Στην ΑΘΗΝΑ. Σεμινάριο “HEARING VOICES”, «Ακούγοντας φωνές και ζώντας με αυτές». Εξερευνώντας το νόημα των φωνών - από το σύμπτωμα στην εμπειρία. Από 22 έως 27 Φεβρουαρίου 2010. Οργάνωση: Κ.Ψ.Υ. Αγίων Αναργύρων.
Σεμινάριο “HEARING VOICES”
«Ακούγοντας φωνές και ζώντας με αυτές»
Εξερευνώντας το νόημα των φωνών- Από το σύμπτωμα στην εμπειρία
22-27 Φεβρουαρίου 2010
Οργάνωση: 9ο Ψυχιατρικό Τμήμα
ΚΨΥ Αγ. Αναργύρων
Το δίκτυο Hearing Voices (HV) ξεκίνησε το 1988 από την Ολλανδία όταν ο ψυχίατρος Marius Romme έλαβε σοβαρά υπόψη τις κριτικές απόψεις μιας γυναίκας που τον επισκεπτόταν επειδή άκουγε φωνές και αμφισβητούσε την αντιμετώπιση που πρότεινε το ορθόδοξο ψυχιατρικό μοντέλο. Αντί της αντιμετώπισης τέτοιων και ανάλογων εμπειριών ως “κούφια” συμπτώματα που στοιχειοθετούν ένα ψυχιατρικό σύνδρομο (π.χ. σχιζοφρένεια), το κίνημα Hearing Voices προτείνει σεβασμό για το νόημα κάθε βιώματος, μια ολιστική προσέγγιση και αποδοχή. Στην Αγγλία σήμερα υπάρχουν 195 ομάδες αυτοβοήθειας HV. Ομάδες υπάρχουν ακόμη σε πολλές χώρες της Ευρώπης, στην Αυστραλία και Νέα Ζηλανδία, στην Ιαπωνία, στην Παλαιστίνη και στις ΗΠΑ.
Μερικά χρόνια αργότερα, στην Αγγλία, εμπνεόμενο από τις βασικές αρχές του Hearing Voices, ξεκινά το Paranoia Network και επικεντρώνει στις «ασυνήθιστες» πεποιθήσεις οι οποίες συνήθως ταξινομούνται ως «παραληρηματικές ιδέες». Ενάντια στην παθολογικοποίηση κάθε ανθρώπινης εμπειρίας, οι ομάδες αυτές βάζουν μπροστά τη δημιουργικότητα και την ενεργό δράση όσων θέλουν να μιλήσουν ανοιχτά για ό, τι τους ταλαιπωρεί, ή να καταθέσουν την εμπειρία τους σχετικά με τους τρόπους που οι ίδιοι βρήκαν για να αντιμετωπίσουν δύσκολες στιγμές.
Το σεμινάριο λοιπόν στοχεύει στο να δουλέψουμε πάνω σε εμπειρίες οι οποίες αντί να εκλαμβάνονται ως «μέρος ενός προβλήματος» μπορούν να γίνουν «μέρος της λύσης του προβλήματος». Η λογική του να λαμβάνεται υπόψη το περιεχόμενο των φωνών έχει να κάνει όχι μόνο με την υποστήριξη της ανάπτυξης ψυχολογικών παρεμβάσεων αλλά και με την απομάκρυνση από το μοντέλο της ασθένειας και την αντιμετώπιση των φωνών ως ένα τμήμα της ανθρώπινης εμπειρίας.
Από αυτήν την άποψη απευθύνεται:
- σε ανθρώπους με αντίστοιχες εμπειρίες
- σε φίλους ή συγγενείς τους
- σε επαγγελματίες που δουλεύουν με ανθρώπους που ακούνε φωνές
- σε όσους ενδιαφέρονται να μάθουν περισσότερα για αυτές τις εμπειρίες
Δευτέρα 22 Φεβρουαρίου 2010
(Πνευματικό Κέντρο του Δήμου Αθηναίων, Ακαδημίας 50)
9:00-14:00 Παρουσίαση του δικτύου και του τρόπου δουλειάς του και περιγραφή εμπειριών.
