Learning to understand those who hear voices
Nursing students walk a mile in the shoes of a mental health patient
There are a lot of people struggling who learn coping strategies. It’s how you look at the experience.
One voice is soft and vague. “It’s a thing. Just some ... thing,” it says.
Another barks angrily: “Eyes down! Don’t look up! Don’t look up!”
Still another voice insists: “You suck!”
Nursing students at Algonquin College are learning to put themselves in the shoes of someone who hears voices. The students try to do ordinary things while listening to a recording of the kinds of voices that plague people with schizophrenia and other mental illnesses.
The point of the exercise is twofold: to increase the students’ empathy for people with mental illness, and to show them that those who hear voices often develop coping strategies to tune out or stop the voices, says nursing professor Carmen Hust.
“There are a lot of people struggling who learn coping strategies. It’s how you look at the experience,” she says.
Hust has always included a session in her mental health course where students learn what it’s like to be deluged by voices. In one exercise, she asks one student to stand on one side and say positive things, while another would say negative things. The person in the middle has to ignore both and make sense of a series of questions.
Listening to a recording of voices takes the experience to the next level. The nursing students are assigned MP3 players with a 45-minute recording produced by U.S. psychologist and disability activist Pat Deegan, a “voice hearer” who was diagnosed with schizophrenia at the age of 17. While the students are listening to the recording, they are required to navigate mundane tasks, like ordering a coffee or doing a word puzzle, or a stressful interaction, like a mock job interview.
Nursing student Taissa Sekret found the voices too distressing and had to put the recording away. “I couldn’t process how someone could listen to that all day,” she says.
Fellow student Brandy Johnson felt drawn in by the negative voices and couldn’t concentrate on what other people in the room were saying. “I can understand the stigma,” she says.
Algonquin nursing instructor Michelle Morley says simulationbased learning helps prepare students for working in the real world in a way that textbooks can’t. This group of students will start a placement in mental health settings later this week.
“Up until now, mental health was all theory,” she says. “These workshops help to bridge that gap.”
Although commonly associated with schizophrenia, there is a growing acceptance that voicehearing is actually quite common. People who are depressed, anxious or bipolar may also hear voices, which tend to increase in intensity during times of stress or trauma.
The British Mental Health Foundation estimates between five and 28 per cent of the general population hears voices that other people do not. Intervoice, an international network of voice hearers, says between 70 and 90 per cent of people hear voices after a traumatic event.
Often called “auditory hallucinations” — some consider this term to be disrespectful — these voices are real to people who hear them. They are not like the “voice of conscience” or having an imaginary conversation, according to Deegan. They can be male, female or without gender. Some people experience a chorus of competing voices.
The voices that are most distressing are those that are disparaging, creating feelings of self-doubt or self-loathing. At other times, they may offer a prediction or a piece of wisdom or good advice. Deegan recalls being at the centre of a “hurricane” of voices when one gave her wise counsel: “You are the flyer of the kite.”
With therapy, some people learn to distract themselves, calm the voices, negotiate with them or even to listen to their advice. Eleanor Longden, a British woman who first started hearing voices when she was in her first year of university, was diagnosed with schizophrenia. She later learned to think of her voices as a meaningful experience to be explored. Longden now has a master’s degree in psychology and speaks about voice-hearing.
Nursing instructor Matt Le Blanc has worked in forensic mental health and schizophrenic recovery. The exercise of hearing voices has something to teach students about the resilience of people with mental health conditions, he says. Between half and two-thirds of people with major mental health disorders go on to have a complete recovery.
One study of 27 nursing students who took a voice-hearing session reported many found the experience to be “transformative,” changing their preconceived notions of mental illness and understanding of what it’s like for people who can’t turn off their voices.
“It helps you to put yourself in someone else’s shoes,” Morley says. “Of course, you get to take them off at the end of the day.”