Tanya Luhrmann, hearing voices in Accra and Chenai

One of the only disappointments of the ‘Culture, Mind and Brain’ conference in Los Angeles this weekend — and there were plenty of things that turned out even better than expected — was that Prof. Tanya Luhrmann of Stanford was not able to join us. However, because she couldn’t be here, she was kind enough to prerecord her lecture: Hearing Voices in Accra and Chennai: How Culture Makes a Difference to Psychiatric Experience.


Tanya Luhrmann’s hearing voices (link to video)

(The video doesn’t seem to want to embed for me. I’ll try to fix it, but let’s get this up sooner rather than later.)

Luhrmann explored in her talk whether culture makes a difference in the voices that patients with serious psychotic disorder experience. She has elsewhere made the argument that the types of voices may vary, based on available research on patterns of hallucination. In a review in the Annual Review of Anthropology, Luhrmann writes:

local theory of mind—the features of perception, intention, and inference that the community treats as important—and local practices of mental cultivation will affect both the kinds of unusual sensory experiences that individuals report and the frequency of those experiences. Hallucinations feel unwilled. They are experienced as spontaneous and uncontrolled. But hallucinations are not the meaningless biological phenomena they are understood to be in much of the psychiatric literature. They are shaped by explicit and implicit learning around the ways that people pay attention with their senses. This is an important anthropological finding because it demonstrates that cultural ideas and practices can affect mental experience so deeply that they lead to the override of ordinary sense perception. (2011: 72)

(The last line, although not the way I would phrase it certainly, will not be news to readers of Neuroanthropology: because of my work on sensory learning, we’ve frequently discussed ways that the concept of ‘ordinary sense perception’ itself is probably not defensible. But that’s a tangent to Luhrmann’s discussion and not terribly important here…)

In the talk she recorded for the Culture, Mind and Brain conference, Luhrmann discusses findings from field research with patients in the US, Accra and Chennai, who all had auditory illusion as their primary symptom. In all cases, the subjects of her research were seriously and negatively affected by the presence of their voices. (Luhrmann has argued elsewhere that there are fundamental differences between pathological and non-pathological hallucinations; see Luhrmann et al. 2010.)

Although Luhrmann acknowledges that schizophrenia is a difficult and messy diagnosis at times, she was satisfied with the fact that she was dealing with ‘loosely the same phenomenon’ based on the extensive interviews she did. Especially in the US, the voices were much like those that Luhrmann describes in her Annual Review of Anthropology article on the subject,

People with psychosis hear phrases repeatedly; they can hear long conversations commenting on their behavior; they can hear back-and-forth conversations about them in the third person. These hallucinations are unpleasant, even horrific. In the condition we identify as schizophrenia, hallucinations are primarily auditory (in all cultures) and they are often accompanied by strange, fixed beliefs (delusions) not shared by other people (for example, that malevolent government agents are running an electrical experiment in one’s brain). This pattern of hearing distressing voices appears to be universal and recognized as illness everywhere. (Luhrmann 2011: 75)

What was more interesting, however, was that the fieldwork in Chennai and Accra showed some significant variation in the nature of the voices, which caused (and was caused by) a profoundly different experience of the condition. Luhrmann and her research assistants asked patients about their voices: how many, what sorts of voices, their relationships to the voices, could they identify any of the voices, what sort of control they had. The interviews paid close attention to the experiential quality of the voices: were they stressful and why; were any experiences of hallucination positive; whether the patients thought that the voices were ‘real’; and what they felt the causes of the voices was. In the video, Tanya details the different topics fairly comprehensively, but I’m only going to gloss them quickly here. (If you’re interested, you really should watch the video; she discusses the specific questions asked around 7:00 mins into the clip.)

Hearing voices in the US

The US patients almost all self-identified as ‘schizophrenic’ and used the diagnosis to talk about their condition; they knew the ‘textbook’ definitions of the condition and ideas about hereditary illnesses. The patients know that ‘hearing voices’ is a sign you’re ‘crazy,’ so they often try to conceal their experiences. They dislike hearing voices and try to deny their existence.

