The Work of Experience Based Experts

Judi Chamberlin died in January, 2010 (Hevesi 2010). This chapter consists of a shortened version of Judi’s chapter in the first edition of Models of Madness, followed by a summary on the effectiveness of user led services and an account of the Hearing Voices Movement by Jacqui Dillon, Peter Bullimore and Debra Lampshire

A presentation by Jacqui Dillon at Carina Håkansson’s Family Care Conference in Sweden from Mad In America

BAD THINGS THAT HAPPEN TO YOU CAN DRIVE YOU CRAZY

Jacqui Dillon, the national chair of the Hearing Voices Network in England, discusses the work of the Hearing Voices Movement at the recent conference  ‘Presence and Participation: Arguments for the Humanistic and Sustainable Work We Do’ hosted by Carina Håkansson’s Family Care Foundation in Sweden (25-27 April 2013). To listen to Jacqui’s presentation, please click here.

The full conference proceedings are available via live streaming video on MadinAmerica.com.

DSM-5 Protest Tuesday 4th June 4.30pm onwards at the Institute of Psychiatry

Speak Out Against Psychiatry (SOAP) are a group of former patients, carers, mental health professionals and concerned citizens who are campaigning for humane treatment for people experiencing mental distress. SOAP are opposed to forced treatment, electro-shock therapy and the psychiatric drugging of children. SOAP also promote humane alternative ways of helping people in distress.

SOAP are organizing a demonstration to coincide with a forthcoming Institute of Psychiatry conference on the DSM-5 (the latest of edition of the “Diagnostic and Statistical Manual of Mental Disorders” a book published by the American Psychiatric Association which is widely used throughout the world to classify mental disorders).

The protest will be on Tuesday 4th June from 4.30pm till early evening at the Institute of Psychiatry, De Crespigny Park, London, SE5 8AF.

SOAP are organizing the protest as they feel that the DSM-5 makes it easier for normal human experiences to be labeled as mental illness. For example people experiencing grief can be more easily given the label “Major Depressive Disorder”, and children with temper tantrums can now be diagnosed as having “Disruptive Mood Dysregulation Disorder”. 

A spokesperson for SOAP says “The DSM encourages a tick-box approach to understanding human distress which serves the interests of professionals and drug companies rather than the people who really need help. With the DSM-5 things have been taken a step further: even mainstream organizations such as the National Institute for Mental Health and the British Psychological Society are distancing themselves from the DSM-5, claiming it is unscientific. ”

SOAP feels the DSM-5 will increase the number of people stigmatized by a mental health diagnosis, increase prescriptions of mind-altering drugs, and further what they see as a worrying trend of everyday human problems being put in the hands of highly paid experts and pharmaceutical companies rather than our families and communities.

SOAP also objects to the DSM approach in general, where new disorders are created by committees without any objective biological evidence. SOAP highlights the fact that in earlier versions of the DSM, homosexuality was classed as a disorder but this has since been removed as it is no longer socially acceptable.   SOAP feel that, while mental disorders are frequently being changed by the professionals, patients are still forced to accept them.

A SOAP advocate says, “In the UK mental health system, if a patient rejects the psychiatric label, they are described as ‘lacking insight into their condition’ and the Mental Health Act is used to force them to take medication. How can a person be expected to agree to a label when they are changing every time the latest guide book comes out?”

The protest will give people the chance to voice their concerns about the DSM-5, and allow survivors of the psychiatric system to speak out about their experiences of labelling and forced treatment. SOAP will also be holding a memorial service for a former member who tragically took her own life following decades of forced medical treatment.

SOAP invites anybody who is concerned about the DSM-5, or other aspects of the mental health system, to come along on Tuesday 4th June – from 4.30pm till the early evening, at the Institute of Psychiatry, De Crespigny Park,London, SE5 8AF.

PDF press release available here: SOAP-DSM-5PressRelease

Maudsley Debates – Enabling or Labelling?

This House believes that psychiatric diagnosis has advanced the care of people with mental health problems.

Wednesday 5th June, 6pm (refreshments served from 5.30pm)

To coincide with the publication of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), sometimes described as the “Bible” of American psychiatry, the Institute of Psychiatry is hosting a debate on the issue of psychiatric diagnosis.  Some argue that a rigorously  standardised system of classification of mental disorders forms an essential role in conceptualising a patient’s problem, in predicting what treatments are likely to be effective, and in conducting valid scientific research.  Others consider psychiatric diagnoses to be no more than labels, which lack scientific and predictive validity and serve only to stigmatise and objectify those who suffer from mental disorders.  These issues will be debated in the 48th Maudsley Debate on Wednesday 5 June at 6pm at the Wolfson Lecture Theatre, Institute of Psychiatry, Denmark Hill.  The motion is “This House believes that psychiatric diagnosis has advanced the care of people with mental health problems.”  

Speaking for the motion:

Prof Norman Sartorius, former president of the World Psychiatric Association

Prof Anthony David, Professor of Cognitive Neuropsychiatry, Institute of Psychiatry

Speaking against the motion:

Dr Felicity Callard, Senior Lecturer in Social Science for Medical Humanities, Durham University and Chair of the Board, Mental Disability Advocacy Center

Dr Pat Bracken, Clinical Director of Mental Health in West Cork and author of “Post- Psychiatry: Mental Health in a Post-Modern World”.  

Chair:  Sir Simon Wessely, Professor of Psychological Medicine and Vice Dean for Academic Psychiatry, Institute of Psychiatry

 Wolfson Lecture Theatre, Institute of Psychiatry Main Building, De Crespigny Park, London SE5 8AF

Contact: Hannah Baker

For further information please see: http://www.kcl.ac.uk/iop/news/debates/index.aspx 

Hearing Voices Network Launches Debate on DSM 5 and Psychiatric Diagnoses

 

IT’S THE BAD THINGS THAT HAPPEN TO YOU THAT CAN DRIVE YOU CRAZY!

The Hearing Voices Network in England has issued a position statement on DSM 5 and the wide issue of psychiatric diagnoses following last week’s debate on the need for a new paradigm in mental health services, reported largely as a ‘turf war’ between psychiatry and psychology. Concerned that this debate can all too easily sound ‘academic’ and miss the voices of the very people these systems impact upon – those diagnosed with mental health problems – HVN are taking the debate back to the people.

We believe that people with lived experience of diagnosis must be at the heart of any discussions about alternatives to the current system.

Jacqui Dillon, Hearing Voices Network, Chair.

In their statement, the Hearing Voices Network (HVN) state that psychiatric diagnoses are both scientifically unsound and can have damaging consequences. HVN suggest that asking ‘what’s happened to you?’ is more useful than ‘what’s wrong with you?’.

Concerned that essential funds are being wasted on expensive and futile genetic research, they call for the redirection of funds to address the societal problems known to lead to mental health problems and provide the holistic support necessary for recovery.

This is part of a growing, international movement by survivors of the psychiatric system who are questioning the adequacy of a biomedical model to make sense of and respond to madness and distress (see: http://www.intervoiceonline.org/ http://www.mindfreedom.org/ http://psychdiagnosis.weebly.com/ http://www.madinamerica.com/ http://www.occupypsychiatry.net/ http://www.youtube.com/openparadigmproject )

HVN invites people with lived experience of diagnosis and their supporters to engage in a discussion about the issues and help plan a way forwards.

