This month in voices: August 2014

This month’s voice-hearing research covered topics ranging from changing how you relate to your voices, brain tumours, interdisciplinary approaches to voice-hearing and ‘friends interventions’.

 

Brighton-and-Hove-20120717-01469

Brighton Rock: The much better selling sequel to Snickers in Southampton. This blog’s regular readers may wonder why Graham Greene puns don’t continue through this month’s blog. They were going to, until I found out that Greene was a man with “a definite quirk for brothels” (he kept a list of his favourite 47 prostitutes – favourite 47?!), and that there are some very serious allegations made about him. He will hence feature here no further.

Brighton, UK. Mark Hayward and colleagues allow us to pier into the future (boom, boom!) to see the design for a trial of a relatively new psychological therapy to help people who are distressed by hearing voices.

Accessible summary: This proposed study draws on work which explores hearing voices from an interpersonal perspective, examining the interactions that can occur between the hearer and their voice(s). As Mark Hayward has put it “if relating to voices is influenced by relationships in the real world, it is likely to be imbued with all the complexity and idiosyncrasy of social relationships”. This therapeutic trial will draw on Relating Therapy which aims to re-balance the power relations between the hearer and their voice(s), as well as the proximity between the person and their voice (i.e., how intrusive the voice is, whether the person distances themselves from their voices, or feels close to them)

The study will assess the success of the therapy by examining changes in voice-related
distress, rather than things like whether the frequency of the voices, or how loud they are, change. A further study will then test whether any  changes in voice-related distress occur because of factors such as people finding their voices to be less dominant and intrusive as a result of the therapy.

Basically, the therapy will run as follows (drawing on the book Overcoming Distressing Voices)

  1. A consideration of how people typically respond to voices that relate to them in a negative way, such as by giving in, fighting back, or trying to escape. This is followed by introducing the idea of relating differently to voices.
  2. An exploration of whether how the person relates to their voices may be linked to how they relate to other people in their lives (including identifying themes of abuse, disempowerment, or rivalry).
  3. The exploration and development of assertive approaches to relating, both to the voice(s) and other people in their social world.

Fingers crossed for some good results.

Link to paper (free to read): Hayward et al. paper

 

HTVDurham, UK. Marco Bernini and Angela Woods discuss interdisciplinary research using a project on hearing voices at Durham University (‘Hearing the Voice‘) as an example.

Accessible summary: First I should say that I am also a member of this project, so my view of it is not unbiased! Anyway, how, asks the paper, do you integrate the cognitive sciences (neuroscience, cognitive psychology, and philosophy of mind), phenomenology, and humanistic disciplines (literature, narratology, history, and theology). You may think the answer is the same way that you would try to integrate a fox armed with an assault rifle, a chicken covered in banana yoghurt, and a gorilla who can only communicate by drumming Phil Collins songs but who has had his drumsticks stolen, i.e., you don’t. And if you do it will be, at best, atonal and sticky, and at worst, a squawkhowling bloodbath.

Indeed, as Bernini and Woods note, disciplinary incursions have previously been viewed as hostile colonial encounters, and fears raised that disciplines will “overflow into each other like anarchic lava lamps”. These are both salient metaphorical concerns. And literal ones: I once opened one of my housemates lava-lamps and tried to explore what the stuff inside actually was. It never worked properly again (sorry, Ed).

But never one to be pessimistic, the Hearing the Voice project is trying (successfully) to overcome these barriers “to attain a new holistic understanding of voice-hearing, examining its significance as an aspect of personal narrative and as psychiatric symptom, conducting empirical studies into its cognitive and neuroscientific mechanisms, performing culturally sensitive investigations of its personal, social, and historical significance, and leading translational research into its therapeutic management.”