Βιωματικές ασκήσεις και στρατηγικές αντιμετώπισης.
Τρίτη 23 Φεβρουαρίου 2010
(Υποστηρικτικό κτίριο Ψ.Ν.Α.)
13:00-20:00 Συνέχεια από την πρώτη ημέρα με σύνοψη της προηγούμενης, ανάλυση των τριών σταδίων των φωνών και των ασυνήθιστων πεποιθήσεων.
Δουλεύοντας με την παράνοια και τις φωνές.
Τετάρτη 24 & Πέμπτη 25 Φεβρουαρίου 2010
(Υποστηρικτικό κτίριο Ψ.Ν.Α.)
13:00-20:00 Σεμινάριο για επαγγελματίες.
Δουλειά με επαγγελματίες μέσα σε ομάδες, δείχνοντας πώς μπορούν να συσχετισθούν με δύσκολες εμπειρίες της ζωής του. Θα παρουσιαστούν οι κατάλληλες δεξιότητες για να μπορεί κανείς να δουλέψει με άτομα που ακούνε φωνές και με άτομα με παρανοϊκή εμπειρία.
Παρουσίαση και συζήτηση περιστατικών.
Παρασκευή 26 Φεβρουαρίου 2010
(Παγκόσμιο Πολιτιστικό Ίδρυμα Ελληνισμού Διασποράς, Δεκελείας 152 Νέα Φιλαδέλφεια)
12:00-18:00 Σεμινάριο για άτομα με ψυχιατρική εμπειρία.
Αναζήτηση τρόπων αντιμετώπισης των φωνών και της παράνοιας και προαγωγή της αξίας της αυτοβοήθειας και των ομάδων στήριξης (peer groups). Δημιουργία ενός ασφαλούς χώρου οπού τα άτομα μπορούν να αρχίσουν να ανιχνεύουν τις δικές τους εμπειρίες και τρόπους για να κατανοήσουν το νόημα τους.
Σάββατο 27 Φεβρουαρίου 2010
(Παγκόσμιο Πολιτιστικό Ίδρυμα Ελληνισμού Διασποράς, Δεκελείας 152 Νέα Φιλαδέλφεια)
12:00-18:00 Ξεκινώντας ομάδες.
Ανοικτή συζήτηση με όποιον ενδιαφέρεται να ξεκινήσει ομάδες, στο ήθος, στις αξίες και στις πρακτικές απαιτήσεις που συνεπάγεται η έναρξη και η λειτουργία ομάδων.
Εκπαιδευτές: Peter Bullimor, Jacqui Dillon, Brian Langshaw, Linda Whiting.
Hearing voices and its historical course
Understanding the phenomenon of hearing voices within the course of history is necessary to be able to understand why this experience must be seen within a broader context. It is relevant to understand the development of a culturally accepted and appreciated experience to the prominent position it currently has within the psychiatric framework. Without truly understanding how the experience slowly shifted into the medical model, with all the implication for the voice hearers, one is not able to be more open minded about voice hearing. In doing so, normalising the experience, one will help the voice hearer to develop and use his/her own resources. The importance of this change of attitude has been shown in our work in promoting the emancipatory approach for voice hearers.
This chapter does not attempt to provide a complete overview of the history of voice hearing. A whole book would be required to do it credit and several authors have already reviewed the relevant literature for different purposes and from different frames of reference (Slade & Bentall, 1988; Thomas, 1997; Watson, 1998). On the other hand, neglecting this completely would not be helpful in understanding the background and rationale for the present study.
