From psychotic perceptual aberration to dissociative part of the self: An historical and personal overview of changing perspectives on voice hearing

Relational approaches to voice hearing (VH), which emphasize changing a person's attitude towards and relationship with their voices, challenge the medical view of VH as a psychotic symptom that can only be managed, typically through medication. In this paper, we review historical perspectives on VH, exploring factors that led VH to be classified as a core symptom of schizophrenia in the late 20th century. Around the same time, an alternative paradigm emerged through the Hearing Voices Movement, which argued that VH was a variation of normal human consciousness that should be accepted and explored without stigma. Dirk Corstens, a psychiatrist working within that perspective, joined forces with Andrew Moskowitz, a clinical psychologist with experience with dissociative disorders, to publish a paper entitled 'Auditory Hallucinations: Psychotic Symptom or Dissociative Experience'? In that seminal paper, Moskowitz and Corstens (2007) argued-after reviewing research on VH in the general population, similarities in VH between clinical and non-clinical populations, and the relationship between dissociation and voice hearing-that VH was better understood as essentially normal and dissociative in nature, rather than pathological and psychotic. They further argued that voice hearers would benefit from dialogical approaches seeking to understand the purpose of their voices and change the voice hearer's relationship to them. Since then, research and clinical trials have strongly supported all the tenets of the 2007 paper, to the point that relational or dialogical approaches to VH are now rapidly becoming an acceptable complement or even alternative to medical treatment for hearing voices.