Papers by Ruvanee Vilhauer
OMEGA - Journal of Death and Dying, 2023
Although sensory and quasi-sensory experiences of the deceased (SED) have been the subject of muc... more Although sensory and quasi-sensory experiences of the deceased (SED) have been the subject of much debate, research on the phenomenology of auditory verbal experiences in the bereaved has been neglected. This case study describes the phenomenology of a regularly occurring voice hearing experience and its meaning for a single bereaved individual. The voice of the deceased can be heard as though in external space, and the experience can feel real, even when the death is fully acknowledged. A bereaved individual can welcome and benefit from the experience even when it is not recognized as a normal part of grieving in the individual’s cultural context, when no afterlife belief is present, and when the experience remains unexplained. The case study demonstrates that hearing the voice of the deceased can be a regular occurrence without causing distress or dysfunction and lends support to the idea that SED are a common concomitant of normal bereavement.
Psychosis, 2018
Understanding the phenomenological range of auditory verbal hallucinations (AVHs), or voice heari... more Understanding the phenomenological range of auditory verbal hallucinations (AVHs), or voice hearing (VH) experiences, is important for developing etiological models. To circumvent potential methodological limitations of previous studies, we used unsolicited online self-reports to examine the kinds of experiences people describe when they say they hear voices. Content analysis was used to examine 499 online posts about VH, the largest VH sample studied to date. Most posters did not report having a psychiatric diagnosis. Unusual bodily sensations and third person voices were less prevalent than in previous studies. Volume of voices was mentioned significantly more often when voices were externally localized, but acoustic qualities were mentioned even when voices were internally localized. Some voice features previously considered atypical, such as unclear voices and voices that are not self-relevant, were described in almost 15% of coded posts. Only 21% described commanding voices, a feature previously considered typical of VH. Individuals sometimes reported voices both consistent with, and inconsistent with, inner speech accounts of VH. These results may have implications for subtyping AVHs. This novel method allowed description of a large sample of self-reports relatively untainted by demand characteristics or social desirability biases.
This study examined the phenomenological characteristics of inner speech during silent reading (i... more This study examined the phenomenological characteristics of inner speech during silent reading (inner reading voices or IRVs), a type of inner speech that may be particularly amenable to empirical study. A survey was conducted in the general population to assess IRV frequency, location, number, identity, and controllability, and auditory qualities of IRVs. Of 570 survey respondents, 80.7% reported sometimes or always hearing an inner voice during silent reading, and the remaining 19.3% reported always understanding words being read without hearing an inner voice. Results indicated that IRVs are a routine experience for many, with 34.2% of respondents with IRVs hearing an IRV every time something was read, and 45% reporting an IRV often. Most respondents reported IRVs with specific auditory qualities such as gender, accent, pitch, loudness, and emotional tone. IRVs were reported in participants' own voices, as well as in the voices of other people. Some respondents reported being unable to control any aspect of their IRVs, while others could control one or several aspects. These results indicate that there is considerable individual variation in inner speech during silent reading.
Background: Voice hearing experiences, or auditory verbal hallucinations, occur in healthy indivi... more Background: Voice hearing experiences, or auditory verbal hallucinations, occur in healthy individuals as well as in individuals who need clinical care, but news media depict voice hearing primarily as a symptom of mental illness, particularly schizophrenia.
Aims: This paper explores whether, and how, public perception of an exaggerated association between voice hearing and mental illness might influence individuals’ need for clinical care. Method: A narrative literature review was conducted, using relevant peer-reviewed research published in the English language.
Results: Stigma may prevent disclosure of voice hearing experiences. Non-disclosure can prevent access to sources of normalizing information and lead to isolation, loss of social support, and distress. Internalization of stigma and concomitantly decreased self-esteem could potentially affect features of voices such as perceived voice power, controllability, negativity and frequency, as well as distress. Increased distress may result in a decrease in functioning and increased need for clinical care.
Conclusions: The literature reviewed suggests that stigma has the potential to increase need for care through many interrelated pathways. However, the ability to draw definitive conclusions was constrained by the designs of the studies reviewed. Further research is needed to confirm the findings of this review.
