What H.V.N. does dispute is that the psychological anguish caused by hearing voices is indicative of an overarching mental illness. This argument, disseminated through a quarterly newsletter, numerous pamphlets and speeches and alternative mental-health journals, are as voluminous and diverse as its membership. But H.V.N.’s brief against psychiatry can be boiled down to two core positions. The first is that many more people hear voices, and hear many more kinds of voices, than is usually assumed. The second is that auditory hallucination — or “voice-hearing,” H.V.N.’s more neutral preference — should be thought of not as a pathological phenomenon in need of eradication but as a meaningful, interpretable experience, intimately linked to a hearer’s life story and, more commonly than not, to unresolved personal traumas. In 2005, Louise Pembroke, a prominent member of H.V.N., proposed a World Hearing Voices Day (held the next year) that would “challenge negative attitudes toward people who hear voices on the incorrect assumption that this is in itself a sign of illness, an assumption made about them that is not based on their own experiences, is stigmatizing, isolating and makes people ill.”

H.V.N.’s insistence that it is not just the psychotic who hear voices does not, in fact, contradict psychiatric orthodoxy. According to the Diagnostic and Statistical Manual of Mental Disorders, the so-called bible of psychiatry, auditory hallucinations are only a potential symptom of mental illness — they must appear with other symptoms, persist for a specified length of time and impede day-to-day functioning in order to become part of a diagnosable syndrome. In a 2001 debate on whether voices are by definition pathological, Tony David, a neuropsychiatrist at the Institute of Psychiatry in London, noted that a “voice-hearer who is not in any distress, who lives a fruitful and productive life according to commonsense criteria, would never enter the arena in which the possibility of mental illness was up for discussion.” Nor does psychiatry insist that the syndrome in question when a voice-hearer is in distress is invariably schizophrenia. Approximately 20 percent of patients suffering from mania and 10 percent of patients suffering from depression hear voices. Auditory hallucinations can also be caused by “organic” conditions, like Parkinson’s, Alzheimer’s, temporal-lobe epilepsy, hyperthyroidism and migraine headaches, and have long been known to occur in the twilight consciousness between wakefulness and sleep.

That said, H.V.N.’s insistence that voice-hearers should attend carefully to what their hallucinations say is far from traditional. Prolonged exposure to untreated psychosis is held by many experts to be damaging to an individual’s ability to hold down a job or to maintain a meaningful relationship and by others to be damaging to brain function — what clinicians refer to as “psychosocial toxicity” and “neurotoxicity,” respectively. And though psychiatrists acknowledge that almost anyone is capable of hallucinating a voice under certain circumstances, they maintain that the hallucinations that occur with psychoses are qualitatively different. “One shouldn’t place too much emphasis on the content of hallucinations,” says Jeffrey Lieberman, chairman of the psychiatry department at Columbia University. “When establishing a correct diagnosis, it’s important to focus on the signs or symptoms” of a particular disorder. That is, it’s crucial to determine how the voices manifest themselves. Voices that speak in the third person, echo a patient’s thoughts or provide a running commentary on his actions are considered classically indicative of schizophrenia.

Interpreting voices in relation to a patient’s past has a checkered history in the treatment of psychosis. Though Freud discouraged the application of psychoanalysis to psychotic patients, it nonetheless became, for 25 years after World War II, a widespread treatment for schizophrenia in the English-speaking world. This episode in psychiatry is now widely acknowledged to have been a medical and moral disaster; crippling psychoses were routinely blamed on insufficiently nurturing and “schizophrenogenic” mothers. “The psychoanalytic approach to psychosis was toxic,” says Peter Weiden, a professor of psychiatry at SUNY Downstate Medical Center in Brooklyn. “Clinicians of that time were often highly antagonistic toward family members. They blamed the parents, left them out of the treatment process and isolated the patient from his family.” Over the past 30 years, the biomedical model displaced the psychoanalytic one, bolstered by advances in pharmacology, modern genetic and neurological research and the completion of large-scale empirical studies that concluded that psychoanalysis was useless at best and actively destructive at worst. Today, medication is typically prescribed to extinguish, or at least mitigate, voices (about 80 percent of patients experience a reduction in voices, Weiden says, from medication alone, though this does not always translate into an equal improvement in day-to-day functioning); psychotherapy is usually admitted as an adjunct, to deal with issues of social functioning and stigma.

There are signs, however, that psychotherapy is again encroaching on the biomedical paradigm in the treatment of psychoses. Since the 1990s, a growing number of researchers and clinicians, predominantly based in England, have been comparing voice-hearing in psychotic patients with voice-hearing in nonpatients, measuring the incidence of hallucinations in the general population, and using cognitive behavioral therapy (C.B.T.), a popular, short-term treatment for depression and anxiety, to help them manage their responses to the voices they continue to hear. C.B.T. typically asks patients to scrutinize how they interpret their symptoms rather than focusing on an illness as an underlying cause. “The matter of whether it’s effective, and to what extent,” Lieberman says, is still being investigated. So far, the use of C.B.T. in the treatment of psychoses is much more prevalent in the U.K. than in the U.S. In large part, Lieberman says, this is because “the motivation to research the treatment has mostly come from investigators in England.” But, he added, “you could also read into the situation the influence of a strong antipsychiatry or antimedication movement in England — there’s more of an interest in getting nonmedication treatments into clinical use.”

In England, this new cognitive approach to psychosis and the efforts of Hearing Voices Network are independent of each other, and are sometimes at odds. H.V.N.’s leading members, for instance, frequently criticize even sympathetic academic researchers for being insufficiently political. Yet both approaches share a similar purpose in seeking to place voice-hearing within the continuum of normal human experience — one, in order to better treat patients, the other, out of a firm conviction that hearing voices need not interfere with leading an otherwise “normal” life. Over the years, they have forged something of an alliance; psychologists, though they may not embrace H.V.N.’s more polemical views, frequently refer their patients to H.V.N. groups, while H.V.N. frequently cites the research of psychologists. And both H.V.N. and the cognitive approach to psychosis can be traced, to varying degrees, to the same radical figure.

When H.V.N. is accused of being hostile to psychiatry, its members sometimes point out that the organization was, in effect, founded by a psychiatrist — albeit a singularly unorthodox one. In 1986, Marius Romme, a professor of psychiatry at Maastricht University in the Netherlands, was referred a patient, Patsy Hage, who suffered from chronic auditory hallucinations and fell into a deep, suicidal depression. Hage took comfort only from reading “The Origin of Consciousness in the Breakdown of the Bicameral Mind,” an eccentric book, published in 1976, by Julian Jaynes, a Princeton psychologist, in which he argues that before around 2,000 B.C., all humans were guided by hallucinated verbal commands caused by a physical split between the right and left hemispheres of the brain.