Voices of Pain, Voices of Guidance

I don’t think there’s anything there or anything. I think it’s just the way my mind works.
— Participant from America

If you catch a cold in Connecticut you'd probably feel about the same as someone who caught a cold in China. The same cannot be said for mental illnesses. In a truly fascinating study, authors Luhrmann, Padmavati, Tharoor, and Osei found that when it comes to illnesses of the mind, where you are matters a great deal.

The art of Louis Wain throughout the progression of his schizophrenia.

The art of Louis Wain throughout the progression of his schizophrenia.

How They Did It

The researchers focused their study on people that heard auditory hallucinations without the influence of drugs, people that would traditionally be diagnosed with schizophrenia or schizoaffective disorder in the United States.  They wanted to know how the experience of hearing voices differed from culture to culture. 20 participants were selected per location in California, Ghana, and India. Their subjects had an average age of 43 years and were split almost evenly along gender lines. All had a history of hearing voices, though they came from a variety of medical backgrounds.

Usually, it’s like torturing people, to take their eye out with a fork, or cut someone’s head and drink their blood. Really nasty stuff.
— Participant from America

Unexpected Findings

There were some constants across all cultures tested. Many participants had mixed experiences with their voices, sometimes good, sometimes bad. In each culture there were some that thought they were hearing divine messages among the voices and some that felt assaulted instead. People everywhere carried out full conversations with voices and heard them ranging from whispers to screams.

The surprising differences emerged when researchers compared the tone and content of the auditory hallucinations. All Americans surveyed had overall negative experiences. Most had been told to hurt themselves or other people. Some heard previous abusers and only one out of twenty predominantly heard people she knew. Overall, Americans felt terrorized by their hallucinations with only occasional pleasant encounters.

I like my mother’s voice. I have a companion to talk to! I need not go out to speak. I can talk with myself!
— Participant from India

Results were radically different in Ghana and India. At least 75% of participants felt they had mostly positive experiences with their hallucinations. In India, people usually heard voices of family, neighbors, or friends. They formed relationships with these voices, even the ones that they didn’t know personally. Sometimes the voices would give advice while other times they’d chastise for perceived failures. The voices sometimes were playful, sometimes risque, and sometimes commanding. Several reported that their voices demanded that they do their chores or other personal tasks. 

Indian participants reported that even though the voices could sometimes be frightening that they saw them as guiding forces throughout their lives. Perhaps it is because of this positivity towards their condition that they were much less likely to use the term “schizophrenia” to describe their experiences than American participants. Many more felt that they were being spoken to by spirits, or even by gods.

Mostly the voices are good. They just tell me to do the right thing. If I hadn’t had these voices I would have been dead long ago.
— Participant from Ghana

People were also less likely to label themselves as having a disorder in Ghana, though most understood that hearing auditory hallucinations was a symptom of psychiatric illness. Like those in India, they also generally heard voices of people they knew or supernatural figures. They were less positive about their condition as those from India, though still far more appreciative than American participants. 

When it comes to the mind, culture plays a huge impact. Western cultures are very self-driven and individualistic while residents of Ghana and India think of themselves as more interconnected with their community. Hindu people especially tend to view themselves through the lens of their relationships. The ambient culture not only determined the manifestation of mental illness in these participants, but also how they felt about their condition.

I went to Bangalore and I could hear the voices there as well, can be heard like it has been soaked and stuck to my body.
— Participant from India

Of course, it isn’t all rosy even for those with positive outlooks. Many of those who were surveyed were found when they were admitted to mental hospitals. Some were driven to aberrant behavior by their seemingly supportive voices. One African man believed he was spoken to by four river spirits who had granted him dominion over domestic animals. He killed and ate the animals that he felt were misbehaving. The village headman objected to this behavior and the man ended up in the local hospital because of it.

Overall, residents of Ghana and India were much more accepting of their voices, treating them like people that they could not control and could form relationships with. There are new schizophrenia treatments in the United States that advocate this sort of thinking, encouraging patients to name and befriend their voices. There is much more research to be done, but it's clear that the harsh and violent voices of schizophrenia may not be so inevitable after all.

- Kate Dzikiewicz, Paul Griswold Howes Fellow