Voice Of Experience Research Articles

Voice and Insomnia: A Daily Study of Underlying Affective and Cognitive Mechanisms

In this study, we examined whether the expression of voice, as a prosocial yet psychologically costly behavior, during the day affects employee sleep quality at night and whether sleep quality affects the expression of voice on the next workday. Having surveyed 113 full-time employees twice a day over the course of two weeks, we found that the same-day effect of voice on sleep and the effect of sleep on the next day voice depend on the type of voice. Specifically, we found that employees who express promotive voice experience higher levels of positive affect at the end of the workday, more effectively detach from work at home, and as a result are less likely to suffer from insomnia at night. We also found that employees who express prohibitive voice tend to experience higher levels of negative affect at the end of the workday, are unable to effectively detach from work at home, and consequently are more likely to experience insomnia at night. Our study further demonstrates that, while there is no association between insomnia and next-day prohibitive voice, sleep-deprived employees are less likely to engage in promotive voice on the next day because of being psychologically depleted.

Mental health professionals’ attitudes and knowledge about hearing voices groups

ABSTRACT Background An initiative was proposed to integrate local Hearing Voices Groups within statutory adult mental health services in a particular NHS Trust. The aim of this service evaluation was to assess clinician’s attitudes towards, and understandings, of the groups to better inform the proposal. Methods Multi-disciplinary NHS staff members were invited to participate in a brief survey on their attitudes towards and understanding about Hearing Voices Groups. The survey was co-produced with people with lived experience of hearing voices, and local mental health professionals. Content analysis was used to analyse qualitative data from an additional free text section of the survey. Results Forty mental health professionals responded to the survey. There was majority agreement (>50% agreement) on all items related to perceived benefit of Hearing Voices Groups. The findings also showed that only 25% of respondents felt that they were aware of the evidence base for Hearing Voices Groups and only 30% felt confident explaining Hearing Voices Groups to service users. Discussion The data suggest that the majority of mental health professionals hold positive attitudes towards Hearing Voices Groups. However, many expressed uncertainty about the evidence base and discussing the groups with service users, highlighting further training needs in these areas.

Treatment Efficacy of Radiofrequency Ablation for Recurrent Tumor at the Central Compartment After Hemithyroidectomy.

OBJECTIVE. The aim of this study was to evaluate the efficacy of ultrasound (US)-guided radiofrequency ablation (RFA) for recurrent tumor in the central compartment after hemithyroidectomy. MATERIALS AND METHODS. The medical records of patients who underwent RFA for recurrent tumor after hemithyroidectomy between January 2008 and December 2018 were reviewed. Eight patients who underwent RFA for 10 recurrent tumors after hemithyroidectomy were included in our study population. Patients underwent follow-up US 1, 6, and 12 months after treatment and annually thereafter. The tumor volume reduction rate (VRR) was calculated as follows: VRR = ([initial volume - final volume] × 100) / initial volume. All patients were advised to undergo contrast-enhanced CT after tumor ablation. Complete tumor disappearance was defined as no visible treated tumor on follow-up US or CT. RESULTS. Mean tumor VRR was 97.8% ± 7.0% (SD) (range, 77.8-100%). Complete tumor ablation was achieved for all 10 recurrent tumors. Complete disappearance was confirmed in nine recurrent tumors, and one recurrent tumor showed a VRR of 77.8% on US but there was no enhancement on CT. All eight patients achieved no evidence of disease during mean follow-up of 33.0 months. RFA was tolerated by all patients; there were no major complications or procedure-related deaths. One patient experienced transient voice change during RFA. CONCLUSION. RFA can be considered to be an effective and safe alternative treatment method for recurrent tumor in the central compartment after hemithyroidectomy.