Psychosis: Psychological, Social and Integrative Approaches, Apr 29, 2015
Inner speech is theorized to be the basis for auditory verbal hallucinations (AVHs), but few empi... more Inner speech is theorized to be the basis for auditory verbal hallucinations (AVHs), but few empirical studies have examined the phenomenology of inner speech, particularly while reading. One hundred and sixty posts from a popular question and answer community website were analyzed using a qualitative content analysis approach, to examine the phenomenology of inner reading voices (IRVs). Results indicated that many individuals report routinely experiencing IRVs, which often have the auditory qualities of overt speech, such as recognizable identity, gender, pitch, loudness and emotional tone. IRVs were sometimes identified as the readers’ own voices, and sometimes as the voices of other people. Some individuals reported that IRVs were continuous with audible thoughts. Both controllable and uncontrollable IRVs were reported. IRVs may provide evidence for individual variation in imagery vividness and support for inner speech accounts of AVHs. IRVs may be a useful model for studying AVHs in the non-clinical population and need further investigation.
International Journal of Social Psychiatry, Feb 2015
Background: The characterization of auditory verbal hallucinations (AVH) in the Diagnostic and St... more Background: The characterization of auditory verbal hallucinations (AVH) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), diverges from recent research literature, which demonstrates the occurrence of AVH in individuals who are psychologically healthy. This discrepancy raises the question of how the public perceives AVH. Public perceptions are important because they could potentially affect how individuals with AVH interpret these experiences and how people view voice hearers.
Aims: Because media portrayals can provide a window into how phenomena are viewed by the public, an archival study of newspaper articles was carried out to examine depictions of AVH.
Methods: A sample of 181 newspaper articles originating in the United States was analyzed using a content analysis approach.
Results: The majority of articles examined contained no suggestion that AVH are possible in psychologically healthy individuals. Most articles suggested that AVH were a symptom of mental illness, and many suggested that AVH were associated with criminal behavior, violence and suicidality.
Conclusion: The news media examined tended to present a misleading and largely pathologizing view of AVH. More research is needed to shed light on how, and to what extent, public perceptions may influence those who experience AVH.
Objective: We sought to assess military veterans' functioning in college by comparing their exper... more Objective: We sought to assess military veterans' functioning in college by comparing their experience to that of civilian students. Participants: The study, conducted from April, 2012 to February, 2013, included 445 civilian and 61 student service member/veteran (SSM/V) undergraduates, drawn from a community college and two four-year Catholic colleges, in Pennsylvania, New Jersey and New York. Methods: Participants completed anonymous online surveys. Six areas of functioning in transition to college were examined: Health, Fitting In, Emotional Adjustment, Productivity, Perceived Career Support, and Social Engagement. Results: Students, both SSM/V and civilian, with past exposure to a potentially traumatic event fit in worse than students without such exposure. Past exposure to trauma was associated with poorer emotional adjustment in civilian students, but not in SSM/V. Conclusions: Implications of results were discussed.
What Was Le f t Ruvanee Pietersz Vilhauer vilhaue rr@ f e lician.e du I remember o ne o f my aunt... more What Was Le f t Ruvanee Pietersz Vilhauer vilhaue rr@ f e lician.e du I remember o ne o f my aunts-I called her Anta, a name left o ver fro m my childho o d-lo o king at the flo wers in the driveway. They had fallen o ff the araliya tree that grew by the garage. Flo wers fell daily, their petals still plump. After they fell, it to o k a day o r two fo r the edges o f the petals to turn bro wn. The gardener must have been keeping up with his sweeping duties because mo st o f the flo wers in the driveway were fresh pink, recently fallen. He had his bro o m o ut, and he had just hitched up his saro ng and begun to sweep. It was early. Dew was flying o ff the grass, brushed o ff by the bro o m's ekel bristles. It might have been the rasping o f the bro o m that drew Anta o ut o n to the po rch that o verlo o ked the driveway. Her hair was still unco mbed, altho ugh she was dressed in daytime clo thes. She sto o d lo o king o ut at the gardener's bro o m whisking the flo wers into a pile, alo ng with a few leaves fro m the mango and rubber trees. "They are so lo vely," she said. "Leave them." The gardener barely paused to lo o k at her. "Lo vely?" he muttered, to the flo wers, to his bro o m. "I can't just leave them lying there, ro tting." He lo o ked at me, sitting o n the po rch with my mo rning tea and sho o k his head pityingly. Anta wasn't paying attentio n to him, o r me. Her eyes were fixed o n the bruising, crumpling flo wers, which the bro o m was pushing. "What a waste, no ?" Anta said.
