Hearing Voices, Making SenseRead Now
Years ago, long before I had thought to become a therapist, I witnessed a rather curious scene on the London Underground. I was going to catch the lift after leaving my train and had come up behind a man who stood by himself, speaking rather loudly and excitedly, seemingly to no one at all. Instinctively, I kept a distance, for though his agitation was obvious, I could see no reason for it. Seeing mentally disturbed people on the Tube is a common enough sight, so I thought he might have been schizophrenic. But when the lift arrived the man turned around, revealing that he had actually been speaking into a mobile phone. Ignoring me, he closed his conversation with a rather theatrical flourish. "This is my life and I don't ever want to speak to you again!", he declared. He then switched off his phone and got into the lift with me and a few other people and stood quietly throughout the ascent before alighting onto Edgeware Road. Perhaps he isn't mad after all, I thought. Still, there seemed something distinctly odd about his phone call which remained in my memory, even though the incident itself was quite trivial.
Years later, when I was training to be a therapist, I found a likely explanation for what I had witnessed long ago on the tube. Caroline Brazier and I attended a talk in Leicester, which featured speakers from a remarkable organization called the Hearing Voices Network, which is an association of self help groups that provide advice and emotional support for people who "hear voices, see visions or experience other unusual perceptions." The organization, which has chapters all over the UK, is part of a world wide movement to help people who suffer from disturbing perceptions find support and fellowship with others who have similar experiences. While HVN is careful not to describe its mission as therapeutic, there is little doubt that it can be profoundly beneficial to people who often find themselves terrifyingly alone in their unusual experiences. Started in 1987 by a Dutch psychiatrist named Marius Romme and his partner, a psychologist named Sondra Escher, the movement began after Romme had been treating a patient who had discovered a way to deal with and make sense of the voices in her head after reading The Origin of Consciousness in the Breakdown of the Bicameral Mind by the American psychologist, Julian Jaynes. Drawing evidence from ancient literature such as the Homeric epics, the book argues that seeing apparitions and hearing disembodied voices were once common in human experience, even quite recently in human history. Romme's patient inferred from this that the private voices she heard needn't be regarded as symptoms of a severe mental illness. They could instead be interpreted as the voices of independent agents--gods or disembodied spirits-- whose influence could either be ignored or heeded by her volition. Her realisation proved so self-empowering that both she and Romme went on Dutch television to discuss her discovery. What followed was an overwhelming public response from thousands of people who had had experiences like her's and led to the formation of the Resonance Foundation, which became the first group in the Hearing Voices Movement.
While HVN does not regard voices and visions as symptoms of mental illness, it does recognise how disturbing such experiences can be. As a self help and support group, it gives members the opportunity to exchange a wealth of practical advice so that they can help each other cope with the difficulties of having unusual perceptions. Hearing the testimony of one member I found a strong clue about the mobile phone conversation that I overheard years ago. He had been advised that whenever the voices in his head became so overwhelming that they demanded a response to pick up a mobile phone and pretend to speak into it, thus transforming his seemingly bizarre behaviour into an apparently normal public act. Everyone in the audience laughed at this and the speaker himself was well aware of how amusing his account was. But there was a horrifying pretext to his using a mobile phone as a prop to hide his conflict with the voices inside his head. It was his childhood of physical and sexual abuse, which included broken bones and hours spent locked up in a dark cupboard. Indeed, he first began to hear voices during such a confinement and at first he found them quite benevolent. Later, though, the voices began to echo the cruel phrases of persecution that he heard throughout his childhood. Those voices are still with him constantly and he could hear them even as he was addressing us. But they no longer dominate his life as they once did.
Given experiences like the speaker's, it may seem curious that HVN does not regard such unusual perceptions as symptoms of a mental illness such as psychosis. Romme himself takes a strong line against pathologising unusual perceptions and the organization in general seems to frown on using the term hallucinations to describe the unusual perceptions that its members experience. Some also argue that hearing voices and seeing visions have provided humanity with some of its greatest mystical and artistic insights, as such phenomena appear to spring from the deepest layers of transpersonal consciousness. Jesus, the Buddha, the Prophet Muhammed and William Blake are a few of the most famous figures whose lives were deeply affected by their unusual--indeed, their extraordinary--perceptions. Without romanticising such experiences, this does raise questions about the phenomenal nature of unusual perceptions. Mainstream psychiatry dismisses them as hallucinations, mere symptoms of pathological conditions. By and large, this appears to be true. But what do we make of those exceptional cases of unusual perceptions that prove to be valuable, perhaps even transcendental or visionary? Could it be that unusual perceptions provide evidence for a faculty of the imagination that becomes roused by a great experiential pressure--either psychological or spiritual in nature--which may, in Blake's famous phrase, "cleanse the doors of perception", revealing a metaphysical depth of experience that ordinary perception does not reveal; or, alternatively, casts the percipient into a hell realm with little hope of escape? We can only speculate. But the speakers we heard that night in Leicester said nothing about Blakean visions of the eternal. It was all about the voices--sometimes menacing, sometimes mocking--addressing them from within a heavy fog of depression that they all said they suffered.
