Wednesday, November 11, 2009

On display in a museum in Heidelberg is a curious jacket created by a patient who spent her adult life locked up inside a mental asylum in the late 1800s. Intricately woven patterns and words were sewn from five colors of threads gathered from scraps of hospital gowns by seamstress Agnes Richter, a “common lunatic” in the parlance of her day. In “Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness,” Gail A. Hornstein, a professor of psychology at Mount Holyoke College, finds a rich metaphor for the conundrum of madness. She thinks Agnes was stitching a diary of sorts from within her madhouse walls.

Beyond the design that has puzzled art historians for generations is a powerful reminder that the mad may be trying to tell us something. Ms. Hornstein’s book battles the assumption within mainstream psychology that they lack insight into their condition. Based on evidence in Europe, where people with a diagnosis of schizophrenia are reclaiming their lives by the tens of thousands, Ms. Hornstein presents a new model for treating those who hear voices and talk back to them.

Their voices, known as auditory hallucinations, are the chief symptom of schizophrenia, a condition affecting 1 percent of the world’s population. These oracular observations may be as incomprehensible as the nonsense words in the Heidelberg jacket, but the success stories in Europe have Ms. Hornstein convinced that they should be major source material for psychologists.

“Just because their voices are difficult to decipher does not mean we shouldn’t try to make them out,” she said in a September interview. “The belief has been that they have no business talking about their voices, but the notion that we have nothing to learn from these people strikes me as very wrong.”

Speaking to their voices and about their voices — the therapy is known as “dialoguing” — has been considered irresponsible within U.S. psychiatric circles wary of “colluding with delusions,” as Ms. Hornstein puts it.

In the United Kingdom, by contrast, Ms. Hornstein attended meetings of the Hearing Voices Network, comprising more than 160 support groups. She was so impressed with the rich tapestry of recovery in Europe that she decided to start a meeting of her own in Holyoke, Mass.

Following in the footsteps of Dr. Marius Romme, a Dutch psychiatrist who launched the network in 1989, Ms. Hornstein provides a safe space for voice hearers to talk freely about their experiences in a nonjudgmental setting. As it turns out, the voices are as variable as the people we meet in the actual world — male and female, young and old, rude and charming.

The experience is nothing like talking to oneself or thinking aloud. “The voices are experienced as coming from other people, from birds or animals, or from the TV, radio, or other objects,” MS. Hornstein explains.

For those who hear voices, it can feel as if discrete thoughts are being dropped into their heads while others, like CD discs, are being removed. What is heard can often sound like a cacophony of half a dozen radio transmitters blaring on and off as the voices keep up a running commentary on the listener’s behavior.

Advocates of dialoguing take issue with colleagues who reach too quickly for the prescription pad. They insist the concern should be with accommodating the voices, not trying to zap them with drugs. “The normal approach in medicine is to focus on complaints,” Dr. Romme says on the phone from Holland. “So why [in the case of schizophrenia] do we not focus on the complaints?”

Dr. Romme and Ms. Hornstein both question the usefulness of the term “schizophrenia” to describe the set of symptoms psychiatry has used since 1911 to diagnose the condition. “Hearing voices is a real experience,” Dr. Romme explains. “Schizophrenia is not. The diagnosis is a construct, not a reality.”

The reality of the voices is no longer in serious dispute, as brain imaging scans reveal that the auditory cortex of the brain lights up with activity when people are hearing voices, despite the absence of outside sound stimuli.

More controversial is the new school of thought’s contention that trauma is solely responsible for the voices. Numerous studies of twins separated at birth point to a biomedical predisposition triggered by real-life events — equal parts nature and nurture, in other words.

The Hearing Voices movement’s flirtation with the anti-hereditary bias that prevailed within psychiatric circles until the mid-1970s puts it at odds with the movement’s intellectual founding father, Julian Jaynes. The late Princeton psychologist theorized that auditory hallucination is a neurological event, a relic of the state of consciousness that may have prevailed before the brains of our earliest pre-human ancestors doubled in size and split into separate hemispheres. In his provocative 1976 work, “The Origin of Consciousness in the Breakdown of the Bicameral Mind,” Jaynes posited that hearing voices externally may have been the norm for all of us up until 3,000 years ago.

• Patrick Tracey is the author of “Stalking Irish Madness: Searching for the Roots of My Family’s Schizophrenia,” which won the 2009 PEN New England Award for Nonfiction. He can be found at stalkingirishmadness. com.

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