People who are diagnosed with ‘severe mental illness’ experience some of the most extreme and pervasive prejudice of all groups in Western society. How can this still be so? Although the term ‘mental illness’ is typically reserved for the most ‘serious’ of ‘cases’, psychiatry’s medical model is expanding into increasingly everyday realms. Thus, in concert with efforts to reduce social stigma, ‘mental illness’ is becoming ‘normal’. Nevertheless, ‘abnormality’ is a requirement of biopsychiatry and its offshoots; professionals require some ‘thing’ to remedy. How do ‘clinical’ professionals manage these tensions? And what alternatives are there to the pathologizing of such phenomena? Such concerns are considered in relation to my main thesis question: How do professionals represent ‘schizophrenia’ and hearing voices in theoretical texts, and how is that played out in the minutiae of therapy practices? Drawing on discourse analysis and conversation analysis, I critique professional categorizations of what are typically known as ‘schizophrenia’, ‘mental illness’, ‘patients’, ‘clients’, and ‘therapists’. My case in point is the experience of hearing voices - pathologically known as ‘auditory hallucinations’. ‘Delusional’ beliefs are also considered. In Part 1, accounts of voices as supernatural or ordinary phenomena, or as a ‘symptom’ of ‘severe mental illness’, are considered. Mainstream psychiatric and psychological texts are analyzed and critical alternatives are summarized. In Part 2, a selection of studies of interactions involving ‘severe mental illness’ are reviewed and ongoing analytic/methodological debates are discussed. A cognitivebehavioural therapy group for hearing distressing voices then provides data from ‘clinical’ talk-in-interaction for analysis. I focus on negotiations of ‘reality’ (the ordinary versus the psychiatric) and on what I take to be sanist prejudice-in-action. Part 3 relates findings from Part 2 to the context and findings of Part 1. There is also discussion of the positive implications of a more social and dialogical approach to understanding and otherwise dealing with the phenomena in question; for voice hearers, ‘schizophrenics’, and society at large.

There is a paucity of literature into the first-person account of hearing voices (HV)1, particularly from diverse cultural groups. This research aimed to explore the meaning-making of African-Caribbean men who have heard voices, within a social constructionist framework. Five participants were recruited via community networks and individually interviewed. Narrative analysis was employed to illustrate both individual and collective stories of HV. Four emerging storylines were constructed: 'Storylines of the changing understandings of hearing voices over time', 'Recovery: Reformation, Redemption and Restoration', 'Storylines of family life and understandings of culture and race', and 'From Silence to Freedom: Speaking Out and Reaching Out'. Findings of this research suggest re-storying HV outside of a medical framework, with voice-hearers' meaning-making of the voices an integral part of understanding the phenomenon, in the context of psycho-social and cultural factors. Implications for de-mystifying voice-hearing, particularly in African-Caribbean communities, are considered in the context of promoting education and awareness of HV through community-based approaches, cross-cultural working and supporting the voice of expert by experience, in the hope of challenging dominant discourses attached to HV. Future research suggestions are discussed and researcher reflexivity concludes the study.

Background Beliefs about voices, their origin, intent and powerfulness can all impact on the voice hearer, their level of distress and their need for help. Interpersonal difficulties can exacerbate distress and be reflected in the person’s relationship with their voices. Emotion regulation strategies, which may be functional or dysfunctional help the person manage their reaction. This study aims to investigate beliefs about voices, symptoms and interpersonal issues as well as how well these areas predict emotion regulation strategies Methods Two groups of participants (18 with low and 16 with high omnipotence scores) were recruited through their mental health workers. The participants completed six self-report measures that assessed beliefs, emotion regulation strategies, interpersonal difficulties, dimensions of voice hearing and symptoms. Results Omnipotence scores differentiated some of the interpersonal issues and only one symptom subscale (phobic anxiety); those who scored high on the omnipotence subscale experienced more difficulties. For the emotion regulation subscales, lower omnipotence scorers differed significantly from the higher omnipotence scorers, using more external functional and dysfunctional strategies. Regression analysis showed that ‘distress’ incorporating the PSYRATS emotion subscale, the BSI grand total and the IIP-32 total predicted the use of dysfunctional emotion regulation strategies, but omnipotence beliefs did not add much to this. Conclusions Overall voice hearers experience a range of beliefs about their voices. Those with higher omnipotence beliefs find it difficult to socialise, be involved with other people, and are too dependent and caring with reference to other people. Omnipotent beliefs did not, in general, differentiate symptoms or emotion regulation strategies. This would suggest that beliefs may not be what determines distress and subsequent help seeking. Distress and interpersonal issues predict the use of emotion regulation strategies with little being added to the prediction by omnipotent beliefs; this suggests that there may be an alternative to the single symptom approach. Further research is required to assess the contribution made by emotion regulation to the development, maintenance and course of voice hearing. Assessment and interventions with reference to emotion regulation also require investigation.

