Given my reaction to Luhrmann’s Wilson Quarterly essay it admittedly took me a few days to persuade myself to read her other new essay on the Hearing Voices Movement. I’m glad I did.
In a refreshingly critical—and also simply “different”—take on the HVM, Luhrmann draws attention to the potential ‘dark side’ of the movement’s focus on trauma.
“Imagination,” she observes, “is a powerful tool that cuts both ways. It may be able to capture and reorient the soul-shattering experience of hearing distressing voices, yet we must be careful that the memories it leaves behind do not do damage of their own. These thoughts jostled in my mind at the Maastricht conference.” (For a chilling story of the ways in which dissociative or trauma-based approaches to distress can catastrophically mislead clinicians, read the blogger Jen’s story here. In fact I recommend Jen’s blog more generally for her very different, but powerful, defense of a more explicitly biomedical understanding of and approach to schizophrenia).
That discourse structures psychatric subjectivity, or, as Luhrmann puts is, that “the way we understand our mental experiences has the potential to alter them fundamentally” is a theme I often turn to in my own work. Luhrmann’s critical edge, however, is what is truly provocative here. Different narratives, different discursive horizons of experience, may be therapeutic, for different people, for different reasons (this includes, IMHO, & no matter how strongly I criticize them in general, biomedical frames). No causal narrative or genre, however, is without any risk, without any potential of negatively (or simply ambiguously and ambivalently, unpredictably) impacting the self, agency, and interpersonal relationships. This is true at the individual level, of course, but also with respect to the ways in which such discourses function at a societal level– culturally and socio-politically.
As Luhrmann is aware (here, quite explicitly–mea culpa), “schizophrenia” is perhaps unusually heterogeneous. I would thus augment her worries (which I think it perfectly appropriate to leave as “suggestive” rather than more fully articulated), with a kind of questioning concern about the arguable over-emphasis of the HVM on trauma (and dissociation). Here my concern is that in over-focusing on a single line of epidemiology and causality, we risk choking out, or even unintentionally delegitimizing (in the user/survivor if not mainstream psychiatric world), other ways of thinking, understanding, and living psychosis. Maintaining pluralism, particularly in the face of the extraordinary stigma that surround psychosis, is admittedly extremely challenging. And yet we must, as I suggested in my last post, if I am convinced of nothing else, it is that the user/survivor movement must not capitulate to the monothetism and monologism of mainstream psychiatry.