Distressing unusual experiences and beliefs in the lives of previously homeless individuals: a narrative analysis of the stories of white British men

ABSTRACT

Background

Research suggests a correlation between homelessness and the prevalence of distressing unusual experiences and beliefs. This study aimed to explore how previously homeless individuals make sense of distressing unusual experiences and beliefs, by hearing their stories.

Method

Narrative analysis was used to understand the stories of six previously homeless White British males who reported distressing unusual experiences and beliefs.

Results

Participants’ stories involved a holistic and whole-life approach when making sense of distressing unusual beliefs and experiences. Plots included interpersonal experiences (trauma and abuse; loss; judgemental attitudes; fitting in and relational coping), and their intrapersonal consequences (physical wellbeing; substance use; spiritual, religious, and paranormal experiences; and safety, security, and stability).

Discussion

A holistic, psychosocial, and whole-life approach may be helpful to support homeless individuals to make sense of distressing unusual experiences and beliefs and their coping responses. It may also be helpful to consider the changing sense of power, agency and autonomy when hearing their stories.

KEYWORDS:

• Hearing voices
• homeless
• unusual experiences
• psychosis

Introduction

It is estimated that 320,000 people are considered “homeless” in England (Reynolds, 2018), defined as rooflessness (without shelter of any kind), living in insecure housing such as temporary accommodation or “sofa surfing” (Public Health England, 2015). In England, 80% of homeless individuals are experiencing psychological distress (Homeless Link, 2014).

This research defines distressing unusual experiences as seeing, hearing, tasting, smelling or feeling experiences which others do not commonly experience (e.g. hearing voices). The research defines distressing unusual beliefs as holding beliefs that other people do not share, and can be considered “unusual” given the person’s socio-cultural and political context. People who are homeless report distressing unusual experiences and beliefs more frequently than homed populations (Folsom & Jeste, 2002; Perälä et al., 2007). Two thirds of homeless individuals report distressing unusual experiences and beliefs beginning prior to becoming homeless, with one third reporting that these experiences began after homelessness (Odell & Commander, 2000). Homeless individuals diagnosed with a “Psychosis” report more severe and distressing unusual experiences compared to homed individuals (Commander & Odell, 2001).

Read et al. (2009) present the evidence for the causal role of adverse life experiences in developing distressing unusual experiences and beliefs. Living in dense, urban environments with a high level of economic deprivation and inequality increases the likelihood of developing such experiences (Kirkbride et al., 2014). Homeless individuals have an increased likelihood of traumatic experiences, both before and during homelessness (Coates & McKenzie-Mohr, 2010). Research suggests that 78% of 102 homeless individuals had experienced bullying, 63% had been socially isolated, 61% had been assaulted and 61% feared being killed or injured (Coates & McKenzie-Mohr, 2010). Homeless individuals experienced more physical assaults and felt more frightened of muggings and being killed since becoming homeless (Coates & McKenzie-Mohr, 2010). Homeless individuals scored considerably higher on all items of the Trauma Symptom Inventory (Briere, 1995) than both homed individuals, and homed individuals who were mistreated as a child, suggesting the experience of being homeless itself may compound existing childhood trauma.

The label “homeless” is associated with severe stigmatisation and elicits negative reactions in others (Phelan et al., 1997). Homeless individuals experience discrimination and “unwelcomeness” from health care providers, which leads to feelings of dehumanisation and disempowerment (Wen et al., 2007). Experiences of discrimination may result in distressing unusual experiences and beliefs (Janssen et al., 2003), whilst social defeat acts as a perpetuating factor, by causing demoralisation, internalised stigma, and helplessness, which adversely impact the well-being “recovery time” (Luhrmann, 2007).

Taking a social inequalities perspective, the position of being homeless in society seems to lead to experiences of oppression and discrimination, with individuals subject to different operations of power; institutional, ideological, economic and material. The Power, Threat, Meaning Framework (PTMF; Johnstone et al., 2018) provides a structure to understand the interplay between the adverse experience of power, the threat that this poses on an individual and group level, and subsequent threat meanings and responses that are used to survive such power operations. The PTMF allows an explicit acknowledgement of, often, invisible social forces, providing an opportunity to raise consciousness about social injustice experienced by marginalised groups, thus creating space for equality practices and a distancing from “blaming the victim” discourse.

