Understanding the experiences of hearing voices and sounds others do not hear

Family Caregivers' Trajectories of Distress While Caring for a Person With Serious Mental Illness

Serious mental illness (SMI) can significantly impact the lives of individuals and their families. These families often experience great emotional distress over time due to the early onset of SMI, which in turn leads to long-term trajectories and only partial recovery. However, we do not fully understand the emotional distress of family caregivers. Thus, our aim was to enrich the understanding of the lived experiences of family caregivers' emotional trajectories of distress while caring for persons with SMI. We conducted a secondary analysis using a hermeneutic approach to the narratives of seven family caregivers from a study on living with voices unheard by others. Participants' trajectories of emotional distress came forth as being thrust on an unpredictable, intensely worrisome, and indefinite journey. The following themes highlighted this tumultuous journey: fumbling in the dark trying to grasp the incomprehensible, "on your toes"-enduring unpredictability, facing different forms of fear, and battling waves of sadness and regret. Caregivers face multiple threats to their well-being and sometimes even to their health. Their distress appeared to vary according to their relationship with the person with SMI, whether they lived with the ill person, illness trajectory, and amount of violent or suicidal behavior. The results underscore the need for individualized and timely information, opportunities for dialogue with healthcare providers with and without the person with SMI, and inclusion in care planning. Caregivers who have experienced trauma, threats of violence, and rejection require special attention.

Filling the Void: The Role of Adult Siblings Caring for a Brother or Sister With Severe Mental Illness

Little is known about the role of adult siblings’ caregiver role within the context of mental illness. Therefore, our purpose was to explore how siblings narrate their experiences of being the main caregivers of a brother or sister with severe mental illness and how they cooperate with their ill sibling and their family of origin. We used a narrative hermeneutic approach and performed a secondary analysis of two interviews of siblings derived from a study of peoples’ experiences of hearing voices. The findings illuminate the participants’ multifaceted roles and how differently siblings might deal with the multiple challenges of caring for an ill sibling. The mediating role between their ill sibling and their family of origin to reestablish the broken family bonds was a significant aspect. Nurses’ awareness of the important and multidimensional role of caregiving siblings can improve the provision of family support and promote involvement of siblings in the treatment of an ill family member.

The Patient Lived-Experience of Ventral Capsulotomy for Obsessive-Compulsive Disorder: An Interpretive Phenomenological Analysis of Neuroablative Psychiatric Neurosurgery

Ventral Capsulotomy (VC) is a surgical intervention for treatment-resistant Obsessive-Compulsive Disorder (OCD). Despite clinical studies, little is known about patient perception and lived experience after neurosurgery for severe OCD. To examine the lived experiences of patients who have undergone VC for severe, treatment-resistant OCD through qualitative analysis. We conducted semi-structured interviews with six participants treated with VC for OCD. Interviews were analyzed using Interpretive Phenomenological Analysis. The following themes emerged: (1) After years of conventional treatments, patients felt neurosurgery was their “last hope” and described themselves as “desperate,” (2) While some described the surgery as a “supernatural experience,” patients also demonstrated understanding of the scientific procedure, its risks and potential benefits, (3) The surgical experience itself was positive or neutral, which was linked to trust in the clinical team, (4) Post-surgery, participants described months of heightened fear as they awaited lesion formation and functional improvement. (5) Patients consistently contextualized outcome in the context of their own life goals. Patients undergoing VC have positive views of this neurosurgical intervention, but psychiatric neurosurgical teams should anticipate patient discomfort with the time needed to achieve behavioral improvement following surgery and emphasize the importance of post-operative psychiatric care.

Hearing voices: From the Experience Qualification to the Possibility of Care

Abstract This article aimed to analyze hearing voices experiences in patients of a Psychosocial Care Center. In this regard, ten people were interviewed. The qualitative method was used, with content analysis. Four categories were chosen: “origin” of voices, phenomenology of voices, coping strategies, and family support. Hallucinatory experiences have emerged in contexts of violence and isolation. Topographic variables of the voices indicate possibilities of understanding the phenomenon. The movement is a basic condition to deal with the experiences. Family support is key to cope with difficulties. It is necessary to qualify the auditory hallucination as a meaningful experience, which must be respected in any intervention that intends care.

