Yesterday, I listened to an All in the Mind podcast from Radio National about hearing voices. It made me think about my time working in mental health in the 1980s. Although I’m really glad I had the experience, I can’t say I enjoyed the work in those days. Perhaps I absorbed some of the oppression, constraint, and for some, hopelessness, felt by people in a system that was at the same time draconian and on the verge of transformation.
As a young social worker in mental health, one of the first things I was told was that you never, ever talked to anyone about their voices because it made things worse. I had really struggled with not talking to people about the very things that caused them distress. After all, one of the basic principles of social work is to ‘start where the person is at’, and any psychosocial assessment worth its salt is surely holistic. You need to understand pretty much everything about a person to understand problems and how to intervene. Understanding a person’s perspective and experience is at the heart of what we do. It never felt right and I never stopped struggling with this tension (I was perhaps less critical in those days). I was quite excited when I first heard about new Scottish research a number of years later. The researchers found that talking to a person with schizophrenia about their voices in ‘talking therapies’ was helpful rather then harmful. People learned to understand and manage their voices. This made an awful lot of sense to me.
I understand my discomfort now. By ignoring something so important, I was not contributing to empowerment, self-determination or knowledge. In hindsight, I do think avoiding talking about it placed a barrier between the person with mental illness and myself. So what could I have done differently? Perhaps the first step is to stop and listen to your own inner voices. Is what you are seeing, hearing and experiencing in your work different to what standard accepted practice says? So if this is the case what do you do? Academic and researcher, Pat Dorsett, had this exact same problem when she worked with people with spinal cord injuries. A standard belief about post-injury adjustment at the time was that people would inevitably experience depression as they adjusted to life with a disability and would crash and burn at some point. This didn’t fit with her experience – so she researched it and changed practices. I wonder what would have happened if I had trusted my instincts. I may have become a researcher much earlier in my career and stayed working in mental health. I may have contributed to new knowledge in this field. So social workers, if something doesn’t ring true, don’t force it – research it! You could change practice and add to knowledge. If you don’t know where to start, talk to social work academics and researchers. They will be more than willing to help!