The power and omnipotence of voices: subordination and entrapment by voices and significant others

Background. Cognitive therapy for psychotic symptoms often embraces self-ev aluative beliefs (e.g. self-worth) but whether and how such beliefs are rel ated to delusions remains uncertain. In previous research we demonstrated t hat distress arising from voices was linked to beliefs about voices and not voice content alone. In this study we examine whether the relationship wit h the voice is a paradigm of social relationships in general, using a new f ramework of social cognition, 'ranking theory. Method. In a sample of 59 voice hearers, measures of power and social rank difference between voice and voice hearer are taken in addition to parallel measures of power and rank in wider social relationships. Results. As predicted, subordination to voices was closely linked to subord ination and marginalization in other social relationships. This was not the result of a mood-linked appraisal. Distress arising from voices was linked not to voice characteristics but social and interpersonal cognition. Conclusion. This study suggests that the power imbalance between the indivi dual and his persecutor(s) may have origins in an appraisal by the individu al of his social rank and sense of group identification and belonging. The results also raise the possibility that the appraisal of voice frequency an d volume are the result of the appraisal of voices' rank and power. Theoret ical and novel treatment implications are discussed.