Trickle down Registration: Exploring the Lived Experiences of Partners of Persons Registered as a Sexual Offender

ABSTRACT Accessing stigmatized persons for research purposes can be difficult, and accessing their significant others is perhaps even more challenging. We present here our defining moments of recruiting and surveying partners of persons registered as sexual offenders for our research on courtesy stigma. The challenges and successes of our journey are described within the larger hypothesis that close relationships are an important source of social support associated with adjustment and well-being outcomes for people involved in the justice system as well as their families. Ultimately, we suggest our reflections will not only encourage other researchers to seek the input of hard-to-reach populations in justice, health, and policy contexts, but also to incorporate the experiences of underrepresented voices, elucidate findings and lessons learned from these unique populations, and engage in reflexive health communication and research strategies with highly stigmatized populations.

Une approche psychologique des hallucinations : mécanismes psychologiques (partie I)

Anglo-Saxon psychology has produced a significant number of studies showing the involvement of psychological mechanisms in the development and maintenance of auditory hallucinations (voice-hearing). Likewise, numerous studies have shown that hallucinations are also described in other psychiatric (e.g. post-traumatic stress disorder) and neurodegenerative (e.g. Parkinson's disease) clinical populations as well as in a minority of the general population. However, despite these advances, hallucinations are still considered as a specific characteristic of schizophrenia, which in most cases, is understood from a biological point of view. For this reason, in this review, we are specifically interested in the psychological models of auditory hallucinations from a transdiagnostic point of view. More specifically, we will describe (1) the role of beliefs about voices and self-schemas, (2) the experience of voice understood as a fundamentally relational phenomenon between the voice hearer and the voices, (3) the role of emotions and emotional regulation strategies, and, finally, (4) the role of past traumatic experiences and dissociation. Regarding the role of beliefs about voices and self-schemas, numerous studies are showing that more important than the experience of hearing voices it is how the individual appraisal their experience that will ultimately impact on how they will cope with the experiences and how they will feel about it (distressed or not). Voices appraised as malevolent and powerful are more often associated with avoidant, escape, confrontation, and compliance coping strategies. Moreover, they are also associated with higher levels of depression and anxiety regardless of the frequency of hallucinations and duration of the disorder. Besides the beliefs about the voices, how the individual perceives him/herself is also essential. It has been shown, for example, that the more individuals feel depressed and inferior in comparison to others in interpersonal relationships, the more inferior they feel about their voices. The relational approach proposed that the experience of voice understood as a fundamentally relational phenomenon between the voice hearer and the voices. Indeed, phenomenological studies have been able to show that voice-hearers describe voices as possessing human characteristics. As a result, voice-hearers often develop a relationship of virtual intimacy with their voices, which often seems to be complex and characterised by a certain ambivalence similar to the interpersonal relationships encountered in everyday life. Thus, current research suggests that it is essential to take into account these relational aspects when working with voice-hearers. Alongside cognitive and relational variables, emotional states and processes play a significant role in the development and maintenance of auditory hallucinations. Indeed, it has been shown that stress, anxiety and depression are predictors of hallucinations. Also, increased use of non-adaptive emotion regulation strategies may play a major role in the phenomenon of voice agreement. Studies have demonstrated that emotional regulation strategies such as experiential avoidance and abstract rumination seem to contribute to the increased frequency of hallucinations and associated distress. Finally, there is now strong evidence showing the involvement of past adverse experiences in the onset and content of hallucinations. In this framework, dissociation is seen as a protective mechanism that allows individuals to psychologically detach themselves from events that they cannot cope with. Consequently, the experience is attributed to external sources, ultimately leading to the phenomenon of voice-hearing. In summary, in this brief review, we have tried to present the best validated psychological models for understanding the experience of voice agreement. The goal is to provide information on how these psychological processes can help us to the adoption of a person-centred approach in mental health care that allows the person to describe their experiences in their own words and thus formulate an understanding of their suffering.

Keeping the inner voice inside the head, a pilot fMRI study.

