BACKGROUND: Despite improved treatment, little is understood about how clients view their hallucinations from a perspective of self, and few studies address the meaning of hallucinations or the relationship of hallucinations to the individual sense of being.OBJECTIVE:To understand hallucinations from an individual perspective of self.STUDY DESIGN: Heideggerian and hermeneutics-guided thematic analysis. Twelve individuals described their experiences of hallucinations. All interviews were recorded (with consent) and transcribed verbatim.RESULTS:Four themes described surviving and persevering: (a) Are they who they are? (b) a not-so-certain life; (c) finding strength in the broken places; and (d) I am still me. Although experiencing hallucinations was analogous to living with loss, participants recalled hallucinations as providing something positive in how they cared for and related to others.CONCLUSIONS:Practitioners can incorporate a language of caring that meets the needs of their clients, rather than the language of empowerment, which proved overwhelming for participants already overwhelmed by the “business of getting better.”J Am Psychiatr Nurses Assoc, 2008; 14(5), 353-362.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
2.
Andresen, R., Oades, L., & Caputi, P. (2003). The experience of recovery from schizophrenia: Towards an empirically validated stage model. Australian and New Zealand Journal of Psychiatry, 37(5), 586-594.
3.
Aschebrock, Y., Gavey, N., McCreanor, T., & Tippett, L. (2003). Is the content of delusions and hallucinations important? Australasian Psychiatry, 11(3), 306-311.
4.
Awad, G. (2004) Antipsychotic medications: Compliance and attitudes towards treatment. Current Opinion in Psychiatry, 17(2), 75-80.
5.
Beck, A.T., & Rector, N. (2003). A cognitive model of hallucinations. Cognitive Therapy and Research, 27(1), 19-52.
6.
Benner, P. (1994). Interpretive phenomenology. Thousand Oaks, CA: Sage.
7.
Benner, P., & Wrubel, J. (1989). The primacy of caring. Menlo Park, CA: Addison-Wesley.
8.
Birchwood, M., Meaden, A., Trower, P., Gilbert, P., & Plaistow, J. (2000). The power and omnipotence of voices: Subordination and entrapment by voices and significant others. Psychological Medicine, 30, 337-344.
9.
Bossart, W.H. (1969). Three directions of phenomenology. In M. Grene (Ed.), The anatomy of knowledge: Papers presented to the Study Group on Foundations of Cultural Unity, Bowdoin College, 1965 and 1966. Amherst: University of Massachusetts Press.
10.
Bustillo, J., Lauriello, J., Horan, W., & Keith, S. (2001). The psychosocial treatment of schizophrenia: An update. American Journal of Psychiatry, 158(2), 163-173.
11.
Casey, B., & Long, A. (2002). Reconciling voices. Journal of Psychiatric and Mental Health Nursing, 9, 603-610.
12.
Corrigan, P.W. (2003) Toward an integrated model of psychiatric rehabilitation . Psychiatric Rehabilitation Journal, 26, 346-358.
13.
Delespaul, P., deVries, M., & van Os, J. (2002). Determinants of occurrence and recovery from hallucinations in daily life. Social Psychiatry and Psychiatric Epidemiology , 37, 97-104.
14.
Diekelmann, N., Allen, D., & Tanner, C. (1989). The NLN criteria for appraisal of baccalaureate programs: A critical hermeneutic analysis. New York: National League for Nursing Press.
15.
Diekelmann, N., Lam, S., & Schuster, R.M. (1995). Martin [Computer software] . Madison: University of Wisconsin-Madison .
16.
Harkavy-Friedman, J.M., Kimhy, D., Nelson, E.A., Venarde, D.F., Malaspina, D., & Mann, J.J. (2003). Suicide attempts in schizophrenia: The role of command auditory hallucinations for suicide. Journal of Clinical Psychiatry, 64(8), 871-874.
17.
Hayashi, N., Igarashi, Y., Suda, K., & Nakagawa, S. (2004). Phenomenological features of auditory hallucinations and their symtomatological relevance. Psychiatry and Clinical Neurosciences, 58, 651-659.
18.
Heidegger, M. (1962). Being and time (J. Macquarrie & E. Robinson, Trans.). New York: Harper & Row. (Original work published 1927)
19.
Heinssen, R.K., Liberman, R.P., & Kopelowicz, A. (2000). Psychosocial skills training for schizophrenia: Lessons from the laboratory. Schizophrenia Bulletin, 26, 21-46.
20.
