Mind Moves: The "voices" were there 24 hours a day. Several in number, they ran a constant commentary on his behaviour and teased him for his various shortcomings.
At first, he thought they were real and he searched for their source in locked presses, up chimneys, and under his bed. Then he realised they were just voices and he stopped worrying about their source. He felt confident enough to take them on, but when he did, they would respond with further taunts "look at this guy, he has guts, he thinks he can stand up for himself."
Arguing only brought him increasingly under their spell. He was smart enough to see through their ploy, to pull back from the endless wrangling and "not go there".
Over time he evolved a way of coping that allowed him to hold his ground in the face of these tormentors and get on with the business of living.
This was a significant achievement that owed a lot to a steady and trusting relationship with a community psychiatric nurse who had maintained contact with him after his discharge from hospital.
Several breakdowns in his early 20s had left him with a very shattered sense of identity. It helped to have someone who treated him with dignity and believed in him when he couldn't believe in himself.
Auditory hallucinations are a much more common experience than one might expect for individuals with and without a diagnosis of mental illness.
Studies based on interviews with a random sample of the general population have found that 10 per cent of people report hearing voices at some stage in their life.
In conditions like schizophrenia, they are a persistent feature of everyday experience for many sufferers, despite compliance with a medical regimen. They experience these voices as coming from outside their head. Sometimes these voices are benign and speak comforting thoughts in times of distress.
More often, they are malevolent and a source of acute fear and embarrassment to the sufferer. They tend to become more audible and distracting in times of emotional stress and contribute to a radical sense of alienation from others.
They represent one of the many puzzling features of schizophrenia and can cause discomfort in others who find them hard to understand. This failure to understand and come to terms with them can disrupt family and social relationships and intensify the experience of loneliness for the sufferer.
In spite of significant improvements in our understanding of the biological aspects of schizophrenia and continued refinements in medication, the distancing of the patient from the rest of humanity has persisted.
This has been partly due to opposing explanations of the illness held by different healthcare providers.
While some have claimed that symptoms are entirely due to deficits in brain functioning, others have viewed them as an expression of pain resulting from the sufferer's experiences of disturbed human relationships. Practitioners have waged professional wars to uphold their preferred explanation for the presenting features of this disorder. An unfortunate by-product of this antagonism between warring factions has been the tendency to view any psychological interventions as an implied attack on the validity of medical interventions, and visa versa.
As we move into the 21st century a more integrated and humane approach is evident in the scientific literature.
Rather than viewing emotional difficulties as either due to biology or psychology, a better understanding is emerging of how brain functioning, thoughts and feelings, and the social and physical environment are inter-related. A deeper appreciation of the sufferer's experience can allow us to engage the person at the heart of schizophrenia, and help them overcome the confusion it generates.
Developments in our mental health services need to reflect these more integrated approaches and bring the sufferer back into the mainstream of humanity.
Effective help for the individual with schizophrenia requires a holistic collaborative endeavour, where medical, psychological, and social needs are identified and addressed through multidisciplinary teamwork. What is needed is a positive recovery plan tailored to the particular needs of individual sufferers and their families.
Cognitive behavioural therapy is one aspect of treatment that can bring understanding, insight and a sense of control to the sufferer. By offering a relationship based on acceptance and respect we can ease the pain of alienation and restore to them a feeling of dignity and normality.
The specifics of this evidence-based therapeutic approach will be presented at a one-day workshop for healtcare professionals in the Marino Institute this Friday. The title of the workshop is Engaging the person at the heart of psychosis - details are available though the email address below, or by phoning Lisa O'Farrell at 01-4162626.
• Dr Tony Bates is principal clinical psychologist at St James's Hospital and course director of the MSc in Cognitive Psychotherapy at Trinity Collge Dublin.