/2016/09/22/behind-the-heavy-metal-doors-institutionalization-and-medicalization-through-the-lens-of-popular-culture/
https://the-art-of-presence.com/2016/10/09/curing-the-incurable-is-not-healing/
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