Distressing unusual experiences and beliefs can impact financial and housing stability. Odell and Commander (2000) suggested that isolation from childhood carers and substance misuse may predict whether a person with distressing unusual experiences and beliefs becomes homeless. Distressing unusual experiences and beliefs can lead to employer prejudice and difficulties gaining and maintaining a job (Hampson et al., 2017). Alongside unemployment difficulties, hospital admissions due to distressing unusual experiences and beliefs may make it difficult for home tenancies to be maintained, potentially resulting in homelessness (Tulloch et al., 2012).

Aims and rationale

It seems that there is a circular relationship connecting trauma, distressing unusual experiences and beliefs and homelessness. Traumatic and adverse experiences may lead to distressing unusual experiences and beliefs, which in turn can lead to homelessness, which may also be experienced as traumatic and lead to a reliance on substances, both of which may further maintain distressing unusual experiences and beliefs. However, the lived experience of this potential circular relationship is not well researched, and existing literature largely medicalises such experiences. There seems to be a gap in the literature for qualitative research that values the individual meaning of a person’s experience. The voices of individuals who have experienced homelessness and distressing unusual experiences and beliefs are largely absent in the literature.

This study aimed to use qualitative exploration to further our understanding of how individuals make sense of distressing unusual experiences and beliefs in the context of homelessness experiences. The research question was as follows:

How do previously homeless individuals make sense of their distressing unusual experiences and beliefs, through the stories in which they tell?

Method

Design

A qualitative narrative methodology was used, due to its consideration of how meaning is assigned to lived experience and conveyed through the stories in which people tell (Willig, 2013). It has also been suggested by The Centre for Narrative Research (2008) that hearing narratives themselves can be important for social change, fitting with the overarching research aim of valuing individuals’ sense-making, stories and voices. The narrative oriented inquiry framework (NOI; Hiles & Čermák, 2008) was used, due to its synthesis of the existing narrative analysis literature, clear steps to analysis, and the choice of a range of possible analytic perspectives to apply to the data. A narrative interview elicited participants’ stories, which followed four phases: 1.) Introduction and explanation to the research 2.) The narrative 3.) Questioning phase and 4.) Conclusion (Anderson & Kirkpatrick, 2016). A statement of research interest was read to each participant, followed by an open invitation for participants to tell their stories.

Participants and recruitment

Ethical approval was obtained from the University of Hull, Faculty of Health Sciences, Research Ethics Committee. Six participants took part in the study, who were recruited via convenience sampling. Participant pseudonyms and demographic information can be found in Table 1.

Table 1. Participant characteristics.

Pseudonym	Gender	Age	Ethnicity	Overall length of time spent homeless	Length of time as a companion in charity accommodation
Martin	Male	38	White British	18 months	4.5 years
Robert	Male	55	White British	Approximately 16 years (sporadically)	First time: 2 years Second time: 3.5 months
Steve	Male	30	White British	9 years – Sofa surfing. 1 night rough sleeping.	9 months
Harvey	Male	39	White British	8–10 years sporadically	First time: 6 months Second time: 5 months
James	Male	39	White British	Sofa surfing homeless – 6 months total (across 6 years) Rough sleeping: 3 nights	5 weeks
Andrew	Male	43	White British	25 years – sporadic sofa surfing/rough sleeping	3 months

Participants were recruited from a charity providing residential accommodation and meaningful work for previously homeless individuals in a northern city in Yorkshire, England. The participant inclusion criteria were: self-identification of having experienced homelessness; self-report of having had distressing unusual experiences; English-speaking; over 18 years of age; and able to give informed consent.

Procedure

Support workers at the charity organisation circulated an advertisement poster and information sheets to residents and discussed the research during resident meetings. The poster and information sheets provided the definition of distressing unusual experiences and beliefs as outlined for the research. The researcher contacted the participants by telephone to assess eligibility to take part and provide an opportunity for questions. Informed consent was gained. Interviews took place through video calling software over three months (November 2020 – February 2021) and duration ranged from 51–127 minutes (mean = 75). The interview was recorded and transcribed verbatim. Participants were provided with a £10 gift voucher as reimbursement for their time, and sent a sources of support information sheet.