People who use services are the true experts on how those services could be developed and delivered; they are the ones that know exactly what they need, what works well and what improvements need to be made. This is not just an academic or professional issue – it’s one that affects our lives.”

Jacqui Dillon, Hearing Voices Network, Chair

 ______________________________________________________________________________________________________________________________

Notes for the editor

 

  • The Hearing Voices Network (England) is a national, user-led charity that supports people who hear voices, see visions or have other unusual experiences. The Hearing Voices Network is part of the rapidly expanding global Hearing Voices Movement with 26 Hearing Voices Networks operating, across 5 continents. The Hearing Voices Network’s position statement can be read, and commented on, via their website http://www.hearing-voices.org/

 

 

Out Now: New Edition of Bestselling Book – Models of Madness

Models of Madness

Psychological, Social and Biological Approaches to Psychosis

Second Edition

Edited by John Read, University of Liverpool, UK

and Jacqui Dillon, National Chair, Hearing Voices Network, UK

 “Truly, a revolution is occuring in our understanding of severe mental illness…This volume will serve as an inspiration, not only to established clinicians and researchers, but to the young people who will develop better services for people with psychosis in the future.” 

– Prof Richard Bentall, From the Foreword.

 

The publication is very timely given the international debate about this month’s publication of DSM-5, the latest and most controversial version of psychiatry’s diagnostic ‘bible’. Our book documents all the evidence showing that these diagnoses are unscientific and a major cause of the stigma faced by people who receive these labels. It also presents the research demonstrating the urgent need for a fundamental paradigm shift towards evidence-based, effective and humane mental health services.”

– Prof John Read, Lead Editor

Are hallucinations and delusions really symptoms of an illness called ‘schizophrenia’? Are mental health problems really caused by chemical imbalances and genetic predispositions? Are psychiatric drugs as effective and safe as the drug companies claim? Is madness preventable?

This second edition of Models of Madness challenges the simplistic, pessimistic and often damaging theories and treatments of the ‘medical model’ of madness. Psychiatric diagnoses and medications are based on the false premise that human misery and distress are casued by chemical imbalances and genetic predispositions, and ignore the social causes of psychosis and what psychiatrists call ‘schizophrenia’. This edition updates the now extensive body of research showing that hallucinations and delusions etc. are best understood as reactions to adverse life events and that psychological and social approaches to helping are more effective and far safer than psychiatric drugs and electroshock treatment. A new final chapter discusses why such a damaging ideology has come to dominate mental health and, most importantly, how to change that.  

 Models of Madness is divided into three sections:

  1. Section One provides a history of madness, including examples of violence against the ‘mentally ill’, before critiquing the theories and treatments of contemporary biological psychiatry and documenting the corrupting influence of drug companies
  2. Section Two summarises the research showing that hallucinations, delusions etc. are primarily caused by adverse life events (eg. parental loss, bullying, abuse and neglect in childhood, poverty, etc.) and can be understood using psychological models ranging from cognitive to psychodynamic
  3. Section Three presents the evidence for a range of effective psychological and social approaches to treatment, from cognitive and family therapy to primary prevention.

This book brings together thirty-seven contributors from ten countries and a wide range of scientific disciplines. It provides an evidence-based, optimistic antidote to the pessimism of biological psychiatry.

Models of Madness will be essential reading for all involved in mental health, including service users, family members, service managers, policy makers, nurses, clinical psychologists, psychiatrists, psychotherapists, counsellors, psychoanalysts, social workers, occupational therapists, and art therapists.

Download flyer to receive 20% discount from Routledge!

Models of Madness Flyer

http://www.routledge.com/books/details/9780415579537/

 

 

Please SIGN THE PETITION to prevent DSM-5 from compromising patient safety and scientific integrity.

 

Statement of Concern – Complete Version

 

Note: DSM-5 refers to the American Psychiatric Association’s fifth edition of the Diagnostic and Statistical Manual of Mental Disorders; a handbook for psychiatric diagnosis and classification, scheduled for publication for 20th May, 2013.

 

Statement of Concern about the Reliability, Validity, and Safety of DSM-5

We, the undersigned, are concerned that the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5):

  • Includes many diagnostic categories with questionable reliability, which may lead to misleading assumptions about their scientific validity;

Prior to the publication of DSM-III in 1980, psychiatric diagnoses were frequently criticized for their substandard reliability, as clinicians too commonly disagreed on diagnostic decisions even when presented with the same information. Thus, a major impetus for those who developed the diagnostic model featured in DSMs III and IV was the improvement of interrater reliability, or the likelihood that two or more professionals would agree on a particular diagnosis (Feighner et al., 1972; Spitzer, Forman, & Nee, 1979). This goal was achieved with marked success, leading to hopes that the next step of achieving validity (i.e., empirical support for the real-world legitimacy of DSM-defined mental disorders) was close within reach (see Robins & Guze, 1970). However, subsequent research –and in fact a large body of data collected over the last 30 years– did not yield consistent validity evidence for DSM-defined categorical diagnoses. Instead, the gradual accumulation of inconsistent data has led some researchers to call for a root-and-branch review of diagnostic classification in psychiatry.

The DSM-5 development process was –especially at first– one effort to conduct that review. In the words of DSM-5 Task Force members (Regier, Narrow, Kuhl, & Kupfer, 2009), “As we began the DSM-V developmental process in 1999, a major concern was to address a range of issues that had emerged over the previous 30 years,” including “the basic definition of a mental disorder” (para. 7). There was hope for a “paradigm shift” in psychiatric diagnosis (Kupfer, First, & Regier, 2002, p. xix), and even though that aspiration has since been pushed to the back-burner (Kendler et al., 2009), the new manual will be published with markedly liberal revisions to DSMs III and IV.

The DSM-5 field trials (conducted in one phase, due the cancellation of plans for a second phase revealed an unexpected change from the previous two editions of the manual: reliability estimates for many major disorder categories had dropped well below not only those for DSM-III/IV-designed disorders, but also below commonly accepted standards (see Frances, 2012c). Furthermore, primary care doctors (family physicians and general practitioners) were not included in the field trials (American Psychiatric Association, 2011), despite the fact that they provide the majority of mental health treatment (Wang et al., 2007) and prescribe the majority of psychiatric medications (Mark, Levit, & Buck, 2009).

A primary tenet of empirical research holds that reliability is a necessary precondition for validity, as scientists cannot make stable claims about a concept that fluctuates empirically or lacks consensus among observers. Thus, before achieving common reliability standards, it is premature and untenable to introduce the DSM-5 revisions into hospitals, clinics, and general practice. Clinical research, likewise, should seek to establish psychometric stability before proceeding on the assumption that DSM-5 diagnostic categories are valid empirical entities. Epidemiological investigations may suffer from inconclusive findings and lack of continuity with research conducted using previous diagnostic definitions.

  • Did not receive a much-needed and widely requested external scientific review;

We recognize and appreciate that numerous professionals have worked hard to produce DSM-5, and have done so in good faith. However, many experts in the field have also spoken out in good faith about flaws in the document, and most of these flaws have not been resolved by the DSM-5 Task Force.

