The Voices in My Head by Eleanor Longden: An Analysis of Factors Affecting Participation in Occupations

This essay analyzes the story of Eleanor Longden in The Voices in My Head and explores the factors affecting participation in occupations. It discusses the interplay between personal, social, environmental, and national factors and their effects on an individual's ability to participate in daily activities. The essay also discusses the importance of occupational therapy in improving participation and reducing mental health issues.

Eleanor Longden 1
‘THE VOICES IN MY HEAD,' BY ELEANOR LONGDEN
Student’s Name
Course Name
Professor
City/State
Date

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Section One
Introduction
This essay is based on the story of Eleanor Longden who, in her life as a local student in London,
experienced some challenges when she started hearing voices and could not comprehend what
was happening. Based on the story published by The Guardian, the situation moved from bad to
worse when the voices became more loud, consistent and persistent, which prompted her to stop
avoiding them and seek some help (Longden, Madill, & Waterman, 2012, p. 55). She noted that
her first step was to explain her predicaments to her friend, just like any other normal human
being would. The frightened friend encouraged her to seek medical attention a fact that finally
produced the much-intended result but after a lot of life-threatening experiences.
Based on the life experiences and examples from Eleanor Longden’s story, the essay will
analyze how the interaction between various factors such as personal, local, social, and national
factors would affect a person's participation in occupations. Occupations are the daily activities
that human being gets engaged in. From the story, we realize that Eleanor Longden was a student
in one of the local universities in London by the time her learning occupation was interrupted. As
will elaborated in details later in the essay, her predicaments were as a result of a combination of
various factors ranging from personal, social, environmental, and finally to national policies
which later on resulted to a health condition (Beck & Verticchio, 2018, p. 200). But it should be
noted from the story that such factors if taken off in a more interactive and inclusive manner,
may not end up as dangerous as Eleanor Longden's case.
Participation in the daily activities of human life is one of the fundamental sections of
development in human being’s life and the life experience in general. It is through active

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participation that people acquire and gain life skills, confidence, and competencies, we get new
friends through connecting with people and eventually find our lives meaningful. If the level and
quality of our participation in our day to day occupation are interfered with and limited in any
way, people become devastated, a matter that may lead to mental health issues like the case of
Eleanor Longden (Westaby, 2010). It is as a result of such reasons that states, relevant
organizations, and professionals try to improve health and well-being of the affected victims
through occupational therapy. Occupational therapy concentrates on making individuals and
groups of people able to take part in the day to day activities that meaningful and bring some
level of satisfaction to them and engage them in daily life activities with other people (Douglas
2013). The main aim of such kind of activity is to improve people's participation in everyday
occupations and enhance their interaction with other people to avoid or reduce stress and
depression in the society. Before assessing the remedial measures for the malfunctions in
occupational participation, the essay would first consider the factors that may promote or limit an
individual's ability to achieve maximum participation as explained in the context of participation
tool.
The context of participation refers to an interactive model aimed at promoting individuals and
groups to make rational decisions regarding participation. This participation tool was developed
by two senior lecturers in as illustrated by Hart Barnett and O'shaughnessy (2015,), Occupational
Therapy in the School of Allied Health Professionals, namely Rayya Gyui and Dr. Ian Marsh.
According to the context of participation tool, the definition of rational decision making involves
the identification and questioning assumptions, putting to task the importance of context,
imagining and seeking other options as well as developing positive criticism.