Whatever the ultimate nature of unusual perceptions, HVN provides invaluable assistance to people who must cope with their immediate experience of suffering such perceptions. It also helps sufferers reclaim their dignity as it insists on regarding unusual perceptions as entirely human. Romme likens hearing voices to homosexuality which also once suffered the stigma of psychiatric censure before it was seen as just another variation in human nature. The speaker who told us about the clever use of his mobile phone, shared another incident with us, which seemed to give supportive evidence for Romme's idea. One afternoon when he went to his lounge for his usual afternoon rest he found himself in an unusually pleasant mood. And when he sat down he found something he never thought he would be able to experience: the voices in his head were silent. The caesura did not last long. But it was the first time he was free of his voices since childhood. Strange, he admitted with a laugh, but his brief period of silence was not as blissful as he might have expected. For he actually missed the voices as a normal feature of his internal awareness. But thanks to the support of HVN, that normal feature of his experience is no longer as hellish as it once was.
Let me give a standard dictionary definition of a word that I use often and consider indispensable, yet still find rather indefinite. The word is "experience" which the Merriam Webster on-line dictionary defines as "direct observation of or participation in events as a basis of knowledge". The same webpage gives another similar, but rather more colloquial definition: "the process of doing and seeing things and of having things happen to you." I would suggest another related definition which is "life in the activities and reflections of living". But I am only offering a different way of expressing the idea that experience is both a mode of action as well as a mode of reflection. There is also another, somewhat terser definition of experience which means "know-how" or, expressed more elegantly in French, "savoir faire." But all these are broad, versatile definitions and would seem to lack the specificity needed to be truly illuminating were it not for the implication that the term experience applies uniquely to each of us as individuals.
Indeed, what is intrinsic to the concept of experience is that it implies the existence of a self to whom experience occurs, even though experience sometimes occurs collectively. Moreover, experience applies to virtually every activity or state of consciousness. There are experiences related solely to the five senses of sight, hearing, touch, smell and taste as well as more mental, if not quite disembodied experiences such as counting numbers or drawing on memory in an act of recollection. Examples of other types of experience which are much more complex are those that are related to particular endeavours or domains of activity. Each type of experience will have a unique set of associations, which might involve a related set of skills, that only those who engage in them could ever possess. Sailors experience the sea and pilots experience the sky much more fully than the rest of us do, but neither experience the streets of London like a London taxi driver does. The logic behind these examples leads to an important and irreducible truth. No one can experience your life as you do.
This should not lead us to suppose that experience is entirely subjective or solipsistic. We create and share experiences with others, so much so that we can easily fall into the opposite error of supposing that the truth of our experience can be found only with others, or even worse, that such truth belongs to others alone. That someone else might have a better understanding of aspects of our experience than we have is often true. A dance master, for example, will readily discern the flaws in our clumsy footwork and a physician may be able to tell why we have a fever. Yet the experience of ourselves as individual subjects remains singular and can be known to others only by analogy or empathic attention and even then, only partially. For only we ourselves as individuals are in a position to know our self experience in depth and over an extended period of time. Thus, experience is the primary means of self revelation for each of us, not so much through the thoughts that we think or the views that we hold, but by the sense of self, the embodied sense of being "me" that seems to survive each transition of self understanding. Though the abstract truth of experience may be maddeningly elusive, the sense of experience is always present in conscious awareness and may feel inescapable.
Buddhist psychotherapy, even in proclaiming the doctrine of not-self, must deal with the exigencies of self experience just like any other form of psychotherapy must do. Although not-self is no get-out-of-jail-free card, it does offer a light for examining experience and making sense of it. Mostly, this has to do with making skilful use of impermanence as an ontological principle. But as I have argued before, therapy must work from the reality of self experience that the client presents before it has any hope of facilitating a deeper realisation of not-self. Getting to know the client in the consulting room offers the possibility of understanding the client as embodied subject--the self that the client experiences out in the world beyond the consulting room. Empathic attention is essential for doing this, but as David Black argues, so is sympathy--feeling with the client, particularly in his or her experience of psychological suffering. Important though analytical skills are, this intimate understanding of the client has less to do with "figuring him out" or subjecting her to exacting analytical scrutiny than it does with respecting the client's experience and working sensitively within it.