Luhrmann describes in an article in The Wilson Quarterly that admitting to being ‘crazy’ in this context is itself painful, especially when confronted by most therapeutic institutions in the US:

In care as usual, people diagnosed with schizophrenia are regarded as severely disabled and thus as appropriate recipients of supported housing and other benefits. People are required to get their diagnosis to justify their placements, sometimes being asked to collect an actual piece of paper from one office and turn it in at another. Many people with schizophrenia cycle through long periods of homelessness. Few of them like it. You would think that they would line up to be housed. But they dislike the diagnosis even more than they dislike being out on the street, because the idea of being “crazy” seems even more horrifying to them than it does to those of us who have roofs over our heads. (Beyond the Brain)

For Westerners, ‘hearing voices’ is so clearly indicative of insanity that, in an experiment reported by Rosenham in Science in 1973, a number of researchers were all institutionalized when they reported hearing indeterminate voices, but no other symptoms. Moreover, once institutionalized, they were detained for up to two months and prescribed antipsychotics even though all of the experimental ‘patients’ (Rosenham’s collaborators) reported to psychiatrists that they no longer heard voices as soon as they were admitted. (I teach this article in the psychological anthropology class I teach with Gabrielle Maranci at Macquarie.)

For Lurhmann’s American subjects, the voices themselves are generally unknown; rarely, some patients heard famous people and a couple of subjects heard individuals who had sexually molested them as children. Luhrmann found that all of the subjects heard ‘horrible voices, telling them that they were worthless and should die.’ Sometimes voices told them to torture others or ‘go to war,’ or that the sufferer should commit suicide or was destined for a horrible end; one patient referred to her ‘suicide voice.’

Hearing voices in Ghana

In Accra, Luhrmann and her assistants found that the patients heard an ‘audible God’ who actually advised them to ignore other ‘evil voices.’ In contrast to the US, in Accra, hearing voices didn’t necessarily mean that you were ‘crazy’; instead, the local explanation of the condition often referred to the subject being under ‘spiritual attack’ by either spirits or witches. To be the victim of a witch carried less stigma than to have a mental illness, and people generally didn’t talk about ‘schizophrenia’.

Some of the voices that individuals in Accra heard were familiar people — family, kin, employers — and half the patients reported that they heard primarily or only positive voices, telling them to do good or offering advice. Even when individuals in Accra heard aggressive or critical voices, they also reported hearing ‘good’ voices that told them to ignore these negative influences. Interestingly, Luhrmann reports that, if you push patients in the US, asking them about ‘good’ voices, they will report that they ‘live for these days,’ suggesting that they don’t even really consider this type of experience ‘schizophrenia,’ ignoring positive voices when asked about their condition without prompting. In Accra, positive voices are central to the experience; in the US, they are treated as an aside, peripheral to their primary condition. In Accra, people even said that the voices had ‘kept them alive.’

The experience of these voices, of course, was much less distressing than the horrible things that American patients reported. Over time, even if the individual initially experiences horrible voices, as their condition progresses, the voices often become more helpful, with new protectors or companions displacing distressing voices. The voices often provide patients with company and advice, with at least half the patients having positive experiences.

Hearing voices in India

In contrast, the patients in Chennai, who were all diagnosed with schizophrenia, tended to hear ‘annoying relatives who told them to get dressed and clean up.’ Kin form the lion’s share of voices, sometimes criticizing them, sometimes advising them and keeping them company, consoling, or helping to motivate patients.

Some of these voices are reassuring, even playful. Luhrmann says that the playful voices can even become imaginary companions. One woman reported hearing Hanauman, the monkey god, who at first encouraged her to do horrible things and threatened to punish her, but over time became a playful companion with whom she ‘had pillow fights’ and parties, playing pranks on each other. However, the voices often talk about sex, which is spectacularly embarrassing.

As Luhrmann explains in an essay in The Wilson Quarterly, the Indian approach to schizophrenia is markedly different to that in the US:

Indian families also don’t treat people with schizophrenia as if they have a soul-destroying illness. As an anthropology graduate student, Amy Sousa spent more than a year in northern India, sitting with doctors as they treated patients who came with their families into a dingy hospital where overworked psychiatrists can routinely have 10 appointments an hour. Many of the doctors didn’t mention a diagnosis. Many of the families didn’t ask. There was a good deal of deception—wives grinding medication into the flour for the daily chapattis they made for their husbands, doctors explaining to patients that they were completely well but should take strengthening pills to protect themselves from the ravages of their youth. As a result, none of the patients thought of themselves as having a career-ending illness, and every one of them expected to get better. And at least compared to patients in the West, they generally did. (Beyond the Brain)

Why the differences?