On January 9, 2012, the Open Letter Committee of the Society for Humanistic Psychology (Division 32 of the American Psychological Association) called for an external scientific review of the DSM-5 proposals by an independent group of researchers who are not affiliated with DSM-5 or the American Psychiatric Association (the full text can be found here: http://dsm5-reform.com/the-open-letter-committee-calls-for-independent-review-of-dsm-5/). This request was made in light of widespread reservation about the scientific status and safety of DSM-5 among mental health professionals and patient advocacy groups. An open letter to the DSM-5 Task Force and the American Psychiatric Association detailing these concerns (http://www.ipetitions.com/petition/dsm5/) was endorsed by more than 14,000 individuals and over 50 professional organizations, including 16 divisions of the American Psychological Association.

  • May compromise patient safety through the implementation of lowered diagnostic thresholds and the introduction of new diagnostic categories that do not have sufficient empirical backing;

DSM-5 has been criticized for lowering numerous diagnostic thresholds, i.e., reducing the number and severity of diagnostic criteria that are considered sufficient for a diagnosis to be made. The anticipated result is broad increase in the number of persons who qualify for a diagnosis of mental disorder, especially among individuals whose symptoms would have been considered subclinical in DSMs III and IV. In the third draft of the manual (formerly available for public viewing on dsm5.org), lowered diagnostic thresholds appeared in the proposed definitions for Generalized Anxiety Disorder, Somatic Symptom Disorder, Bulimia Nervosa, and Alcohol Use Disorder, among other diagnoses.

DSM-5 also introduces new disorders that did not appear in earlier editions of the manual. Among them: Premenstrual Dysphoric Disorder, Disruptive Mood Dysregulation Disorder, Somatic Symptom Disorder, and Mild Neurocognitive Disorder. These new diagnoses have generated significant controversy as a result of their questionable research backing and their potential for application to vulnerable populations, including children, the elderly, and persons with chronic medical illnesses. Some of the feared consequences of these new categories are as follows:

  • Somatic Symptom Disorder (a modification of the Somatoform Disorders in DSM-IV-TR) includes a new stipulation that will allow for the diagnosis of mental disorder in persons with chronic medical illness complaining of excessive pain. As a result, doctors may prematurely jump to the conclusion that “it’s all in the head” (Frances, 2012b, para. 3).
  • Disruptive Mood Dysregulation Disorder may be diagnosed in children and adolescents displaying significant mood swings (temper tantrums), which may be developmentally normal and resolve without treatment. Although the new category was invented with the aim of precluding the controversial practice of diagnosing Pediatric Bipolar Disorder, the latter diagnosis never existed in previous editions of the manual due to its questionable validity.
  • Mild Neurocognitive Disorder appears to describe normal cognitive decline that may be expected in elderly populations. Over-diagnosis of mental disorder and psychiatric treatment in the elderly –especially elderly populations in nursing homes– is already a nationwide problem in the US and other countries.
  • Premenstrual Dysphoric Disorder transforms severe PMS into a psychiatric disorder. In the past, similar proposals have been excluded from previous editions of the DSM due to substantial controversy and attention from women’s rights groups because of the risk of pathologizing women’s experience.

Altogether, the lowering of diagnostic thresholds and introduction of new disorders in DSM-5 has led to increasing concern about patient safety. Though it has been suggested that psychotropic medication may not be the first line of treatment for some of these diagnoses, the vast majority of psychiatric diagnoses are made in fast-paced treatment settings by general medical practitioners who do not have time to critically evaluate the research literature behind the DSM and often have few alternatives to prescribing medications.

Our duty in the medical and helping professions is, first and foremost, to do no harm. Thus, as mental health practitioners and researchers, we are greatly concerned about the introduction of empirically questionable diagnostic concepts into psychiatric and general medical practice.

  • Is the result of a process that gives the impression of putting institutional needs ahead of public welfare.

Several aspects of the DSM-5 development process reflect an apparent prioritization of institutional needs above patient safety and general public welfare. For example, the DSM-5 field trials were designed for implementation in two stages; the first was intended to address reliability, the second quality control. The second stage of the field trials was ultimately cancelled due to delays in the development process. Despite the importance of assessing quality control before the manual is used in patient care, DSM-5 will proceed with its expected May 2013 publication. For more information about the conduct and findings of the DSM-5 field trials, see Frances (2012a).

Additional concerns about the DSM-5 development process include hiring of a pubic relations firm (GYMR) to influence public opinion about the manual through a PR website (http://dsmfacts.org/), the lack of external scientific evaluation of the proposals, and the lack of a formal forensic review.

Because of the above, we fear that DSM-5:

  • May result in the mislabeling of mental illness in people who would fare better without a psychiatric diagnosis;

We have no doubt that many of the issues considered by DSM-5 constitute clinical and societal problems. It is worrying that many people are so affected by economic crises that they contemplate taking their own lives. Excessive alcohol or recreational drug use are dilemmas for individuals and societies. We have aging populations, troubled and disruptive children. It is a marker of humanitarian progress that we attempt to help people in distress. But, to take one example of many, it is unhelpful to suggest that a child throwing temper tantrums or a woman experiencing ‘period pains’ is mentally ill. It is unhelpful to suggest that a consumer seeking help from medical doctors is, by virtue of multiple complaints or visiting multiple doctors, mentally ill. Clients and the general public are negatively affected by the continued and continuous medicalization of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences that demand helping responses, but which do not reflect illnesses so much as normal individual variation. The mental health professions are uniquely suited for helping to create a better global society. But the application of inappropriate psychiatric labels is not a solution.

  • May result in unnecessary and potentially harmful treatment, particularly with psychiatric medication;

It is highly likely that, if a person receives a diagnosis under DSM-5, recommended treatment will involve medication. Recently, mounting empirical evidence has suggested that psychiatric medication, though helpful when used properly, may lead to iatrogenic consequences when used inappropriately. For example, antipsychotic medications, which are increasingly used to treat non-psychotic symptoms such as depression and anxiety, may lead to metabolic syndrome, obesity, diabetes, Parkinson’s-like movement disorders, neurocognitive decline, psychotic symptoms, reduced brain volume, and significantly shortened lifespan (Ho, Andreasen, Ziebell, Pierson, & Magnotta, 2011; Olfman & Robbins, 2012; Robbins, Higgins, Fisher, & Over, 2011; Whitaker, 2010). .

  • May divert precious mental health resources away from those who most need them.

Mental health problems affect one person in every four, making them the leading cause of disability worldwide (World Health Organization, 2012), at an estimated cost of $2,500 billion in 2010 (Bloom et al, 2011). The provision of high-quality and appropriate mental health care is an urgent global issue. Although the aspiration to improve the well-being of all citizens may be laudable, the use of scientifically unstable diagnoses will only confuse a complex picture and lead to the inappropriate investment of scarce resources. Since mental health problems disproportionately affect poor and socially excluded people, questionable diagnostic systems risk further disadvantaging the most vulnerable.