Hearing voices has been reported throughout history, from the ancient civilisations of Egypt, Rome, Babylon, Tibet and Greece until the modern day (Watson, 1998). In these earliest societies positive voices were commonly reported. It was believed that, at certain sacred sites, it was possible to obtain advice and guidance for important decisions from the voice of a God. In later times it was more common that these divine messages were mediated through appointed priests or priestesses. The earliest well-known voice hearer was Socrates (469-399 BC). Although he reported hearing the voice of a demon, he valued the voice positively.
The first hypothesis about hallucinations came from Aristotle (384-322 BC), who did not relate them to his own experience. According to Aristotle, voices were produced by the same mechanisms that normally produce hallucinations during sleep, the mechanism of dreaming (Feinberg, 1970).
Experiences of voice hearing are often mentioned in a religious context. Significantly, people identified as founders of religious movements reported hearing voices: Jesus (Christianity); Mohammed (Islam); George Fox (Quakers) and Joseph Smith (Mormons). Both in the old and new testament; Moses, Jesus, the apostle Paul and Maria were all described as hearing voices. It is known that the abbess Hildegard von Bingen, the saints Teresa of Avila and Fransiscus of Assise, and the protestant Luther heard voices (Watson, 1998). Probably the best known voice-hearer is Jeanne d’Arc (1412-1431) who perhaps gives the earliest example of a voice hearer where political events had a great influence in the way people looked at her experiences. She was openly known by her troops to be guided by voices when she took them into battle to free France from the English. However, when she was captured she was then accused of witchcraft because of her voices. In fact her trial was a political debate about who would own the French crown.
The first noticeable change toward hearing voices might be seen in relation to the development of individualisation as part of the evolving European cultural movement of the ‘Renaissance’. It was a time widely regarded as involving the emancipation of mankind in respect to the powers that dominated their existence: the clergy and the state. Across much of Europe during the middle ages, political power was in the hands of the Roman Catholic Church as church and state operated as one body. The church functioned as the prime controller of knowledge, and the development of independent thought represented by individualism threatened the power of the church.
As early as the fourteenth century one can find the first traces of the Renaissance and individualisation in the work of Dante (1265-1321) who was a poet, statesman and a philosopher. In his text, ‘Monarchia’ (Winkler Prince, 2002; Perler in Routledge 2000) Dante proposed that the aim of civilisation was the bundling of human potentials to obtain peace and freedom. Dante held revolutionary ideas and proposed that the individual, state and church should have separate roles, where the role of state and church provided guidance rather than control. In the fifteenth and sixteenth century the developing influence of the renaissance was so strong that it influenced all facets of daily life, including all kinds of art such as architecture, painting, sculpturing, music, copper-plating, tapestry, glass blowing and also beliefs about the treatment of ill people (Thomas, 1997).
Until the early renaissance, theories of disease were still grounded in astrology and alchemy (Thomas, 1997). Medical changes were a consequence of an apparently harmless revival and interest in classical Greece. This interest was stimulated by an interest in the human body, exemplified by the work of the artist Leonardo da Vinci, who published a series of anatomical sketches, which in turn influenced the Belgian anatomist Vesalius, who studied medicine in Paris. Vesalius was taught in the traditions of anatomy unchanged since Galen (around the second century BC.), who in his work extended the theories of Hypocrates. To learn more about anatomy, Vesalius undertook dissection, a very risky business as the church had forbidden to do this, the Roman Catholic Church regarding the structure and function of the human body as God-given, sacred and not for men’s eyes (Thomas, 1997). Vesalius’ actions and observations thus challenged ideas sacred to organized Christianity, for example the belief that women had one more rib than men and that the heart was the centre of the mind.
Many others challenged the established views of the church. Copernicus calculated that the sun, not the earth, lay at the centre of the solar system, a view at that time that was seen as heretical. The invention of the telescope, thermometer, barometer and microscope provided the means by which the early scientist philosophers could delve ever more deeply into material properties of the natural world. (Thomas, 1997, p.153). The church perceived the development of science as a threat, as the acquiring of knowledge through scientific exploration effectively made God and the church redundant. Therefore the church sought means to retain control, and across Europe it greatly expanded the system of inquisition to detect heretics. The inquisition started around 1184 in Rome when it was legislated by Pope Lucius III and it finally stopped in 1772 in France:
- ‘In order to defend Christendom against Satanic influences, Pope Innocent VIII ordered in 1489 the publication of the book ‘Malleus malefircarum (The hammer of the witches). This book set the conditions for the burning of people who were suspected of witchcraft or possession by demons. ‘(Slade en Bentall, 1988 p. 6).