Luhrmann warns that the research is in early stages but that the experiences may be different because in each case, people are encouraged to have different sorts of opportunities when they start hearing voices. Although the local explanations of the condition or the models of the condition vary, the point is that mental practice or patterns of interaction and attention to mental events are also distinct.

The way that individuals experience the ‘mind’ in each place also matters. When the research team asked American patients whether the voices were ‘real,’ the question was easy for US subjects to answer; they recognized the distinction between ‘real’ voices and voices ‘inside your head,’ in part because the mind was understood to be a closed space. Having some other agents in your mind was clearly a sign of illness or dysfunction, so the voices were ‘extremely disconcerting.’

In contrast, even the distinction between ‘real’ and ‘not real’ didn’t quite make the same intuitive sense to the subjects in other places, perhaps because their understanding of ‘mind’ was less private. Although Luhrmann cautions that her ideas are preliminary, she suggests that ‘mind’ in Chennai was more transactional and social, rather than purely private, but that it was important to achieve calm.

Although it’s not clear to me how this relates to the question of ‘reality’ of voices, Luhrmann suggests that, in Accra, mind was seen as a moral quality, and thought as having effects in the world. To have good thoughts was to bring about desirable effects, so people strove to exercise control over their thoughts in order to influence the world around them.

Talking with your voices

Perhaps one of the most interesting things that Tanya says in her lecture, however, is a discussion she also picked up in a piece in The American Scholar (Living with Voices). In a single slide, toward the very end of the talk, Luhrmann discusses the ‘Hearing Voices’ movement, a therapeutic movement in Europe, America, and elsewhere, that encourages individuals to have more of a positive and engaged relationship with the voices that they hear. She suggests that cross-cultural research offers an opportunity to examine ‘natural experiments,’ in which different local relationships to auditory hallucinations might influence the prognosis for schizophrenia.

Luhrmann describes the Hearing Voices movement:

…recently a new grassroots movement has emerged. It argues that if patients learn to address their voices directly and appropriately, as if each voice had intention and agency, the voices will become less hostile and eventually go away. From the perspective of modern psychiatry, this assertion is radical, even dangerous. But it is being taken seriously by an increasing number of patients and psychiatrists. (Living with Voices).

The Hearing Voices movement was initiated by Dutch psychiatrist Marius Romme and his wife, Sandra Escher, together with their patients. Romme had met patients in his psychiatric practice who seemed to cope surprisingly well with hearing voices, so he advertised on national television in the Netherlands to make contact with people more broadly, including those who had never shared their experiences with psychiatrists (see Luhrman’s Living with Voices piece for a more comprehensive account). Romme learned that a surprising number of people who responded to his call got along quite well in spite of their audio hallucinations.

Talking with those who got along well, Romme, together later with Escher, found that those who were less disturbed by voices told individual stories that followed a common pattern: ‘Some voices had started out mean and difficult, and the hearers had first responded with startled fear, but once they had chosen to interact with them, the voices settled down and became more manageable, sometimes even useful’ (Living with Voices). As Luhrmann explains elsewhere, the irony of treating the voices as independent agents, recognizing them, means ‘they are imagined as having the ability to choose to stop talking’ (Beyond the Brain).

Julian Jaynes and the bicameral mind

Romme and Escher were partially inspired by the work of Julian Jaynes, a controversial American psychologist who proposed that modern consciousness arose from a ‘breakdown’ in a prior ‘bicameral mind’. Julian Jaynes (1990) had argued that, prior to its ‘breakdown,’ humans survived mostly from habit, acting on the basis of stereotypical reflexes, and they did not possess elaborate ‘consciousness’. When faced with an unfamiliar situation, they were not capable of sophisticated self-reflection or meta-consciousness, that is, being able to think about how they thought. Rather, they heard voices — gods, spirits, chiefs, or other authority figures — as if from an upper house or assembly (hence, ‘bicameral’) — ordering them what to do.