Experiences of presence are common in bereavement. The bereaved person may see the deceased, hear their familiar voice, or otherwise feel they are close at hand. But although common, they are experiences not without controversy. They have come under a variety of descriptions, from 'hallucinations', lacking in meaning and even essentially meaningless, to 'continuing relationships', of rich personal significance. The current thesis represents the first systematic investigation of the properties and meaning of experiences of presence. Narrative biographic interviews with bereaved informants were analysed using Ethnomethodology and Conversation Analysis. Analytical focus was on the ways in which participants made such experiences meaningful. As a novel approach, this thesis reports several new findings about these phenomena. Firstly, the experiences happened in a variety of bonds (including spouses, parents, grandparents, children, siblings and others), and in a variety of circumstances of the bereavement (including sudden and expected deaths). In all cases, they were described as richly meaningful experiences and as relying on several sources for this meaning. The personal histories of participants were of particular importance in making sense of experiences of presence. Within this context, the experience acquired sense as a continuation of some aspect of the relationship with the deceased. The experiences also had diverse functions, from soothing to destructive. Sometimes, the experiences helped the bereaved to resolve unfinished business with the deceased; at other times, the help was with a much more ordinary problem. On some occasions the experiences of presence caused the bereaved more problems; they simply pronounced the grief or continued a fraught relationship. Participants showed that they had many cultural resources available to them in making sense of their experiences but they did not use all of them. Many informants used some spiritual and psychological ideas to make sense of their experiences. The thesis concludes that many of the most popular theories for these experiences impoverish them by stripping them of their diversity and important aspects of their meaning. The thesis also makes recommendations for psychotherapy for those who have problems of living as a result of their experiences of presence. The study also has implications for psychological research as none of these findings could have been observed through the use of an experimental methodology.

Hearing voices is a well researched experience, found in both schizophrenia and the general population. Previous research investigating the unusual experience has reinforced cognitive psychology concepts such as beliefs, power, core beliefs about the self, intent and identity. It has been suggested that these factors all mediate individual coping with the experience. Coping with voices is a clinically significant area of research pioneered by Romme and Escher and requires careful consideration. Kelly‘s Personal Construct Psychology and the repertory grid technique were used in the study to compare two ways of coping with voices: engaging and resisting coping. The groups were compared on the repertory grid measures of construed distance between the self and the voice, salience of the self and voice, and tightness of the overall construct system. In a sample of 18 voice hearers, the Beliefs about Voices Questionnaire- Revised (BAVQ-R), a measure of psychological distress (OQ45.2) and Kelly‘s repertory grid were administered. The study also used three case examples and content analysis of construct poles applied to the dominant voice and the self as coper to supplement the quantitative analysis with a more in-depth exploration. Resisting coping was found to be associated with a greater construed distance between the self and the voice, a more salient view of the voice, and a tighter construct system. However, neither resisting nor engaging coping was associated with psychological distress. In addition, voice malevolence was associated with distancing oneself from the voice, suggesting that distancing was an adaptive coping strategy used, possibly as a way to preserve selfhood. The study therefore added to the list of mediating factors between the voice hearing experience and the coping strategy adopted. As a result, the repertory grid showed some scope in assessing the three areas of interest. The findings suggest that clinically, voice hearers can best be supported by adopting the appropriate relational approach with the voice (closeness or distance), reducing the salience of the voice and moving through Kelly‘s Creativity and Experience Cycle.