- It was a brutal system run by monks who were given wide-ranging powers, such that their actions were unaccountable to the local bishops. When heretics were detected they were brought to trial according to the Roman laws. The inquisition was thus much feared and at this time reporting hallucinations was clearly a danger to ones life.
Theresa of Avila (1515-1582), who was an abbess, was able to save a number of visionary nuns from the machinations of the Inquisition by introducing concepts of ‘sickness’ and ‘lack of responsibility’. She explained that certain ‘natural causes’ were capable of explaining visitations, namely (a) melancholy, (b) a weak imagination, or (c) drowsiness, sleep, or sleep-like states (Slade & Bentall, 1988, p.6). Thus it was Avila who developed the first medical conceptualisation of hallucinations, born out of a political need. Positive reports of voices thus disappeared, but whilst this did not mean that these experiences no longer occurred, a strong cultural taboo was created.
The second historical influence on the contemporary attitude towards hearing voices is the cultural development in the period of ‘Enlightenment’. This movement started around the sixteenth century, where it is related to the era of British ‘Glorious Revolution’ and the end of the French Revolution (Winkler Prince, 2002). This period is also sometimes called the ‘the period of philosophy’, a time when people were challenged to use their minds, challenging beliefs that a human being could not use his reason as he was bound by superstition, prejudices and the powers that maintained these. The new optimistic view was that through reason one could separate what is natural and what is unnatural. (Thomas, 1997).
Influential to the Enlightenment movement was the French philosopher Descartes (1596-1650), with his ‘Cartesian’ system of thought, regarded as the foundations for the science of psychology (Thomas, 1997). His famous phrase ‘I think and therefore I am’ introduced ‘dualism’, the doctrine that conceptualised the separation of body and mind.
‘Our understanding of the world is located in internal experiences, in the mind of the individual. The twin peaks of Cartesian thought, mind/body, that opened the way for the materialistic study of human behaviour, and the belief in the foundation of knowledge through the experience of the individual, has had a potent effect in shaping psychological thought. In particular, it has stimulated scientific approaches aimed at understanding the internal mechanisms of minds, and their relationship to brain. The problem is that it has led to neglect of the relationship between the individual and other(s), for as Russell observed, morals and ethics, those aspects of philosophy that understand the values that govern our individual and social relationships, had little or no place in Cartesian thought. ‘(Thomas, 1997 p. 157/158).
In the centuries to follow, this scientific approach became the dominant culture with many consequences. The tools of science are objectivity assured by the condition that what is accepted as knowledge must be produced by methods and thus results that are replicable. By separating the body and mind, Descartes created the possibility of studying the mind as an object, separate from the body and from the environment, as if there is no interaction, no relation what so ever. (Thomas, 1997, 2003).
With the development of science, terminology developed as well. In relation to such experiences as hearing voices, the term hallucinations was for the first time introduced by Lavater in 1572 (Slade & Bentall, 1988), based it on a translation of Galen’s conception of madness as ‘a disturbance of bodily humours’.
‘The word ‘hallucinations’ is an anglicised version of the latin allucinatio (wandering of the mind, idle talk). The term was used to refer to a variety of strange noises, omens and apparitions. ‘(Slade& Bentall, 1988 p. 7).
The French physician Esquirol (1832) conceptualised hallucinations in an attempt to distinguish between ‘insane’ and ‘sane’ hallucinations. He differentiated these extra-ordinary experiences into illusions and hallucinations.