The Water Diviner and Other Stories
"Objective: To compare the experiences of women with metastatic breast cancer (MBC) in computer-m... more "Objective: To compare the experiences of women with metastatic breast cancer (MBC) in computer-mediated and face-to-face support groups.
Method: Interviews from 18 women with MBC, who were currently in computer-mediated support groups (CMSGs), were examined using interpretative phenomenological analysis. The CMSGs were in an asynchronous mailing list format; women communicated exclusively via email. All the women were also, or had previously been, in a face-to-face support group (FTFG).
Results: CMSGs had both advantages and drawbacks, relative to face-to-face groups (FTFGs), for this population. Themes examined included convenience, level of support, intimacy, ease of
expression, range of information, and dealing with debilitation and dying. CMSGs may provide a sense of control and a greater level of support. Intimacy may take longer to develop in a CMSG,
but women may have more opportunities to get to know each other. CMSGs may be helpful while adjusting to a diagnosis of MBC, because women can receive support without being
overwhelmed by physical evidence of disability in others or exposure to discussions about dying before they are ready. However, the absence of nonverbal cues in CMSGs also led to avoidance of topics related to death and dying when women were ready to face them. Agendas for discussion, the presence of a facilitator or more time in CMSGs may attenuate this problem.
Significance of results: The findings were discussed in light of prevailing research and theories about computer-mediated communication. They have implications for designing CMSGs for this population."
Psychology & Health, Jan 1, 2011
The objective of this study was to explore the experiences of women with metastatic breast cancer... more The objective of this study was to explore the experiences of women with metastatic breast cancer (MBC) in mixed-stage and stage-specific groups. Interpretative phenomenological analysis (IPA) was used to examine 15 interviews from eight women with MBC. The interviewees felt that their experiences were very much different from those of women with primary breast cancer (BC), because of their different prognoses. In mixed-stage groups, the interviewees described feeling silenced, marginalised and helpless. They did not receive support in these groups because survivors of primary BC are often afraid to face the idea of metastasis. In stage-specific MBC groups, on the other hand, women were able to talk openly and were understood by others with whom they identified. They became more informed about issues related to their illness. Seeing others living well despite MBC made them feel more hopeful. Although there are some disadvantages of participating in stage-specific groups, the findings suggest that, overall, stage-specific groups are more helpful to women with MBC than mixed-stage groups. These findings have implications for the provision of group support for this population.
Women & Health, Jan 1, 2009
Women with metastatic breast cancer (MBC), a life-threatening illness, stand to benefit a great d... more Women with metastatic breast cancer (MBC), a life-threatening illness, stand to benefit a great deal from online support groups, but none have been studied specifically within this population. The present mixed-method study was carried out to determine which therapeutic factors occurred in online MBC support groups, and to see how such factors might have acted to benefit participants. Participants were 20 women with MBC who participated in online peer support groups. Most reported benefiting in some way from their groups. Six therapeutic factors theorized to be helpful in online support groups and cancer support groups were present in the groups studied: group cohesiveness, information exchange, universality, instillation of hope, catharsis, and altruism. However, although participants reported being able to discuss many other concerns freely, they had difficulty discussing death and dying, which are critical issues for this category of women with BC.