Data analysis

All participant names were replaced with pseudonyms. Data analysis followed the steps of NOI (Hiles & Čermák, 2008). The raw transcript was read and organised into numbered segments to produce a working transcript. The Sjuzet-Fabula coding perspective was then applied to the transcripts, which is deemed an essential initial stage by NOI (Hiles & Čermák, 2008). The “Fabula” (i.e. “the told”) refers to the outline of the key events of the story, comprising of the basic storyline. The “Sjuzet” (i.e. the “telling”) refers to the way in which the story is told within its particular context, which adds colour and personal meaning. These components were separated within transcripts – the Sjuzet was underlined, and the Fabula left nonunderlined.

From the five additional interpretative perspectives offered by NOI, three were selected (Holistic-Content, Holistic-Form, and Identity Positioning; (Emerson & Frosh, 2004; Hiles & Čermák, 2008; Lieblich et al., 1998). This was to obtain a comprehensive analysis of participants’ stories of sense making, through exploration of the “Fabula”, as well as the “Sjuzet”. Due to word limit restrictions for publication, only one is fully reported in the present paper. The Holistic-Content perspective results were deemed to be the most pertinent for publication. Information on the findings from the additional perspectives can be gained by contacting the researcher directly.

The Holistic-Content perspective (Lieblich et al., 1998) provides a holistic picture of participants’ sense making across their stories, and highlights the factors that they consider to be important in this process, with an emphasis on the “Fabula” story component. This analysis involved: reading the transcript several times until key foci and themes emerged; writing a holistic impression of the story; and deciding, marking and tracking special foci/themes that repeatedly appeared. The resulting key foci and themes were interpreted as the important factors, experiences and concepts involved in sense-making.

Three full transcripts were shared with two research supervisors (AG and CS). The supervisors individually identified emerging themes within the transcripts and reviewed the primary researcher’s identified key themes and foci. The results were discussed in supervision to consider different perspectives.

Researcher position

The primary researcher was a white-British, 24-year-old female trainee clinical psychologist, who had previously undertaken a six-week placement within the charity organisation. The researcher viewed distress through a trauma-informed lens and felt strongly about working alongside individuals to develop meaningful understandings. The researcher held the belief that the medicalisation and illness model of distress could be potentially harmful, and professional support should offer multiple ways of making sense of their experiences.

Results

A holistic-content analysis of each narrative resulted in several key themes emerging from each participant’s story. These key themes were then synthesised to establish overall themes across stories, to understand how the previously homeless individuals made sense of their distressing unusual experiences and beliefs.

Overall, participants’ stories seemed to span both the interpersonal and intrapersonal realms, with multiple factors considered when trying to make sense of their distressing unusual experiences and beliefs (See, Table 2). These appeared to be interconnected – interpersonal events appeared to have intrapersonal consequences and vice versa.

Table 2. Synthesised themes and subthemes across stories, from the Holistic-Content analysis.

Theme	Subthemes
Interpersonal Factors in sense making	Trauma, abuse and neglect
	Loss
	Judgemental attitudes
	Fitting in: isolation vs connection
	Relational Coping
Intrapersonal factors in sense making	Physical wellbeing
	Substance use
	Spiritual, Religious and Paranormal sense making
	Psychological safety, security and stability

Interpersonal factors in sense making

Relationships and connections to other people appeared to play a key role in participants’ stories of sense making of distressing unusual experiences and beliefs.

Trauma, abuse and neglect: Participants considered their painful childhood experiences within their stories, including abuse and neglect from others, which was experienced as traumatic. The inclusion of such experiences indicates participants viewed them as important when making sense of distressing unusual experiences and beliefs, and pertinent in conveying such sense making to the listener. Childhood abuse featured within three participants’ stories. Participants explained how these traumatic experiences resulted in anger at being let down by others, breaking the law, and the use of substances to block out painful emotions and memories:

… and then the experiences I had when I was in the care system, the abuse and that what went on with that, people meant to look after me didn’t look after me. That sent me off the other way and I started to break the law and all me anger and that started to come out, everything’s interlinked. (Robert)

Childhood abuse led to mistrust of others, difficulties sleeping (and therefore physical exhaustion), feelings of paranoia and self-isolation. All these effects of childhood trauma were discussed as key components in beginning to hear voices and develop paranoid beliefs, and also entering cycles of crime, substance misuse and homelessness.