‘People who suffer from hallucinations are dreamers while they are awake. Hallucinations are “memory recalls without the intervention of senses. ‘(Slade& Bentall, 1988 p. 8).
The insane were mistaken about the nature and cause of their present sensation. Illusions, on the other hand, were seen as situations where:
‘…the sensibility of the nervous extremities are excited; the senses are active, the present impressions call into action the reaction of the brain’. (Slade& Bentall, 1988 p. 8).
The distinction between ‘insane’ and ‘sane’ was strongly debated. Esquirol described the insane as ‘mistaken about the cause of the present sensation’, while in 1855 the French Société Medico-Psychologique distinguished insanity in relation to the inability to control experience. Both arguments still play a role in the contemporary debates.
However insanity did not restrict itself to an individual illness but within a social context.
‘It was Esquirol and his teacher Pinel who rejected the view of mental illness as a self-acting entity, independent and alienated from the community of people that produced it. To the contrary, they argued, how much the mental patient and the normal had in common. In attempting to refute the notion that the mental patient was globally disturbed, possessed, they attempted to differentiate precise symptom pictures. In what they called ‘ folie raisonnante’ as patient might at times have a different perception of reality than his examiner, but in many other aspects he might be reasonable. It is by some lamentable misinterpretation of history that Esquirol is now reported in the textbooks to deserve credit for the modern mystifying use of the term hallucinations. ‘(Rabkin, 1970, p. 115.)
According to Rabkin (1970) it was not Esquirol’s idea to diagnose a person as an individual that is without reason.
‘By defining the two terms, Esquirol’s main purpose was to point to the rest of the patients behaviour and circumstances, behaviour which was rational. This is usually not mentioned.‘ (R. Rabkin, 1970, p.116).
Categorisation into illness entities and the consequences
In the second half of the nineteenth century and in the first half of the twentieth century mental illness was mostly still considered in terms of an interaction between environment and individual. Under the influence of Freud’s philosophy, Adolf Meyer even attempted to integrate Freudian theory into the practice of clinical psychiatry:
‘Meyer’s approach to understanding mental illness was normalising, in that he regarded it as an understandable reaction to a set of life experiences. His approach was significant in the importance that it attached to the person in understanding mental illness. His approach focused on persons not patients.’(Thomas, 1997, p. 148).
At the same time a small but powerful group in Germany criticized this social approach (Kraepelin, 1883 Bleuler,1911). They found working with the psychosocial model unscientific, believing that it would fail to generate any meaningful research in the field of mental illness. They instead wanted to refine the pathological concept that attempted to explain mental illnesses from within a biological or genetic frame of reference. It was step a forwards in trying to refine pathological concepts.
‘Kraepelin (1856-1915) developed a classification system for mental illnesses. His first modest overview was published in 1883 as ‘Compendium der Psychiatrie’, followed in 1887 by a second edition ‘ein kurzes Lerchbuch fur studerende und Arzte’ (Blom, 2003.p.53).
‘Chronicity’ and ‘deteration’ were the essence of Kraeplins concept of ‘dementia praecox’, which, as can be shown today, was biased due to the more severly ill patients Kraepelin saw in the mental hospitals of his time. While Bleuler (1911) corrected this consept of chronicity by pointing out that several subtypes exist and that the defining criterion should be psychopathology and not the course, he unwittingly created another misunderstanding by introducing the term of schophrenais. (Katchnig, 2002).
In his early work Bleuler, in contrast to the European psychiatric establishment, acknowledged Freud’s more dynamic and reconstructing access to psychopathological phenomenon. It must have been the setting again that influenced his idea. Bleuler lived and worked in close contact with his patients. Later under the pressure of the German-speaking psychiatry to confirm to their idea, Bleuler stripped the schizophrenia concept from all psycho-analytical influences (Richartz, 1985) Under the influence of Eugen Bleuler psychiatry in the United States has diagnosed nearly all psychotic experiences with a clear conscious involving hallucinations and/or delusions with the label of schizophrenia (Richartz, 1985)
So with the development of classification system, expressions of mental illness were no longer seen as understandable reactions to a set of life experiences, but as expressions of an illness entity, an underlying illness of the functioning of the brain. The influence of this line of understanding is predominant in medical faculties nowadays. Textbooks structure the first medical ideas of medical students - the doctor’s to be. This kind of thinking is the first step toward learning to use diagnosis on the basis of symptoms, categorised into illness entities without aetiological knowledge of these symptoms.