Beliefs about voices and their relation to severity of psychosis in chronic schizophrenia patients

BACKGROUND

Auditory hallucinations may persist in a subset of chronic psychotic patients in spite of treatment. It is important to understand the personal meaning and significance of voices in these patients. In spite of its relevance, only a limited literature is available.

AIM

This exploratory study aimed to assess the beliefs regarding voices in treatment-seeking patients with chronic schizophrenia having persistent auditory verbal hallucinations (AVHs) and assess their relation to the severity of psychosis.

MATERIALS AND METHODS

We recruited thirty adult patients with chronic schizophrenia as per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with both lifetime and current significant AVHs (≥50% days/month). Co-occurring psychiatric disorders were ruled out using the Mini International Neuropsychiatric Interview-7.0.0. Patients were assessed using a semi-structured proforma, Beliefs about Voices Questionnaire-Revised (BAVQ-R), Psychotic Symptom Rating Scale (PSYRATS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), and Clinical Global Impression-Schizophrenia (CGI-SCH)-severity.

RESULTS

The median age of the patients was 32 years (interquartile range [IQR]: 23.8-40.5). The median duration of illness and treatment was 7 years (IQR: 3.4-15.0) and 3 years (IQR: 1.9-10.5), respectively. Higher BAVQ-R scores were found on "malevolence," "omnipotence," and "emotional and behavioral resistance." These beliefs had a significant positive correlation with PSYRATS hallucination subscale, but not with the severity of psychosis (SAPS, SANS, and CGI-SCH). The sample had lower scores for "benevolence" and "engagement" subscales of BAV-Q.

CONCLUSION

Overall, the study sample believed AVH to be more malicious and omnipotent rather than benevolent, and resisted the voices, engaging only minimally with them. These beliefs were not related to the severity of psychosis, but were related to the severity of hallucinations. Assessing the beliefs regarding AVH in larger, diverse samples may help to plan behavioral interventions.

The Phenomenon of "Hearing Voices": Not Just Psychotic Hallucinations-A Psychological Literature Review and a Reflection on Clinical and Social Health

The phenomenon of hearing voices is currently a much-discussed topic, both in the field of research and in the field of care services. The majority of people who report "hearing voices" do not subsequently receive services or receive a diagnosis of psychopathology. This topic raises questions for professionals in the health field about the lack of tools that can help illuminate the phenomenon. The purposes of this work are (a) to highlight the psychological studies that approach the phenomenon in a non-psychopathological way and (b) to determine which concepts could aid the comprehension of the phenomenon. The method consists of a systematic review of the literature that characterizes the phenomenon of hearing voices from a non-pathological perspective. The literature offers different theoretical approaches to interpret the phenomenon in a way that is not necessarily pathological and presents new tools for examining the phenomenon. For example, a few studies state that it is possible to coexist with voices, while others indicate that it is necessary to know how to manage voices. We highlighted and discussed several concepts that can support doctors, psychiatrists and practitioners in understanding "hearer" patients, particularly attention to the context of belonging, attention to language, and the role of the sense-making process.

