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

Abstract

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 13-18 years (28% = male; 61% = female; 21% = Transgender and Gender Non-Binary [TGNB]), who selfidentified 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.

“Figuring out how to be normal”: Exploring how young people and parents make sense of voice‐hearing in the family context

“…This chimes with Morrison et al ( 2020 ) who highlighted that young people in first episode psychosis (FEP) services can be reluctant for family to be involved. However, in line with Parry et al ( 2021 ), family stories and influences had clearly been absorbed, even if they were not explicitly acknowledged. Supporters that were most valued were often parents that they did not live with, siblings, extended family and friends.…”

“…Shame, secrets, and isolation are a common feature of voice‐hearing accounts (Woods, 2017 ) and these are no exception. Here they tangle together with cultural and systemic influences such as fear of judgement and stigma (Parry et al, 2021 ). The strongest common influence between parents and young people, though contested in different ways, was ‘voices = bad/mad’.…”

Distress factors of voice‐hearing in young people and social relating: Exploring a cognitive‐interpersonal voice‐hearing model

“…By using a nuanced first‐person perspective analysis of online survey data, Parry and Varese ( 2020 ) reported that distressing voices were mostly described with a sense of relational distance, which is consistent with adult literature (Hayward, 2003 ). Moreover, findings indicated that voices often reflected how young people experienced close social relationships, potentially showing an important role for the influence of appraisals of social others on young people's voice‐hearing experience and/or vice versa (Parry et al, 2020 ).…”

“…Adult research has suggested that hearers could spend a substantial amount of time talking to voices, creating interpersonal relationships with them (Corstens et al, 2012 ) and that voices could be fulfilling social needs that are not met in other relationships (Beavan & Read, 2010 ; Corstens et al, 2012 ; Mawson et al, 2010 , 2011 ), potentially leading to spending less time in other social interactions (Favrod et al, 2004 ). Parry et al ( 2020 ) reported that young people commonly attributed their voice‐hearing to loneliness and social isolation. In turn, however, voices, irrespective of being positive or negative, could make social interactions more difficult as they can have a negative effect on concentration, leading to more social isolation and in some cases young people becoming more dependent upon their voices, as a result (Parry & Varese, 2020 ).…”

“…Collectively, there is only limited research that draws from cognitive models of voice‐hearing to investigate potential psychological determinants of distress in young people with this experience (Cavelti et al, 2019 , 2020 ) or that adopts a relating perspective in understanding voice‐related distress in youth (Parry et al, 2020 ; Parry & Varese, 2020 ). This gap in the literature impacts on the development of appropriate psychological support and interventions for young people with distressing voice‐hearing.…”