Metaphor framing and distress in lived-experience accounts of voice-hearing

This paper explores the potential role of metaphor as a signal and determinant of distress in first-person accounts of voice-hearing by people with schizophrenia diagnoses. The degree of distress experienced by voice-hearers depends, amongst other factors, on voice-hearers’ perceptions of the “power” of the voices, and on the extent to which the voices can control or be controlled by the person. Metaphors are well known to both reflect and reinforce particular ways of making sense of subjective and sensitive experiences, including in terms of attributions of agency, power and control.Metaphors were systematically identified and analysed in semi-structured interviews with 10 voice-hearers with diagnoses of schizophrenia-spectrum disorders. Divergent uses of metaphors framed the experience of voice-hearing in distinctive ways and were found to have different implications for perceptions of mutual power and control between voice-hearer and voices. Participants who used metaphors in which they are in disempowered positions tended to report higher level of distress, while participants who used metaphors in ways that constructed them as empowered tended to report lower levels of distress. It is argued that metaphor analysis can be usefully added to well-established approaches to both understanding and addressing distress in voice-hearers.