What Was Le f t Ruvanee Pietersz Vilhauer vilhaue rr@ f e lician.e du I remember o ne o f my aunt... more What Was Le f t Ruvanee Pietersz Vilhauer vilhaue rr@ f e lician.e du I remember o ne o f my aunts-I called her Anta, a name left o ver fro m my childho o d-lo o king at the flo wers in the driveway. They had fallen o ff the araliya tree that grew by the garage. Flo wers fell daily, their petals still plump. After they fell, it to o k a day o r two fo r the edges o f the petals to turn bro wn. The gardener must have been keeping up with his sweeping duties because mo st o f the flo wers in the driveway were fresh pink, recently fallen. He had his bro o m o ut, and he had just hitched up his saro ng and begun to sweep. It was early. Dew was flying o ff the grass, brushed o ff by the bro o m's ekel bristles. It might have been the rasping o f the bro o m that drew Anta o ut o n to the po rch that o verlo o ked the driveway. Her hair was still unco mbed, altho ugh she was dressed in daytime clo thes. She sto o d lo o king o ut at the gardener's bro o m whisking the flo wers into a pile, alo ng with a few leaves fro m the mango and rubber trees. "They are so lo vely," she said. "Leave them." The gardener barely paused to lo o k at her. "Lo vely?" he muttered, to the flo wers, to his bro o m. "I can't just leave them lying there, ro tting." He lo o ked at me, sitting o n the po rch with my mo rning tea and sho o k his head pityingly.
Journal of Psychosocial …, Jan 1, 2010
This study evaluates the feasibility and acceptability of an online peer support group interventi... more This study evaluates the feasibility and acceptability of an online peer support group intervention for women with metastatic breast cancer (MBC). Feasibility, participation rates, participant satisfaction, and preliminary outcomes are examined from a 1999 to 2000 study of online peer support groups for women with MBC. Thirty women with MBC were randomly assigned to either an immediate online support condition or a waitlisted control condition. For practical and ethical reasons, the waitlist period was limited to 2 months. Six monthly assessments were collected using standardized measurement instruments. Intervention retention rates (73%), assessment completion rates (range = 100%-86% in retained participants) and support group participation (M = 5.9 days per week) were high compared to other published studies on this population. Reported satisfaction with the intervention was also high. An online support intervention study is feasible using a waitlist control. Despite the feasibility and acceptability of the study procedures, the study design and small sample size precluded definitive conclusions about intervention effectiveness. As such, study procedures should be replicated with a larger more representative sample to examine the effectiveness of the intervention.
Palliative and Supportive Care, Jan 1, 2008
"ABSTRACT
Objective: My objective was to investigate the experiences of women diagnosed with... more "ABSTRACT
Objective: My objective was to investigate the experiences of women diagnosed with metastatic breast cancer.
Method: I did a qualitative study based on interview data. Fourteen women with metastatic breast cancer were recruited into a larger study of online support group use. Participants were interviewed by phone.
Results: The women indicated that they experience distress because of concerns about body image, declines in aspects of their sexual lives, and worries about the effect of stress on their illness. The stress that worries these women comes from fear of dying, fear of disease progression and debilitation, the loss of their future, and practical concerns. The women were also likely to experience a decline in daily activity after being diagnosed with metastatic disease. They become less active because of the physical symptoms of the illness and the side effects of treatments, the medicalization of their lifestyle, their desire to avoid stressful situations, the constraints imposed by their social world, and the need to maintain disability benefits. Although women are often in need of emotional and material support from others after they are diagnosed, social support can decrease, both because women find it difficult to be open about the difficulties they face and because the responses of others are not adequately supportive. Distress and declines in daily activity and social support can feed into each other to create a vicious circle.
Significance of results: This paper makes a significant contribution to the literature by providing a rich description of how metastatic breast cancer affects women. Further research, with more diverse samples, is needed in this understudied area."
To cite this article:
Vilhauer, R.P. (2011). Life-threatening illness and the family. In M. Craft... more To cite this article:
Vilhauer, R.P. (2011). Life-threatening illness and the family. In M. Craft-Rosenberg & S. Pehler (Eds), Encyclopedia of Family Health (pp. 708-712). Thousand Oaks, CA: Sage.
Journal of Women & Aging, 2012
This article may be used for research, teaching, and private study purposes. Any substantial or s... more This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.
