Doctorate in Clinical Psychology: Main Research Portfolio
: (Alternative format thesis) 1) Kintsugi – identity change and reconstruction following an episode of psychosis: a systematic review and thematic synthesis; 2) Surviving and thriving – a mixed-methods study of staff experiences of occupational wellbeing in a psychiatric Place of Safety service; 3) Epistemic injustice amongst voice-hearers with and without a clinical need: a qualitative thematic analysis study.

  • Olivia Harris

Student thesis: Doctoral ThesisDoctor of Clinical Psychology (DClinPsy)


Introduction: People with mental health conditions, particularly serious and stigmatised conditions like psychosis, are at high risk of epistemic injustice. This is a form of discrimination whereby someone is unfairly judged to be unreliable (testimonial injustice) or is unable to contribute to and therefore access concepts that make sense of their experience within mainstream society (hermeneutical injustice). Common psychotic symptoms, such as hearing voices (also called auditory hallucinations) occur both in people who are mental health service users and in the general population (clinical and non-clinical voice-hearers respectively). The degree of distress and impairment associated with voices has been shown to relate to how individuals make sense of their experiences and how others respond to their identity as a voice-hearer. The aim of this study was to explore people’s experiences of epistemic injustice in relation to voice-hearing, and to understand how these may differ between clinical and non-clinical voice-hearers.
Method: Eight clinical and nine non-clinical voice-hearers were recruited via special interest groups (i.e. spiritualist churches), Hearing Voices groups and NHS mental health services to take part in qualitative semi-structured interviews. Interviews were transcribed verbatim and analysed using thematic analysis.
Results: Eight themes were constructed overall. Three pairs of themes related to i) identity, ii) relationships and iii) power and position across the clinical and non-clinical groups, and two shared themes arose within both groups relating to testimonial and hermeneutical injustice.
Discussion: Both clinical and non-clinical voice-hearers described experiencing epistemic injustice in wider society, with voice-hearing being both misunderstood and heavily stigmatised. The presence of a ‘safe haven’ (e.g. spiritualist churches) for non-clinical voice-hearers ameliorated the impact of this to some degree, by allowing people to make connections with others with similar experiences within a non-judgemental and accepting community.
Conclusion: This study shows both clinical and non-clinical voice-hearers experience epistemic injustice, but that it differs in its form and severity between the groups. These findings could better inform strategies to reduce stigma and societal marginalisation in people who hear voices.
Keywords: voice-hearing; psychosis; epistemic injustice; discrimination; qualitative
Date of Award15 Sept 2021
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorPamela Jacobsen (Supervisor) & Megan Wilkinson-Tough (Supervisor)

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