what are voices?
From mental illness and pathology to trauma and recovery
how have voices traditionally been framed?
Historically, within the psychiatric and psychological fields, two assumptions have been made regarding voice hearing, one a continuation of the other. The first assumption has been that all hallucinatory voices are pathological in the sense of involving or caused by a physical or mental illness. The second assumption, which is an extension of the first, has been that there exists an essential connection between hallucinatory voices and a diagnosis of schizophrenia.
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Since Kurt Schneider's work in the 1950's, it has been common among psychiatrists to categorize certain types of auditory hallucinations as "first rank symptoms" and to use them as a basis for the diagnosis of schizophrenia, as against other psychiatric conditions.
But at least since the 90's it has been known among researchers and clinicians that voice hearing occurs in many other psychiatric conditions and therefore is not a valid basis for the diagnosis of schizophrenia. In fact, voice hearing is more common in clients who have been diagnosed with what are called dissociative disorders and connectedly, who have experienced childhood trauma.
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So voices are indicative of dissociation, are they?
If we take a closer look at hallucinatory voices, we can see that they do indeed contain some interesting dissociative features. A voice that keeps up a running commentary on a person may be subjectively experienced by the person as not being their voice, as not being part of them and as not belonging to them, as if the voice were a separate individual, and as being imposed on them from outside: This constitutes a loss of self-ownership (the sense that it is my body and mind that undergoes experiences) and a loss of self-agency (the sense of controlling one's body and mind).
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"The challenge of recovery is to reestablish ownership of your body and your mind - of your self." - Bessel van der Kolk
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Isn't dissociation caused by trauma?
From the great works on trauma and dissociation, we know that trauma tends to produce a disconnecting - that is, dissociating - effect on the self. One main, disconnecting effect is to split the self into two parts so that it can no longer act in a coordinated and cohesive way, as a whole. Hence the presence of relatively dissociated (separated and autonomous) parts of the self is an indication of trauma. And it is these dissociated parts that may manifest as inner, hallucinatory voices.
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is recovery possible?
I wholeheartedly believe that recovery is entirely possible. In healing from the interpersonal trauma driving voice hearing, clients need to embark on what we can call an internal relationship process based on shared communication between the adult self and his or her dissociated- or trauma-related parts, which manifest precisely through inner, hallucinatory voices. Clients acquire the ability to communicate internally, step by step, through the development of the healthy adult self. A healthy adult self is one that can engage in integrative communication with his or her voices through which resolution of the inner conflict within the dissociated, internally fragmented self will occur. An integrated self is one that maintains key elements of differentiation between the healthy adult self and his or her voices while cultivating their connection through respectful, understanding, and compassionate communication.
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