Diagnosis: Some pros and cons

Scales Some people find it useful to think of hearing voices as a symptom of an illness or disorder, and something to try and reduce or manage. Medication might be used to try and blunt the voices, and make them less loud. For some people, the medication works, while others find it less helpful.

There are some advantages to this way of thinking. Diagnoses can provide a useful framework for accessing help, including mental health services, benefits and time of work with sick pay if this is ever needed. For some voice-hearers, having a diagnosis can bring a huge sense of relief: it helps give shape to what they’re going through and makes them feel less alone, as it implies that other people are also experiencing similar things.

It was helpful for me to regard myself as having had an illness. This made me respectful of the need to maintain and titrate medication … the medication has helped me to make more, not less, use of psychological insight and thus genuinely to gain ground ... Peter Chadwick

I think I prefer my illness having a name because it makes me feel less lonely, and I know that there are other people experiencing my kind of misery. And that people live through my illness and make meaningful existence with it. But I also have to be careful not to adopt the sick role, since I know I would just give up if I did that

Karen Falk
Understanding Psychosis and Schizophrenia t

When someone confronts you with the line ‘you’re ill’ it’s easy to reject it out of hand and dismiss it totally. But denial can be extremely damaging. I see my first six years in the system as being in limbo. Acceptance of my illness was a turning point – the start of my path to wellness.

Terry Bowyer
Recovery Insights: Learning from Experience, Rethink

On the other hand, many voice-hearers don’t find diagnoses useful and think they do more harm than good. Reasons for this include:

People who are seen as mentally ill are often avoided, treated unfairly and subject to prejudice and discrimination.
Receiving a diagnosis can often leave people feeling that there’s no hope for the future
Negative stereotypes associated with some psychiatric diagnoses can lead to decreased confidence and self-esteem.

In addition, thinking of voices as a symptom of a psychiatric disorder that one can do nothing about can be disempowering. It can discourage people from addressing the underlying social and emotional problems that give rise to the voices, and can also send the message that there is nothing they can do to manage their experiences except keep taking their medication.

Find out more: Understanding Psychosis and Schizophrenia, The British Psychological Society (revised version), 2017, section 3

Hearing voices and psychiatric diagnosis

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What is hearing voices?

Hearing voices and psychiatric diagnosis

A psychiatric diagnosis is usually given by a doctor or mental health specialist on the basis of what someone says about their thoughts, feelings and experiences, alongside observations about their behaviour. In the US, clinicians use the DSM-5 to make a psychiatric diagnosis, whereas in the UK they mainly use the ICD-10 system.

Around 75% of people with a diagnosis of schizophreniat hear voices. Voices can also occur in people who have a diagnosis of psychosist, bipolar disordert, borderline personality disordert, dissociative identity disordert, PTSDt, anorexiat or severe depression.

Many people think that voices that are loud, commanding, and come from an external location are more of a worry than those that are experienced as occurring ‘inside the head’. In the past, people thought that these kind of voices were typical of schizophrenia. However, research suggests that the volume, content or perceived location of a voice is not relevant to the type of diagnosis a person may receive. There is little evidence for the once widespread view that ‘internal voices’ – i.e. voices that occur ‘inside the head’ – are somehow more benign than those that appear to come from an external location.

Some people who hear voices find psychiatric diagnoses helpful, others find them stigmatising and harmful. What is important to understand is that hearing voices is not in itself a sign that someone has a mental health problem, regardless of whether the voices shout or whisper or are experienced as ‘internal’ or ‘external’. In some people’s experience, it’s not the voices themselves which are upsetting. Rather, it’s difficulties in coping with voices, and the stigmat and negativity that surrounds the experience, which causes the most distress.

Psychiatric diagnosis: Some pros and cons

Did you know?

Researchers and clinicians differ over the question of whether psychiatric diagnoses pick out ‘real illnesses’.

Some think they are best understood as describing patterns of experience, thoughts and behaviour that may be distressing or disruptive. On this view, psychiatric diagnoses are useful classificatory tools – they can help health professionals communicate with each other or decide which forms of treatment might help – but they can’t tell us anything about the underlying causes of someone’s moods or experiences.

If you’re interested in these different views about diagnosis you can find out more about them here and here.

A closer look:

Voice-hearing in people who don’t need psychiatric care

Many people who hear voices live well with their experiences without ever needing mental health support. Watch this short animation to find out more about the latest research in this field.

Emmanuelle Peters and her colleagues at Kings’ College London have spent the last few years researching the way hearing voices occurs in the general population, and the way it occurs in people with mental health problems such as psychosis. In this short talk, she explains what her work has revealed so far.

NEXT: FINDING MEANING IN VOICES

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