IntroductionThe inner voice is experienced during thinking in words (inner speech) and silent reading and evokes brain activity that is highly similar to that associated with external voices. Yet while the inner voice is experienced in internal space (inside the head), external voices (one's own and those of others) are experienced in external space. In this paper, we investigate the neural basis of this differential spatial localization.MethodsWe used fMRI to examine the difference in brain activity between reading silently and reading aloud. As the task involved reading aloud, data were first denoised by removing independent components related to head movement. They were subsequently processed using finite impulse response basis function to address the variations of the hemodynamic response. Final analyses were carried out using permutation‐based statistics, which is appropriate for small samples. These analyses produce spatiotemporal maps of brain activity.ResultsReading silently relative to reading aloud was associated with activity of the “where” auditory pathway (Inferior parietal lobule and middle temporal gyrus), and delayed activity of the primary auditory cortex.ConclusionsThese pilot data suggest that internal space localization of the inner voice depends on the same neural resources as that for external space localization of external voices—the “where” auditory pathway. We discuss the implications of these findings on the possible mechanisms of abnormal experiences of the inner voice as is the case in verbal hallucinations.

Exploring Voice Hearers’ Occupational Experience of Romantic and Sexual Relationships

Background: Limited research has been conducted that explores the occupational experience of hearing voices, including the impact it has on romantic and/or sexual relationships. This study aims to address this gap by capturing the experience of romantic and sexual relationships for those who hear voices.

Tackling Gender and Racial Inequities: Climate Solutions for All

This commentary peice argues that tackling gender and racial inequities is a key piece in addressing the the climate crisis. When women and BIPOC feel comfortable and included in at the cliamte solutions table, the team that we need to save our planet grows significantly. Due to disportionate impacts of climate that women and BIPOC face, they have had to defend land and come up with their own solutions for years - it simply makes sense to listen to their experienced voices. Finally, the system of oppression and the system that prodoces greenhouse gases are very similar, meaning we cannot seperate issues of white supremacy, misogyny, and climate change. Dismanteling systemic racial and gender inequities needs to be part of the climate action plan.

Black Autism: A Conversation with Diana Paulin

Black Autism:A Conversation with Diana Paulin1 Julia Miele Rodas (bio) and Diana R. Paulin (bio) On May 18, 2019, at the Hotel Belleclaire on Manhattan's Upper West Side, I had the privilege of sitting down with Diana Rebekkah Paulin, author of the Errol Hill Award-winning Imperfect Unions: Staging Miscegenation in U.S. Drama and Fiction and Associate Professor of American Studies and English at Trinity College, Hartford. This interview was the outgrowth of years of more casual, ongoing conversations with Dr. Paulin about the ways that autism articulates with experiences of race, voice, representation, parenting, and definitions of personhood. Over the years, my conversations with Dr. Paulin have been far-ranging and exploratory, informed by intellectual questions as well as by personal concerns. The purpose of formalizing this conversation and bringing it to print is to offer readers a glimpse of Dr. Paulin's ongoing, long-term project—delving into expressions, experiences, and representations of Black autism and exploring the cultural configurations of autism in Black families and communities. The dialogue transcribed here is grounded in our May 18 interview and draws as well on the arc of our longer conversations to present some of her project's core questions. Julia Miele Rodas: I'd like to begin by asking you about a quotation from Paul Heilker's article, "Autism, Rhetoric, and Whiteness," where he talks about autism "being rhetorically constructed in public discourse as an overwhelmingly white condition." In your own project, "Black Autism," is this the starting point, this larger cultural context that privileges white autism and obscures Black autism? Diana Rebekkah Paulin: Well, yes and no. I think part of what I'm doing is excavational work. For me, thinking about all this started almost 20 years ago. So, yeah there wasn't Prahlad's memoir, The Secret Life of a Black Aspie, or the co-edited volume, All the Weight of Our Dreams. I had to think in terms of finding blogs or personal articles or short pieces. I had to look for short films, which are really hard to find. YouTube has been my friend! I've been collecting bits from a wide variety of sources, like Autism: the Musical—there's a young biracial boy, whose mother is very insistent on his ability to play the cello, and their family dynamics are also part of this, and there are also these twin boys who are African American who aren't [End Page 121] really featured, but they're sort of in the background of this production. I'm also still considering this, but in The Secret Life of Bees, there's a sister, May, one of the members of the family. She writes little notes and bits of poetry. And, to me, she reads as autistic. It's like she's too fragile for this world they're in, and she can't stand the racialized violence, and she escapes by drowning herself. I'm thinking about these spaces, asking how this character fits. What is it that she's representing that's unnamable, that fits into a longer trajectory of neurodivergence that kind of gets glossed over? I do see these flashes, these excerpts of culture, as an archive that is just being built. So, the project is excavational in that it's looking at stagings of autism and representations of Blackness. I can't ignore the historical disparities in diagnoses among people of color. JMR: This kind of excavation, building this kind of archive is already a vital piece of scholarship, but you're saying this is only part of the work? DRP: Yeah. I also want to focus on this underexplored intersection. For example, when autism is racialized as white, it's often seen as a puzzle or something that's inscrutable. And, there are all these ways in which those same characteristics invoke pathologies applied to Blackness historically. The same tropes that get used to erase white autism have also been used to render Blackness invisible, because Blackness was always pathologized, or it was constructed as inscrutable, or it was seen as a blank space on which you infuse meaning. JMR: So, Blackness and autism both...