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Papers by Ruvanee Vilhauer
Aims: This paper explores whether, and how, public perception of an exaggerated association between voice hearing and mental illness might influence individuals’ need for clinical care. Method: A narrative literature review was conducted, using relevant peer-reviewed research published in the English language.
Results: Stigma may prevent disclosure of voice hearing experiences. Non-disclosure can prevent access to sources of normalizing information and lead to isolation, loss of social support, and distress. Internalization of stigma and concomitantly decreased self-esteem could potentially affect features of voices such as perceived voice power, controllability, negativity and frequency, as well as distress. Increased distress may result in a decrease in functioning and increased need for clinical care.
Conclusions: The literature reviewed suggests that stigma has the potential to increase need for care through many interrelated pathways. However, the ability to draw definitive conclusions was constrained by the designs of the studies reviewed. Further research is needed to confirm the findings of this review.
Aims: Because media portrayals can provide a window into how phenomena are viewed by the public, an archival study of newspaper articles was carried out to examine depictions of AVH.
Methods: A sample of 181 newspaper articles originating in the United States was analyzed using a content analysis approach.
Results: The majority of articles examined contained no suggestion that AVH are possible in psychologically healthy individuals. Most articles suggested that AVH were a symptom of mental illness, and many suggested that AVH were associated with criminal behavior, violence and suicidality.
Conclusion: The news media examined tended to present a misleading and largely pathologizing view of AVH. More research is needed to shed light on how, and to what extent, public perceptions may influence those who experience AVH.
Method: Interviews from 18 women with MBC, who were currently in computer-mediated support groups (CMSGs), were examined using interpretative phenomenological analysis. The CMSGs were in an asynchronous mailing list format; women communicated exclusively via email. All the women were also, or had previously been, in a face-to-face support group (FTFG).
Results: CMSGs had both advantages and drawbacks, relative to face-to-face groups (FTFGs), for this population. Themes examined included convenience, level of support, intimacy, ease of
expression, range of information, and dealing with debilitation and dying. CMSGs may provide a sense of control and a greater level of support. Intimacy may take longer to develop in a CMSG,
but women may have more opportunities to get to know each other. CMSGs may be helpful while adjusting to a diagnosis of MBC, because women can receive support without being
overwhelmed by physical evidence of disability in others or exposure to discussions about dying before they are ready. However, the absence of nonverbal cues in CMSGs also led to avoidance of topics related to death and dying when women were ready to face them. Agendas for discussion, the presence of a facilitator or more time in CMSGs may attenuate this problem.
Significance of results: The findings were discussed in light of prevailing research and theories about computer-mediated communication. They have implications for designing CMSGs for this population."
Objective: My objective was to investigate the experiences of women diagnosed with metastatic breast cancer.
Method: I did a qualitative study based on interview data. Fourteen women with metastatic breast cancer were recruited into a larger study of online support group use. Participants were interviewed by phone.
Results: The women indicated that they experience distress because of concerns about body image, declines in aspects of their sexual lives, and worries about the effect of stress on their illness. The stress that worries these women comes from fear of dying, fear of disease progression and debilitation, the loss of their future, and practical concerns. The women were also likely to experience a decline in daily activity after being diagnosed with metastatic disease. They become less active because of the physical symptoms of the illness and the side effects of treatments, the medicalization of their lifestyle, their desire to avoid stressful situations, the constraints imposed by their social world, and the need to maintain disability benefits. Although women are often in need of emotional and material support from others after they are diagnosed, social support can decrease, both because women find it difficult to be open about the difficulties they face and because the responses of others are not adequately supportive. Distress and declines in daily activity and social support can feed into each other to create a vicious circle.
Significance of results: This paper makes a significant contribution to the literature by providing a rich description of how metastatic breast cancer affects women. Further research, with more diverse samples, is needed in this understudied area."
Vilhauer, R.P. (2011). Life-threatening illness and the family. In M. Craft-Rosenberg & S. Pehler (Eds), Encyclopedia of Family Health (pp. 708-712). Thousand Oaks, CA: Sage.