Committee Members

Richard Bentall; Professor of Clinical Psychology, University of Liverpool, UK

Mary Boyle; Emeritus Professor of Clinical Psychology, University of East London, UK

Pat Bracken; Consultant Psychiatrist and Clinical Director of Mental Health Services, West Cork, Eire

Joanne Cacciatore; Assistant Professor; Arizona State University School of Social Work, USA

Tim Carey; Associate Professor, Flinders University, Australia

David Castle; Professor of Psychiatry, University of Melbourne, Australia

Jack Carney; Licenced Psychologist, Alabama, USA

Anne Cooke; Clinical Psychologist, Canterbury Christ Church University, UK

Jacqui Dillon; Chair; Hearing Voices Network, UK

Suman Fernando; Consultant Psychiatrist, UK

Daniel Fisher; Consultant Psychiatrist, National Empowerment Centre, USA

Dave Harper; Reader in Clinical Psychology, University of East London, UK

Louis Hoffman; Continuing Education Coordinator, Society for Humanistic Psychology, USA

Lucy Johnstone; Clinical Psychologist, Bristol UK

Dayle Jones; Associate Professor, University of Central Florida, USA

Sarah Kamens; Society for Humanistic Psychology, USA

Peter Kinderman; Professor of Clinical Psychology, University of Liverpool, UK

Patrick Landman; Psychiatrist and Psychoanalyst; Paris, France

Eleanor Longden; Psychologist, London UK

Jason McCarty; Psychotherapist, British Columbia, Canada

Nancy McWilliams; Psychologist and Psychoanalyst, Rutgers University, USA

Gordon Milson; Clinical Psychologist, Manchester, UK

Bradley Olsen; President-Elect, Division 48 of American Psychological Association; President, Psychologists for Social Responsibility, Chicago, USA

Ana Padilla; University College London, London UK

Richard Pemberton; Chair, British Psychological Society Division of Clinical Psychology, UK

Dave Pilgrim; Professor of Health and Social Policy, University of Liverpool, UK

John Read; Professor of Clinical Psychology, University of Auckland, NZ

Melissa Raven; Research Fellow, Flinders University, Australia

Brent Robbins; President, Society for Humanistic Psychology, Div32 American Psychological Association, USA

Dave Traxsom; Educational Psychologist, UK

Sara Tai; Senior Lecturer in Clinical Psychology, University of Manchester, UK

Phil Thomas; Honorary Visiting Professor, University of Bradford, formerly consultant psychiatrist, UK

Sam Thompson; University of East London, UK

Sami Timimi; Consultant Psychiatrist, UK

Steve Trenchard; Chair, International Society for the Psychological Treatment of Schizopnrenia and other Psychoses

Martin Whitely; MLA, Parliament of Western Australia, Australia

References

American Psychiatric Association. (2011, March 18). Protocol for DSM-5 field trials in routine clinical practice settings. Retrieved 17 March from http://www.dsm5.org/Research/Documents/DSM5%20FT%20RCP%20Protocol%2003-19-11%20revlc.pdf

Bloom, D.E., Cafiero, E.T., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L.R., Fathima, S. … Weinstein, C. (2011) The global economic burden of noncommunicable diseases. Geneva: World Economic Forum. Retrieved from http://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf

Feighner, J. P., Robins, E., Guze, S. B., Woodruff, R. A., Winokur, G., & Munoz, R. (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26, 57-63. http://archpsyc.jamanetwork.com/article.aspx?articleid=490573

Frances, A. (2012a, October 31). DSM-5 field trials discredit the American Psychiatric Association. Huffington Post. Retrieved from http://www.huffingtonpost.com/allen-frances/dsm-5-field-trials-discre_b_2047621.html

Frances, A. (2012b, December 28). Mislabeling medical illness as mental disorder. DSM-5 in Distress: Psychology Today. Retrieved February 18, 2013 from http://www.psychologytoday.com/blog/dsm5-in-distress/201212/mislabeling-medical-illness-mental-disorder

Frances, A. (2012c, May 6). Newsflash from APA meeting: DSM-5 has flunked its reliability tests. Psychology Today: DSM-5 in Distress. Retrieved from http://www.psychologytoday.com/blog/dsm5-in-distress/201205/newsflash-apa-meeting-dsm-5-has-flunked-its-reliability-tests

Ho, B-C., Andreasen, N. C., Ziebell, S., Pierson, R., & Magnotta, V. (2011). Long-term antipsychotic treatment and brain volumes. Archives of General Psychiatry, 68, 128-137. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476840/

Mark, T. L., Levit, K. R., & Buck, J. A. (2009). Datapoints: psychotropic drug prescriptions by medical specialty. Psychiatric Services, 60(9), 1167. Retrieved from http://ps.psychiatryonline.org/data/Journals/PSS/3889/09ps1167.pdf

Olfman, S., & Robbins, B.D. (2012). Drugging our children. Santa Barbara, CA: Praeger. http://www.abc-clio.com/product.aspx?isbn=9780313396830

Papanikolaou, P. N., Churchill, R., Wahlbeck, K., & Ioannidis, J. P. (2004). Safety reporting in randomized trials of mental health interventions. American Journal of Psychiatry, 161(9), 1692-1697. Retrieved from http://ajp.psychiatryonline.org/article.aspx?articleid=177043

Regier, D. A., Narrow, W. E., Kuhl, E. A., & Kupfer, D. J. (2009). The conceptual development of the DSM-V. American Journal of Psychiatry, 166(6), 645-650. Retrieved from http://ajp.psychiatryonline.org/article.aspx?articleid=100852

Robbins, B.D., Higgins, M., Fisher, M., & Over, K. (2011). Conflicts of interest in research on antipsychotic treatment of pediatric bipolar disorder, temper dysregulation disorder, and attenuated psychotic symptoms syndrome: Exploring the unholy alliance between big pharma and psychiatry. Journal of Psychological Issues in Organizational Culture, 1(4), 32-49. http://onlinelibrary.wiley.com/doi/10.1002/jpoc.20039/abstract

Robins, E., & Guze, S. B. (1970) Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. American Journal of Psychiatry, 126, 983-987. http://ajp.psychiatryonline.org/article.aspx?articleID=151746

Spitzer, R. L., Forman, J. B., & Nee, J. (1979). DSM-III field trials: I. initial interrater diagnostic reliability. American Journal of Psychiatry, 136, 815-817.

​Wang, P. S., Aguilar-Gaxiola, S., Alonso, J., Angermeyer, M. C., Borges, G., Bromet, E. J. … Wells, J. E. (2007). Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet, 370(9590), 841-850. Retrieved from

Whitaker, R. (2010). Anatomy of an epidemic. New York, NY: Random House. http://www.amazon.co.uk/Anatomy-Epidemic-Bullets-Psychiatric-Astonishing/dp/0307452425/ref=sr_1_1?ie=UTF8&qid=1363113445&sr=8-1

World Health Organization. (2012) Global status report on non-communicable diseases 2010. Geneva: World Health Organization. www.who.int/nmh/publications/ncd_report_full_en.pdf

 

 

The Hearing Voices Movement: In Response to a Father – ‘My Daughter, the Schizophrenic’

Originally posted on: http://www.madinamerica.com/

There was a heart-breaking and disturbing story in yesterday’s Guardian newspaper entitled, My Daughter, the Schizophrenic’, (1) which featured edited extracts from a book written by the father of a child called Jani. He describes how Jani is admitted into a psychiatric hospital when she is 5, diagnosed with schizophrenia when she is 6 and by the time she is 7, she has been put on a potent cocktail of psychotropic medications:

”Jani is on three medications: Clozapine, lithium and Thorazine (known in the UK as Largactil). This combination has been the most successful. Are her hallucinations completely gone? No, but as she will tell us, they are not bothering her. It’s like having the TV on in the background, volume turned down, while you’re doing something, and every so often you look up at the screen to see what 400 the cat and other hallucinations are doing. They remain on Jani’s periphery, but she can still function in our common reality.”(2)

This harrowing description exemplifies the worst excesses of responding to a deeply troubled child’s distress as if it were a pathological illness, with the full psychiatric arsenal. What ensues can only be described as an account of psychiatric, human rights abuse.