With this approach, Kreapelin and others working in clinical psychiatry had little regard for what the symptoms (of the illness) the patients alleged to be suffering from, might mean for them (Zilborg & Henry, 1941). Nonetheless, Kraepelinplin’s system became a great success.
Slade and Bentall formulated their criticism:
‘The development of specified illnesses has all kind of consequences which might be considered negative.
Firstly the medical model has led to the study of syndromes rather than symptom. Most research into abnormal behaviour over the last 50 years or more has taken diagnostic categories such as ‘schizophrenia’ or ‘depression as independent variables.
Secondly the view that hallucinations are medical phenomena has led to a relative lack of interest in them by psychologists. (Slade and Bentall, 1988, p.9).
Slade and Bentall are right in their criticism, but in the first half of the last century psychiatrists felt in need of diagnostic system to establish whether certain symptoms were pathognomonic for certain illnesses. Therefore, the psychiatrist Kurt Schneider (1956) developed criteria for identifying verbal hallucinations which he thought were specific to schizophrenia. He distinguished: ‘hearing voices that speak your thoughts aloud; hearing two or more voices talking about you (in the third person, referring to you as ‘he’ or ‘she’); hearing one or more voices carrying on a running discussion in which your actions or thoughts are commented on’. Schneider suggested that any one of these characteristics could be indicative of the presence of the illness of schizophrenia.
However the existence of this kind of reality is hypothetical. As Mary Boyle (1990) states:
‘What is perhaps most remarkable about their work (Kraepelin, Bleuler, Schneider) is that in spite of aligning themselves to a scientific framework, not one of them presented a single piece of data relevant to their assumption that they were justified in introducing and using the concept of dementia praecox and schizophrenia’(Boyle, 1990. p. 75).
In our own study (Romme, 1996, Honig, 1998, Pennings, 1996) no clear differentiation between characteristics of verbal hallucinations were found, experienced in patients diagnosed with schizophrenia, with dissociative disorder or in the non-patients (people with no psychiatric illness when assessed with the CIDI, Robins et al., 1988).
Whilst it is clear that criticism can be levelled at diagnostic systems, the recognition of disease entities had much to offer clinicians, encapsulating a desire to work scientifically, culminating in the development of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association.
‘It was a victory for biological psychiatry over the psychosocial movement and psychoanalysis in particular. Its detailed prescription of criteria for the diagnosis of mental illness has had international implications. It proved a firm basis for diagnosis which generated a new impetus in biological research’. (Thomas, 1997 p.149).
The American Psychiatric Association Committee on Nomenclature and Statistics published in 1952 the first edition of the Diagnostic and Statistical Manual: Mental Disorders (DSM-I). Since 1952 the DSM has been upgraded several times.
‘DSM-I contained a glossary of descriptions of the diagnostic categories and was the first official manual of mental disorders to focus on clinical utility. The use of the term ‘reaction’ throughout DSM-I reflects the influence of Adolf Meyer’s psychobiological view that mental disorders represented reactions of the personality to psychological, social and biological factors’ .’(DSM-IV.1994. p. xvii).
In 1980 the DSM-III was published.
‘DSM-III introduced a number of important methodological innovations, including explicit diagnostic criteria, a multiaxial system, and a descriptive approach that attempted to be neutral with respect to theories of etiology. ‘(DSM-IV. 1994. p. xvii/xviii).
In 1994 the DSM-IV was published.