O GRUPO DE OUVIDORES DE VOZES: DISPOSITIVO DE CUIDADO EM SAÚDE MENTAL

A alucinação auditiva é um fenômeno que participa da vida de muitas pessoas que fazem tratamento no sistema público de saúde mental de nosso país. No cotidiano de um Centro de Atenção Psicossocial de uma capital brasileira, ouvidores de vozes relatavam com frequência que continuavam sofrendo em função de experiências alucinatórias, mesmo seguindo o tratamento prescrito pela equipe de saúde. Considerando esse problema, foi criado no local um grupo voltado para a lida com o fenômeno. Este artigo teve como objetivo analisar experiências desse grupo. Para isso, utilizou-se o método qualitativo, o qual envolveu o registro de 62 sessões sob a forma de diário de campo, e a análise do corpus. A organização dos dados se deu em três espectros temporais estruturantes de (psico)terapias de grupo em geral: “apresentação”, “trocas de experiências”, e “fechamento”; além de um aspecto dinâmico, denominado de “manejo terapêutico”. A apresentação promoveu a ambientação dos participantes e possibilitou o surgimento de temas importantes, os quais foram trabalhados no decorrer da sessão. Ao trocarem experiências, os integrantes conseguiram compreender algumas dinâmicas relativas às vozes, e houve a promoção de determinados fatores terapêuticos. O manejo serviu para alinhavar os espectros temporais e garantir a fluidez da atividade. Recomenda-se a adoção de grupos com esse foco e formato nos serviços de saúde mental, considerando que eles ampliam a capacidade de cuidado.

The use of phenomenology in mental health nursing research

BACKGROUND

Historically, mental health research has been strongly influenced by the underlying positivism of the quantitative paradigm. Quantitative research dominates scientific enquiry and contributes significantly to understanding our natural world. It has also greatly benefitted the medical model of healthcare. However, the more literary, silent, qualitative approach is gaining prominence in human sciences research, particularly mental healthcare research.

AIM

To examine the qualitative methodological assumptions of phenomenology to illustrate the benefits to mental health research of studying the experiences of people with mental illness.

DISCUSSION

Phenomenology is well positioned to ask how people with mental illness reflect on their experiences. Phenomenological research is congruent with the principles of contemporary mental healthcare, as person-centred care is favoured at all levels of mental healthcare, treatment, service and research.

CONCLUSION

Phenomenology is a highly appropriate and suitable methodology for mental health research, given it includes people's experiences and enables silent voices to be heard.

IMPLICATIONS FOR PRACTICE

This overview of the development of phenomenology informs researchers new to phenomenological enquiry.

Understanding auditory verbal hallucinations: a systematic review of current evidence

OBJECTIVE

Auditory verbal hallucinations (AVHs) are core features of psychotic illness and remain significant in predicting poor outcome and risk. There has been a wide range of approaches to understanding these experiences.

METHOD

A systematic literature review summarizing different methods of investigation and their results; phenomenology, descriptive psychopathology, psychological, cognitive neurobiology, and neuroimaging.

RESULTS

A number of 764 papers and texts were screened and 113 reviewed. Phenomenological studies are comparably few in number, and psychopathology remains based on concepts defined in the early 20th century. Psychological models focus on voice content and emotional reaction, and suggest a continuum of AVHs from normal experience. Neuropsychological models include AVHs as misattribution of inner speech, whilst functional neuroimaging studies focus on the spontaneous activity and connectivity of auditory networks.

CONCLUSION

There has been a large growth in research on AVHs in recent decades dominated by neurobiological and neuroimaging studies. Future research should include focus on phenomenological aspects and AVHs change over the course of developing illness. Integration between branches of enquiry is needed, and the risk is that without this, models are proposed and investigated that bear scant relevance to the symptom itself.

"Sometimes I walk and walk, hoping to get some peace." Dealing with hearing voices and sounds nobody else hears

Our objective in this article is to add to the understanding of how people with mental illness experience dealing with hearing troublesome voices and sounds in everyday life. Fourteen people contributed through in-depth interviews and we analysed these using a hermeneutic phenomenological approach. We found that the participants (a) tried to block out the voices and sounds, (b) navigated the health care services, and (c) struggled to come to terms with limitations. Our overall understanding of how the participants dealt with hearing voices is that they sought to be independent and lead ordinary lives despite being troubled by voices. The participants fought desperately to find relief and avoid being overcome by the voices and sounds in intense phases. In less intense phases, they developed ways of getting along with daily life in spite of these experiences. We reflect on the implications of these findings and emphasize the need for care providers to attempt to understand and engage in collaborative explorations with service users in search of the most helpful ways of dealing with hearing troublesome voices and sounds in everyday life.