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- Scrap A Case Study Voices Of Nursing Home Residents
The speaker is Margaret, a woman in her seventies with a bright, open face and a gentle smile. She has come along today with her daughter, who is desperate for advice on helping her mother to cope with her frequent voices. There are around 20 of us in the room. Apart from a couple of clinical psychologists and a few of us from the academic team, everyone gathered here in a conference suite at Durham University on a cold, sparkling spring afternoon, is a voice-hearer.
We are hosting the event with our special guest Jacqui Dillon, chair of the UK Hearing Voices Network and an old friend of our project. Before Margaret came into this room, she had never met another voice-hearer.
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Now she is surrounded by them. I see her deep in conversation with Julia, a writer of a similar age who has come to talk to us several times about her experiences. Two elderly ladies, sipping tea and chatting about the voices in their heads. Julia is an old hand, but Margaret is in entirely new territory. I have the sense that a life could be changing in front of my eyes.
Groups like this come together around a starting assumption that voices are meaningful, and that they convey valuable emotional messages. The idea is antithetical to the traditional biomedical view from psychiatry, which has tended to see voices as neural junk, meaningless glitches in the brain — yet many people are now finding solace in this approach. In the past, medicine had treated auditory hallucinations as meaningless glitches in the brain - but many people now find meaning in the inner voices Credit: Olivia Howitt.
Longden was urged to seek medical help, and her college doctor referred her to a psychiatrist — the beginning of a journey from a straight-A student to cowering, degraded psychiatric patient. Like countless others, Longden has benefited from the alternative framework of understanding that the Hearing Voices Movement has given her. After her grim days in hospital, she was seen by an enlightened psychiatrist, Pat Bracken, who helped her to understand her voices not as symptoms of disease but as survival strategies.
She had been brutalised by her experiences, and her psyche was struggling to adapt. Longden began to understand her voices as resulting from the horrific and organised sexual torture she had suffered as a small child. Instead, the Hearing Voices Movement approach is to encourage voice-hearers to try to understand the events that led to the emotional distress that the voices are expressing. Rather than attempting to quash the hallucinations, the Hearing Voices Movement encourages people to question the story behind their voices Credit: Olivia Howitt.
The movement has its origins in a particular therapeutic partnership between Romme and one of his patients, a young Dutch woman named Patsy Hage.
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But Hage insisted that her voices were as real and significant as the deities to whom those around her prayed. When they appeared together on Dutch television to discuss the work they had been doing and to appeal for voice-hearers to contact them, there was an overwhelming response.
Around of the people who contacted them had found ways of living contentedly with their voices. As the movement grew, its basic tenets began to cohere: that hearing voices is a common aspect of human experience, which can be distressing but is not inherently a symptom of illness; and that voices bear messages about emotional truths and problems which can, through taking the voices seriously and with appropriate support, be resolved. Some voice hearers believe their experiences parallel the way Ancient Greeks in the Iliad communicated with the gods Credit: Olivia Howitt.
At first glance, this looks utterly different to the idea that voices result from atypical processing of inner speech. Rather than pointing us to the processing of language and the speech perception networks in the brain, it suggests that we should look for a link with traumatic memories. Clinically, and from the evidence of personal testimony, this makes perfect sense. What scientific support, though, is there for the idea that voices are about memories of the past? One way of addressing this question is to ask whether those who hear voices show any differences in how they process memories.
Flavie Waters and her colleagues at the University of Western Australia have proposed that auditory hallucinations result from a failure to inhibit memories that are not relevant to what the person is currently doing. Coupled with a problem with context memory — which refers to the ability to recall the details of the context in which an event happened — this can lead to memories intruding into consciousness shorn of the contextual anchors that would usually allow us to recognise them as a memory rather than a hallucination. Another line of evidence comes from associations with trauma.
There is now very strong evidence for a link between hearing voices and early adversity, particularly childhood sexual abuse. In one recent study led by Richard Bentall, childhood rape was strongly and specifically associated with hallucinations later in life. To give an indication of the strength of the relationship, Bentall likened it to that between smoking and lung cancer.