If only Jani and her family were offered alternative kinds of help such as that developed by Voice Collective, (3) a London-wide project set up to support children and young people who hear, see and sense things others don’t. Voice Collective works with children, young people & families, and with professionals and organisations offering a whole range of services including peer support groups, so young people can meet with other young people with similar experiences, creative workshops, 1-2-1 support around making sense of voices and finding coping strategies, an online support forum. Voice Collective also offers a range of support services to families as well as supporting schools, social services, child and adolescent mental health services and other youth agencies to work with children & young people who have these experiences.

As one parent who has been supported by Voice Collective said:

‘You have brought us ‘normality’ within these experiences. You have taught us that with the appropriate support young people can lead happy and successful lives. You recognise the love we have for our children and have taught us how to support them”.

– Mother of a 12 year old           

How different things could be for Jani, her family and countless other children and families around the world if there were greater awareness that such humane and healing alternatives exist; approaches which help without doing more harm.

Questions, comments and/or reflections are welcome on this website or via Twitter @JacquiDillon

Jacqui Dillon’s website: http://www.jacquidillon.org

(1)  http://www.guardian.co.uk/society/2013/jan/19/my-daughter-the-schizophrenic

(2)  January First: A Child’s Descent Into Madness And Her Father’s Struggle To Save Her, by Michael Schofield, published on 1 February by Hardie Grant Books.

(3)  http://www.voicecollective.co.uk/

 

Jani and her family originally appeared on the Oprah show in 2009. Many of us within the Hearing Voices Movement were so saddened and disturbed by Jani’s treatment that we wrote an open letter to Oprah Winfrey. Here is the open letter from INTERVOICE – the International Network for Training, Education and Research into Hearing Voices – an international organisation dedicated to spreading positive and hopeful messages about the experience of hearing voices across the world, reprinted again.

Dear Oprah,           

We are writing in response to your programme about “The 7-Year-Old Schizophrenic”, which concerned Jani, a child who hears voices, which was broadcast on the 6th October 2009. We hope to correct the pessimistic picture offered by the mental health professionals featured in your programme, and in the accompanying article on your website. What upset us most and moved us to write to you, is that parents will have been left with the impression that they are powerless to help their children if they hear voices. We are also concerned that the programme gave the impression that children with voices must be treated with medication. We note that the medications mentioned in your programme all have very serious side effects. (For example, antipsychotics such as Haldol cause neuronal loss, block the dopamine pathways in the brain required to processes rewarding stimuli, and carry a high risk of neurological and metabolic side effects such as Parkinsonianism and diabetes. Their effects on the developing brain are largely unknown and, in our view, they should only be given to children as a treatment as absolutely last resort.)

We have been researching and working with adults and children like Jani for the last twenty years, and our work has led us to very different conclusions from those reached by the mental health professionals on your programme. One of our founding members, Dr. Sandra Escher from the Netherlands, has spent the last fifteen years talking to children who hear voices, and to their parents and carers. This work is the most detailed and thorough investigation of children who hear voices carried out to date [1, 2]. The most important findings from recent research on hearing voices are as follows:

Prevalence of voice hearing in adults and children

Recent large-scale population (epidemiological) studies have shown that about 4-10 % of the adult population hear voices at some time in their lives [3-5]. Only about a third seek assistance from mental health services. Amongst children, the proportion hearing voices may be even higher [6] and, again, only a minority are referred for treatment. Hence, it is wrong to assume that voice hearing is always a pathological condition requiring treatment.

Psychological mechanisms

Everyone has an inner voice. Psychologists call this phenomenon ‘inner speech’ and it is an important mechanism that we use to regulate our own behaviour (plan what we want to do, direct our own actions). Child psychologists have long understood that this ability begins to develop at about 2-years of age [7, 8]. Hearing voices seems to reflect some kind of differentiation in the mind’s ability to tell the difference between inner speech and the heard speech of other people [9, 10].

Link to trauma

A common theme in research with both adults and children is the relationship between hearing voices and traumatic experiences. In adults, around 75% begin to hear voices in relationship to a trauma or situations that make them feel powerless [11-13], for example the death of a loved one, divorce, losing a job, failing an exam, or longer lasting traumas such as physical, emotional or sexual abuse. The role of trauma was identified in 85% of the children we have studied, for example being bullied by peers or teachers, or being unable to perform to the required level at school, or being admitted to a hospital because of a physical illness. In short, our research has shown that hearing voices is usually a reaction to a situation or a problem that the child is struggling to cope with.

Voices have a meaning. A related and equally striking finding is that the voices often refer to the problem that troubles the child, but in an elliptical manner. To take just one example from the children studied by Sandra Escher:

The voices told an 8-year-old boy to blind himself. This frightened his mother. But when we discussed whether there was something in the life of the boy he could not face, she understood the voices’ message. The boy could not cope with his parents’ problematic marriage. He did not want to see it.

We wonder whether anyone has attempted to establish why, in Jani’s case, the rat is called “Wednesday”, why the girl is called “24 Hours”, and why is the cat called “400″? What do these mean for her? Why does Jani want people to call her “Blue-Eyed Tree Frog” and “Jani Firefly”?

Good outcomes without treatment

Recently, Sandra Escher conducted a three-year follow up study of eighty children who heard voices, aged between 8 and 19 [1]. Half received mental health care but the other half were not given any specialist care at all. The children were interviewed four times, at yearly intervals. By the end of the research period 60% of the children reported that their voices had disappeared. Very often, this was because the triggering problems were dealt with or because the child’s situation changed – for example, following a change of schools.

Helping children who hear voices: Advice to parents

It is important to appreciate that the desire to make voices disappear, although usually the goal of the mental health care services, is not necessarily in the best interests of children. Some children do not want to lose their voices. If children can find within themselves the resources to cope with their voices, they can begin to lead happier and more balanced lives.

The most important element in this process is support from the family. Unfortunately, we have found that mental health services often fail to have a positive effect on children’s voices, because they foster fear rather than coping. However, we have found that referral to a psychotherapist who is prepared to discuss the meaning of voices is often helpful.

It is important that parents do not assume that hearing voices is a terrible disaster but instead regard it as a signal that something is troubling their child. If parents assume that voices are a symptom of an illness, and are afraid of them, the child will naturally pick up on this feeling. This can lead to a self-defeating cycle in which the child becomes fearful and obsessed by the voices.