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Based on this context of participation tool, the factors that influence the participation of an
individual in the everyday occupation activities are categorized in different levels in the society,
some of which are beyond the control of the affected individual.
Socio-cultural values that surround an individual can have a limiting factor or promote the
participation of a person in his or her occupation. Some cultural beliefs limit some groups in the
society from taking part in a given set of occupations (Williams & Reid, 2012,). For instance, in
some parts of the world, women are not permitted by the society to walk alone at some hours of
the day. Such cultures have limiting effects on women regarding their participation in their day
to day activities and lower the ladies rational thinking concerning the times they should stop their
activities of the day.
An explanation by Ladner (2014), National policies may have some limiting effects on the rate at
which an individual takes part in his or her occupation. Cases like governments imposing
curfews in some parts of the country tend to have limiting effects on the people's freedom to
move from one place to another. The type of economy one operates in can also have some
controlling effects on a person. The people who operate in well-developed economies do have
plenty of options at their disposal as compared to individuals working in less developed states
(Johnston, Khalil, & Ming-Sung Cheng, 2018). Developed economies offer a wide range of
opportunities hence leave the trader with a wide area to apply rational thinking. Whereas another
business person is operating the same type of business but in a less developed economy may
have limited options to make a well-informed decision.
Another level in the context of participation tool comprises of determinants that are within the
control of an individual but are primarily class-based. These factors include the person's

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economic status in the society, education level, housing, media, work, health and social care as
well as his or her leisure. The society may tend to limit or promote a person's participation based
on his or her level of education (Westaby, 2010). For example, there are some countries in which
attainment of a Bachelor's degree is one of the basic qualifications to contest in any political
post. Such a case have a limiting effect on the citizens who lack such academic skills in their
quest to participate in their political occupation, while on the contrary, promotes the people with
such academic qualification.
Another example of this level of factors affecting participation in occupation is the economic
status of a person in the society. According to (Gernigon, Vallacher, Nowak, & Conroy, 2015),
the society may hinder an individual from being socially included in a given occupation due to
his or her lower economic class. An example is again in politics where the society may require
that for someone to vie for some political post, he or she must have attained some amount of
wealth and be able to pay some fee to be given the green light to proceed with the ambition. It
should be noted that this level of social inclusion and exclusion give the individual a chance to
choose his or her side, based on the ability to achieve the standards set by the society.
Another level of context of participation tool reflects on the immediate surroundings of the
person in question. They are those factors within reach of the affected individual, but he or she
may not be able to control some of them. As explained by (Díaz Andrade, & Doolin, 2016), this
part includes the daily living activities, local environment as well as the surrounding support
networks. This part is sometimes complicated to victims of violence, be it at family level of at
school or workplace, due to the nature of them seeming within control yet somehow out of his or
her hands. For instance, from the story of Eleanor Longden, she claimed that she, later on,
realized that the voices he was hearing represented the type of life she experienced in the past.

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The experience, according to her, involved various kinds of abuse in her life including sexual
abuse at a tender age. Such experience does have some damaging effects on children mostly if
they do not have the right channels to present their grievances.
In this same part of the context of participation in occupation, there is the local environment
factor. Eleanor Longden, from her story of ‘The voices in my head,' tried to use the readily
available strength the local environment presented, the close friend whom she shared her
predicaments with. The friend, who was to offer some motivation according to Eleanor Longden,
ended up more stressed that the victim herself. The friend’s reaction, made Eleanor Longden
conclude that she made a mistake sharing her story with the friend. The situation worsened when
the doctor she was referred to adapted the friend's belief that the voice she heard were very
disastrous and that she needed to be examined and preferably admitted to the hospital. Such
reactions from the immediate local environment may lead to stigmatization and make people
avoid sharing their problems in future.
In this part of the context of participation in occupation, there is the availability or the absence
of support networks for people suffering from a unique challenge. Such support networks
promote the participation of individuals in their everyday activities, as the affected persons hear
from other victims who had recovered from the same condition. Support networks play an
important role in encouraging victims like Eleanor Longden and give them hope that their
conditions are reversible. This hope alone is a curative measure; the affected persons would then
develop a positive attitude towards the medical procedures they are subjected to. Additionally,
the networks like the UK Hearing Voices Network, help reduce stigma among the victims as
they realize they are not alone in the battle.