Jaynes found an example of this bicameral experience in the Iliad. There, we find individuals who don’t have inner dialogues or contemplate their situation; rather, they seem to experience gods interacting with them, shaping their reactions and motivations. Jaynes argued that these accounts of divine intervention were not poetic devices or dramatic devices of epic poetry:

The characters of the Iliad do not sit down and think out what to do. They have no conscious minds such as we say we have, and certainly no introspections. It is impossible for us with our subjectivity to appreciate what it was like. When Agamemnon, king of men, robs Achilles of his mistress, it is a god that grasps Achilles by his yellow hair and warns him not to strike Agamemnon (1:197ff.). It is a god who then rises out of the gray sea and consoles him in his tears of wrath on the beach by his black ships, […] a god who leads the armies into battle, who speaks to each soldier at the turning points, who debates and teaches Hector what he must do, […] (p. 72; cited by Erik Weijers; note: Weijers’ page numbers are from the 1976 edition, I believe.)

The ‘voices’ that our ancestors heard were a kind of introjected order from a leader, experienced as the voice of a god or authority figure, according to Jaynes: ‘The gods were in no sense ‘figments of the imagination’ of anyone. They were man’s volition’ (p 202; cited by Erik Weijers). Internalized speech was not a constant companion, as it is for us, but rather an unusual, seemingly divine interruption in the course of a normally quiet, habit-guided reality.

Only later did the ‘mind’ become invented, especially as social, technological, and cultural upheaval multiplied the sources of authority and threw humans back on themselves to make their own decisions, bereft of a clear internalized authoritative voice. Jaynes explained: ‘And as this complexity develops, there is the first unsureness, the first need for personal gods to intercede with the higher gods, who seem to be receding into the heavens where in one brief millennium they will have disappeared’ (p 202; cited by Erik Weijers).

Jaynes’ ideas are controversial, to say the least: Richard Dawkins, for example, has said that his book is ‘either complete rubbish or a work of consummate genius, nothing in between’ (cited in Jaynes’ Wikipedia entry; see also review by Block 1981; Cavanna et al. 2007). Some of Jaynes’ most contentious ideas — especially that consciousness is a construct with heavy cultural influence — are likely less controversial to anthropologists. But Jaynes’ account of the emergence of self-reflection through the developing of internal language is also provocative for a number of theorists working on the evolution of ‘mind’ (e.g., Willliams 2011).

The consequences of listening & talking back

Romme and Escher’s work in the Netherlands led to meetings, publications, and eventually what might be called a therapeutic ‘movement.’  Luhrmann describes:

In a series of workshops, Romme and Escher taught that people who heard voices should take them seriously and pay attention to what they said. In 1993 they published Accepting Voices, with techniques, case studies, and commentary by mental health professionals and patient activists (the activists sometimes call themselves survivors of psychiatric care). More detailed manuals and books followed. The workshops grew into conferences. Soon Romme and Escher were the unofficial leaders of a movement. …

Its method, to treat voices like people, is almost the inverse of the biomedical understanding of psychotic voices and a completely different perspective on how to handle them. The organization insists that hearing voices is a normal human experience, which indeed it is, although what is common (and thus “normal”) is hearing a voice as you slip into sleep, perhaps calling your name, perhaps your mother’s voice. About half of a standard subject pool (read: university undergraduates) will say that they have had some experience like that at least once. Many more will say so if the experimenter gives them examples. The Hearing Voices method takes this fact and turns it into an attitude. The problem is not the voices but the relationship to the voices, and the goal is to help voice-hearers live with them as if they were sharing a cramped apartment with crabby roommates. The voice-hearer is asked to talk directly to the voices and negotiate with them: asking what they want, offering to meet them partway if they will leave the hearer alone for a time. The hearer is told to treat the voices with respect, just the way you would treat a roommate you cannot kick out, whose behavior you really want to change. (Living with Voices)

Western psychiatry was not always so hostile to the content of audible hallucinations. In some of the earliest research on schizophrenia or Dementia Praecox, Eugen Bleuler, who directed Burghölzli asylum near Zurich from 1898 to 1927, argued that the voices, however seemingly outrageous, represented all the patients’ ‘strivings and fears … their entire transformed relationship to the external world … above all … [to] the pathological or hostile powers’ (from Chapter 4 of Oliver Sacks’ forthcoming book, Hallucinations, cited here).

