Memoir and the Diagnosis of Schizophrenia: Reflections on The Center Cannot Hold, Me, Myself, and Them, and the 'Crumbling Twin Pillars' of Kraepelinian Psychiatry

Lived experience of loneliness in psychosis: A qualitative approach

BACKGROUND

Loneliness impedes recovery from mental illness. Despite increased interest in loneliness in psychosis, qualitative methods are underused in clinical research on this topic.

AIMS

We used qualitative interviews to explore loneliness among persons with schizophrenia spectrum disorders (SSDs). We examined which aspects of living with psychosis were associated with the experience of loneliness, including symptomatology, social relationships, and disruptions in school/work.

METHODS

Sixteen participants diagnosed with SSDs engaged in semi-structured, qualitative interviews about loneliness. Participants commented on current activities and social relationships, including their perceptions of the quantity, quality and types of relationships. Important demographic and clinical information was acquired through communication with participants and/or through medical record review. Thematic analysis was used to examine interview content.

RESULTS

Our analyses revealed four key topic areas and several sub-themes related to loneliness across participants, including aspects of the physical environment (e.g. financial limitations), social context (e.g. lacking a romantic partner), and psychological functioning (e.g. psychotic/symptoms) that impact lonely feelings. Participants commented on coping strategies to manage loneliness and provided suggestions for possible interventions.

CONCLUSIONS

Persons diagnosed with SSDs report significant and impactful feelings of loneliness. This study highlights the need for novel and effective treatments targeting loneliness in this population.

Henry's voices: the representation of auditory verbal hallucinations in an autobiographical narrative

The book Henry's Demons (2011) recounts the events surrounding Henry Cockburn's diagnosis of schizophrenia from the alternating perspectives of Henry himself and his father Patrick. In this paper, we present a detailed linguistic analysis of Henry's first-person accounts of experiences that could be described as auditory verbal hallucinations. We first provide a typology of Henry's voices, taking into account who or what is presented as speaking, what kinds of utterances they produce and any salient stylistic features of these utterances. We then discuss the linguistically distinctive ways in which Henry represents these voices in his narrative. We focus on the use of Direct Speech as opposed to other forms of speech presentation, the use of the sensory verbs hear and feel and the use of 'non-factive' expressions such as I thought and as if. We show how different linguistic representations may suggest phenomenological differences between the experience of hallucinatory voices and the perception of voices that other people can also hear. We, therefore, propose that linguistic analysis is ideally placed to provide in-depth accounts of the phenomenology of voice hearing and point out the implications of this approach for clinical practice and mental healthcare.

The voice-hearer

BACKGROUND

For 25 years, the international Hearing Voices Movement and the U.K. Hearing Voices Network have campaigned to improve the lives of people who hear voices. In doing so, they have introduced a new term into the mental health lexicon: "the voice-hearer."

AIMS

This article offers a "thick description" of the figure of "the voice-hearer."

METHOD

A selection of prominent texts (life narratives, research papers, videos and blogs), the majority produced by people active in the Hearing Voices or consumer/survivor/ex-patient movements, were analysed from an interdisciplinary medical humanities perspective.

RESULTS

"The voice-hearer" (i) asserts voice-hearing as a meaningful experience, (ii) challenges psychiatric authority and (iii) builds identity through sharing life narrative. While technically accurate, the definition of "the voice-hearer" as simply "a person who has experienced voice-hearing or auditory verbal hallucinations" fails to acknowledge that this is a complex, politically resonant and value-laden identity.

CONCLUSIONS

The figure of "the voice-hearer" comes into being through a specific set of narrative practices as an "expert by experience" who challenges the authority and diagnostic categories of mainstream psychiatry, especially the category of "schizophrenia."