Neurodiversity Affirming Practice: hearing voices and experiencing visions

Western society and the pathology paradigm including psychiatry have always labelled hearing voices or experiencing visions as an illness or disease; something that is terrible and distressing for an individual.

In comparison, the neurodiversity paradigm views hearing voices and experiencing visions as a part of the diversity of being human and human experiences. While the pathology paradigm views hearing voices or experiencing visions as a distressing experience that must be treated or fixed, the neurodiversity paradigm doesn’t make that choice for individuals; it recognises and honours the experiences, meanings and choices of each individual.

This is important because there are many individuals who do not find their voices or visions distressing and there are many individuals who choose to live their voices or visions. There are both first hand stories and studies that show how the association of distress with voices or visions varies within different cultures and for each individuals. Just look at the Hearing Voices Movement and the stories shared.

There needs to be a framework within therapy that honours the diversity of these experiences which is exactly what Neurodiversity Affirming Practice can provide.

Unfortunately, Neurodiversity Affirming Practice is a framework usually only applied to Autism, ADHD and learning differences but if we were to apply it to individuals who hear voices or experience visions, perhaps this is what it would look like:

• We do not frame hearing voices or experiences visions as an inherently harmful or dangerous way of being but instead, we recognise it as an altered state or a different way of being that can be disabling or distressing.

• We do not automatically assume the reason for these experiences is illness and instead, understand that there are multiple explanations for voices and visions.

• We consider cultural meaning, context and experiences when making sense of hearing voices.

• We respect an individual’s choice when it comes to medication without assuming someone lacks insight if they don’t want to use medication.

• We do not assume hearing voices or experiencing visions is always distressing and instead, allow individuals to define what experiences are distressing for them as well as what functional or dysfunctional looks like for them.

• We presume competence and respect their autonomy.

• We recognise that ‘recovery’ doesn’t have to include getting rid of voices and only individuals get to define what recovery looks like for themselves

• We do not impose our own beliefs on someone else’s experience and instead, seek to understand their own meanings and sense-making.

• We support individuals in finding strategies and tools that support their well-being and we recognise the importance of community care and access to support and a support system.

Every neurodivergent individual deserves access to neurodiversity affirming care so I hope more mental health providers can make the paradigm shift and adopt Neurodiversity Affirming Practice.

And not just for Autistic people or ADHDers but also for individuals who hear voices or experience visions.

While I recognise I am not someone who hears voices or experiences visions, I am someone who thinks and writes a lot about Neurodiversity Affirming Practice so I recognise this is an emerging framework and I hope I have done this justice.