Elsewhere in the article, Luhrmann explains why the idea that the voices might be taken seriously is so radical as to be considered even dangerous by more mainstream forms of contemporary psychiatry:

When a patient heard an audible voice, it was the sign of an illness that had to be treated with medication [according to most psychiatrists]. Thus would the symptom be removed. These days, talking much with a patient about voices is often seen as encouraging that person’s belief in the false reality the voices represent. In biomedical psychiatry, mental health professionals ask whether the patient hears voices, not what the voices say. The goal is to get rid of the voices, like getting rid of a fever, and the mind-numbing, sleep-inducing antipsychotics are prescribed toward that end. (Living with Voices)

The current biomedical approach encouraged a scorched earth pharmacological assault on the patient’s voices, with many of the patient’s other psychic attributes—attention, ability to concentrate, sexual desire, even sense of well-being—the regrettable collateral damage of the war on madness. Luhrmann tells the story of Hans, a Dutch man who increasingly experienced disturbing psychotic delusions. He entered treatment and wound up on Clozaril, an atypical antipsychotic drug that caused him to pack on weight and become preternaturally calm; he slept all day even though he still heard voices. Then Hans found a Hearing Voices group:

Hans joined a group of people like him who met once a week. They talked about their voices, and they were encouraged to talk back to them. They were even encouraged to negotiate with their voices. One of Hans’s voices thought he would be better off if he devoted his life to Buddhist prayer. Hans is not a Buddhist—like many Dutch, he grew up as a secular Protestant—and he did not want to follow the voice’s command. The group persuaded him to cut a deal with his voices. He told his voices that he would read a book on Buddhism every day for one hour—but no more. He would say one Buddhist prayer every day—but no more. And if he did this, he told them, they had to leave him alone.

The significance of voices

At the end of her Culture, Mind and Brain talk, Luhrmann asks about the significance of cultural differences in patients’ relationships and interactions with their auditory illusions. Might crosscultural variation in the relationship between a schizophrenic and his or her ‘voices’ lead to a more benign outcome for the disease? Is the quality of this relationship part of what explains the better-than-expected prognosis for schizophrenics in the developing world relative to in the developed world (Luhrmann cites this, and I discussed it here)?

In his forthcoming book, Hallucinations, Oliver Sacks talks about how Western attitudes toward hearing voices have changed (preview of Chapter 4 here). He writes about Daniel Smith, an author with a history of audible hallucinations in his family that stretched across changing attitudes toward these hallucinations:

The voices that are sometimes heard by people with schizophrenia tend to be accusing, threatening, jeering, or persecuting. By contrast, the voices hallucinated by the “normal” are often quite unremarkable, as Daniel Smith brings out in his book Muses, Madmen, and Prophets: Hearing Voices and the Borders of Sanity. Smith’s own father and grandfather heard such voices, and they had very different reactions. His father started hearing voices at the age of thirteen, Smith writes:

These voices weren’t elaborate, and they weren’t disturbing in content. They issued simple commands. They instructed him, for instance, to move a glass from one side of the table to another or to use a particular subway turnstile. Yet in listening to them and obeying them his interior life became, by all reports, unendurable.

Smith’s grandfather, by contrast, was nonchalant, even playful, in regard to his hallucinatory voices. He described how he tried to use them in betting at the racetrack. (“It didn’t work, my mind was clouded with voices telling me that this horse could win or maybe this one is ready to win.”) It was much more successful when he played cards with his friends. Neither the grandfather or the father had strong supernatural inclinations; nor did they have any significant mental illness. They just heard unremarkable voices concerned with everyday things — as do millions of others.

Smith’s father and grandfather rarely spoke of their voices. They listened to them in secrecy and silence, perhaps feeling that admitting to hearing voices would be seen as an indication of madness or at least serious psychiatric turmoil. Yet many recent studies confirm that it is not that uncommon to hear voices and that the majority of those who do are not schizophrenic; they are more like Smith’s father and grandfather.