Herrings R.M., & Erkins, J.A. (2003). Increased suicide attempt rate among patients interrupting use of atypical antipsychotics. Pharmacoepidemiology and Drug Safety, 12, 423-424.
21.
Humberstone, V. (2002). The experience of people with schizophrenia living in supported accommodation: A qualitative study using grounded methodology . Australian and New Zealand Journal of Psychiatry, 36(3), 367-372.
22.
Jaspers, K. (1963). General psychopathology (J. Hoein & M. W. Hamilton, Trans.). Manchester, UK: Manchester University Press. (Original work published 1942)
23.
Jones, S., Guy, A., & Omrod, J. (2003). A Q-methodological study of hearing voices: A preliminary exploration of voice hearers' understanding of their experiences . Psychology and Psychotherapy: Theory, Research and Practice , 76, 189-209.
24.
Kim, S.W., Shin, S., Kim, J.K., Yang, S.J., Shin, H.-Y., Yoon, J.-S. (2006). Association between attitude toward medication and neurocognitive function in schizophrenia. Clinical Neuropharmacology , 29(4), 197-205.
25.
Kubler-Ross, E. (1975). Death: The final stage of growth. Englewood Cliffs, NJ: Prentice Hall.
26.
Lataster, T., van Os, J., Drukker, M., Henquet, C., Feron, F., Gunther, N., et al. (2006). Childhood victimisation and developmental expression of non-clinical delusional ideation and hallucinatory experiences: Victimisation and non-clinical psychotic experiences. Social Psychiatry Psychiatric Epidemiology, 41, 423-428.
27.
Leudar, I., & Thomas, P. (2000). Voices of reason, voices of insanity. London: Routledge.
28.
Lysaker, P., & Lysaker, J. (2004). Schizophrenia as dialogue at the ends of its tether: The relationship of disruptions in identity with positive and negative symptoms . Journal of Constructivist Psychology, 17, 105-119.
29.
Mackinnon, A., Copolov, D., & Trauer,T. ( 2004) Factors associated with compliance and resistance to command hallucinations. Journal of Nervous and Mental Disease, 192(5), 357-362.
30.
Millar, E., & Walsh, M. (2000). Mental health matters in primary care. Cheltenham, UK: Stanley Thornes.
31.
Read, J., Agar, K., Argyle, N., & Aderhold, V. (2003). Sexual and physical abuse during childhood and adulthood as predictors of hallucinations, delusions and thought disorder . Psychology and Psychotherapy: Theory, Research and Practice , 76, 1-22.
32.
Ritsher, J.B., Lucksted, A., Otilingam, P.J., & Grajales, M. (2004). Hearing voices: Explanations and implications . Psychiatric Rehabilitation Journal, 27(3), 219-227.
33.
Rogers, P., Watt, A., Gray, N., MacCullogh, M., & Gournay, K. (2002). Content of command hallucinations predicts self-harm but not violence in a medium secure unit. Journal of Forensic Psychiatry, 13(2), 251-262.
34.
Romme, M. (1998). Listening to the voice hearers. Journal of Psychosocial Nursing, 36(9), 36-45.
35.
Schulze, B., & Angermeyer, M.C. (2003). Subjective experiences of stigma: A focus group study of schizophrenic patients, their relatives, and mental health professionals. Social Science and Medicine , 56(2), 299-312.
36.
Sells, D.J., Stayner, D.A., & Davidson, L. (2004). Recovering the self in schizophrenia: An integrative review of qualitative studies. Psychiatric Quarterly, 75(1), 87-97.
37.
Simpson, J.A., & Weiner, E.S.C. (Prep.). (1989). Oxford English dictionary (Vol. 6). London , UK: Clarendon.
38.
Smythe, E. (2002). The violence of the everyday in healthcare. In N. Diekelmann (Ed.), First, do no harm (pp. 164-203). Madison: University of Wisconsin.
39.
Van Dorn, R., Swanson, J., Elbogen, E., & Schwartz. (2005). A comparison of stigmatizing attitudes toward persons with schizophrenia in four stakeholder groups: Perceived likelihood of violence and desire for social distance. Psychiatry, 68(2), 152-163.
40.
Waters, F., Badcock, J.C., Maybery, M.T., & Michie, P.T. (2002). The role of affect in auditory hallucinations in schizophrenia. Unpublished manuscript.
41.
Worden, J.W. (1991). Grief counseling and grief therapy: A handbook for the mental health practitioner. New York: Springer.