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It should be noted that the various parts or levels of the context of participation in the occupation
have effects among themselves, some are complementary to one another whereas others have
conflicting effects on others. For instance, the policies made at national level determine the
availability of the support networks, if the policies are against the formation of such networks,
definitely they would not exist (Reyes & Arteaga, 2018). Some cultural practices have limiting
effects on an individual’s ability and freedom to be part of a given group, as seen in the Muslims
culture prohibiting women from participating in mixed sporting events. Again, the presence of
positive local environment rejuvenates the work done by the support networks.
The interaction of the various parts of the context has varying effects on the individual's
participation in occupation. The interplay may be a barrio or enabler of the process. The presence
of a good supportive local environment plus the existence of a strong support network
accompanied by national policies that encourage such networks would create an interplay that
would encourage the participation of affected individuals in their occupation even when they
continue battling the challenges they face.
Like in the case of Eleanor Longden, the story explains that if the lady had met a supportive
doctor during her first visit to the hospital, the healing process would have been better. The lady
acknowledged that the male psychiatrist and his nursing staff were better in that they were
positive to her and were ever willing to support her (Williams, & Reid, 2012). The presence of
her mother who showed a strong belief that the daughter would get well and return to her no
matter how long the process would take. The circumstances got even much better when Eleanor
Longden was able to get in touch with the UK Hearing Voices Network. The whole ordeal
proved that a combination of supportive parts of the tool is likely to result into enabling the

Eleanor Longden 8
environment for people with challenges to take part in their normal duties and fell included just
like any other member of the society.
On the other hand, a combination of non-supportive parts of the tool can be disastrous to people
with any form of disability. This was evident in the story, ‘The voices in my head’ when Eleanor
Longden met strange shock from her friend (Švajger & Piškur, 2016). The situation got worse
when even the doctor borrowed the friend’s mentality and started feeling that the situation was
getting out of hand. Such scenario presents very negative effects on the patience for they develop
the feeling that they would never be normal again. Eleanor Longden narrated in the story that the
two, her friend and the first doctor, could not see her strengths and her willingness to fight the
condition; all they saw was mental illness. She recognized that such a condition made her loss
her fighting spirit, helpless and was just there waiting for her fate. But luckily, she later met the
male doctor who encouraged her not to think about what people said about her, but to focus on
her life; and that marked the much-needed turning point.
From the story, ‘The voices in my head,' Eleanor Longden had to cope with some other
challenges that resulted from her condition, such the stigma (LONGDEN, & READ, 2016).
Stigma does not come from the disease or the condition itself, but from the perception, others
have regarding a condition. It should be noted that voice hearing and other unusual experiences
like delusional beliefs are common in the general population; what makes the difference is how
the condition is managed.
Eleanor Longden’s case was an example of somehow mismanaged condition at the beginning, a
fact that led to some stigma and hopelessness. A study conducted by Friedman and Rossi (2015),
the reception she had in the hands of her friend and the first doctor created a feeling f not

Eleanor Longden 9
belonging to the society, exclusion. The story elaborated that at the point of her admission to the
hospital, after being diagnosed with Schizophrenia, even the friend was not very welcoming. The
stigma worsened the already worse situation when she tried to confront the voices not knowing
that the more she rebuked them, the more aggressive the voices became.
Occupational Therapy
According to Adam, Gibson, Lyle, and Strong, (2010), occupational therapy entails the use of
well-coordinated follow up and periodic supervision to try to develop, recover, or maintain the
meaningful life activities of an individual or a group of people, and it’s mostly applied to patients
with mental problems, disabilities, impairments, or injuries. Like in the story, ‘The voices in my
head,' Eleanor Longden’s situation ended up being considered as a mental health issue that
finally required occupational therapy.
An occupational therapist is regarded as someone who assists people across the lifespan takes
part in activities that they need to participate in through therapeutic mean of daily activities.
Occupational therapists mostly help children with disabilities to take part in school activities and
social situations, injury rehabilitation and assist the elderly people who are undergoing physical
and cognitive changes in their lives (Brown, & Hollis 2013). Occupational therapists are
professionals who have to pass some licensing exams and mostly work closely with other
professionals in various areas such as physical therapy, speech therapy, and social work.
Based on the information in the story, ‘The voice in my head,' Eleanor Longden’s condition
could be well monitored and addressed through the Person Environmental Occupational
Performance (PEOP) Model (Grabham & Smith, 2010). The model pays attention to the basic
information the patient holds. In this model, such information is grouped into two; the intrinsic

