She has been in the system before — as an addict, the many times she detoxed and relapsed. But this is different. The doctors explain that she has schizophrenia, which is a medical condition, like diabetes. There is a chronic chemical imbalance in her brain, and the voices she hears are symptoms of the disease. They tell her she'll need to take medication for the rest of her life.
No one talks about recovery.
For Marty, being diagnosed feels like a trap closing. "I felt that I was no longer normal, and was permanently and totally fucked," she'll say later. "It's hard to believe otherwise when everyone you try to get help from thinks that."
She thinks her childhood was enough to make anyone sick. She remembers a quote from her long-ago year in college, from the writings of a radical psychiatrist named R.D. Laing: Madness is a sane response to an insane world.
But now she's out of control and out of options. Over time, her memory of this first hospitalization will blur, become entangled with other hospital rooms. Which time was it that they kept her in a cold room by herself for four days? How many times has she been strip-searched?
She will take up smoking, so that when she's hospitalized she'll have an excuse to leave the ward and stand outside every day.
Three years after Marty's first hospitalization, an American psychology professor called Gail Hornstein arrives in the UK, looking for the Hearing Voices Network.
Bespectacled and thoughtful, with a close-cropped cap of white hair, Hornstein has been fascinated with first-person narratives of madness since she was a teenager. Those narratives have made her question much of what she's learned about psychiatry. In her book, Agnes's Jacket — named for an asylum inmate who embroidered her narrative on her clothes — she will write: "For patients, madness isn't about 'scrambled electrical signals' or 'new breakthroughs in the exciting world of brain research.' They write of captivity, insight, and resilience."
In London, Hornstein finds a movement that has begun to establish itself in the British psychiatric world.
At the start, the Hearing Voices Network had faced a certain amount of hostility. Earlier "psychiatric-survivor" movements — like R.D. Laing's — rejected psychiatry outright, sometimes idealizing madness as a shamanic gift. That history put psychiatrists on the defensive against any movement that presented itself as an alternative to medical care.
"We spend an awful lot of time trying to persuade people to have treatment. For someone to come along and say, 'Live with your voices' is not very helpful," London psychiatrist Cosmo Hallstrom told the Observer in 2000, in an early article on the Hearing Voices Network. "I think untreated schizophrenia is dangerous, and the longer you delay treatment, the worse the outcome."
But the movement's leaders didn't want to estrange themselves from psychiatry — they wanted to change it. Drawing inspiration from past identity-politics efforts like the gay-rights movement — which successfully demedicalized homosexuality — they started out by holding workshops for psychiatry professors in Sheffield, for psychiatric nurses in Manchester. They called it "community in-reach."
Now, a decade since its founding, the network has chapters all over the UK, and across the world. Hearing Voices groups meet in hospitals run by the National Health Service, in prisons and high-security hospitals. The movement holds training modules for nurses and clinical-psych students at universities across the country.