For one participant, James, parental separation, witnessing inter-parental violence and extreme bullying at school was considered when making sense of feelings of paranoia and feeling “on edge”. Traumatic life experiences continued and intensified during James’ time in the army. He considered the impact of being repeatedly under threat, and the subsequent development of paranoia:

… there’s a lot of situations where you’re being hunted down, and stuff like that, you’re always watching your back, and your friends backs, all the time, constantly. (James)

Three participants spoke of how neglect, feeling unwanted and overlooked led to a lack of direction and resulted in them following a difficult life path, punctuated by crime, drugs, prison and homelessness.

… And then as I’ve grown older, it’s just not caring. just thinking well If my mam don’t care, why should I? So that’s … led me to taking drugs and then obviously drugs to prison. (Harvey)

Substance use was then viewed as resulting in the development of paranoid beliefs.

Loss: The concept of loss featured heavily in participants’ stories indicating its pivotal role. The experience of loss through the death of a loved one featured within four participants’ stories. For Martin, unresolved loss and complex grief was the main way he made sense of hearing his mother’s voice inside his head. Martin also discussed how the further loss of his daughter intensified his mother’s voice, often commenting on his life choices and situations, making it difficult to accept that his mother had gone:

… I didn’t give myself to grief. From the death of my mum. I just put it to the side and just didn’t … [shakes head] … at all […] I think they call it like a grieving … a um grieving voice. (Martin)

Other participants considered how the loss of a loved one resulted in a substance use relapse, which they perceived as increasing their distressing unusual experiences and beliefs. Robert spoke of a breakdown in familial relationships as another experience of loss. Such loss was described as leading him “back down the bad path” of substance use, crime, prison and homelessness, which was later related to making sense of distressing unusual experiences and beliefs.

Judgemental attitudes: Perceived judgemental attitudes of others whilst homeless featured within three participants’ stories of making sense of paranoia and hearing voices:

When I was rough sleeping […] people walking past thinking ‘oh he’s a bum, he’s a druggie, he’s this that and the other … ’ But, I wasn’t.[…]’ Cause you ask anyone these days what they think of homeless? […]druggie, drunk, smelly, doesn’t bath. (Martin)

Two participants spoke of their own past judgemental attitudes towards others, to explain their anxiety that others were doing the same to them:

Like, like being younger and seeing smack heads on the streets and spitting at ‘em and shit … I never thought I’d turn into one. Because I used to fuckin hate ‘em when I was a kid but then obviously it backfired on me because then I became one of them and then I really understood what it was like to being to be on drugs and … what they must have felt like. (Harvey)

Fitting in: isolation vs connection: The concept of “fitting in” with people around them, and a subsequent sense of either connection or isolation featured in participants’ stories. One participant described his sense of isolation during his school years, in contrast to his time in the army:

…I got bullied quite bad, especially in secondary school […] So err a lot of the time I’d keep to myself, not be open and just shy away and that … Erm, but when I joined the army I fitted in like a glove, you know it was the best thing I did. (James)

Participants also discussed the importance of connection to others for their sense of worthiness and hope. Within Robert’s story, the sense of isolation experienced whilst rough sleeping played an integral role in making sense of how his voice hearing began:

Yeah … I put my voices down, I think they, they started I think from being by myself, being alone, being alone, sitting in doorways talking to yourself, it does, you get to that point where you’re getting answers from nowhere … (Robert)

Relational Coping: Participants described the importance of spending time with other people when coping with adverse life experiences and their distressing unusual experiences and beliefs. Two participants discussed the role of laughter in their lives, in maintaining their psychological wellbeing and connections to other people:

And I use my sense of humour a lot, you know to fit in and make people laugh […] cause I think laughter’s quite, quite important in people’s lives. D’ya know, like once you can make someone laugh, you know you’re halfway there. (Andrew)

Participants also discussed the role of being respected and helping others as a resident in the charity organisation, and the positive impact this had on their psychological well-being and sense of self. One participant discussed the importance of sometimes having alone time and some distance from other people, and termed this “self-preservation”:

I do like spending time by myself […] cos it’s like pressure cookers, everything is like build, build, build, and if you don’t let that steam off, you explode. And this is my … disappearing is me opening that little valve, let a bit of steam out, give me a bit of time, and I can come back. (Robert)

Intrapersonal factors in sense making

This theme explored the internal physical and psychological processes that participants discussed within their stories of sense making. It considered participants’ wellbeing, beliefs, internal emotional experience, and individual coping methods.