Young people's narratives of hearing voices: Systemic influences and conceptual challenges.

Despite the prevalence of voice hearing in childhood and adolescence, little qualitative research has been undertaken with young people directly to advance phenomenological and aetiological insights into their experiences and interpretations. Consequently, the researchers sought demographic, contextual, and qualitative data from 74 young people from eleven countries, aged 13-18years (28%=male; 61%=female; 21%=Transgender and Gender Non-Binary [TGNB]), who self-identified as hearing voices. A Foucauldian-informed narrative analysis yielded four analytic chapters, offering novel perspectives into individual, relational, systemic, and cultural interpretative narratives surrounding multisensory and multi-self voice hearing. Overall, young people reported heterogenous experiences of voice hearing and associated sensory experiences, and most participants reported voice hearing beginning between ages 8 and 11. Further, the emotions felt by the child, as well as reactions displayed by people around the child in relation to the voices, influenced voice-related distress and the nature of the voices in a triadic relationship. A continuum of multisensory features of voice content, nature, and relational significance is tentatively proposed to capture the breadth and depth of voice hearing for adolescents to offer a possible framework for future study and intervention design. Specifically, participants described that voice-related distress could be exacerbated by observed anxiety or internalized stigma about voice hearing, social isolation, and attribution to illness. These findings suggest that we may need to reconsider how the experience of hearing voices in childhood influences their relationships and how relationships influence the voice hearing experience. Further, young people seem to have a broad understanding of what the term "hearing voices" means, which could inform how researchers and practitioners work with this group of young people. Finally, participants described benefitting from multisensory coping strategies, such as imagery and meditation, which could offer important considerations for tailoring therapeutic interventions for adolescent voice hearers.

Development of the German Speech Intelligibility Index for the treatment of oral cancer patients

ObjectivesThis study aimed at 1) adapting the well-established Speech Handicap Index (SHI) to German, 2) testing the suitability of the instrument for assessing speech-related quality of life, 3) comparing it to the German Voice-Handicap-Index (VHI), in order to support treatment of oral cancer patients who experience posttreatment speech difficulties that affect their quality of life. Material and methodsParticipants completed a web-based survey that employed a 2 (experienced problem: speech/articulation-related vs. voice-related) x 2 (SHI vs. VHI) between-subject experimental design, enabling it to distinguish between the experiences of voice and intelligibility impairments, and to determine the discriminatory ability of the two instruments. ResultsThe German SHI reliably assessed speech intelligibility and articulation-related Quality of life. While voice impairments were equally well assessed by both, VHI: M 2.48, SD 0.65; SHI: M 2.52, SD 0.63; only the latter appropriately registered intelligibility handicap in speech impairments (VHI: M 2.05, SD 0.70; SHI: 2.68, SD 0.73). The responsivity of the SHI in capturing the experienced handicap was significantly greater in the speech/articulation-impairment condition (p = .001). ConclusionThe German SHI is a reliable and responsive measure for speech intelligibility and articulation-related quality of life that should be chosen in preference to the VHI.

