Neuroscience
When a patient with schizophrenia hears voices in their head, is the experience shaped by the culture they live in? Tanya Luhrmann and her colleagues investigated by interviewing twenty people diagnosed with schizophrenia living in San Mateo, California; twenty in Accra, Ghana; and twenty others in Chennai India. There were similarities across cultures, including descriptions of good and bad voices, but also striking differences.
In San Mateo the interviewees talked about their condition as a brain disease, they used psychiatric diagnostic terms to describe themselves, and their experiences were almost overwhelmingly negative. Fourteen described hearing voices that told them to hurt others or themselves. Eight people didn't know the identity of their voices and few described having a personal relationship with their voices.
By contrast, in Chennai, the interviewees frequently spoke of their relationships with their voices - that is, they heard the voices of relatives or friends, giving them advice or scolding them. These patients rarely used diagnostic terms, and rarely talked of voices instructing them to commit violence. Instead, distress, when it occurred, usually arose from their voices talking about sex. Nine interviewees described voices that were significantly good - in terms of being playful or entertaining.
In Accra, yet another picture emerged. Most of the interviewees here mentioned hearing God. This isn't simply a case of this sample being more religious - the interview groups in all three locations were predominantly religious. Half the interviewees in Accra reported that their voice hearing was mostly or entirely positive. Others frequently emphasised the positive. Use of diagnostic labels was rare, as were incitements to violence by voices.
Luhrmann and her team said their most striking finding was that the experiences of voice hearing in the two non-Western samples were less harsh and more "relational" - that is, patients perceived their voices as other people, who could not be controlled. The researchers believe this difference is likely due to Western cultures emphasising independence and individuality - in which case heard voices are experienced as a violation - whereas African and Asian cultures emphasise how each person's mind is interwoven with others. "We believe that these social expectations about minds and persons may shape the voice-hearing experience of those with serious psychotic disorder," the researchers said.
These results need to be replicated with larger samples matched more precisely for illness severity, and with more tightly controlled measures (the current study was deliberately qualitative and exploratory). If replicated, the findings would imply the experience of hearing voices in schizophrenia is to some extent malleable, which could have exciting therapeutic implications. Indeed, it's notable that the outcomes for patients with schizophrenia outside the West, especially in India, are known to be more positive - perhaps because of the way patients relate to their voices. "The harsh violent voices so common in the West may not be an inevitable feature of schizophrenia," the researchers said.
_________________________________
Luhrmann, T., Padmavati, R., Tharoor, H., & Osei, A. (2014). Differences in voice-hearing experiences of people with psychosis in the USA, India and Ghana: interview-based study The British Journal of Psychiatry DOI: 10.1192/bjp.bp.113.139048
--further reading--
What's it like to hear voices that aren't there?
The same voices, heard differently?
Psychosis isn't always pathological
Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.
- What's It Like To Hear Voices That Aren't There?
Traditionally, when a person says they can hear voices that don't exist in external reality (not to be confused with inner speaking), psychiatry has treated this as a sign of mental illness. However, it's become clear in recent years that many...
- The Same Voices, Heard Differently?
It isn't just people with a diagnosis of schizophrenia who claim to hear voices inside their heads. Many other people do too. However, a key difference between psychiatric and non-psychiatric voice hearers is that the latter usually claim not to be...
- A New Approach To Help Those Who Hear Voices
When it comes to the ‘positive’ symptoms of schizophrenia, such as hearing voices, cognitive behavioural therapy (CBT) has mostly be used to help reduce the distress and burden that they can cause. But now Jerome Favrod and colleagues in Switzerland...
- Fmri Neuroimaging Of Neural Control Over Speech
Inside the mind of an actor (literally) How does an actor engage with the part they are playing? Fiona Shaw undergoes a brain scan while reciting TS Eliot to help shed some light on the mystery Stuart Jeffries The Guardian Tuesday 24 November 2009 [snip]...
- Aural Synesthesia?