Physical Wellbeing: Two participants discussed their physical wellbeing when making sense of distressing unusual experiences and beliefs. The physical exhaustion and unmet physiological needs (food, shelter, rest) experienced whilst rough sleeping was one way in which participants made sense of distressing unusual experiences and beliefs:

I’ve experienced it when I’ve seen things, but I put that down … through to physical exhaustion when I’ve been travelling the roads. It’s like I’ve got to a stage when I’m walking through woods and I’m seeing people in trees, talking, and guiding me to where I need to be going. (Robert)

One participant, who had spent much of his life in the army, spoke of the importance of maintaining his physical wellbeing through exercise:

Doctors said to me you need to exercise, you’ve always been used to exercise, you’ve got to do it, because even if its 4, 5 times a week, just to keep yourself sane. (James)

Substance use: Substance use featured heavily within five participants’ stories. Participants discussed why they used substances and the impact of this on their lives, well-being and distressing unusual experiences and beliefs.

Substance use appeared to be a way of coping with distressing interpersonal experiences, such as trauma and loss, and numbing the resulting painful emotions:

I’m a man, so it’s different for a man to talk about what’s happened as a kid and I suppose it was just. I never dealt with it. And that’s probably one of the reasons why I turned to drugs because it was summat to try and block it out and I didn’t have to think about it. (Harvey)

One participant explained his substance use as a way of feeling “seen” by others, after experiencing neglect during childhood, highlighting the strong connection to the interpersonal element of his story:

… but that’s when the drugs came in aswell, the more and more drugs I took, the more attention I got … you know what I mean? (Martin)

One participant discussed how alcohol almost became a trusted part of his life, after being repeatedly let down by other people:

Alcohol has always been there for me, it’s a friend, its took my worries away from me […] it’s a very close friend, its family, its family, it’s never let me down … (Robert)

Although substances were used to cope with loss, they also resulted in the loss of relationships and connections for participants. One participant discussed how the use of illegal substances put his family in danger, and the impact this had on his relationship to them:

Like in and out of jail, fucking drug dealers knocking on the door looking for me, not paying stuff like that, police coming around […] So they saw the whole lot … and the day that I walked away and said well I can’t do this anymore … It’s best decision I’ve ever done in my whole life […] (Martin)

Substances were discussed as a way of directly understanding how and why their distressing unusual experiences and beliefs came to be. Three participants discussed the impact of substances in leading to and maintaining feelings of paranoia and their distressing visual experiences:

Being homeless as well you’ve got nothing to lose, so you go and use drugs to try and keep yourself sane. But you take the wrong drugs and you see you see things […] thinking the plain clothes police are walking behind me like the drug squad […] And like now I’m clean, I understand that it was probably the drugs that I was taking […] it’s got to have been … the MDMA. (Harvey)

Participants explained how substance use and homelessness can act as a barrier to accessing help and support for mental health difficulties. Martin discussed how he believed substance withdrawal may have resulted in an imposed diagnosis of Bipolar Disorder, suggesting that it interfered in gaining a true understanding of his difficulties:

… And that’s when the psychiatrist went … you’ve got bipolar … manic depression … whatever it’s called … and stuff like that. And I was like oh great thank you. Bearing in mind that I’m also withdrawing from heroin as well. Thank you. (Martin)

Harvey discussed how substance withdrawal impacted the ability to attend support appointments. For Andrew, supplying and using substances enabled him to access accommodation upon release from prison. This made it difficult to find a way out of substance use, given that his temporary accommodation was dependent upon his involvement in the substance use world:

And when you’re involved in that lifestyle, someone’ll always put you up if they know you’re earning decent money. If they know you’ve always got heroin or you’ve always got cocaine, people are willing to open their doors … (Andrew)

Spiritual, Religious and Paranormal sense making: Spiritual and religious sense making was another key theme featuring throughout three participants’ stories and seemed to have key relationships with other sub-themes of loss, safety, and physical wellbeing. For one participant, their non-distressing tactile unusual experiences were made sense of in relation to the loss of a loved one:

When I got touched in my back yeah, yeah, I believe that was me dad letting me know he was still around because it wasn’t harmful it wasn’t scary, it was just like ‘I’m here son’ […] But I’m abig believer in the afterlife and spirit world. (Harvey)

