Reviewed by Nancy Nyquist Potter, Professor of Philosophy and Associate with the Department of Psychiatry and Behavioral Sciences at the University of Louisville.
Emily Knoll offers readers a first-person account of her experiences with voice-hearing, telling of her journey of fear and despair, and her growing path to understanding not only herself but the phenomenon as well. Her memoir is aimed at a young adult audience and is written accessibly but powerfully in the present tense, giving an immediacy and concreteness to Emily’s story. This memoir is extremely rich in conveying to readers a non-pathologizing way to think about voice-hearing and voice-hearers. It should be read not only by voice-hearers themselves, who will find comfort in her narrative, but also by mental health professionals, as it presents a challenge to the biomedical model of voice-hearing as evidence of psychosis.
Challenging the biomedical model.
In terms of treatment, some clinicians suggest that she needs to lower her expectations, and they medicate her in ways that she finds are dampening her creativity (96). These forms of treatment are fairly common experiences for voice-hearers. But other clinicians normalize Emily’s voice-hearing, bringing together questions of ontology with questions about treatment and recovery. When Emily arrives at University, for example, her therapist Daphne Coton explains that ‘You can hear voices and not be psychotic,’ a position that some clinicians who are committed to the biomedical model of mental disorders may reject (154). Daphne also tells Emily that ‘the voices are parts of yourself’—an idea that seems antithetical to Emily’s belief that they are separate from her— and she asserts that no medication can make the voices go away. ‘We all hear inner voices,’ Daphne says to Emily. ‘It’s just that yours are outside your head. So you have to work hard to remind yourself that they come from within you. And that it’s your mind creating them’ (104). Later, when Emily tells Daphne, ‘I just wish that I was like the others, and I didn’t hear voices,’ Dr. Coton bluntly replies, ‘Well tough, you do. So you’ve got to think of ways to cope.’ A central part of Emily’s coping and recovery includes becoming part of a network of people who are talking about voice-hearing and reframing it so that it isn’t as stigmatizing and damaging (see below.) Many clinicians guide Emily toward communities with whom she can feel more comfortable. For instance, she is recommended to attending a ‘hearing voices’ training course to learn to facilitate peer support groups, and this somewhat alleviates isolation and stress by finding connection with others who will listen openly and respectfully and will be encouraging of change and growth.
An important message in Emily’s book is that there is no monolithic way to frame voice-hearing. Instead, there exist diverse experiences and many strategies of dealing with voices. Some reject their voices and yell at them to go away, others have a dialogue with them. Emily learns that some voice-hearers accept their voices and even welcome them.
Emily’s Voices is a poignant and ground-breaking memoir on the phenomenological experience of one voice-hearing person that plainly illustrates the fears, hopes, and strength it requires to face stigma and loneliness yet come out radiant. I was moved by reading this memoir and urge clinicians to read it and consider the limitations of the biomedical model and the successes of other treatment options for voice-hearers.
Corrigan, P. 2004. How stigma interferes with mental health care. American Psychologist: 614-625.
Thachuk, A. Stigma and the politics of biomedical models of mental illness. International Journal of Feminist Approaches to Bioethics, Special Issue: Feminist Perspectives on Ethics in Psychiatry, 4(1): 140-163.
Vilhauer, RP. 2017. Stigma and need for care in individuals who hear voices. Int. J. Soc Psychiatry, 63(1): 5-13.
Posted on JANUARY 19, 2018 by MDICLHUMANITIES