Hearing Different Voices

Much of the research that I do on mental disorders impacts how I understand and experience my own mental disorder. There have been recent, fascinating studies on how people in different cultures experience mental disorders. One study comes from Tanya Luhrmann et al. who researched the experiences of people with Schizophrenia who 'hear voices' (or experience auditory hallucinations) in San Mateo, California; Accra, Ghana; and Chennai, India. People in these three places not only tend to understand their mental disorders differently but also tend to experience them differently.

Many of the most striking differences were between the experiences of those in America, on the one hand, and those in India and in Ghana, on the other. When people in India and Ghana 'heard voices', they tended to experience these voices as more positive and familiar; in contrast to those in America who tended to experience their voices as harsher and unfamiliar. For example, Americans reported that their voices "told them to hurt other people or themselves" often "described their voice-hearing experience as a battle or war" and overall found the voices to be very intrusive and distressing. In contrast, most of the participants in India and Ghana insisted that the voices they experienced were mostly or entirely positive! Those in India reported that their voices often helped guide them, and told them to take care of themselves and their living space. One person said: "voices, I like it. It will keep talking which is enjoyable"; and another explained that "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."

It's not like all Americans (or all Indians or all Ghanaians) experience 'hearing voices' in exactly the same way, but it is really noticeable that overall the American participants tended to experience this symptom in one way, and the Indian and Ghanaian participants in another. According to Luhrmann, one important cause of these differences seems to be the participants' cultures and the influence they have on their beliefs about who they are, how they relate to the world, and what their 'voices' are.

In Western countries like America, we view our mind as something private that is typically under our control - like your house or apartment that you can lock the door of and kick people out of. The idea is that because Americans understand their minds in this way, they then experience 'hearing voices' like they experience an intruder breaking into their house - understandably, it is very intrusive, distressing, and uncontrollable. In non-Western countries like India and Ghana, people understand their minds differently. They think of their mind as more social and open to the influence of others - more like your yard: it might belong to you, but it's not all that surprising to see someone walking across it from time to time. In these non-cultures, spirits, supernatural influences, and disembodied ways of communicating are also much more accepted as a part of daily life. So, because they understand their mind in this way, their experiences of ‘hearing voices’ may be less intrusive and distressing.

The fascinating thing here is that these different views about the mind seem to not just influence how people interpret or understand what is happening when they 'hear voices', they also seem to influence what people experience (how harsh or kind the voices are, what kinds of things the voices talk about, how familiar the voices seem, etc.). Like Luhrmann explains, this study and other studies like it, seem to show that "the harsh, violent voices so common in the West may not be an inevitable feature of schizophrenia."

But these effects don't just apply to Schizophrenia and 'hearing voices' - they apply to other mental disorders and symptoms as well. The way that you understand yourself, your mind, and how you relate to the world can impact your experience of your mental disorder. The ways you experience your symptoms and mental disorder are not set in stone. When you learn more about how other cultures or even other individuals understand mental disorders, this can impact how you experience your mental disorder. When you learn more about the way that your mind works, the way mental disorder occurs, the way treatments can impact it - this can all impact your actual experience as well as your understanding of your mental disorder. In other words, the way that you think about and label things like this matters.

We can see the effects of labeling in our everyday life when we look at examples of a psychological effect called the 'misattribution of arousal'. Because the emotions of fear, excitement, anxiety, and romantic interest all spring out of similar bodily states (think 'butterflies in your stomach'), people can sometimes shift or misunderstand which emotion they're experiencing by applying a different label to it. For example, when you go on a date to a scary movie you can sometimes misinterpret your fear response to the movie as a sign of interest in your date. Or, when you're getting ready for a speech, game, or some other kind of performance, you can try to channel your anxiety by telling yourself that you are excited rather than anxious.

To be clear, all of this does not mean that the pain and suffering caused by mental disorders and their symptoms are in any way unreal, 'all in your head', something you should be able to 'think your way out of' or force yourself to experience more positively. It also does not mean that when people experience things like 'hearing voices' in a different or more ‘positive’ way (like those participants in India and Ghana) that these voices aren't still symptoms of mental disorder. These symptoms are real, they often are the result of mental disorder, and they can and often do cause a lot of suffering and sometimes no amount of thinking (by itself) can change that. But, being more aware of the beliefs that you have (about yourself, your mental disorder, how you experience the world), the labels you apply to things (especially to things like your emotions, thought patterns, etc.), and the ways this may be impacting your mental health can be extremely eye-opening. And, learning about other interpretations or understandings of a mental disorder - especially from those who come from a different cultural or individual perspective can be extremely helpful - and again, not just for how you understand your mental disorder, but also for how you experience it!

References

Luhrmann, Tanya M., et al. (2015). Differences in voice-hearing experiences of people with psychosis in the USA, India and Ghana: interview-based study. The British Journal of Psychiatry, 206(1), 41-44.