We would like to offer this 10-point guide for parents, indicating what they can do if a child tells them that he or she hears voices:

1. Try not to over react. Although it is understandable that you will be worried, work hard not to communicate your anxiety to your child.

2. Accept the reality of the voice experience for your child; ask about the voices, how long the child has been hearing them, who or what they are, whether they have names, what they say, etc.

3. Let your child know that many other children hear voices and that usually they go away after a while.

4. Even if the voices do not disappear your child may learn to live in harmony with them.

5. It is important to break down your child’s sense of isolation and difference from other children. Your child is special – unusual perhaps, but really not abnormal.

6. Find out if your child has any difficulties or problems that he or she finds very hard to cope with, and work on fixing those problems. Think back to when the voices first started. What was happening to your child at the time? Was there anything unusual or stressful occurring?

7. If you think you need outside help, find a therapist who is prepared to accept your child’s experiences and work systematically with him or her to understand and cope better with the voices.

8. Be ready to listen to your child if he or she wants to talk about the voices. Use drawing, painting, acting and other creative ways to help the child to describe what is happening in his or her life.

9. Get on with your lives and try not to let the experience of hearing voices become the centre of your child’s life or your own.

10. Most children who live well with their voices have supportive families who accept the experience as part of who their child is. You can do this too!

Conclusion

In conclusion we would like to stress that, in our view, labelling a seven-year-old child as schizophrenic and subjecting her to powerful psychotropic medication and periodic hospitalisation is unlikely to help resolve her problems. Indeed, the opposite is most probable: children treated in this way will simply become more powerless. Because your well respected, award winning show reaches out to so many people, we are concerned that there will be many viewers who will be left with the impression that the treatment Jani receives is the only method available. We fear that this may cause some children to be subjected to an unnecessary lifetime in psychiatric care. It is very important to recognise that hearing voices, in itself, is not a sign of psychopathology.

We hope you will give consideration to the possibility of making a future programme showing the other side of the story, one of hope, optimism and with a focus on recovery. Perhaps you could make a programme about a child with similar voice experiences to Jani, who has been helped to come to terms with her or his experiences and to discuss with the child, parents and therapists how this was achieved? If there is any way we could help make this happen, please contact us.

We look forward to hearing from you on the issues raised in our letter.

Yours sincerely,

Paul Baker

INTERVOICE coordinator

(Letter re-edited with the kind assistance of Professor Richard Bentall)

Selected bibliography:

1.         Escher, S., et al., Independent course of childhood auditory hallucinations: A sequential 3-year follow-up study. British Journal of Psychiatry, 2002. 181 Suppl 43: p. 10-18.

2.         Escher, S., et al., Formation of delusional ideation in adolescents hearing voices: A prospective study. American Journal of Medical Genetics (Neuropsychiatric Genetics), in press.

3.         Tien, A.Y., Distribution of hallucinations in the population. Social Psychiatry and Psychiatric Epidemiology, 1991. 26: p. 287-292.

4.         van Os, J., et al., Strauss (1969) revisited: A psychosis continuum in the normal population?Schizophrenia Research, 2000. 45: p. 11-20.

5.         van Os, J., et al., Prevalence of psychotic disorder and community level of psychotic symptoms: An urban-rural comparison. Archives of General Psychiatry, 2001. 58: p. 663-668.

6.         Poulton, R., et al., Children’s self-reported psychotic symptoms and adult schizophreniform disorder: A 15-year longitudinal study. Archives of General Psychiatry, 2000. 57: p. 1053-1058.

7.         Berk, L.E., Why children talk to themselves. Scientific American, 1994: p. 61-65.

8.         Vygotsky, L.S.V., Thought and language. 1962, Cambidge, Mass: MIT Press.

9.         Alleman, A. and F. Laroi, Hallucinations: The science of idiosyncratic perceptions. 2008, Washington: American Psychological Association.

10.       Bentall, R.P., Madness explained: Psychosis and human nature. 2003, London: Penguin.

11. Read, J., et al., Sexual and physical abuse during childhood and adulthood as predictors of hallucinations, delusions and thought disorder. Psychology and Psychotherapy: Theory, Research and Practice, 2003. 76: p. 1-22.

12. Hammersley, P., et al., Childhood trauma and hallucinations in bipolar affective disorder: A preliminary investigation. British Journal of Psychiatry, 2003. 182: p. 543-547.

13. Shevlin, M., M. Dorahy, and G. Adamson, Childhood traumas and hallucinations: An analysis of the National Comorbidity Survey. Journal of Psychiatric Research, 2007. 41: p. 222-228.

Signed by 155 people from 20 countries, listed in order of the time they were received.

Dr. Sandra Escher, – Board member of INTERVOICE, The Netherlands

Professor Marius Romme, psychiatrist, MD, PhD, President of INTERVOICE, The Netherlands

Dirk Corstens, Social psychiatrist and psychotherapist, Chair of INTERVOICE, The Netherlands

Paul Baker, coordinator of INTERVOICE, Spain

Jacqui Dillon, consultant trainer and voice hearer, chair of Hearing Voices Network England, board member of INTERVOICE, UK

Ron Coleman, consultant trainer and voice hearer, board member of INTERVOICE, UK

Hywel Davies, chair of Hearing Voices Network Cymru (Wales), honorary board member of INTERVOICE; UK

Amanda R. E. Aller Lowe, MS, LPC, LCPC, QMRP – Agency Partner, Communities In Schools & Area Representative, The Center for Cultural Interchange, Aurora, Illinois, INTERVOICE supporter, USA

Adrienne Giacon, Secretary and Hearing Voices Network Support group facilitator Hearing Voices Network Aotearoa, INTERVOICE member, New Zealand

Dr John Read, Associate Professor, Psychology Department, The University of Auckland, Auckland, New Zealand

Ann-Louise S. Silver, MD, founder and past president, International Society for the Psychological Treatments of Schizophrenia and Other Psychoses (www.isps-us.org), ISPS-US, USA

Matthew Morrissey, MA, MFT, Board Member, MindFreedom International, Northern California Coordiator, ISPS-US, San Franciso, USA

Irene van de Giessen, former voice hearer and foster-daughter of Willem van Staalen and Willem van Staalen, voice integrating foster-father of Irene, The Netherlands

Olga Runciman, consultant trainer and voice hearer (BSc psychiatric nurse and graduate student in psychology), INTERVOICE member, Denmark

Professor Wilma Boevink, Chair of Stichting Weerklank (Netherlands Hearing Voices Network), Professor of Recovery, Hanze University; Trimbos-Institute (the Dutch Institute of Mental Health and Addiction), Netherlands

Marian B. Goldstein, voicehearer, (fully recovered thanks to trauma-focussed therapy, the opportunity to make sense of the voices) INTERVOICE supporter, Denmark

Professor Dr J. van Os, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, INTERVOICE supporter, Netherlands

Virginia Pulker, Mental health Occupational Therapist with young people with psychosis, recovery promoter, HVN Australia, Northern Ireland and England. INTERVOICE supporter, UK/Australia

Professor Richard Bentall, PhD, Chair Clinical Psychology, University of Bangor, INTERVOICE supporter, Wales, UK

