Psychosis as a Personal Crisis: An Experience-based Approach

Editors: Marius Romme & Sandra Escher

This book seeks to challenge the way people who hear voices are both viewed and treated, paying particular emphasis to the individual variation between people who have such experiences. With twenty international contributors, who in their professional work, research or their own personal experience of psychosis all focus on the person’s subjective experience of psychosis rather than the medical and often pathologising understanding, this book presents a way of challenging and departing from the dominant psychiatric model of ‘madness’.

It presents compassionate, non-pathologising ways of understanding and working with people who predominantly hear voices, but also those with unusual beliefs, terms the book promotes instead of medical language such as ‘auditory hallucinations’ and ‘delusions’ which often stigmatise, alienate and confuse.

Contributors of this book assert that voice-hearing is not a sign of mental illness such as ‘schizophrenia’; a diagnostic term they argue continues to be widely used and accepted, but is no longer scientifically valid or indeed helpful for the individual or those involved in their care. Instead, they draw on research showing the high prevalence of voice-hearing experiences among people who live fulfilling lives and do not require psychiatric support, and in doing so seek to normalise the experience. The authors argue the implicit meaning of voices can become lost when psychiatric understandings and interventions lead the person to view their voice-hearing experience solely as a negative experience and ‘symptom’ of psychiatric disorder. The book contends that for many the most disturbing aspect of the experience is dismissing the meaning and ignoring the content of voices. The general approach advocated in this book is ways of opening up safe and supportive exploration to help individuals make personal sense of the experience of hearing voices.

The foreword to the book emotively begins by providing a historical overview of how people who hear voices have been silenced, labelled insane, socially isolated, shunned and stigmatised; acknowledging the pain psychiatric ignorance has caused and may continue to cause in using practices that mark and shame the person, and cause them to lose hope and become passive. Building on the pioneering work of Romme and Escher and the hearing voices movement, many of these principles are championed by the contributors, showing the growing activity of the hearing voices movement which is enabling the wall of silence and shame to subside for many voice-hearers.

Three Sections

The chapters of this book provide a fluid overview of the personal crisis that psychosis represents; split into three sections. Part I presents five chapters relating to ‘Changes in attitude’ within psychiatric services. This section begins with setting the scene of contemporary psychiatry and the limitations of the over-valued role of diagnostic-led approaches often resulting in pharmacological interventions and little else. Coherently flowing from this is first a professional account of changing attitudes in clinical settings and developing clinical practice and second the use of psychological formulation as an alternative to diagnosis to help demystify and reframe psychosis as an understandable response to unbearable life events. The personal process of recovery is presented with implications for how to work with psychosis. This section ends with a chapter outlining clinical tools that can be used to explore the subjective experience of hearing voices and paranoia.

Part II moves on to explore psychosis and its ‘Relationship with trauma or other life experiences’; initially setting the scene presenting persuasive research linking childhood trauma with the development of psychosis. The subsequent two chapters explore the relationship between trauma and paranoia and traumatic experiences and distorted emotions in those who hear voices.

Part III, the remaining nine chapters and bulk of the book, looks at ‘Recovery-oriented approaches’ focusing on psychotherapeutic ways of working with people experiencing psychosis; initially looking at how to support children who hear voices, normalising the experience and attending to the message voices convey. Subsequently, creating space for open dialogues with people experiencing psychosis and their families is described before the benefits of hearing voices groups is presented in the following chapter. Next, ways of relating to alternative realities by maintaining curiosity, respect and open-mindedness are introduced, followed by a chapter looking at accepting and making sense of voices using a recovery-focused therapy plan. Talking with voices as an empowering source of support is explored in the subsequent chapter. Understandings of psychosis are then offered firstly from a cognitive-behavioural and secondly from a psychoanalytic perspective guiding ways of working within each modality. The final chapter crucially addresses how medication can be used wisely and effectively as part of a holistic recovery plan in treating psychosis; a necessary chapter as it felt important to remain mindful of those who may find psychiatric models and medication helpful, whilst encouraging individuals to become active agents in their own recovery.


Collectively the authors urge voice-hearers to find meaning in their experiences. Arguing that voices can represent traumas expressed in guised, symbolic forms, which seek resolution, these contributors advocate for giving voice to the voices. The task they assign to mental health professionals is to teach people how to listen to their voices, understand them in the context of their personal biographies, so they may change their perception of the voices and in doing so take the reins in steering their own recovery journey. A central tenet in this book is how recovery is often facilitated through hearing from others with similar experiences and professionals are persuaded to take a more active role in facilitating voice-hearers to make contact with other sources of support such as self-help groups.

Each chapter is concise and clear in its message; offering moving, respectful and compelling arguments for developing subjective understandings of voice-hearing and providing a trauma and recovery-led framework for working with people experiencing psychosis. Helpful examples of how to put recovery principles and therapeutic techniques into clinical practice are provided, but in a way that voice-hearers, their families and carers can also engage with.

I recommend this book to any mental health professional working with people experiencing psychosis and the contribution from people with lived experience of psychosis also makes this book of fundamental value for people with similar experiences, their family and carers.

Psychosis as a Personal Crisis: An Experience-based Approach
Editors: Marius Romme & Sandra Escher
Publisher: Routledge
Published for: The International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses (ISPS)
Date of Publication: 2012
Retail Price: £21.99
ISBN: 1745-7483

Thanks to Sam Bampton for this review.