Psychosis, Dissociation and Voice Hearing: Recovery and Discovery

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Psychosis, Dissociation and Voice Hearing
Recovery and Discovery

• Dr. Eleanor Longden

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Hearing voices is an experience that, when
considered in good faith, is as profound and
complex as human consciousness itself. Smith
(2007)
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www.intervoiceonline.org
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Countries with Hearing Voices Networks, 1993
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Countries with Hearing Voices Networks, 2015
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• Dissociation must occur in some form for a mind
  to hear part of itself talking and to experience
  that as non-self talking.
• Ross (1997)

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Adversity Psychosis
Our findings suggest that clinicians should
routinely inquire about adverse events in
childhoodwhen working with patients with
schizophrenia or similar diagnoses (p.9).
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Trauma

• Schizophrenia
• Dopamine, serotonin and norepinephrine
  irregularities
• Reversed cerebral asymmetry
• Hippocampal damage
• Ventricular enlargement
• Cerebral atrophy

TRAUMA
Traumagenic Neurodevelopmental Model of Psychosis
(Read et al., 2001, 2008, 2014)
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• Moskowitz, A., Schäfer, I., Dorahy, M.J.
  (2008). Psychosis, Trauma and Dissociation
  Emerging Perspectives on Severe Psychopathology.
  Wiley-Blackwell.

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Longden E, House AO, Waterman MG (in
submission). Associations between auditory
hallucinations, dissociation and psychological
distress in first episode psychosis a case
control study.

• Pseudo-random sample 31 cases with AVH and 31
  non-hallucinating controls.
• Demographic variables
• Age, gender, ethnicity, marital status, housing
  status, employment status, years in education.
• Clinical variables
• Medication use, anxiety, stress, depression,
  psychosis in first degree relatives, illness
  duration.
• DES-II scores the only significant predictor of
  AVH when controlling for pre-onset adversity
  exposure (LSC-R scores) and anxiety, stress and
  depression (DASS-21 scores) OR5.91 95 CI
  1.94-17.94 p.002.

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• Voice phenomenology (n46)
• PSYRATS-AH emotional characteristics, physical
  characteristics, cognitive appraisals.
• DASS-21 scores (anxiety, depression, stress) were
  the only variable to retain significant
  associations with emotional (ß.43, t 2.38,
  p.02) and physical (ß.35, t 2.14, p.03)
  characteristics.
• Total victimisation adversity (ß.37, t 2.49,
  p.02) was the only variable to retain
  significant associations with cognitive
  appraisals.

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Longden, E., Corstens, D., Escher, S., Romme,
M. (2012). Voice hearing in a biographical
context A model for formulating the relationship
between voices and life history. Psychosis,
4(3),224-234.
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The Construct Cracking the Code

• Voice identity
• Voice characteristics
• Triggers for the voices
• History of the voices
• Persons life history
• Who/what might the voices represent?
• What problems might the voices represent?

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• Corstens, D. Longden, E. (2013). The origins of
  voices Links between voice hearing and life
  history in a survey of 100 cases. Psychosis,
  5(3),270-285.

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• 100 individuals (80 diagnosed with schizophrenia
  spectrum disorders).
• Average length of voice hearing was 18 years.
• At least one form of childhood adversity was
  reported by 89.
• Who or what do the voices represent?
• Apparent in 78 of cases (e.g., aspects of self,
  a family member, a past abuser).
• What problems do the voices represent?
• Apparent in 94 of cases (e.g., low self-worth,
  anger, shame, guilt).

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Crisis
Relapse
Denial
MAINTENANCE
Insight
Recovery
Adapted from Dillon, J. (2010). The personal is
political. In S. Benamer (Ed.), Telling stories?
Attachment based approaches to the treatment of
psychosis (pp. 2349). London Karnac Books.
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Crisis
Growth
Acknowledgement
RECOVERY
Insight
Recovery
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Its better to light even a little candle than
to curse the blackness. Peter Benenson,
founder of Amnesty International