Living in a World of Voices: A mixed-methods investigation of non-clinical voice-hearing in context

Abstract

Although hearing voices is often seen as a sign of illness, there are many people for whom it is an ordinary, non-distressing, and meaningful part of life. These individuals, known in psychological literature as “non-clinical voice-hearers” have been the subject of a growing body of research. Such work often compares their experiences to those of individuals who hear voices as part of disorders such as schizophrenia, with the aim of developing new therapies and learning about risk factors for such conditions. However, this often ignores non-clinical voice-hearers’ wider contexts. For instance, many of those who make up non-clinical voice-hearing participant groups practice Spiritualist mediumship and view voices as spirits of the dead. There is a need for a deeper understanding of the ways in which spiritualism, and the wider contexts of participants’ lives impact their experiences and descriptions of voices. This work addresses this need through a mixed-methods, multi-site, investigation of non-clinical voice-hearing built around the central question of: How do the broader contexts of participants lives, such as their family-lives, spiritual communities, and broader experiences of their own minds interact with their experiences of voice-hearing?

This thesis reports on the results of six studies addressing this question. These include four qualitative studies based on semi-structured interviews with non-clinical voice-hearers, and two quantitative studies designed to explore novel areas based on the qualitative findings. The first qualitative study found that the experiences of voice-characteristics and voice-related emotions falls outside of standard ways of categorizing them, and that participants were often comfortable with uncertainty about the nature of their experiences. The second study used an online questionnaire-based approach to find that higher intolerance of uncertainty was associated with higher voice-related distress. The following three studies used semi-structured interviews to carry out qualitative thematic analysis looking at the experiences of those who had participated in non-clinical voice-hearing research at Durham, Yale, and King’s College London. These studies identified a wide array of themes speaking to the interpersonal nature of voices, which intertwined with participants’ relationships, their families, their communities, and themselves. These studies also identified patterns in unusual experiences that did not fall neatly into the category of ‘voice’, such as a sense of voices as coming from a different “world.” This showed that voices often are not isolated perceptual moments, and instead are interwoven with background states of experience. Overall, these findings demonstrated that grappling with and resisting the assumptions built into our research methodologies and standardized measures of hallucination opens up new possibilities for research and understanding.