When spirits speak: absorption, attribution, and identity among spiritualists who report “clairaudient” voice experiences

ABSTRACT For mental health researchers and others committed to a bio-cultural understanding of religious experience, there is a need for empirical studies capable of shedding light on the interplay between beliefs, personalities, and the occurrence of anomalous sensory experiences. Absorption, a trait linked to one’s tendency to become immersed in experience or thought, may be key for understanding that relationship. Spiritualist mediums (N = 65) completed an online questionnaire assessing the timing, nature, and frequency of their auditory (clairaudient) spiritual communications – including scales measuring paranormal beliefs, absorption, hallucination-proneness, and aspects of identity. These measures were compared to a general population group (N = 143), with results showing higher levels of auditory hallucination-proneness and absorption among the Spiritualists as well as correlations between spiritual beliefs and absorption, but not spiritual beliefs and hallucination-proneness, for the general population. Findings are discussed in relation to attribution models of religious experience and the complexity of “absorption” as a construct.

Treatment efficacy of electronic endoscope-guided botulinum toxin injection in adductor spasmodic dysphonia patients

Objective:To investigate the treatment efficacy of electronic endoscope-Guided botulinum toxin injection in Adductor Spasmodic Dysphonia Patients. Method:Clinical characteristics of forty- three cases were retrospectively analyzed. The disease were diagnosed with adductor spasmodic dysphonia and graded according to the severity of the disease by experienced voice specialist. All the cases were treated by electronic endoscope-guided botulinum toxin type A injection in bilateral thyroarytenoid muscles. All the subjects underwent stroboscopic laryngoscope examination and filled in the Voice Handicap Index-10（VHI-10）. They also filled in the VAS score of Voice related symptoms by self evaluation and other evaluation . One month Later, the patients and someone they lived with filled in the VAS score of Voice related symptoms again. Result:After the first injection, the voice-related symptoms of 35 patients improved to varying degrees..All The average onset time of drug was（2.33±1.86） days. The duration of curative effect ranged from 1 to 6 months, the average duration was（2.42±1.65） months. After injection, no one had serious or persistent adverse reactions. There were significant differences in the total score of VHI-10, physiology（P） and function（F） dimensions in VHI-10 of moderate and severe SD patients before and after injection（P<0.05） in all patients. For moderate cases, no significant change in speech articulation（P>0.05）, overall evaluation of voice quality and any other subprojects are statistically significant（P<0.05） in the VAS score of Voice related symptoms; For severe cases, the degree of squeezing and effort during vocalization are no statistically significant（P>0.05）, overall evaluation of voice quality and any other subitems are statistically significant（P<0.05） in the VAS score of Voice related symptoms. Conclusion:In the absence of LEMG, electronic endoscope-guided botulinum toxin injection in adductor spasmodic dysphonia patients can significantly improve the voice quality and quality of life of adductive SD patients. The method is simple to operate, less traumatic, safe and effective, and easy to carry out outpatients service.

The challenges and opportunities of social connection when hearing derogatory and threatening voices: A thematic analysis with patients experiencing psychosis.