I began this post by reflecting on the imprecision of experience as a term. But that imprecision is no defect of the concept. For in its wide embrace, experience can be anything that can happen to us as persons.
David SmailRead Now
A quick note on the death of David Smail, a clinical psychologist whose writing I admired very much and whose death in August I have only recently learned about. I came to Smail's work by a fortunate accident years ago, long before I decided to become a therapist. I was at Waterstone's on Picadilly and sat down in an armchair and found a stack of books at my elbow. The book at the top was a dual text edition that contained two titles, Why Therapy Doesn't Work and Taking Care. Intrigued, I began to read the book and was quickly taken by the case he made. Therapy doesn't work, he argued, because it promises certainty based in objective evidence which we as embodied subjects cannot possess. Moreover, by locating the source of people's problems inside their minds, therapy overlooked and tacitly excused the actual living conditions that caused them to suffer psychologically. Indeed, by ignoring the social context of mental illness, psychotherapy was guilty of blaming the victim for their problems and abetting the social forces that were truly to blame. For me, the echo of Laing could be heard loud and clear in Smail's argument. Smail was in fact, an admirer of Laing, but there was much that separated their work. Laing, surely the more adventurous thinker, sought to plumb the depths of the psyche and saw psychotic breakdown as a legitimate means of breaking free of repressive norms. Smail offered a more modest and perhaps more compelling argument. Can't we as a society see that it is socially sanctioned cruelty that is most responsible for making people's lives a misery?
In fact, much of Smail's thinking drew from his work in the 1980's as an NHS psychologist dealing with people who suffered from the emergence of Free Market capitalism as a new social ethic. In a backhanded tribute to Thatcher, he credited her for teaching him the most about the misuse of political power as a source of widespread psychological suffering. But Smail offered something other than a standard leftist critique of the abuses of capitalism. Above all, he insisted on the moral necessity of recognising our common humanity. It was, he thought, the abandonment of compassion as an essential psychological value and the celebration of power as a positive psychological value in its own right that were most responsible for the distress that people suffered. Kindness, he seemed to suggest, was what mentally ill people really needed to find dignity and their well being.
It would seem Smail had little time for exploring the more hidden dynamics of the psyche. Certainly, many people might question raising social criticism above self formation as a concern of psychotherapy. But research (such as that which can be found in Richard Wilkinson and Kate Pickett's excellent The Spirit Level) tends to confirm Smail's conviction that is the gross inequality caused by rampant and unchecked capitalism that lies behind a host of social ills, including mental illness. Smail did not shy away from the political implications of his thinking, and this too may have caused unease among some observers. In fact, therapists do not possess any special insight into politics and their political opinions deserve no particular respect. At the same time, it must be recognised that there are pernicious psychological influences within a society that preserves the interests of the powerful and wealthy and organises a vast industry of deception to do so. In a previous post I cited Smail's remark that consumerism--free market capitalism's cunning master of propaganda--seeks to convince that love is always in short supply and that only the wealthy, the successful and the well- adjusted deserve to get it. We only begin to appreciate the scale of such deception and the cultural corruption that ensues from it when we consider the amount of time people spend watching television and other forms of popular entertainment---amusing ourselves to death, in Neil Postman's memorable phrase. Smail was surely right to point out that there was a relation between the values society promotes and the mental agony that society's "losers" suffer.
For all of my admiration for him, I am not an expert on Smail and I am not competent to discuss his work in any depth. But I credit him as an influence in my own thinking and think back to that day at Waterstone's when I first encountered his books as a pivotal moment towards my decision to become a therapist.
In my last post I considered things from an existential perspective and drew heavily on my reading of existentialism, particularly Heidegger and Sartre, in my understanding of how we encounter the world as individuals. What I called a moment of truth, Heidegger termed the call of conscience, but both refer to the solitary self reckoning that must be involved in any individual's quest for personal truth. I also followed the thinking of virtually every existential thinker--beginning with Kierkegaard and Nietzsche-- in characterising the search for personal truth and meaning as an inherently anxious undertaking. For there appears no possibility of ever finding solid factual ground on which such a search for meaning can be based. "The moment of truth is also a moment of doubt," I wrote. Yet, in closing I wondered if my position could be reconciled with Buddhism which not only confidently asserts the possibility of shedding all doubts and arriving at a final gnosis, but also prescribes a way of making such a realisation. This may seem far removed from the concerns of psychotherapy which of necessity must have more modest aims. But in fact, the nature of the Buddha's realisation either does or does not tell us about the psychic possibilities of being human. So what was the nature of the Buddha's realisation and how is it relevant to psychotherapy?