However with all the efforts of refining the DSM the influence of social circumstances as refered to in the first DSM was not taken in again. Aetiological factors are not longer taken into account in the DSM classification system, with one exception: the Post Traumatic Stress Disorder.
Criticism on this classification system started more openly at the end of 1980’s, resulting amongst others in the publication of a number of seminal texts: Richard Bentall’s (1990) ‘Reconstructing Schizophrenia’, Mary Boyle’s (1990) ‘Schizophrenia: a scientific delusion’, Phil Thomas’ (1997) ‘The dialectics of Schizophrenia’ and Dirk-Jan Blom’s (2003) ‘Deconstructing Schizophrenia’.
Criticism has also grown out of daily practice, leading clinicians to question the utility of the diagnosis of schizophrenia, so that today it is enormously diminished in credibility amongst many practitioners (van Os & McKenna, 2003). In the Maudsley Discussion Paper (No.12) Jim van Os express the following concern;
‘The DSM definition is severely biased towards non-affective symptomatology. The reason for this discrepancy is likely to be related to the need of medical practitioners to convince of illnesses as clearly separable disease entities, based on the old Kreapelinian distinction between poor-outcome schizophrenia and good-outcome affective illness. ‘(van Os & McKenna, 2003).
There is also clearly an argument about why this DSM classification system is inadequate for voice hearers, as it does not incorporate the significance of the social context. In the Maastricht research, that looks for a relationship between the voices and the life history, great care was taken to clarify the onset of the voices and any traumatic events at that specific time. About 70% of the voices hearing in adults began after stressful events, including death of a family member, divorce, moving houses, losing a job, sexual abuse (Romme & Escher, 1989). The events occurred in social circumstances, and happened to people beyond their control. The voices often tell about circumstances that created an overwhelming experience of powerlessness. Voices are messengers of the problem or problems of the voice hearer. In any diagnostic system including the DSM, the social context and the content of the voices needs to be included instead of exluded, in order to understand the experience and the need of the voice hearer. Instead of moving forwards the medical profession seems to have lost this social context, something that was still taken on board in the beginning of the last century. In search of scientific objectivity, psychiatry seems to have lost the patient and has not found what it aimed at.
As the clinician Rabkin (1970) formulates it:
‘It is my contention that Esquirol’s worst fears have been realized, that his term has achieved the opposite of his intention: namely that the psychiatrist as alienist, as he used to be called, has created a set of alienating ideas or ideologies, prominent among which is hallucinations, which he mistakes for the real world of behaviour as one can mistake the image in the mirror for the veridical perception. By using these myths to alienate his patients in space he has alienated himself in a much more profound fashion. ‘(Rabkin, 1970, p.116).
Modern diagnoses in relation to hallucinations
The attitudes towards hallucinations of modern psychiatrists have been shaped by widely accepted assumptions about the diagnosis of psychiatric disorders. Following the work of Emil Kraepelin and others in the 19th and early 20th centuries, attempts were made to develop standardised criteria for classifying different conditions (Bentall, 2003). These efforts, which culminated in the creation of the American Psychiatric Association’s DSM system, placed great effort in determining the presence or absence of particular symptoms such as hallucinations, but have led to an almost total neglect of their meaning.
The DSM is a categorical system with no proven scientific validity (Bentall, 2003). It is a classification system not a diagnostic system because it does not include aetiological factors. In the DSM manual psychosis is described as:
‘The term psychotic has historically received a number of different definitions, none of which has achieved universal acceptance. The narrowest definition of psychotic is restricted to delusions or prominent hallucinations, with the hallucinations occurring in the absence of insight into their pathological nature. A slightly less restrictive definition would include prominent hallucinations that the individual realizes are hallucinatory experiences. Broader still is a definition that also includes other positive symptoms of schizophrenia (i.e., disorganised speech, grossly disorganised or catatonic behaviour). ‘(DSM-IV. p.273)
This reduces the scope on hallucinations and it is not open for the reality which we observed in our research that hallucinations are also a signal of social, emotional problems and should not be alienated from the person.
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