It is clear that attitudes to hearing voices are critically important. One can be tortured by voices, as Daniel Smith’s father was, or accepting and easygoing, like his grandfather. Behind these personal attitudes are the attitudes of society, attitudes which have differed profoundly in different times and places.

The importance of this question is not simply practical and therapeutic —although these are both crucial considerations. Luhrmann points out that, currently, in Western therapeutic practice, the experiential qualities of the hallucinations —what the voices are saying and how they are saying it— is largely treated as an ‘uninteresting sequelae’: a symptom or experiential sign of an underlying cause or disease mechanism. As symptoms, the voices are largely irrelevant except that they point to the existence of the underlying condition.

But if we recognize that experience itself can affect our neurological and psychological development, including the trajectory of a condition like schizophrenia, than listening to hallucinations is likely to matter. Rather than simply trying to chemically erase the hallucinations, therapy and social interaction might transform the way that hallucinations are lived, with potentially crucial importance to the prognosis for the condition.

Mechanisms for explaining difference

Luhrmann’s research may point to the way that cultural influences may facilitate adaptation to hallucination: or as she puts it, ‘the world as imagined can change the world as it is’ (Beyond the Brain). These local influences include local disease models (whether you think your voices are a sign of an innate, inherited condition that is a life sentence or that you are under attach by a witch) and opportunities for experiencing your mind in different ways (whether these voices violate a rule that a mind be absolutely private or mix in amongst other interactional and social elements in mental experience).

The opening panel of the conference (presented by Steven Heine, Marco Iacoboni and me) asked how the skewed sample we have of psychological and neurological subjects in most research might bias our understandings of human nature and neurology. How does the fact that psychology subjects are disproportionally WEIRD (Western, Educated, Industrialized, Rich, and Democratic) lead us to understand human nature? Luhrmann’s presentation puts another wrinkle on this subject for me: how does our own culture bias our understandings of psychopathology? And might WEIRD understandings of the audio hallucination in schizophrenia, our own horrified and medicalized reaction to hearing voices, shape the unfolding of the condition?

I find these ideas, touched on clearly in Luhrmann’s various discussions, absolutely plausible. A number of neuroanthropological mechanisms might be partially responsible for the variation that Luhrmann has observed, and noted by the Hearing Voices movement.

  • For example, one of the key themes of day two of the Conference (as Daniel has discussed) was the profound genetic, endocrine, and psychological effects of stress. If one finds audio hallucinations especially stressful, for example, if one firmly believes that these hallucinations both assure and justify a life of institutionalization, unemployment, disappointment and madness, one can only imagine how stressful they would become.
  • Another possibility is that the act of seeking to repress auditory hallucinations actually reinforces them and further strengthens the sense that they are an alien imposition on one’s ‘mind.’ Attentional dynamics might lead to exaggerated reactions to ‘voices,’ such as the way that having someone say, ‘Don’t think about an elephant,’ makes it virtually impossible to do anything else.
  • Or, since we know that the perception of alien voices tends to occur especially in times of stress (see Sacks’ discussion, for example), the stress of fearing them might actually summon voices that appear particularly vivid (or angry or insulting or deranged).
  • If a particular brain mechanism underwrites auditory hallucinations, these stress-related and attentional dynamics might actually reinforce any aberrant neurological activity, in essence, making hallucination-producing mechanisms more practiced and easy-to-initiate.
  • If hearing voices is not that unusual, but that most of us have a facility to identify these perceptions and suppress them, perhaps those who hallucinate simply have an underdeveloped or under-practiced mechanism for suppressing hallucinations or identifying them as hallucinations.
  • If hallucinations arise from normal subvocal or sub-perceptual thought processes, perhaps those who hallucinate are simply better at paying attention to them (or comparatively weaker at paying attention to the internal dialogue upon which they would prefer to concentrate).