I was recently in DC for conference of special librarians and I was lucky enough to have a tour of the NPR building. My guide, library director Laura Soto-Barra, asked about my favorite shows on NPR. News junkie that I am, I said that the top- and bottom-of-the-hour...
Neuroscience
The voices heard by people with schizophrenia are friendlier in India and Africa, than in the US
In San Mateo the interviewees talked about their condition as a brain disease, they used psychiatric diagnostic terms to describe themselves, and their experiences were almost overwhelmingly negative. Fourteen described hearing voices that told them to hurt others or themselves. Eight people didn't know the identity of their voices and few described having a personal relationship with their voices.
By contrast, in Chennai, the interviewees frequently spoke of their relationships with their voices - that is, they heard the voices of relatives or friends, giving them advice or scolding them. These patients rarely used diagnostic terms, and rarely talked of voices instructing them to commit violence. Instead, distress, when it occurred, usually arose from their voices talking about sex. Nine interviewees described voices that were significantly good - in terms of being playful or entertaining.
In Accra, yet another picture emerged. Most of the interviewees here mentioned hearing God. This isn't simply a case of this sample being more religious - the interview groups in all three locations were predominantly religious. Half the interviewees in Accra reported that their voice hearing was mostly or entirely positive. Others frequently emphasised the positive. Use of diagnostic labels was rare, as were incitements to violence by voices.
Luhrmann and her team said their most striking finding was that the experiences of voice hearing in the two non-Western samples were less harsh and more "relational" - that is, patients perceived their voices as other people, who could not be controlled. The researchers believe this difference is likely due to Western cultures emphasising independence and individuality - in which case heard voices are experienced as a violation - whereas African and Asian cultures emphasise how each person's mind is interwoven with others. "We believe that these social expectations about minds and persons may shape the voice-hearing experience of those with serious psychotic disorder," the researchers said.
These results need to be replicated with larger samples matched more precisely for illness severity, and with more tightly controlled measures (the current study was deliberately qualitative and exploratory). If replicated, the findings would imply the experience of hearing voices in schizophrenia is to some extent malleable, which could have exciting therapeutic implications. Indeed, it's notable that the outcomes for patients with schizophrenia outside the West, especially in India, are known to be more positive - perhaps because of the way patients relate to their voices. "The harsh violent voices so common in the West may not be an inevitable feature of schizophrenia," the researchers said.
_________________________________
Luhrmann, T., Padmavati, R., Tharoor, H., & Osei, A. (2014). Differences in voice-hearing experiences of people with psychosis in the USA, India and Ghana: interview-based study The British Journal of Psychiatry DOI: 10.1192/bjp.bp.113.139048 --further reading--
What's it like to hear voices that aren't there?
The same voices, heard differently?
Psychosis isn't always pathological
Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.
- What's It Like To Hear Voices That Aren't There?
Traditionally, when a person says they can hear voices that don't exist in external reality (not to be confused with inner speaking), psychiatry has treated this as a sign of mental illness. However, it's become clear in recent years that many...
- The Same Voices, Heard Differently?
It isn't just people with a diagnosis of schizophrenia who claim to hear voices inside their heads. Many other people do too. However, a key difference between psychiatric and non-psychiatric voice hearers is that the latter usually claim not to be...
- A New Approach To Help Those Who Hear Voices
When it comes to the ‘positive’ symptoms of schizophrenia, such as hearing voices, cognitive behavioural therapy (CBT) has mostly be used to help reduce the distress and burden that they can cause. But now Jerome Favrod and colleagues in Switzerland...
- Fmri Neuroimaging Of Neural Control Over Speech
Inside the mind of an actor (literally) How does an actor engage with the part they are playing? Fiona Shaw undergoes a brain scan while reciting TS Eliot to help shed some light on the mystery Stuart Jeffries The Guardian Tuesday 24 November 2009 [snip]...
- Aural Synesthesia?
I was recently in DC for conference of special librarians and I was lucky enough to have a tour of the NPR building. My guide, library director Laura Soto-Barra, asked about my favorite shows on NPR. News junkie that I am, I said that the top- and bottom-of-the-hour...