‘These ideas have enabled people to be more accepting and open about voice-hearing experiences’

Assistant Psychologist Fauzia Khan meets psychiatrist Dr Marius Romme, who co-pioneered the Hearing Voices Movement – also known as the Maastricht approach – along with Science Journalist and Researcher Sandra Escher in the 1980’s.

You’re one of the pioneers of the Hearing Voices Movement. What inspired it?

The Hearing Voices Movement was first inspired by our work with Patsy Hage in the ‘80s. Patsy was a patient of mine who told me that she heard voices, but she told it in a different way. Most people who hear voices want to get rid of them, but she asked me how she could cope with her voices, which was more invitational. She had a question to ask. Her question was not about trying to get rid of something, but rather it was about learning how to cope with something. This was really interesting because it conceptualised the voice hearing experience as something that had a meaning and relationship with the individual’s life story, as opposed to understanding it through an illness phenomenon. 

The Movement seems to have grown so much in popularity over the last 25 years; why do you think that is?

Because it acknowledges the uniqueness of the voice-hearing experience, and recognises it as a personal experience for the individual. In psychiatric settings, the experience of hearing voices is often seen as a symptom of a mental illness that you’re supposed to get rid of, but the hearing voices movement does not focus on getting rid of the voices… instead it focuses on how the individual can cope with their voices. In these settings, traditionally professionals often differentiate between these experiences as being good or bad, and they don’t think that it is something that you can learn to cope with. However, learning how to cope with the experience is crucial. There are a plethora of voice-hearers who never become patients and that is because they are able to cope with their voices and view them as an extra possibility, which can be life enhancing. When people are able to view their experiences in this way, they are not afraid of them. They are able to talk with them, and develop a relationship. The hearing voices movement has essentially changed the way in which the experience can be conceptualised, and I believe that these factors have contributed to its increasing popularity.

Although the Movement has been positively received by many people – voice-hearers, non-voice hearers and mental health professionals – there has also been some opposition and challenges to it. Can you tell us a bit about that?

Some mental health professionals have not been very positive about it because they depict the voice hearing experience as a symptom of a psychiatric illness, namely of schizophrenia or a dissociative disorder, and so they do not see voice hearing as something that has any value or meaning for the person. I have also experienced opposition from some psychiatric organisations. 

Interestingly, however, child psychiatrists have been the most receptive to it. I believe this is because professionals are less anxious in working with children with voices, as children do not make a big fuss about it and find it easier to explain what is going on for them, compared to adults, who are likely to find it difficult to explain and make sense of. For children, the experience is much more likely to be considered normal because they are more used to ‘strange’ experiences as they are still ‘figuring’ out the world, and they are not primarily negative about their experiences. Adults on the other hand are more rigid in their thinking… they are not used to these kinds of experiences and are likely to have more of a startling response to it.

You’re a psychiatrist; what distinction do you see between how you approach this subject, and how psychologists might?

I believe that the way in which psychologists might approach the subject would really depend on their conviction of whether they view the voices as a symptom of a psychiatric illness or not. However, I think that psychologists in general are more likely to be open to the idea of the significance of the experience for the person, as opposed to psychiatrists. Psychiatrists traditionally view voices as being symptomatic of an illness, and initially I also viewed voices in the same way. However, the discussions arising from our work with Patsy Hage and later with other voice hearers that we treated at our institute really changed my thinking. I think that psychologists and psychiatrists who want to understand the voices need to recognise it as a reaction to an experience that has resulted from something that has happened to that person. 

What concrete change do you think this Movement has caused?

The movement has led to the acceptance of voices as something that is not necessarily a strange experience, but rather something that has significance to the individual’s life story and is a reaction of something that has happened to them. These ideas have enabled people to be more accepting and open about their voice-hearing experiences, and they are able to choose how they conceptualise their experiences. People are now not only restricted to understanding voices as an illness phenomenon but as something that is an asset and has value for them.

What would you advise other professionals who have never worked with people who hear voices, and may be interested in doing so?

I would advise other professionals who have never worked with people who hear voices to be open to understanding the voices and what it symbolises for the voice-hearer, and to take it as an experience of something that has happened to the person. 

I have co-written a number of books on the subject of hearing voices – Accepting VoicesMaking Sense of Voices: A Guide for Mental Health Professionals Working with Voice-HearersLiving with Voices: 50 Stories of Recovery and Young People Hearing Voices: What You Need To Know And What You Can Do. I would really recommend these as a starting point for anyone wanting to know more hearing voices. 

Are there any current or future projects that you are working on?

I am in the process of writing a history about the hearing voices movement that we developed in Holland. I have also co-written a new book with Dirk Cortsens (Psychiatrist affiliated with Intervoice) called ‘Stemmen Horen’, which was recently published and is only available in Dutch at the moment. This new book aims to make the phenomenon of hearing voices more understandable and contains a plethora of literature and research from around the world. Dirk is very active in research in his outpatient clinic in Holland where he works with voice-hearers, and has written most of the research into the book. We have a great working relationship; he does the work and I look at it over a can of beer with him! 

And what about your life outside of psychiatry?

I have many hobbies. I love being out in nature, and I used to enjoy horse riding with my late wife Sandra Escher, whom I discovered it through and I got really good at it. I used to also take part in Dressage, which I enjoyed very much. At the moment, I’m not really into any sporty activities, because I’m 87 – although I don’t look it! – and that’s not an age to do much sport. I just enjoy my walking now and exploring nature. 

Thank you so much for your time, it has been such a pleasure interviewing you and getting to know more about your inspiring work with voices. 

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