Aims: This paper explores whether, and how, public perception of an exaggerated association between voice hearing and mental illness might influence individuals’ need for clinical care. Method: A narrative literature review was conducted, using relevant peer-reviewed research published in the English language.
Results: Stigma may prevent disclosure of voice hearing experiences. Non-disclosure can prevent access to sources of normalizing information and lead to isolation, loss of social support, and distress. Internalization of stigma and concomitantly decreased self-esteem could potentially affect features of voices such as perceived voice power, controllability, negativity and frequency, as well as distress. Increased distress may result in a decrease in functioning and increased need for clinical care.
Conclusions: The literature reviewed suggests that stigma has the potential to increase need for care through many interrelated pathways. However, the ability to draw definitive conclusions was constrained by the designs of the studies reviewed. Further research is needed to confirm the findings of this review.
Aims: Because media portrayals can provide a window into how phenomena are viewed by the public, an archival study of newspaper articles was carried out to examine depictions of AVH.
Methods: A sample of 181 newspaper articles originating in the United States was analyzed using a content analysis approach.
Results: The majority of articles examined contained no suggestion that AVH are possible in psychologically healthy individuals. Most articles suggested that AVH were a symptom of mental illness, and many suggested that AVH were associated with criminal behavior, violence and suicidality.
Conclusion: The news media examined tended to present a misleading and largely pathologizing view of AVH. More research is needed to shed light on how, and to what extent, public perceptions may influence those who experience AVH.
Method: Interviews from 18 women with MBC, who were currently in computer-mediated support groups (CMSGs), were examined using interpretative phenomenological analysis. The CMSGs were in an asynchronous mailing list format; women communicated exclusively via email. All the women were also, or had previously been, in a face-to-face support group (FTFG).
Results: CMSGs had both advantages and drawbacks, relative to face-to-face groups (FTFGs), for this population. Themes examined included convenience, level of support, intimacy, ease of
expression, range of information, and dealing with debilitation and dying. CMSGs may provide a sense of control and a greater level of support. Intimacy may take longer to develop in a CMSG,
but women may have more opportunities to get to know each other. CMSGs may be helpful while adjusting to a diagnosis of MBC, because women can receive support without being
overwhelmed by physical evidence of disability in others or exposure to discussions about dying before they are ready. However, the absence of nonverbal cues in CMSGs also led to avoidance of topics related to death and dying when women were ready to face them. Agendas for discussion, the presence of a facilitator or more time in CMSGs may attenuate this problem.
Significance of results: The findings were discussed in light of prevailing research and theories about computer-mediated communication. They have implications for designing CMSGs for this population."
Objective: My objective was to investigate the experiences of women diagnosed with metastatic breast cancer.
Method: I did a qualitative study based on interview data. Fourteen women with metastatic breast cancer were recruited into a larger study of online support group use. Participants were interviewed by phone.
Results: The women indicated that they experience distress because of concerns about body image, declines in aspects of their sexual lives, and worries about the effect of stress on their illness. The stress that worries these women comes from fear of dying, fear of disease progression and debilitation, the loss of their future, and practical concerns. The women were also likely to experience a decline in daily activity after being diagnosed with metastatic disease. They become less active because of the physical symptoms of the illness and the side effects of treatments, the medicalization of their lifestyle, their desire to avoid stressful situations, the constraints imposed by their social world, and the need to maintain disability benefits. Although women are often in need of emotional and material support from others after they are diagnosed, social support can decrease, both because women find it difficult to be open about the difficulties they face and because the responses of others are not adequately supportive. Distress and declines in daily activity and social support can feed into each other to create a vicious circle.
Significance of results: This paper makes a significant contribution to the literature by providing a rich description of how metastatic breast cancer affects women. Further research, with more diverse samples, is needed in this understudied area."
Vilhauer, R.P. (2011). Life-threatening illness and the family. In M. Craft-Rosenberg & S. Pehler (Eds), Encyclopedia of Family Health (pp. 708-712). Thousand Oaks, CA: Sage.