Voices may come from dissociation, a phenomenon in which thoughts, feelings and experiences are not integrated into our consciousness in the usual way Credit: Olivia Howitt. The memory account faces serious problems, though. For one thing, it has to explain how memories of horrible events can lie dormant for so many years before resurfacing in early adulthood — the peak time for the diagnosis of disorders like schizophrenia. Creating a memory is a reconstructive process that involves bringing together lots of different sources of information, some of which are erroneously included, having not figured in the original event at all.
We are particularly bad, even over a short period, at recalling the exact words that people say to us: we tend to recall the gist of messages rather than their verbatim information. That would be problematic if we wanted to propose that voices are literal reproductions of earlier conversations. The missing link between trauma and voice-hearing might be a psychological phenomenon known as dissociation. First described by the French psychiatrist Pierre Janet towards the end of the 19th Century, dissociation refers to the phenomenon whereby thoughts, feelings and experiences are not integrated into consciousness in the usual way.
The connection with hearing voices comes through the finding that people who live through horrific events often describe themselves dissociating during the trauma. It is as though there is some drastic attempt by the psyche to remove itself from the horror that is unfolding: drastic because it effectively involves the psyche cleaving itself into pieces.
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Dissociation perhaps just describes an extreme version of what is normal in the rest of us. Eleanor Longden is now a postdoctoral researcher specialising in how the psychological processes of dissociation might help to explain the occurrence of trauma-related voices. Voices feel more disowned and externalised in most cases, but essentially I think they represent a similar process. Voices may represent a fragmented self - and integrating them back into the conscious experience could be a key to recovery Credit: Olivia Howitt.
Voices, then, might give us important clues about the fragmentary constitution of an ordinary human self. This view of a dissociated self is already paying dividends in research on voice-hearing, although much remains to be done in explaining exactly what these fragments of self look like, and how they operate and behave.
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A dissociation account is still some way from explaining how traumatic memories become transmuted into hallucinations — and in particular why those experiences are so often verbal — but it is a promising avenue for future research. Perhaps the most valuable thing about thinking about voices in this way is its implications for managing the experience. If voices are at least partly about things that happened to you, then they give you something you can work with.
They hold out the prospect of recovery. This is an idea that the Hearing Voices Movement has used to powerful effect. When Eleanor Longden offered forgiveness to her most unpleasant voice, the tone of its communications with her changed. This was war. The homeless bed down for the night, stag and hen parties traipse through, and drunks pass out on the street leaking trails of urine.
So when developer Salboy, owned by billionaire bookie Fred Done, announced at a public consultation about luxury flats that one of the Victorian warehouses on the Soap Street site was to be demolished under emergency orders the next day , residents rallied. The Northern Quarter in context.
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Image: Google. Unease about gentrification had been growing for several months. Arts organisations and long-time independents were forced out when their rents were put up per cent overnight. The Northern Quarter has become a hotspot for short-term lets , with visitors throwing all night parties, failing to follow waste management rules, and even, say some, harassing residents in their own buildings.
Property management companies are now renting flats as short-term lets rather than to long-term residents, and individuals are building up property portfolios of their own.
Scrap A Case Study Voices Of Nursing Home Residents
As in other cities, there is both a concern that short-term lets are pushing up house prices, and long term questions about what sort of economy short-term lets stimulate: night clubs, not hardware stores. Salboy has three projects in the works — one under construction and two, including Soap Street, seeking planning permission. The only way to make the numbers work — to maximise profit — is to sell at a higher price point to overseas investors.
So is the Northern Quarter a cultural hub or a party district? Is it a cherished conservation area for a diverse mix of residents to call home, or a free-market playground for international capital to make a fast buck? Despite having powers to issue notices requiring owners of decaying buildings to conduct repairs, some buildings have sat derelict for decades. Image: Andrea Sandor. When I meet with Sir Richard Leese, I ask the leader of the City Council what measures were taken to save the recently demolished buildings.
He tells me both were under development, as though the expectation was they were being refurbished. Even Leese reminds me it can be more profitable to knock down and build new. So how did we get here? Manchester, having fallen from its industrial heyday into a depressed backwater, was in a dire state. Between and , jobs in the city declined by 22 per cent and Manchester residents cleared out of the slummy city centre for the greener fringes.
Around this time, artists and architects started moving into the derelict Northern Quarter due to cheap rents, slowly transforming it into a bohemian mecca. And there is much to admire. But now the market-driven approach is running away from them: on some estimates, Manchester is growing 15 times faster than it can build housing.