How does it do this? Well, central to this project is “Voice-Club”, facilitated by the artist Mary Robson, and attended by all members of the core Durham-based team. Here, there occurs a “cognitively integrated system of extended disciplinary minds”, which interact in what Bernini and Woods call ‘enhancing loops’ (“feedback loops which produce cognitive enhancement, i.e., they disclose theoretical and/or testable hypotheses previously unthinkable by a single disciplinary mind”). In concrete terms, these loops involve things such as:

  • Intuition Pumps: These are tools which stimulate specific kinds of thinking and are present in every discipline, whether it be Plato’s cave or Aesop’s short stories. In Voice Club new intuition pumps can be generated and previous pumps powered by the output of other pumps, or re-engineered to pump out different products.
  • Front Loading: What we learn from disciplines such as phenomenology or the humanities can be ‘front-loaded’ into the design of scientific experiments. What to load and how has been the subject of two Hearing the Voice ‘neurohackathons’ in which humanities researchers have participated directly in experimental design.
  • Terminological Negotiations: Each discipline has different words for describing a similar concept, or the same word signifying completely different meanings. By exploring these, loops can be created that lead to unexpected terminological and conceptual innovations.
  • Enactive Constraining: Interdisciplinarity is not a form of ‘knowing-that’ but of  ‘know-how’. Disciplinary minds discover in the interaction and extension with other minds what is possible to do and what is not.

As Bernini and Woods reiterate, these processes all function to produce thoughts and outcomes that were unthinkable or unpredictable before. In the always lyrical prose of Fitzgerald and Callard, the Hearing the Voice project seeks “experimental entanglements”, where “To be entangled is precisely not simply to labour together, or to compare – or engage in ‘dialogue’ about – our different disciplinary perspectives. It is to proceed, instead, on the assumption that entanglements … might produce something new in the world, even as the forms that that newness might take are undecided, and undecidable, prior to the moments of experimentation”.

How could you not love this project?

Link to paper (free to read): http://dx.doi.org/10.1002/wcs.1305

 

Rudi

Howzat for a paper! (sorry, wrong Rudi).

Colwyn Bay, Wales: Rudi Coetzer discusses a case of voice-hearing after a brain tumour.

Accessible summary: So, a woman in her mid-60s, with no history of previous psychiatric problems, presents to hospital with a history of progressively worsening
lethargy, headaches, and left leg weakness.

Let’s get the whiteboard out and figure out what’s causing this.

It’s Lupus! Grab the prednisone and start the plasmapheresis! Sorry, I’ve been watching too much House M.D. No , it wasn’t Lupus.

A brain scan revealed a solitary meningioma (brain tumour) in the right frontal lobe. This was surgically removed, but the lady then started hearing voices. The voices never went into remission, despite her trying antipsychotic medication. The voices said she was being controlled by persons in the neighborhood or poisoned, and the experience also involved hearing the voices of dead people.

Does this mean there is a role for the right frontal brain region in causing some voice-hearing experiences? Perhaps so.

Link to paper: http://journals.psychiatryonline.org/article.aspx?articleid=1893502

 

Other papers:

  • Swiney and Sousa march into the debate about the mechanics of the relation between inner speech and hearing voices, offering a thoughtful consideration of the comparator account of hearing voices. The paper is free to read here.
  • Brockman and colleagues examine the psychometric properties of the short-versions of the Voices Acceptance and Action Scale (VAAS). Link to abstract here.
  • Mark Ellerby argues that “Hallucinating also sounds a lot better and much less dangerous to me than saying someone hears voices. I am aware that many patient groups would disagree with what I have said here because hearing voices is so common and uses everyday language. However, ‘hallucinations’ only suggests another more medical sounding label, which still may not be readily understood, but carries less associations of stigma”. Link to paper here.
  • A ‘friends interventions’ for young people with psychosis. Link to abstract here.
  • One theory runs that excess striatal dopamine causes hallucinations, so drugs which increase striatal dopamine should cause hallucinations? Yes. Link here.

Thanks for reading. More soon!

SMJ

 

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