Some participants explained their unusual experiences in the context of God/ a religious guide, which was an explanation that they found comforting, rather than distressing. In Steve’s story, spiritual and paranormal sense-making was the main way in which he made sense of his distressing unusual experiences, and his “spiritual gift” featured throughout his story from childhood to the present day. The imminent loss of his mother led to a developing interest in the paranormal and spiritual world:

Me and one of my friends had actually done a Ouija board, in the house, and my mum was ill at this point, she was already ill, and so I think for me I kind of did it cause I wanted to sort of access the Spirit realm to find out like what was happening … (Steve)

Steve conceptualised his spirituality as a strength and resource, specifically explaining how it helped him to cope with substance use withdrawal:

Obviously your anatomy in your body is so crippled with pain withdrawing from this … toxic drug, It’s very difficult to then tap into your spirit body and your mind body and be able to overcome it through meditation and self-hypnosis, but it is possible cause I’ve done it. (Steve)

Steve’s story briefly mentioned an imposed diagnosis made by a professional:

… but I have been told in the past that I could possibly have bipolar, but in the end I got diagnosed with borderline personality disorder. (Steve)

Interestingly, within Steve’s own narrative of sense making, this diagnosis was rarely mentioned when considering his distressing unusual experiences and beliefs. He instead used spiritual, paranormal and religious frames of meaning.

Psychological safety, security and stability: A sense of psychological safety, security and stability commonly featured throughout all participants’ stories. Experiences within the interpersonal realm appeared to relate to a lack of psychological safety, security and stability across various life domains. Rough sleeping was a large component in participants’ experiences of feeling under threat and unsafe. Andrew explained how this related to his increased anxiety and hypervigilance:

You’ve always gotta be alert and switched on. And its physically and mentally draining. Having to be alert all the time, never knowing what’s gonna happen. […] I know a lad that’s had his bed set on fire. I know another person that was asleep in his tent, and they’d hooked it up to the back of a motorbike and toed his tent away whilst he was asleep in it. So, there’s always that part in the back of your mind ‘Am I gonna wake up alright in the morning?’. (Andrew)

Participants also discussed the impact of lacking a permanent base and secure accommodation, and explained how this influenced their sense of security, stability and confidence, which in turn they perceived as increasing their distressing unusual experiences and beliefs:

The unintentional sporadicity of my life, and not being able to settle … always wondering where I’m going to end up that night, or that day you know, so I think now that I’m grounded and I’m in a better place with my mental health, it has now settled down massively. But yeah, it’s intense. (Steve)

Previously homeless individuals stressed the importance of establishing safety, security and stability within their living arrangements, before being able to engage in additional support around their psychological well-being and substance use. Participants also discussed how they would sometimes be allocated unsuitable and unsafe accommodation by organisations and professionals, and discussed the impact of this:

Probation were gonna put me in the middle of the town centre […]They were gonna put me in a shared house[…] living with drug addicts, prostitutes, drug dealers. I just can’t get my head round that concept, of why they’d want to put you in that area, and not try and keep ya safe. (Andrew)

Theme relationships

Participants’ experiences of trauma, abuse and neglect linked clearly to several other subthemes: substance use to block painful memories; compromised physical wellbeing due to sleeping difficulties; loss of psychological safety and stability; and a sense of isolation. Substances were used to cope with loss, but also resulted in loss through compromised familial relationships. Loss also related clearly to spiritual and paranormal sense making of unusual experiences and beliefs. Substance use and “fitting in” were related – substances were a way to achieve this. Relational coping experiences and spiritual, paranormal and religious sense making appeared to enhance psychological safety, security and stability. Substance use and spirituality were also connected – spiritual practices were used to cope with substance withdrawal. Substance use negatively impacted on physical wellbeing and also compromised psychological safety; some participants felt under threat and hypervigilant whilst using substances. Living arrangements were expressed as vital to establish psychological safety, security and stability, prior to being able to engage in support around substance use, trauma, loss and additional mental health needs.

Discussion

This research aimed to amplify the voices of individuals who have experienced homelessness and distressing unusual experiences and beliefs, and to understand more about their individual sense making. When trying to make sense of their experiences, participants took a holistic and whole-life approach; their stories explored interpersonal events and experiences, and explained the intrapersonal consequences of such experiences. Their stories moved beyond medicalised understandings, and instead reflected individualised frames of meaning.