ObjectivesRelationships with other people are important determinants of the course of psychosis, yet social isolation is common. This study sought to learn about the patient experience of being around other people when hearing derogatory and threatening voices (DTVs).DesignA qualitative interview study.MethodsFifteen participants with experience of hearing DTVs in the context of non‐affective psychosis were recruited from NHS services. Data were obtained by semi‐structured interviews and analysed using thematic analysis.ResultsThree themes were identified: (1) reasons why interacting with people is difficult when hearing DTVs; (2) the relationship between social connection and DTVs; and (3) factors which enable voice hearers to connect with others. A further ten sub‐themes are outlined as reasons why hearing DTVs led to lower social connection, including difficulties during conversations (e.g., the concentration required is hard), negative expectations of interactions (e.g., fearing negative judgement from others), and difficulties sharing experiences of voices (e.g., people will be hurt or upset if I tell them about the voices). Isolation was a common response to hearing DTVs but also a time of vulnerability for hearing voices. Managing the challenges of interacting with people led to some improvements in DTVs.ConclusionsThere are understandable reasons why hearing DTVs leads to lower social connection. Yet isolating oneself can also be a time of vulnerability for DTVs. Social connection might be one vehicle for disengaging from and disputing derogatory and threatening voice content. The effect on voice hearing of social recovery interventions warrants further investigation.Practitioner points Participants shared 10 reasons why being around people is challenging when hearing derogatory and threatening voices. These typically affected both daily social experiences and contact with clinicians.Common initial responses to hearing DTVs were to reduce contact with people, experience difficulties connecting during conversations and to avoid sharing the experience of voice hearing.However, social isolation was a time of vulnerability to DTVs, and hence, increasing social connection might be a target for interventions.A range of factors enabled voice hearers to manage social situations, for example: the fostering of trust, self‐acceptance, learning when it is better to stay at home, and developing a narrative to explain voice hearing to others.Addressing the barriers to connecting with others might have an important role in personal recovery from voice hearing.

Perceptual Voice Qualities Database (PVQD): Database Characteristics

To develop a perceptual voice quality database for educational and research purposes. Development of a database. A total of 296 high quality audio file recordings consisting of sustained /a/ and /i/ vowels and sentences from Consensus Auditory-Perceptual Evaluation of Voice were made in clinical environments. Nineteen experienced voice clinicians rated the audio samples using voice qualities from the Consensus Auditory-Perceptual Evaluation of Voice (without visual anchors) and GRBAS scales. The database includes samples of a wide range of voice quality severities across a wide range of speaker age and sex. Both inter- and intrarater reliabilities were established to be good for the database overall. The database is housed in the Mendeley Data online repository and is free for public use.

Moodle LMS Integration with Amazon Alexa: A Practical Experience

The frequency of interaction between teachers and students through Learning Management Systems (LMSs) is continuously rising. However, recent studies highlight the challenges presented in current LMSs to meet the specific needs of the student, regarding usability and learnability. With the motivation to support the research of effectiveness when using a Voice User Interface (VUI) for education, this paper presents the work done (RQ1) to build the basic architecture for an Alexa skill for educational purposes, including its integration with Moodle, and (RQ2) to establish whether Moodle currently provides the necessary tools for voice-content creation for develop voice-first applications, aiming to provide new scientific insight to help researchers on future works of similar characteristics. As a result of this work, we provide guidelines for the architecture of an Alexa skill application integrated with Moodle through safe protocols, such as Alexa’s Account Linking Web Service, while our findings ratify the need for additional tooling within Moodle platform for voice-content creation in order to create an appealing voice experience, with the capabilities to process Moodle data structures and produce sensible sentences that can be understood by users when spoken by a voice device.

The phenomenology of auditory verbal hallucinations in emotionally unstable personality disorder and post-traumatic stress disorder.