Listening to voices & repressed memories

In her piece in The American Scholar, however, Luhrmann also points out the dangers of taking one’s voices seriously. In the United States, the powerful alignment of therapists’ receptivity and patients’ imagination produced the scandal of the ‘repressed memory’ movement:

European psychiatrists have no history with the ravages of the repressed memory movement, when thousands of American women discovered memories of childhood sexual abuse at the hands of their fathers and pressed charges on the basis of those memories, so that many fathers were falsely arrested and even imprisoned. European psychiatrists do not know about the strange collusion between some therapists and some patients, when patients seemed to deliver one alter after another, satisfying the eager expectations of their determined therapists. By the early 1980s, many of those memories included accounts of horrific satanic rituals in which women were forced to eat their own babies before masked and murderous men. Patients struggling with whatever had brought them into therapy now also had to deal with the anguished grief of remembering that they had cannibalized their own children. A thorough FBI investigation found no evidence to support these assertions, and not one police report had been submitted at the time that the babies supposedly had died. (Living with Voices)

As Luhrmann cautions, the Hearing Voices movement appears to be doing fascinating work, although no randomized clinical trial has yet demonstrated that the technique works. The fact that some practitioners are moving toward treating hallucinations as suppressed memories, especially of sexual abuse, is likely to raise red flags for some in the US therapeutic community. But the core insight of the movement appears to be linked, as Luhrmann herself also pointed out in her talk at the Culture, Mind, and Brain conference, to the evidence from the cross-cultural research:

The search for hidden memory is not intrinsic to the movement’s central insight, which is that the way we understand our mental experiences has the potential to alter them fundamentally. The Hearing Voices proponents believe that if you do not envision schizophrenia as a life sentence, you increase the chance that patients will be able to discover their own resilience. That is a profound insight, and it offers hope to those who face the horrors of psychosis. (Living with Voices)

What does seem to be indisputable is this final point: how we understand an experience like hearing voices — including the emotional reaction we have, the way the community treats us, and the way that the world changes in response to our hallucinations — will affect the subsequent experiences we have with the same symptoms, and perhaps even the unfolding of the condition over time. Whether we fear each time that we hear a voice that our world may come unraveled, or whether we listen and hope for positive voices to advise us and even keep us company, may turn out to be a self-fulfilling expectation.


A bit more about Tanya Luhrmann’s research

For more on Jaynes, see the Julian Jaynes Society webpage.

Also Erik Weijers’ excellent summary and discussion, from which I also extracted passages of Jaynes.

A few more reads on delusions and schizophrenia across cultures

If you want to read more about delusions and schizophrenia, consider clicking onto Daniel’s recent post, Othello Syndrome, Denial, and Delusion, which discusses the implications of delusions leading to severe jealousy. Or, a few of our older posts:


Block, N. 1981. Review of Julian Jaynes’ origins of consciousness in the breakdown of the bicameral mind. Cognition and Brain Theory 4: 81–83.

Cavanna, A., Trimble, M., Cinti, F., and Monaco, F. 2007. The “bicameral mind” 30 years on: a critical reappraisal of Julian Jaynes’ hypothesis. Functional Neurology 22(1): 11-15. (abstract here & available for download)

Jaynes, J. 1990 (1976). The origin of consciousness in the breakdown of the bicameral mind. Houghton Mifflin.

Luhrmann, Tanya. 2011. Hallucinations and Sensory Overrides. Annual Review of Anthropology 40: 71-85.

Luhrmann TM, Nusbaum H, Thisted R. 2010. The absorption hypothesis. American Anthropologist 112(1): 66–78.

Myers, Neely. 2011. “Update: Schizophrenia across cultures,” Current Psychiatry Reports 13(4): 305-311.

Rosenhan, David. 1973. On Being Sane in Insane Places. Science 179: 250-258.

William, G. 2011. What is it like to be nonconscious? A defense of Julian Jaynes. Phenomenology and Cognitive Science 10: 217–239.

