Hearing voices, dissociation and the self: A functional-analytic perspective

Abstract

In the current paper, we review existing models of the aetiology of voice hearing. We summarise the argument and evidence that voice hearing is primarily a dissociative process, involving critical aspects of self. We propose a complementary perspective on these phenomena that is based on a modern behavioural account of complex behaviour, known as Relational Frame Theory (RFT). This type of approach to voice hearing concerns itself with: the functions served for the individual by this voice hearing; the necessary history, such as trauma, that establishes these functions; and the relevant dissociative processes involving self and others. In short, we propose a trauma-dissociation developmental trajectory in which trauma impacts negatively on the development of self, through the process of dissociation. Using the RFT concept of relations of perspective-taking, our dissociation model purports that trauma gives rise to more co-ordination than distinction relations between self and others, thus weaking an individual's sense of a distinct self. Voice hearing experiences, therefore, reflect an individual's perceptions of self and others, and may indicate impairments in the natural psychological boundaries between these critical related concepts. One clinical implication suggested by this model is that therapeutic 'intervention' should understand the behaviours associated with a sense of self that is fragile and threatened by others. Relations with self and others should be a key focus of therapy, as well as interventions designed to enhance a coherent distinct sense of self.