A Dialogical Narrative Analysis of Voice Hearers and Emotions Jonathan Gadsby A thesis submitted in partial fulfilment of the requirements of Birmingham City University for the degree of Doctor of Philosophy September 2016 Health, Education and Life Sciences, Birmingham City University !1 Abstract This thesis is the result of a process of Dialogical Narrative Analysis with twelve participants who hear voices that other people cannot hear. It uses the socio-narratology of Arthur Frank to examine their stories about their experiences in the context of the complex and conceptually contested fields of knowledge that are considered relevant to voice-hearing. The 12 voice-hearers present a wide range of ideas and explanatory frameworks about their experiences. Emotions are deliberately part of this thesis and many stories are as moving as they are complex. The author’s own experiences of these stories is also acknowledged and explored. Whereas much research about hearing voices is biological, psychological or occasionally sociological, this research has many aspects of political exploration and the field is understood as one of conflicting vested interests and ideologies. Many ethical considerations come to light, especially concerning forms of power and knowledge within mental health professions and services in the UK, but also within the Hearing Voices Movement, which is seen as a vital movement with a variety of possible histories. One possibility suggested by this research is that voice-hearers are able to tolerate, and benefit from, more dialogical approaches and that those that do may find more successful ways to live with their experiences than those who are subject to the strongly monological emplotments of much professionalised knowledge. Another strong theme is the great influence of neoliberal politics over individuals and notions of ‘health’. !2 Contents: A Dialogical Narrative Analysis of Voice Hearers and Emotions 1 Abstract 2 Contents: 3 Section 1 6 Living with Voices 6 Style 7 Me 8 Contested Categories 10 Section introduction 10 Three sets of terms 11 A first attempt 13 The effects of a shift towards the parochial/interactive historical 14 Hearing voices? 15 Narrativity contested too 16 Dialogical Narrative Analysis 17 Interview design 18 A narrative tool 19 How emplotting were my interviews? 20 Bringing dialogue 21 Recruitment Strategy 22 Ethics 23 Preparing for DNA 24 The Location of Experience 25 Smith’s Structural Model of Genre 27 The left and right of experience 29 The emplotment of "emotions" 31 Can socio-narratology be neutral? 32 Summary 33 Section 2 34 Relationships and Reflections 34 Becky 36 Diagnosis, re-diagnosis 36 Eight months later 41 Claire 47 !3 Ten Weeks 58 Angela 60 A timeline 62 Violence 62 First violent story 62 Second violent story 63 Third violent story 66 The war on drugs 68 Revisiting the HVM with Angela 70 Something made me tell a lie 75 Lisa 77 Emplotment 77 Common Human Variation 79 Interfaces within the HVM 80 Re-storying and a new voice 83 Pseudo-hallucinations / Hallucinations; 90 Understanding / Explanation 90 The Inman Defence 90 Whom does it suit? 91 Matthew 93 Inclusion/exclusion 93 Gifts 94 Steve 97 People and places 97 Storying 99 John 101 Self Reliance? 102 Smail 103 Wilde and Rowntree 104 Illusory and necessary 105 Emotions and coping 105 Kirkland and Masco 106 Jenny 109 Well, it’s schizophrenia, isn’t it? 109 Second interview 112 !4 Rosie 113 Gravy Boat 113 What of stories? 115 The time when I heard a voice 117 Amber 119 Mel 121 Something made me tell a lie (part 2) 126 Ross 129 Medical story 132 Thinking with, thinking about 134 Relationship with services 135 Section 3 139 Limitations and evaluations 139 Possibilites 141 1. More dialogue is responsible and imperative 141 Responsible biology 142 2. What would a dialogical approach to hearing voices and emotions look like?143 Medical and Legal power 144 Increased visibility of trauma 145 More visible philosophical problems 146 More visible political struggles 147 3. Voice-hearers, nurses and researchers 149 References 151 Appendix 1 161 Press release 161 Appendix 2 162 Participant Information Sheets and Consent Form 162 Appendix 3 167 Ethical Permissions 167 Appendix 4 177 Appendix 5 187 !5 Section 1 Living with Voices This work has been undertaken as a research studentship and I have been given freedom to re- interpret the original brief considerably. It was explained at my interview that this research was in certain ways felt to be related to a book co-authored by my supervisors Mervyn Morris and Marius Romme (with Sandra Escher, Jacqui Dillon and Dirk Corstens): Romme, M, et al., 2009. Living with Voices: 50 Stories of Recovery. PCCS Books in association with Birmingham City University. This