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13 Responses to Tanya Luhrmann, hearing voices in Accra and Chenai

  1. Pingback: Hearing Voices: Culture and Mental Experience — C L O S E R

  2. karen taylor says:

    Perhaps you could look a bit nearer to home, there is a growing hearing voices network in Australia, Nsw has its own network and website as does WA & voices vic in Melbourne which is hosting the world hearing voices congress in Melbourne nov 2013.
    I think the view on the network is a bit limited we embrace all voice hearers perspectives on voices, icluding psychological and spiritual . Closer to home both the indigenous people of australia & maori population absolutely its normal to hear the voices of their ancestors, many times they have been locked in our institutions because of the lack of understanding by western psychatry

    • Daniel Gill says:

      I study English literature in University. I have class on literature of Australia and New Zealand like an hour from now. We will be looking at themes of the supernatural in that literature. I am studying religion and anthropology in my spare time. I had originally wanted to study psychology so that I can understand people. but I realized that psychology ignores the human all the time. Studying psychology is studying business. You sell pills. You sell therapy. Studying religion is also like studying business. Studying English set me free.

  3. Daniel Gill says:

    I hear thoughts in my head. Whether they be authors that I like, living or dead, whether they be my own wife (and we’ve confirmed simultaneous experiences), like finishing sentences even, or knowing when my wife wants me home, etc.. but I have never heard AUDITORY hallucinations, and there is a huge difference.

    A thought is just a thought.

    A voice? What are you talking about? Thoughts or Voices? Define your terms, stick to them, or don’t ask the patient a confusing question.

  4. Daniel Gill says:

    the Tamil people are often worshippers of Shiva, a God who resides at the border of the cremation grounds, and ancestors and spirits are extended kinship. Hearing voices of kin is common amongst neopagans/neoshamans. I had a reiki attunement in 2004 (a kind of americanized Shinto) and I have also given treatments to my wife. It has deepened the bond between us.

  5. Daniel Gill says:

    One more comment before I disappear,
    I have listened to the whole lecture, thank you for your expertise and valuable insight.

    Don’t underestimate trans-national influences like yoga and reiki on the evolving consciousness amongst westerners.

    Many of whom have had their world-beliefs radically altered by newly-emerging art movements such as collectible card games such as Magic The Gathering and japanese animated movies and series. as well as asian horror movies etc. We live in a world where many american kids are growing up playing Phoenix Wright detective games, where they are experiencing involuntarily and sub-consciously the world views of cultural ideas like Shinto, such as the miko shrine maidens, these ideas are increasingly prominent in videogames.

    even really big budget, most popular games, like Mass Effect, have this trans-national vibe.. increasingly we are roleplaying game characters who are channellers of necromantic spiritual energies.

  6. Daniel Gill says:

    Sorry one more comment,
    culture has nothing to do with it

    Those who have had kundalini awakening in the USA, reiki attunement, who may be mediums, who may even be Pentecostal Christians, they have a spiritual emergence awakening, often that develops into a flash dramatic but brief psychosis.

    it has nothing to do with their environment, but the way they expand the notion of a kinship network from just the family, to family ancestors and exterior wandering ghosts.

    research Vietnam, and Korea.

    the mediums, shamans, respectively, change their consciousness, upon initiation. and not the other way around.

    I am not from Japan, but from Japanese influence as a youngster, from meeting certain people, and being engaged with these new art movements, allowed me to understand their worldview intuitively.

    Communion with spirits causes dramatic inner transformation.
    there is evidence of this. seek it.


  7. Pingback: Tanya Luhrmann, hearing voices in Accra and Chenai | Neuroanthropology | Social Neuroscience Advances | Scoop.it

  8. Pingback: Tanya Luhrmann, hearing voices in Accra and Chenai | Neuroanthropology | Brain Tricks, Bias and Blindspots | Scoop.it

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  11. Muriel says:

    Hello Greg,

    This has to be one of the most fascinating blogs I have come across. I never considered the cultural influences on the “voices” people with schizophrenia hear, and reading your article really opened my eyes to another way of looking at people with schizophrenia. Thank you for sharing such an insightful and inspiring article!


  12. K.Phani Sekhar says:


    From the last 1 year i am hearing alot voices which consists of,

    second motion of human voices.

    Really i am sourounded by those voices and most of life is running with those voices and i am not able to control.

    Pls help me out or else i am sure i am going to die soon.


    i have gone to psychiatrist and taken few medicines long back.

    again its following me…..its spoiling my regular life.

    pls help me out.

    My family members are laughing at me when i am saying this

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