The results align with the literature that suggest distressing unusual experiences and beliefs can be understood in the context of distressing life experiences which shape the way in which individuals perceive, understand, and respond to their internal and external world (Cooke, 2017). Many of the adverse life experiences found to have a causal or strong associative relationship to the development of distressing unusual experiences and beliefs within the general population literature (Read et al., 2009), also featured throughout previously homeless individuals’ stories, including: childhood abuse, early parental loss through abandonment and neglect, war trauma, witnessing inter-parental violence and childhood bullying.

Participants discussed the intrapersonal consequences of adverse life experiences, which resulted in difficulties maintaining a job, relationships, and housing, which for some resulted in homelessness. The experience of homelessness itself maintained these difficulties for individuals, with repeating patterns of compromised safety, security, stability, agency and power featuring throughout their narratives of distressing unusual experiences and beliefs.

For some participants, understanding distressing unusual experiences and beliefs as having religious or spiritual origins provided comfort and appeared to allow them to integrate their experiences within their individual identities and move forwards with their lives. This finding echoes recent research which provided evidence for the role of religion and spirituality when making sense of voice hearing in the general population, and highlighted the importance of this for the development of identity and positive coping resources (Lewis et al., 2020).

Given the role of power, agency and control within previously homeless individuals’ narratives, the PTMF (Johnstone et al., 2018) is important to consider. Participants appeared to intrinsically weave the conceptual elements detailed by PTMF into their stories of sense-making. The emerging themes were synthesised into Interpersonal factors (i.e. What has happened to you?), and the Intrapersonal consequences (i.e. the effect, meaning, survival strategies). Although substance use played a role within five participants’ stories and was considered when making sense of distressing unusual experiences and beliefs, participants did not consider the use of substances to be the sole explanation for their distressing experiences. Substance use was also constructed as a “solution” to underlying distress, rather than the “problem” in itself. In this way, the use of substances may be considered one type of “threat response” through a PTMF lens (Johnstone et al., 2018). Such threat responses were explained as leading to crime, relationship breakdowns, financial instability and subsequently, homelessness.

Interestingly, despite some participants having contact with psychiatric services and being in receipt of diagnostic labels of mental illness, understandings characterised by illness played a minor role within participants’ narratives and their individual construction of meaning. Participants discussed imposed professional understandings within their narratives but did not readily accept these as “truth”, and instead took a more holistic and psycho-social approach to understanding distressing unusual experiences and beliefs and its interactions with homelessness, that would align more with the PTMF framework (Johnstone et al., 2018) of understanding distress.

Limitations

The presented study represents the voices of six individuals, all of whom were white-British, male and from the Yorkshire region. There was limited diversity in terms of nationality, race, cultural backgrounds, or gender identity, providing a relatively homogenous sample. However, as with all qualitative research, there are limitations on how much can be extrapolated from the present study, which must be noted when considering potential clinical implications.

The individuals who partook in the study were not currently street-homeless and were in stable accommodation within the supportive environment of the charity organisation. This may have provided a good opportunity to reflect on their life experiences in context. However, the experiences and sense making of individuals who are currently street-homeless and rough sleeping could differ and this may be an area for future research. Future research may also have a theory testing and development focus, to explore casual relationships between adverse life experiences, homelessness and distressing unusual experiences and beliefs.

Clinical implications

It is hoped that sharing these stories may be normalising for those with similar experiences, and may provide hope for positive change. Awareness of these narrative themes could be important for those supporting individuals with experience of homelessness; they offer contextualised understandings of distressing unusual experiences and beliefs, as an alternative to the medical “illness” model. This may encourage the valuing of individual sense making, which may be empowering for service users. Consideration of substance use as a coping/threat response may allow alternative understandings to emerge, which may be de-stigmatising and highlight additional areas for support and change. Providing space for story-telling within services may allow these individual frames of meaning to be heard and understood.

Clinical professionals may wish to consider power operations and aim not to replicate homeless individuals’ experiences of being “done to” by others. Facilitating choice, autonomy and agency is important, both within formulations and possible interventions.

Disclosure statement

No potential conflict of interest was reported by the author(s).