Psychosis as a Personal Crisis: An Experience-Based Approach

The experience of hearing voices has played a significant role in the development of psychiatric nomenclature for two centuries. The interpretation of the experience has varied from the inspirational to the pathological, but the experience is often seen as a marker of severe mental illness. Psychosis as a Personal Crisis is an attempt to challenge the notion of auditory hallucinations as a psychiatric symptom and broaden the understanding of the person who hears voices. This personal experience of hearing voices serves as the core of the arguments discussed here by a group of European authors, primarily British, in a collection aimed at mental health professionals. The authors represent psychiatrists and other clinicians who work with people who hear voices, as well as individuals who themselves have this experience.

Many of the authors are connected to the “hearing voices movement” that advocates for the recognition of individual variation between people who hear voices and the nonpathological nature of many of these sensory experiences. The authors stress the importance of self-help and call for individuals to take control of their experience as an essential step in the recovery process. The authors argue that medicalizing the experience of hearing voices stigmatizes the individual, distances the individual from the experience, and sets up an expectation of “curing” the condition that is causing the voices instead of living alongside them. Although the movement does not deny that hearing voices is distressing and debilitating for many individuals, it recognizes the need to understand the personal experiences and vulnerabilities that have led to the development of hearing voices.

Overall the text serves as a thorough exposure to an argument not well represented in traditional psychiatric literature. In particular the authors highlight the importance of considering the psychological meaning of hearing voices. The importance of this meaning is often lost in the diagnostic and treatment approaches most commonly used today. The content of the voice (what is being said), rather than its mere existence, takes on a primary importance.

The second point the authors make clearly and to which they devote a good portion of the book is the connection between hearing voices and a history of trauma. In clinical work there is a growing distinction between auditory experiences that grow out of trauma, which might fit within the phenomena of posttraumatic stress disorder, and other auditory experiences that are understood as part of a psychotic disorder of either an affective psychosis or schizophrenia.

Unfortunately the value of the text suffers from the lack of recognition throughout psychiatric literature of the nonburdensome or nonpathological nature of auditory hallucinations, even from early distinctions between hallucinations of reason and hallucinations of madness through current studies that reveal surprisingly high rates of psychosislike experiences in the general population (1–3). The arguments are weakened by an overreliance on outdated epidemiologic and outcome data and by an alarmist tone that includes statements that refer to “brutal practices … such as electroshock” and to “the damage that psychiatry causes.”

Overall, Psychosis as a Personal Crisis invites consideration of an individual's experience of hearing voices in a broader manner than the training of mental health clinicians provides. In particular, the authors effectively make the case for consideration of the individual who is hearing voices and for exploring their meaning.