book I knew very well and had encouraged voice-hearers and professionals to read, as well as referencing it in my Masters dissertation. This new research was to be in some ways part of the same lineage as that text, part of the same movement, but might achieve something slightly different; Living with Voices is a collection of annotated personal accounts, but is not research following a particular method. It was hoped that my research would perhaps satisfy those that might dismiss that work. The Hearing Voices Movement, (hereafter HVM) both seeks new avenues for research and is simultaneously cautious about it, something acknowledged by their current chair, Dirk Corstens (Corstens et al., 2014, p289). One idea envisaged at that time was something which used validated tools to measure dissociation, researching its relevance to hearing voices and emotions. I began to move away from that idea. Of all of the possible emplotments (about which, more later) I encountered it was probably the most attractive single story with which to think about voice-hearing and emotions. It was to the politics of emotions and of voice-hearing that I was drawn; I felt that the heterogeneity of the field demanded it. The method of research I came upon was suited to thinking about vested interests. An academic whose work on mental health I thought highly of, Katherine Angel, often quoted Chris Kraus’ 1997 book, "I love Dick": who gets to speak and why is the only question (Kraus, 1997); I was fascinated. !6 Style The only non-standard referencing method I have employed in this text is when referencing e- books. Some helpfully provide the text’s paper page equivalent for citation purposes; some do not. Where it has not been possible to provide page numbers from direct citations, I have provided the “location number” under the abbreviation “loc”, e.g. (Smith, 2010, loc 368). " !7 Me Stories are “recipient designed” (Arthur Frank, 2012, p90) and I was the recipient. The research method, which will be discussed in this section, requires me to be visible in this research. This is not seen as a weakness: Dialogical interpretation begins with the interpreter’s recognition of being caught up in his or her own stories, which may overlap with the narrative habits of the storyteller or may require a substantial shift in horizons, in order for the other’s story to be recognisable (Frank, 2012, p94). This asks the question of whether objectivity is not only seldom possible, but if it is desirable, since the dialogue between my stories and participant stories is part of what is revelatory. It raises my thinking and my research narrative as explanatory in this work and it is frequently most honest to write in the first person, although there are times when I have wished it otherwise. Primarily, I want to explore the narratives of 12 voice-hearers, and place them centrally within a plethora of strong cultural narratives about them and their experiences. However, I also need their stories to bring out what is relevant for the reader to know about myself; dispersed within that text are some of my stories. Occasionally I get a little in the way of the participants’ texts, and the stories of others certainly do, and the question for Dialogical Narrative Analysis is not whether this can be disguised but rather to ask why that happens and what it tells us about all stories in question. I am 40 this year, a man, married with three children. I live in the house my wife’s grandfather built. I have a sit-on mower. Most of this thesis has been written looking out onto a garden with a children’s sandpit and a small field with our chickens busily being chickens. It is different from the blocks of flats I lived in as a child and teenager in Hong Kong and Singapore. My children, all under ten, ensure that strong emotions are never far from daily life. Put me in the middle of three children whom I love, bickering about breakfast, and I wonder if I really have any better skills with emotions than I had at 15. Five minutes later we are hugging on the sofa, or laughing at the dog, or shouting about Lego. Being a mental health nurse, which began in my early twenties, has been utterly energising in my life. I have never become bored. The more I have learned, the more questionable the role of mental health nurse has become, so what started relatively simply has become something that, rather painfully, I am not sure I ever want to do again. It will be important for me to articulate the role of this research in that difficulty; it is part of the "findings" of research designed to ask what stories do. Increasingly over the last five years (although it began much earlier) I have become alienated from colleagues and feel most at home with "the mad".