The lived experience of older adults who have heard voices throughout their lifespan following early-onset psychosis: an interpretative phenomenological analysis

Research into the subjective experiences of hearing voices has increased over the past two decades, and has had important implications for the treatment of people who are distressed by their voices. However, most research has focussed on adults of working age, whilst little research has been done to understand older people’s subjective experiences of voices. This is particularly so for older adults who have heard voices since an early onset of psychosis.
Five participants (two male, aged 68-75) who had heard voices since an early onset, were recruited from the local community mental health team. They were interviewed about their subjective experiences of hearing voices. Transcripts were then then analysed using IPA, individually and then for the group.
The results of the analysis yielded four master themes and eleven superordinate themes. The master themes showed that participants were ‘experiencing a relationship with the voices’ characterised by their negative perceptions of the voices as powerful and controlling, and leading to varied emotional and behavioural responses. Secondly, the voice-hearing experience resulted in an ‘alteration to sense of self in the world’, where participants felt a sense of loss, stagnation and alienation. At times participants were also ‘struggling to understand’ their voice hearing experience as they sought to make sense using various frameworks. Finally, participants also displayed both ‘improvement and hope’ and ‘deterioration and despair’ when looking back over their lives and considering their futures.
The main themes found in the study are discussed in relation to existing literature regarding subjective understandings of voices, the changing models and approaches to psychosis that have occurred during participants’ lifetimes, and literature on the course of schizophrenia and lifespan development. Implications for clinical practice and future research are also made, the most fundamental being the value of opening up dialogue about subjective understandings of the voice hearing experience.