Let me begin with the second question by speaking personally as a Buddhist psychotherapist. Although I don't flaunt my spiritual colours, I don't conceal them, either, More importantly, I would never try to convert anyone to Buddhism. As I have written before, I believe it would be unethical to use psychotherapy as an opportunity to proselytise, for therapy should try to work within the client's spiritual orientation, whatever it happens to be. Perhaps for this reason most therapists prefer to remain silent about their spiritual convictions, especially as this helps to keep the focus on the client's experience. But many Buddhist therapists are like me and tend to be more open about their spiritual beliefs. This may be justified on the grounds that Buddhist psychology offers a comprehensive theoretical model of human experience which features a penetrating analysis of the dynamics of attachment. But even more important for me is the idea that we all possess a Buddha nature, that is we are already enlightened, yet fail to realise it. This amounts to a kind of faith and makes Buddhism more important for me in my role as therapist than for the client. There is, however, one glaring difficulty with this. I am not enlightened and have had no direct experience of Buddha nature.
Of course, there are all sorts of facile ways of justifying my position. I might, for example, claim that Buddha nature is the inmost ground of being and as such is the most fundamental endowment of human consciousness. This, however, would be more of a theological position and would be scarcely different than the Christian belief in the soul. Besides, in my understanding Buddha nature has an active, if mostly hidden function in the psyche and might be described as awareness prior to self awareness or knowing before any accumulation of knowledge. But any attempt to find an abstract expression for something that I have not directly experienced leaves me open to the charge that I am only speaking speculatively, without the authority of actual insight. Indeed, I am not entirely convinced of these claims, myself. Yet, I still find my orientation as a psychotherapist (to say nothing of my personal, spiritual convictions) through my belief in Buddha nature. Although this belief may be entirely justifiable for my spiritual practice, it may seem somewhat questionable for psychotherapy. After all, shouldn't therapy rely on something more than faith healing?
I would say not and would argue that every therapeutic approach, even the most sceptical, demands at least a modicum of faith in the possibility that psychotherapy can help the client. To be sure, those who hold faith in therapy may see it as determinedly rational and might indignantly deny any association with anything that smacks of spirituality. But every form of therapy must begin with a sense of the latent, unrealised potential that the client has not been able to find by himself. Even Freud, who dismissed spirituality as infantile, believed that psychoanalysis could help patients drop their neurotic defences and become capable of love and work. Moreover, in almost all forms of psychotherapy success is conceived as a kind of emancipation from the self defeating habit patterns that govern the lives of clients. Practically speaking then, faith in therapy may amount to little more than the belief in the possibility of finding such a freedom.
But let me go back to my own faith and what I said before about the dynamic function of Buddha nature. Buddha nature for me as a therapist isn't so much a latent potential as it is the primary, fundamental property of consciousness. Indeed, it is the radiant fact of consciousness itself whose very light makes possible the divagations away from it. I can offer no proof for this belief nor can I bring much in the way of evidence to support any argument I might make for it. I also know it can be easily dismissed as a fantasy or soft headed fabrication. But my belief in Buddha nature is not about demonstrable facts. It is about meaningful wonder based both in the happenstance of the everyday world and in the inherent mystery of being existent at all. In this connection, I always think of the Buddha's own moment of seminal wonder as a boy sitting under a rose apple tree, watching his father's fields being ploughed on a beautiful spring day. What of all the worms and insects that were dislodged and eaten by birds as their habitats were being destroyed? Was this their inevitable fate? he wondered. There could be no factual answer to his question. Facts would only allow the flat observation that this is how the world is. Yet, at this precise moment when he might have turned away from an unfathomable mystery, he fell spontaneously into meditative rapture and kept alive the spark of wonder that might have been extinguished by strict objective reasoning. Later, the memory of this episode inspired him to meditate in his own way which gave rise to the deep insights that made him a Buddha.
I am no Buddha, but as a therapist I do try to be like the boy under the rose apple tree. In a world I cannot imagine being more beautiful, I am amazed by the infinite variety of suffering that I witness in it. In being with a client and attuning myself to his or her experience of suffering, it would be easy to succumb to hopelessness. Yet my faith in therapy which is founded on my faith in Buddha nature, gives me hope when my powers of reasoning fail me.