Voices and 'psychosis': dissociation at what cost?

I’ve long been troubled by attempts to dissociate “voices” from other aspects of psychosis, but this concern struck me with particular poignancy a few days ago when I was introducing Chicago Hearing Voices to a group of very marginalized service users (most transitioning off the streets) at a peer-run drop-in center in Uptown.  “I don’t have that kind of schizophrenia,” one man said, “I have the paranoia, doesn’t sound like you include people like me;” another reported that he did not have schizophrenia or psychosis or voices, but rather “paranormal experiences.”  “Do you talk about those?” he asked.   Increasingly, I find that I am almost always forced to clarify or backtrack in presentations on CHV.   Even with respect to personal introductions,  I’ve found myself growing increasingly wary of referencing myself as a ‘voice hearer’ (unless I add “and a service user with psychosis”, which seems both redundant and far-too-problematically rhetorically and politically displaced or de-centered).

The purpose of this post is not to delve into the academic literature and associated debates currently revolving around the connections between trauma, dissociation and voices, the population-level prevalence of voice hearing, voices as pathognomonic (or not) of psychosis (a somewhat bizarre argument that seemingly accepts the claim that psychosis truly is a “categorical entity” rather than a complex and over-determined cultural construct).   Perhaps, at some point, I will tackle these issues at greater length in a more appropriate academic venue.

The issue I will stick to here is instead my growing concern that voices and voice hearers have been (or are being), as Romme famously put it, “liberated” at the expense of a messier, more complicated, and more politically self-aware exploration of psychosis—or the many, diverse and heterogeneous but nevertheless often tightly interwoven, experiences assembled under this historical and still culturally salient name.    A few weeks ago Keith Laws (a researcher I disagree with close to 90% of the time), tweeted something I did (for once) agree with: “where,” to paraphrase, “are the psychological treatments and alternative terms for “formal thought disorder”’ he asked—why doesn’t anyone talk about it?  What about “cognitive deficits”?  What about the inability (in some cases) of select service users to communicate with others for decades because of these “inconvenient” symptoms…?

I’m afraid that the answer is that voices (never mind my own concerns that the division between voices and other thought-specific and perceptual experiences is tenuous at best) are, at the moment, sexy, both in academia and activist circles on both sides of the Atlantic, in ways that other “experiences” are not.  Madness in its ‘positive’ form has, of course, always occupied a central place in culture (cf Woods’ Sublime Object of Psychiatry), and every generation—perhaps as a means of personal or collective ‘expiation,’ perhaps (ultimately) to salvage reason—has always appeared so eager to “liberate previous madness while enclosing within itself, in its present existence, the madman of the day.”  (There is undeniably a certain pathos in the fact that my undergraduate preoccupation with Derrida’s “Cogito…” remains the source of so much insight nearly 10 years later.)  Voices, I suppose, are appealing because of their myriad, almost-impossible-to-not-romanticize or exoticize—connections to multiple religious and spiritual traditions, to art and literature,  to culturally recognized meaning and insight (rather than the black hole of even madder forms of madness),  and so on.

Having said all this, I have not hit on the larger issue of, as I put it in an earlier post, the even greater complexity of the “agencements” (dynamic systems, assemblages) that I personally find most relevant and necessary—temporally drawn out intersections of race, class, social exclusion, culture, perception , trauma, disability and experience that go well beyond discrete psychiatric symptoms or syndromes as the appropriate anchoring objects of academic research or activist intervention.

Since I’m hardly at the center of discourse about “voices,” I’m certainly not in a position to assert that these conversations are not happening.  If they’re not, however, they badly need to….