Alessandra Santoni, professional working in a Mental Health Service of Milan, voice hearer and facilitator of a hearing voices group, INTERVOICE supporter,Italy

Geraldo Peixoto and Dulce Edie Pedro dos Santos, São Vicente – Est. São Paulo – INTERVOICE supporter, Brasil

Joanna & Andrzej Skulski, INTERVOICE supporters, Polska

Darby Penney, INTERVOICE supporter and President, The Community Consortium, Inc., Albany, NY, USA

Jacqueline Hayes, researcher at Manchester University about hearing voices in ‘non-patients’ and therapist, UK

Phil Virden, MA, MA, Executive Editor, Asylum Magazine, UK

Matthew Morris, Mental Health Locality Manager, East Suffolk Outreach Team, Suffolk Mental Health Partnerships NHS Trust, INTERVOICE supporter, UK

Ros Thomas, Young Peoples Worker, Gateway Community Heath, Wodonga Victoria, INTERVOICE supporter, Australia

Dr. Rufus May Dclin/ Consultant Clinical Psychologist, INTERVOICE supporter, UK

Dr. Simon Jones, INTERVOICE supporter, UK

Dr. Louis Tinnin, Psychiatrist, Morgantown, West Virginia, USA

Linda Gantt, PhD, Intensive Trauma Therapy, Inc., USA

Burton Norman Seitler, Ph.D., New Jersey Institute for training in Psychoanalysis and Psychotherapy, Child and Adolescence Psychotherapy Studies

Ron Bassman, PhD., Founding member of International Network Towards Alternatives for Recovery (INTAR), Past president of The National Association for Rights Protection and Advocacy, USA

Michael O’Loughlin, Adelphi University, NY, USA

Dorothy Scotten, Ph.D., LCSW, USA

Marilyn Charles, Ph.D., The Austen Riggs Center, USA

Bex Shaw, Psychotherapist, London, UK

Ira Steinman, MD, author of “TREATING the ‘UNTREATABLE’ : Healing in the Realms of Madness”, USA

Mike Lawson, Ex Vice Chair National MIND UK 1988-1992, INTERVOICE supporter, UK

Dr. Dan L. Edmunds, Ed.D., B.C.S.A., International Center for Humane Psychiatry, USA

Ron Unger LCSW, Therapist, USA

Daniel B Fisher (Boston, MA): Person who recovered from what is called schizophrenia, Executive Director National Empowerment Center; National Coalition of Mental Health Consumer/survivor Org., member of Interrelate an international coalition of national consumer/user groups, community psychiatrist, Cambridge, Mass., USA

Mary Madrigal, USA

Paul Hammersley, University of Manchester, INTERVOICE supporter, UK

Phil Benjamin, mental health nurse and voices consultant, Australia

Eleanor Longden, Bradford Early Intervention in Psychosis Service, England, UK

Karen Taylor RMN, director Working to Recovery, Scotland, UK

Bill George, MA, PGCE, Member of the Anoiksis Think Tank, Netherlands

Dr Andrew Moskowitz, Senior Lecturer in Mental Health, University of Aberdeen, Scotland, UK

John Exell, BA(Hons), Dip Arch, voice-hearer, sculptor, artist, writer, poet, UK.

Tineke Nabben, a voice hearer who has learned to cope with her voices and student, learning to help other children and parents to cope with their voices. Germany

Marcello Macario, psychiatrist, Community Mental Health Centre of Carcare, Italy, INTERVOICE supporter, Italy

Ian Parker, Professor of Psychology, co-director of the Discourse Unit, Manchester Metropolitan University, England, UK

David Harper, PhD, Reader in Clinical Psychology, School of Psychology, University of East London, England, UK

Wakio Sato, representative of the Hearing Voices Network – Japan. President of the Japanese Association of Clinical Psychology. The representative of an NPO named “Linden” for community mental health in Konko town, Okayama prefecture, Japan

Suzette van IJssel, Ph.D., spiritual counsel and voice hearer, Utrecht, The Netherlands

Jeannette Woolthuis, psycho-social therapist working with children hearing voices, The Netherlands

Dr. Louise Trygstad, Professor Emerita, University of San Francisco School of Nursing, USA

Erik Olsen, Board member ENUSP European Network of Users (x)-users and Survivors of Psychiatry and Executive Committee in European Dsability Forum (EDF)

Astrid Zoetbrood, recovered from psychosis and voices, the Netherlands

Christine Brown, RMN, Hearing Voices Network Scotland, INTERVOICE supporter, UK

Rachel Waddingham, Manager of the London Hearing Voices Project (inc. Voice Collective: Young People’s Hearing Voices Project), trainer and voice-hearer, UK

Joel Waddingham, Husband and supporter of someone who hears voices, sees visions and has other unusual experiences, UK

Professor Robin Buccheri, RN, MHNP, DNSc, University of San Francisco, CA, USA

Jørn Eriksen, Board member of INTERVOICE, the Danish Hearing Voices Network and The International Mental Health Collaboration Network, Denmark

Douglas Holmes, voice hearer working in a Mental Health Service in Darlinghurst, Sydney, and facilitator of a hearing voices group, INTERVOICE supporter, Australia

Matthew Winter, Student Mental Health Nurse and INTERVOICE supporter

Anneli Westling, Relative of a voice hearer from Stockholm, Sweden

Lia Govers, recovered voice hearer, Italy

Molly Martyn, MA in Clinical Mental Health, Hearing Voices Network of Denver, USA

Tsuyoshi Matsuo, MD, INTERVOICE supporter, Japan

Janet M. Patterson RN, BSN, USA

Odette Nightsky, Sensitive Services International, Australia

Barbara Belton, M.S., M.S. trauma survivor who has recovered and former behavioral health professional, USA

Luigi Colaianni, PhD sociologist, researcher, Community Mental Health Centre, Milano, Italy

Teresa Keedwell, Voice Hearer Support Group, Palmerston North, New Zealand

Maria Haarmans, MA, Canadian Representative INTERVOICE, Canada

Ami Rohnitz, Voice hearer, Sweden

Sharon Jones, University of York, INTERVOICE Supporter, England, UK

Gail A. Hornstein, PhD, Professor of Psychology, Mount Holyoke College, USA

Siri Blesvik, INTERVOICE supporter, Norway

Lynn Seaton, mental health nurse, Scottish Hearing Voices Network and INTERVOICE supporter, UK

Rozi Pattison, Clinical Psychologist, CAMHS, Kapiti Health Centre, PARAPARAUMU, New Zealand

Suzanne Engelen, Experience Focussed Counselling Institute (efc) and member of INTERVOICE. She is an expert by experience and also works for Weerklank (Dutch Hearing Voices Network) and the TREE project, The Netherlands

Susie Crooks, Voice hearer, Mad & Proud, Hawkes Bay, New Zealand

Lloyd Ross, Ph.D., FACAPP., P.A., New Jersey, USA

Catherine Penney, RN, USA

Nancy Burke, PhD, Northwestern University Medical School, Chicago Center for Psychoanalysis, USA

Nels Kurt Langsten, M.D., USA

Michael S. Garfinkle, PhD, New York, USA

Andy Phee RMN, community mental health nurse, Kings Cross, London ,facilitated a hearing voices group for 10 years, member of the London Hearing Voices Project advisory group. England, UK

Helen Sheppard, AMHP, West Yorkshire, England, UK.

