Psychosis, Dissociation and Voice Hearing: Recovery and Discovery

1. Psychosis, Dissociation and Voice Hearing: Recovery and Discovery Dr. Eleanor Longden

2. “[Hearing voices is] an experience that, when considered in good faith, is as profound and complex as human consciousness itself.” Smith (2007)

3. www.intervoiceonline.org

4. Countries with Hearing Voices Networks, 1993

5. Countries with Hearing Voices Networks, 2015

6. “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)

7. Adversity & Psychosis “Our findings suggest that clinicians should routinely inquire about adverse events in childhood…when working with patients with schizophrenia or similar diagnoses” (p.9).

8. ‘Schizophrenia’ Dopamine, serotonin and norepinephrine irregularities Reversed cerebral asymmetry Hippocampal damage Ventricular enlargement Cerebral atrophy Trauma TRAUMA Traumagenic Neurodevelopmental Model of Psychosis (Read et al., 2001, 2008, 2014)

9. Moskowitz, A., Schäfer, I., & Dorahy, M.J. (2008). Psychosis, Trauma and Dissociation: Emerging Perspectives on Severe Psychopathology. Wiley-Blackwell.

10. 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): OR=5.91; 95% CI: 1.94-17.94; p=.002.

11. Voice phenomenology (n=46) • PSYRATS-AH: emotional characteristics, physical characteristics, cognitive appraisals. • DASS-21 scores (anxiety, depression, stress) were the only variable to retain significant associations with emotional (β=.43, t = 2.38, p=.02) and physical (β=.35, t = 2.14, p=.03) characteristics. • Total victimisation adversity (β=.37, t = 2.49, p=.02) was the only variable to retain significant associations with cognitive appraisals.

12. 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.

13. The Construct: “Cracking the Code” • Voice identity • Voice characteristics • Triggers for the voices • History of the voices • Person’s life history • Who/what might the voices represent? • What problems might the voices represent?

14. 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.

15. 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).

16. Crisis Relapse Denial MAINTENANCE Recovery Insight Adapted from Dillon, J. (2010). The personal is political. In S. Benamer (Ed.), Telling stories? Attachment based approaches to the treatment of psychosis (pp. 23–49). London: Karnac Books.

17. Crisis Growth Acknowledgement RECOVERY Recovery Insight

19. “It’s better to light even a little candle than to curse the blackness.” Peter Benenson, founder of Amnesty International