Hearing voices, and living with them

Ron Coleman has been hearing voices no one else hears for 36 years.

For the first 10 of those, he was homeless or hospitalized with schizophrenia. During the remainder, the quick-witted Scotsman learned to live with the voices and teach others how to do it, too.

Coleman and his wife, Karen Taylor, a psychiatric nurse, came to Philadelphia this week as emissaries of what is known as the hearing voices movement. It argues that taking psychotic voices seriously and developing a relationship with them can help people with serious mental illnesses have fulfilling lives.

"Hearing voices is a normal human experience," Coleman said. "The problem is not hearing voices. The problem is how people respond to voices."

Coleman and Taylor are in town to conduct a three-day workshop for people who work with the mentally ill, psychiatric consumers, and their families at Resources for Human Development, a national social-services provider based in Germantown. A couple of dozen people attended.

The hearing voices movement began in Europe in the late 1980s after a Dutch psychiatrist became curious about the experiences of voice hearers. Locally, it has a foothold in Montgomery County, where Berta Britz, a former social worker who is now a peer counselor, has started several groups. After decades of disabling symptoms of schizophrenia, she said, the movement's approach has greatly improved her ability to function.

Arthur C. Evans Jr., commissioner of the Philadelphia Department of Behavioral Health and Intellectual Disability Services, is a strong supporter of the recovery model, which asserts that serious mental illnesses such as schizophrenia and bipolar disorder need not lead to lifelong disability. It parallels the addiction recovery movement.

Treatment providers, Evans said, have traditionally had the unrealistic goal of eliminating all symptoms. He called the hearing voices philosophy a "very important development" that is "very consistent with our goal, which is to help people recover to the extent that they can."

He sees the approach as an "adjunct" to other forms of treatment, not an alternative.

Paul Grant, a University of Pennsylvania schizophrenia expert who has worked with the city to provide cognitive behavioral therapy to people with psychosis, said only about 20 percent of patients respond well to antipsychotic medicines. Many continue to hear voices after treatment. The hearing voices movement, he said, has done those patients a "world of service" by helping them feel less alone.

Coleman said that 3 to 4 percent of the population hears voices, but that only about a third of that group gets psychiatric treatment.

Typically, psychiatrists have considered voices a symptom of a mental illness, but have not cared about who those "meaningless hallucinations" sounded like or what they said, Coleman said. Both workshop leaders think that's a mistake. Coleman said the voices often can be traced to specific traumas or belief systems. They are a way to understand what hearers feel and a route to recovery.

"If we don't engage with the voices, if we don't enter or at least understand some of these different-world experiences, how do we help?" Taylor asked. "We have to know what it's about in order to work through it."

Coleman said he began hearing voices after being abused by a priest, finding his first wife dead of suicide, and being unable to engage in his coping mechanism - rugby - because of an injury.

When he was younger, he often heard the voice of his priest abuser. "It's your fault. You led me into sin," the voice would say.

"All its power came from the fact that I blamed myself for the abuse, like many people," Coleman said.

Now that he understands what those voices represented and is emotionally healthier, the voice he most often hears is from what he thinks of as a wiser, older version of himself. On the rare occasions when the priest resurfaces, he knows it's time to relax.

During Wednesday's training session, the couple asked non-voice hearers to talk to each other while voice hearers stood close to them and said the sorts of things their voices say. "You really need a bath," Britz told one woman. "You cause suffering."

When it was over, those in the group told of feeling anxious, frustrated, and overwhelmed. They had had trouble speaking normally. Coleman pointed out that many of their "symptoms" flowed directly from hearing the voices.

Later, he orchestrated a compelling visual representation of what it's like to hear voices with the help of Emmy, a 22-year-old Maryland woman who did not want her full name used. Using other members of the group, he created a "sculpture" of Emmy surrounded by her voices.

A deeply religious woman who had struggled to stay awake earlier, Emmy came alive as she helped arrange other participants according to how she hears their voices. "God" stood on a chair to tower above her. The voice of wisdom, which says, "You're a fool," stood to the side. Two "demons" were behind her. Voices representing her struggle with bisexuality stood in front and in back. Her voices were not kind. They accused her of cruelty and sin.

Emmy revealed that close friends bullied her in high school after she told them she was attracted to women. Those conversations replayed in her head as she tried to sleep. Now, after a religious conversion, her voices all have moral messages.

Coleman instructed all the "voices" to speak at once and let Emmy's real mother stand inside their mean circle. "Dear God," she said after she emerged. "That was really overwhelming."

Emmy rather enjoyed it. "Yes, this is what it's like," she said.

Coleman, who once wanted to be a priest, matched Emmy verse for verse in a dialogue about whether a loving God would say hurtful things.

At the end, she said, "I don't trust that this voice of God I'm hearing is God."

That, Coleman said later, was a place to start. Maybe she would come to see that those demons were her bullies and that she needs to face how they made her feel.

"They're all her," he said. "They're all aspects of herself that she's struggling through. What I thought was wonderful was that she clearly was able to see the struggle."

sburling@phillynews.com

215-854-4944@StaceyABurling