Eleanor Longden 10
and extrinsic characteristics. The intrinsic characteristics, the natural information that could not
be changed in the ladies life were useful in developing a working occupational therapy for her.
The model would then consider the patient's extrinsic characteristics that would then add as an
added advantage in the process.
Following Eleanor Longden’s story, the condition required a flexible occupational therapy that
depends on the facts available to formulate the way forward, a perfect match of Person
Environmental Occupational Performance (PEOP) Model. Eleanor is said to have undergone
some experiences in her early life that had escalated the voices, and she was on record stating
that the voices represented the damages she had experienced (Smith & Hudson, 2012). She went
ahead and appreciated that the moment she realized the voices meant well for her and she needed
to listen to them, the whole process showed some future. This fact meant that to help her, the
occupational therapist had to start by handling the life experiences.
The occupational therapist handling Eleanor's condition was therefore required to listen to her
past life experience; the devastating challenges and abuses she mentioned. With this information
in mind, the therapist could easily identify that Eleanor's condition was not as dangerous as had
been insinuated (Smith & Hudson, 2012). Her condition worsened due to the manner in which
she was received and perceived by her handlers, a perception that made her lose hope and face
stigma even from people she trusted most. It can be noted that at one point, only her mother had
faith that she would become normal again.
Section Two

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The story, ‘the voices in my head,' has illustrated that it did the barriers and enablers to
participation in the occupation have effects on health and the well-being of an individual. The
external factors can be limiting or enabling factors in taking part in everyday activities (Grabham
& Smith, 2010). Her predicaments were as a result of a combination of various factors ranging
from personal, social, environmental, and finally to national policies which later on resulted in a
health condition. From the scenario, one can firmly reason that the procedures used in handling a
patient can either be a barrio or enabler in participation in occupational life. There are various
occupational therapy models that can be applied in different patients depending on the conditions
they are in and the underlying factors. Such occupational therapy models include the person
environmental occupation performance model (PEOP), model of human occupation (MOHO)
mode, and Kawa model.
Various occupational therapy models can be applied in different patients depending on the
conditions they are in and the underlying factors. Such occupational therapy models include the
person environmental occupation performance model (PEOP), model of human occupation
(MOHO) mode, and Kawa model. The Person Environmental Occupational Performance (PEOP)
Model serves as a guide for an Occupational therapy to be able to understand their patients better
and, therefore, provide better therapy (Désiron, Donceel, Rijk, & Hoof, 2013). The PEOP Model
is a top-down, client-centered model, which means it focuses first on the client, paying attention
to the client's intrinsic and extrinsic characteristics. A person's intrinsic characteristics are those
things they are born with and typically cannot change, like gender, race, and age. A
person's extrinsic characteristics have to do with their environment and often can be changed,
like their culture and economic status. The PEOP Model states that patients should not all be
treated the same.

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From the scenario, one can strongly argue that the procedures used in handling a patient can
either be a barrio or enabler in participation in occupational life. The proper management she
received from the male psychiatrist introduced positive attitude in her and improved her self-
belief and participation in the normal daily routines (Grabham & Smith, 2010). This fact
improved her health, and a sense of well-being increased in her. It is after the analysis of the
patient's condition and the underlying factors behind the condition that a remedial procedure can
be prescribed, in such a case, an occupational therapist.
The facts in the story proved that Eleanor Longden’s condition could be well monitored and
addressed through the Person Environmental Occupational Performance (PEOP) Model. The
model pays attention to the basic information the patient holds. In this model, such information is
grouped into two; the intrinsic and extrinsic characteristics (Švajger & Piškur, 2016). The
occupational therapist handling Eleanor’s condition was therefore required to listen to her past
life experience; the devastating challenges and abuses she mentioned. With this information in
mind, the therapist could easily identify that Eleanor’s condition was not as dangerous as had
been insinuated.

Eleanor Longden 13
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