To explore the phenomenology of auditory verbal hallucinations (AVHs) in a clinical sample of young people who have a 'non-psychotic' diagnosis. Ten participants aged 17-31 years with presentation of emotionally unstable personality disorder or post-traumatic stress disorder and frequent AVHs were recruited and participated in a qualitative study exploring their subjective experience of hearing voices. Photo-elicitation and ethnographic diaries were used to stimulate discussion in an otherwise unstructured walking interview. 'Non-psychotic' voices comprised auditory qualities such as volume and clarity. Participants commonly personified their voices, viewing them as distinct characters with which they could interact and form relationships. There appeared to be an intimate and unstable relationship between participant and voice, whereby voices changed according to the participants' mood, insecurities, distress and circumstance. Equally, participants reacted to provocation by the voice, leading to changes in mood and circumstance through emotional and physical disturbances. In contrast to our previous qualitative work in psychosis, voice hearing was not experienced with a sense of imposition or control. This phenomenological research yielded in-depth and novel accounts of 'non-psychotic' voices which were intimately linked to emotional experience. In contrast to standard reports of voices in disorders such as schizophrenia, participants described a complex and bi-directional relationship with their voices. Many other features were in common with voice hearing in psychosis. Knowledge of the phenomenology of hallucinations in non-psychotic disorders has the potential to inform future more successful management strategies. This report gives preliminary evidence for future research.

The oppressive boss and workers’ authoritarianism: effect of voice suppression by supervisors on employees’ authoritarian political attitudes

ABSTRACT This study examines the relationship between employee voice suppression by workplace authorities (i.e. supervisors) and the formation of employees’ attitudes towards political authority. We test whether the effect of experienced voice suppression by supervisors on employees’ preference for authoritarian governance is positive, negative or nonlinear. The hypotheses are tested on original data gathered within the Dutch Work and Politics Survey 2017 (N = 7599), which allows for a wide range of demographic and organisational control variables. The results favour a nonlinear effect of suppression on employees’ authoritarianism. These results support the notion that political attitudes are dynamic and that the workplace plays a role in shaping them.

Why do patients with psychosis listen to and believe derogatory and threatening voices? 21 reasons given by patients.

Around two-thirds of patients with auditory hallucinations experience derogatory and threatening voices (DTVs). Understandably, when these voices are believed then common consequences can be depression, anxiety and suicidal ideation. There is a need for treatment targeted at promoting distance from such voice content. The first step in this treatment development is to understand why patients listen to and believe voices that are appraised as malevolent. To learn from patients their reasons for listening to and believing DTVs. Theoretical sampling was used to recruit 15 participants with non-affective psychosis from NHS services who heard daily DTVs. Data were obtained by semi-structured interviews and analysed using grounded theory. Six higher-order categories for why patients listen and/or believe voices were theorised. These were: (i) to understand the voices (e.g. what is their motive?); (ii) to be alert to the threat (e.g. prepared for what might happen); (iii) a normal instinct to rely on sensory information; (iv) the voices can be of people they know; (v) the DTVs use strategies (e.g. repetition) to capture attention; and (vi) patients feel so worn down it is hard to resist the voice experience (e.g. too mentally defeated to dismiss comments). In total, 21 reasons were identified, with all participants endorsing multiple reasons. The study generated a wide range of reasons why patients listen to and believe DTVs. Awareness of these reasons can help clinicians understand the patient experience and also identify targets in psychological intervention.

Visited by spirits – ‘Betwixt and between’ in meditation and solitary confinement in Myanmar

This article takes as its starting point the similar, yet differing, experiences of hearing voices among prisoners in Myanmar. It discusses why the experience of hearing voices described by prisoners is regarded as an occasion to share compassion when it occurs during meditation retreats and as torture when it occurs in solitary confinement. The article uses the concept of liminality to make sense of variations in these spiritual experiences and focuses on three factors: the presence or absence of communitas; a master of ceremony or other guidance; and whether the experiences take place at the volition of the person or is forced upon him. This leads to the conclusion that solitary confinement, due to its forced nature and the absence of communitas and guidance, represents a situation in which the prisoner is at risk of prolonged liminality and social harm which can unhinge him from his interrelational self.