Dr Gillian Proctor, Clincial Psychologist. Bradford, UK

Jane Forrest, sister of voice hearer, Sweden

Tami Williams, Ph.D., Licensed School Psychologist, Clinical Psychologist, Psychiatric Survivor, USA

Lone Jeppesen, Works as a social teacher in an institution with a lot of voice hearers and the diagnosis of schizophrenia, INTERVOICE supporter, Denmark

Judith Haire, author and voice hearer, Ramsgate, Kent, England, UK

Peter Lehmann, Peter Lehmann Publishing, Berlin, Germany / Eugene, OR / Shrewsbury, UK

Sigari Luckwell, Senior Clinical Psychologist, Bunbury Clinic, INTERVOICE supporter, Western Australia

Will Hall, voice hearer with schizophrenia diagnosis, founder of Portland hearing voices, host of madnessradio.net, USA

Richard Gray, specialist mental health support worker, random hearer/ seer of voices, visions and past lives. HVN NZ treasurer. New Zealand

Jacqueline Roy, Department of English, Manchester Metropolitan University, England, UK

Dr Mike Jackson, Consultant Clinical Psychologist, Betsi Cadwaldr University Health Board, North Wales

Frank Blankenship, Chair of Affiliate Support Committee, MindFreedom International, MindFreedom Florida Gainesville, Florida USA

Dorothy Dundas, psychatric survivor, MA, USA

Sigrun Tømmerås, mental health acitvist/ childhood abuse survivor, Norway

Karyn Baker BSW, MSW, RSW, Executive Director, Family Outreach and Response Program, Toronto, Canada

Monika Hoffmann psychologist and co-founders of the “NeSt”, the German Hearing Voices Network, Germany

Paul Beelen connected to the INTERVOICE network and voice hearer, The Netherlands

Rossa Forbes Holistic Schizophrenia, North America

Teresa Keedwell Voice Hearer Support Group, Palmerston North New Zealand

Yutaka Fujimoto Psychologist, Tokyo Metropolitan Govemment Mental Health and Welfare Cente, vice president of the Japanese Association of Clinical Psychology, member of the Hearing Voices Network Japan. Tokyo, Japan

Cheontell Barnes High support mental health worker and voices group co-facilitator Brighton UK

Yutaka Fujimoto Psychologist, Tokyo Metropolitan Govemment Mental Health and Welfare Cente, vice president of the Japanese Association of Clinical Psychology, member of the Hearing Voices Network Japan. Tokyo, Japan

Pino Pini, Psychiatrist, Mental Health Europe, INTERVOICE supporter, Italy

Ivona Amleh Psychiatrist, Bethlehem Psychiatric Hospital, Palestine

John Robinson, Integrative Therapist (and voice hearer) for the Hearing Voices Project, SE London

Yann Derobert Psychotherapist, France

Indigo Daya , Voices Vic Project Manager, Melbourne, Australia

Stephen McGowan , Early Intervention in Psychosis Lead. Yorkshire and the Humber Improvement Programme, UK

Adam James Editor and award winning journalist, psychminded.co.uk, UK

Tori Reeve, counsellor, member of HVN, Intervoice supporter, UK.

A. C. Sterk MA Psychologist and psychotherapist, director of the Ann Lee Centre community mental health project, and person with previous experience of psychosis. Manchester, UK.

Geoff Brennan Nurse Consultant Psychosocial Interventions for Acute Inpatient Care, Berkshire healthcare NHS Foundation Trust, Co-editor Serious Mental Illness a manual for clinical practice”, UK

Lyn Mahboub voice hearer, trainer, consultant, mother, daughter, student, teacher and, also, one who has navigated the psychiatric service system, Australia

Kristin Hedden, Ph.D. VA Puget Sound Health Care System, Tacoma, Washington, USA 126

Agna Bartels MSc , psychologist and researcher in the University Medical Center Groningen, The Netherlands.

Rita Brooks, BS in Human Services Recovery Consultant, writer and producer of DVD called: The Reality of Recovery, Covington, Kentucky, USA

Angel Moore David Romprey Oregon Warmline, Oregon, USA

Chuck Hughes Corresponding Secretary Los Angeles County Clients Coalition, USA

Amy Sanderson, Bradford Early Intervention in Psychosis Team, UK

Pam Pinder parent of voice hearer, Plymouth, Devon, UK

Gerard van de Willige MSC psychologist and researcher, University Medical Center Groningen, The Netherlands

Mette Askov voice hearer with the diagnosis of schizoprenia and on the road to recovery, INTERVOICE supporter, Denmark

Claire Attwood , Voice hearer and mental health support worker, Isle of Wight. UK,

Alberto Diaz MSc Argentinian psychologist, PhD student in collective health at Universidade Estadual de Campinas, researching mental health, special interest schizophrenia, Campinas, São Paulo, Brazil

Barney Holmes, running a Level 1 Affiliate – MindFreedom, Lancaster, UK

Cindy Highsmith Myron, psychiatric survivor, completely recovered from voice hearing and severe mental illness, mental health professional and life coach for persons with mental illness in a self-directed care program, INTERVOICE supporter, Florida, USA

Mad Hatters of Bath. We are a group of people who have experienced mental extremes, including hearing voices and seeing visions. Bath, England, UK

Karin Daniels, mother of a voice hearing daughter who suffered a lot, but who has now recovered. Maastricht, The Netherlands

Jim Probert, PhD Psychologist, Student Health Care Center, University of Florida, USA

Dr David Lee Clinical Psychologist, Dept of Psychological Therapies, Royal Bolton Hospital, Bolton, Supporter of INTERVOICE, UK

Professor Sue Cowan, Registered Mental Health Nurse and Chartered Health Psychologist, University of Abertay Dundee, Scotland, UK

Paul Harris psychotherapist and support worker based in the UK

Marina Beteva voices hearer for 8-9 years, on medication treatment, Moscow, Russia

Monica Cassani North Carolina, USA

Rikke Bitsch Denmark

Afaf Swaity Nursing Director of Bethlehem Psychiatric Hospital, Palestine

Mary Maddocks MindFreedom Ireland, Ireland

Tania Linden North Lincolnshire Early Intervention Service, UK

Rosemaree Ashford honours psychology student, recovery worker, Richmond Fellowship of WA, Australia

Gemma Hendry Trainee Clinical Psychologist with a specialist interest in Community Psychology and Voice hearing, UK

Erica van den Akker Social worker in Forensic Psychiatry, The Netherlands

Caroline von Taysen psychologist, Netzwerk Stimmenhören, Germany and Normal Difference, Mental Health Kariobangi in Kenya, Germany

Poppy Rollinson Mental Health Nurse, Brighton, UK

Vanessa Jackson Healing Circles, Inc. , USA

Dr. Julie Arthur Kirby Supporter of INTERVOICE and Senior Lecturer, UK

Peter Bullimore Expert by experience, Asylum Associates, UK

Paul Cheminais voice hearer, Bournemouth, UK 159

See: http://www.intervoiceonline.org/news-events/campaigns/open-letter-oprah/dear-opra