More on hearing voices, locally

As noted in my previous post, this week's Insight re-ignited my interest in how cultural factors might influence the experience of hearing (and dealing with) voices in the head, a common feature of schziophrenia.

I seem to have missed, or forgotten, the reporting around this study in 2014:  an anthropologist who found that it seemed relatively common for people from Indian and Ghana to find the voices "playful" or entertaining; whereas all of the Americans found them nasty and unpleasant.

Here's part of the report in Stanford news (my bold on the bits about India):

For the research, Luhrmann and her colleagues interviewed 60 adults diagnosed with schizophrenia – 20 each in San Mateo, California; Accra, Ghana; and Chennai, India. Overall, there were 31 women and 29 men with an average age of 34. They were asked how many voices they heard, how often, what they thought caused the auditory hallucinations, and what their voices were like.

"We then asked the participants whether they knew who was speaking, whether they had conversations with the voices, and what the voices said. We asked people what they found most distressing about the voices, whether they had any positive experiences of voices and whether the voice spoke about sex or God," she said.

The findings revealed that hearing voices was broadly similar across all three cultures, according to Luhrmann. Many of those interviewed reported both good and bad voices, and conversations with those voices, as well as whispering and hissing that they could not quite place physically. Some spoke of hearing from God while others said they felt like their voices were an "assault" upon them.

The striking difference was that while many of the African and Indian subjects registered predominantly positive experiences with their voices, not one American did. Rather, the U.S. subjects were more likely to report experiences as violent and hateful – and evidence of a sick condition.
The Americans experienced voices as bombardment and as symptoms of a brain disease caused by genes or trauma.

One participant described the voices as "like torturing people, to take their eye out with a fork, or cut someone's head and drink their blood, really nasty stuff." Other Americans (five of them) even spoke of their voices as a call to battle or war – "'the warfare of everyone just yelling.'"

Moreover, the Americans mostly did not report that they knew who spoke to them and they seemed to have 
less personal relationships with their voices, according to Luhrmann.

Among the Indians in Chennai, more than half (11) heard voices of kin or family members commanding them to do tasks. "They talk as if elder people advising younger people," one subject said. That contrasts to the Americans, only two of whom heard family members. Also, the Indians heard fewer threatening voices than the Americans – several heard the voices as playful, as manifesting spirits or magic, and even as entertaining. Finally, not as many of them described the voices in terms of a medical or psychiatric problem, as all of the Americans did.

In Accra, Ghana, where the culture accepts that disembodied spirits can talk, few subjects described voices in brain disease terms. When people talked about their voices, 10 of them called the experience predominantly positive; 16 of them reported hearing God audibly. "'Mostly, the voices are good,'" one participant remarked. 

While this doesn't seem all that many subjects, it's still fascinating. Interestingly, though, the anthropologist didn't seem to think that it was religiosity per se which made the difference.  (Although by that, does she mean how intensely religious they are in practice and interest?  Because as noted above, they seem to be religious in the sense of just accepting a supernatural spirit world):

Why the difference? Luhrmann offered an explanation: Europeans and Americans tend to see themselves as individuals motivated by a sense of self identity, whereas outside the West, people imagine the mind and self interwoven with others and defined through relationships.

"Actual people do not always follow social norms," the scholars noted. "Nonetheless, the more independent emphasis of what we typically call the 'West' and the more interdependent emphasis of other societies has been demonstrated ethnographically and experimentally in many places."

As a result, hearing voices in a specific context may differ significantly for the person involved, they wrote. In America, the voices were an intrusion and a threat to one's private world – the voices could not be controlled.

However, in India and Africa, the subjects were not as troubled by the voices – they seemed on one level to make sense in a more relational world. Still, differences existed between the participants in India and Africa; the former's voice-hearing experience emphasized playfulness and sex, whereas the latter more often involved the voice of God.

The religiosity or urban nature of the culture did not seem to be a factor in how the voices were viewed, Luhrmann said.

"Instead, the difference seems to be that the Chennai (India) and Accra (Ghana) participants were more comfortable interpreting their voices as relationships and not as the sign of a violated mind," the researchers wrote.

The research, Luhrmann observed, suggests that the "harsh, violent voices so common in the West may not be an inevitable feature of schizophrenia." Cultural shaping of schizophrenia behavior may be even more profound than previously thought.

The findings may be clinically significant, according to the researchers. Prior research showed that specific therapies may alter what patients hear their voices say. One new approach claims it is possible to improve individuals' relationships with their voices by teaching them to name their voices and to build relationships with them, and that doing so diminishes their caustic qualities. "More benign voices may contribute to more benign course and outcome," they wrote.

The Atlantic had a story about this too, ending with a story of the success (for some people) of not ignoring the voice, but developing a kind of relationship with it:

In an article for the American Scholar, Luhrmann describes one such patient, a 20-year-0ld Dutch man named Hans, whose inner voices were urging him to study Buddhism for hours each day. He cut a deal with his demons, telling them he'd say Buddhist prayers for one hour per day, no more, no less. And it worked—the voices subsided and he was able to taper his dose of psychosis medications.
At one support group for schizophrenic patients, Hans said a new, "nice" voice he had been hearing recently threatened to get mean.

"This new voice seemed like it might get nasty," Luhrmann writes. "The group had told [Hans] that he needed to talk to it. They said that he should say, 'We have to live with each other and we have to make the best of it, and we can do it only if we respect each other.' He did that, and this new voice became nice."

Call me too cautious, perhaps, but I have spoken to both my young adult children about the show, and the key message that if ever they do start hearing voices, don't try to keep it a secret and deal with it alone, but tell others what is happening and seek some assistance.