By the end of this learning package you will:

  • Understand the philosophical implications of the medical model
  • Understand the lived experience of hearing voices
  • Appreciate the possibility for multiple explanations for hearing voices

In Europe today, the medical model dominates mental health service delivery. A Recovery and Social Inclusion approach can be in conflict with the medical model. This is because they originate from different philosophical positions.

One area of potential conflict is the area of what are referred to as “hallucinations” and “delusions”.

The medical model would consider these symptoms of illness, a Recovery and Social Inclusion approach may accept these as normal human experiences. Because the medical model dominates European thinking in mental health care, this learning package will deliberately take a position critical of the medical model and support a Recovery and Social Inclusion approach.

Before you begin this topic, think about the following question:

  • Are hallucinations and delusions symptoms of illness or normal human experiences?

Now consider whether your beliefs are informed by medial science or psychosocial theories.

When you think about the Medical Model, what does this bring to mind for you? How would you define the Medical Model in Mental Health? Read this short article that debates the merits of the Medical Model in Mental Health.

How would you summarize this article? What do you agree with? What do you disagree with?

View a TED talk given by Eleanor Longden

Now write your answers to the following questions:

  • When Eleanor was a student and first heard a voice, was it real?
  • When she heard this voice at first, was it disturbing in any way?
  • One early interpretation of her “reading the news at 6pm” was that she was deluded. Can you think of other occasions when people’s accounts of reality have been dismissed as “delusional”?
  • Once diagnosed, Eleanor soon developed a sense of hopelessness. Type “hope” “recovery” and “mental health” into Google Scholar and find some journal articles on this topic. This is a good way to begin a collection of academic articles on this topic
  • Eleanor describes a “psychic civil war”. What brought this on? How do you evaluate this experience?
  • Once diagnosed and medically treated, Eleanor recalls things going from bad to worse. She experienced abuse, discrimination and sexual assault. Why do you think that was the case?
  • When told by the psychiatrist that cancer was easier to cure than schizophrenia, what effect may that have had on her sense of hopelessness?
  • Eleanor talks about people that helped her. How did they help?
  • Eleanor is very clear that the voices were directly related to traumatic life-events. Type “trauma” and “psychosis” into Google Scholar and find some journal articles on this topic. This is a good way to begin a collection of academic articles on this topic
  • Eleanor views the voices as the key to her recovery. In what way? She looks for metaphors from her voices, how did this help?
  • How might you explain Eleanor’s connection with the voice and her emotions?
  • Eleanor learnt to listen to her voices and negotiate and deal with them. Visit the intervoice network website and learn about this approach: http://www.intervoiceonline.org/
  • How can statutory mental health services develop “empathy, fellowship, justice and respect” that Eleanor talks about?

In 2014, the British Psychological Society published a report called “Understanding psychosis and schizophrenia”. This document is very helpful to the Recovery and Social Inclusion approach to understanding psychosis and schizophrenia. It outlines the current thinking and developments in this area and argues that psychosis can be addressed in psychosocial and non-medical ways. You can download the report here.

There are a number of books specifically about hearing voices. For a list visit the Intervoice Associates store

A Recovery and Social Inclusion approach will also challenge the idea that paranoia is an illness. In this Youtube video, Peter Bullimore tells his story of hearing voices and paranoia. You will find parallels with Eleanor’s story.

One proponent of the Recovery approach in the UK is Rufus May.

Go to his website for information. He made a film called “The Doctor Who Hears Voices”. His approach is controversial. Watch this hour-long film and consider the questions below.

Questions regarding: “The Doctor Who Hears Voices”

  • What did Rufus do that might have made you feel uncomfortable?
  • What do you admire about his approach?
  • What can you learn about risk and therapeutic risk-taking?
  • What do you think has informed Rufus’ approach

Return to narrative of JOHN:

  • If you were working with him, how might this learning package influence the way you work with him?
  • If you use a Recovery and Social Inclusion approach, how will you argue your position with others who may have strong feelings about the medical model?
  • Write a short account of how a Recovery and Social Inclusion approach might help with John and what you would include in a care plan.

Whilst the medical model dominates mental health service provision, there are multiple explanations for hallucinations and hearing voices. Whilst the medical model considers hallucinations as symptoms of mental illness, they may also be considered as a normal response to intense trauma and stress. Psychosis therefore can be addressed in psychosocial and non-medical ways as well as by medication. People’s stories of living with voices can help others to cope, manage and learn about themselves.

British Psychological Society (2015) Understanding psychosis and schizophrenia*. British Psychological Society, Leicester.

Romme M and Escher S (1993) Accepting Voices. Mind, London.

Jaynes, J (1982) The Origins of Consciousness in the Breakdown of the Bicameral Mind. Penguin, Harmondsworth.

Repper, J and Perkins, R (2003) Social Inclusion and Recovery. Balliere Tindall, Edinburgh

Visit the publications page of Jacqui Dillon. You will see that she has written with other people mentioned in the unit. Her body of work about hearing voices is a very useful resource for anyone wishing to read further around this topic.

The European Commission support for the production of this publication does not constitute an endorsement of the contents which reflects the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein.