Voice-hearing Experiences Differ Across Cultures


People’s voice-hearing experiences are shaped differently by their respective cultures, according to a study in the British Journal of Psychiatry. Stanford University anthropologist Tanya Luhrmann led the analysis of interviews with 60 culturally-diverse people who’d been diagnosed with serious psychotic disorders. “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,” stated a Stanford press release about the study. “The Americans experienced voices as bombardment and as symptoms of a brain disease caused by genes or trauma.”

Luhrmann said in the press release that American clinicians “sometimes treat the voices heard by people with psychosis as if they are the uninteresting neurological byproducts of disease which should be ignored. Our work found that people with serious psychotic disorder in different cultures have different voice-hearing experiences. That suggests that the way people pay attention to their voices alters what they hear their voices say. That may have clinical implications.”

Hallucinatory ‘voices’ shaped by local culture, Stanford anthropologist says (Press Release, Stanford University, July 16, 2014)

Differences in voice-hearing experiences of people with psychosis in the USA, India and Ghana: interview-based study (Luhrmann, T. M. et al. British Journal of Psychiatry. Published online ahead of print June 26, 2014, doi: 10.1192/bjp.bp.113.139048)


  1. This is an email I sent to Dr Tanya Luhrmann, the author of this study. I thought the folks as Mad in America might find it interesting….

    My name is Sean Blackwell, I have a website, bipolarORwakingUP.com, which features a number of YouTube videos I have created which promote the spiritual dimension and healing potential of bipolar disorder. My work is primarily based on the theoretical ideas laid out by pioneering transpersonal psychologist, Dr. Stanislav Grof.
    Here is a video I did on the relationship between Hallucinations and Bipolar Disorder which I think you will enjoy.
    I was very excited to read about your research and see your presentation online. I think the work you are doing is very important. And, as I went through your work, I thought of a few points for you to consider as you move forward.
    1. It´s clear that your American group labeled as Schizophrenic had very disturbing hallucinations. However, in my own informal research online, speaking with thousands of people since 2007, I realized that if someone’s hallucinations during an acute psychosis are positive, benevolent, even spiritual, that they will, most likely, not be labeled with schizophrenia. Instead, they will be labeled with Bipolar One. In other words, it may not be the case that Americans have more disturbing hallucinations than people in other cultures. Rather, in America, it’s simply that those with positive feelings for their hallucinations are no longer labeled with schizophrenia, but with bipolar disorder.

    As a result, for future research, you may want to look at the type of hallucinations that people labeled with Bipolar One have. I would think that their hallucinations would be much more positive, as a whole.

    2. Your main point is that cultural context shapes the content of hallucinations, which I agree with completely, and is a very important insight. However, have you considered that the stage of consciousness of the culture (and the person) would also shape not only the nature of hallucinations, but whether or not we would even call it mental illness?

    As an example, as people (and cultures) evolve, they shift from pre-modern to modern to post-modern forms of consciousness. As that evolution in consciousness takes place, the way of thinking (or psychological structure) shifts from concrete, to rational, to symbolic. Regarding hallucinations, that would mean the following:

    – Pre-modern cultures (like those in India and Africa) tend to see hallucinations as they appear to be – i.e.: if you see the devil, then you saw the devil; you don’t have a mental illness. The culture validates your experience exactly as it appears, (and you may pay the price for that, by being judged as evil yourself).

    – In modern, rational culture (America), your experience must fit with scientific materialism – ie: if you see the devil, you are mentally ill because nobody can measure the devil you see. Your experience is totally invalidated.

    – In post-modern culture (like that of Transpersonal Psychology, The Hearing Voices Network and the entire Peer Support movement), if you see the devil, it may not be scientifically verifiable that this is true, however, your vision may be symbolically meaningful and important. For example, the vast majority of people with disturbing hallucinations that I’ve met were severely abused in childhood.

    For many years, I have studied the work of Ken Wilber and Don Beck’s Spiral Dynamics regarding the evolution of consciousness. I have an entire video series on consciousness as well. I have come to believe that our inability to heal mental disorders as a whole is intimately related to our limited capacity for understanding experiences which are spiritual, but non-religious in nature.
    Of course, I could go on forever, but I’ll spare you!
    Thank you for your efforts, and I hope my comments are thought provoking!
    Sean Blackwell

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  2. Good comments, Sean!

    I thought it interesting that she did not consider the possibility that the voices for Americans diagnosed with schizophrenia are more negative and battling may be because of how our culture, and specifically, how psychiatric practitioners, define our relationship to these voices. If you are told by your doctor that these voices are bad, the content of their statements is meaningless, and your main goal is to get rid of them, it seems you’ve set up a state of warfare with the voices, which in some psychological schools of thought suggests a state of warfare with oneself. It makes sense to me that a culture which accepts that voice-hearing is OK or maybe even views it as a gift is more likely to have positive experiences with those voices, as they are not fighting them off but listening to what they have to say.

    Would be interested to hear if this makes any kind of sense to those who have had this experience themselves?

    —- Steve

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    • Hi Steve,

      I have never had the experience of hearing voices but what you are saying makes total sense to me. Even if we haven’t technically heard voices, all of us at times struggle to deal with those negative ones in our brain for example that are critical.

      I know from personal experience when i accept them, they have alot less power over me vs. trying to fight against them. So it would stand to reason that people with schizophrenia who are hearing a negative spin on what they experience and are drugged to the gills for it don’t generally fare as well as in cultures that are accepting and even consider it as a gift and who aren’t placed on meds.

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  3. Of course, Sean Blackwell, you nailed it! Sadly, it seems no-one cares in the 21st century of MH ” treatment” at making thorough observations, and accurate diagnosis! It’s just a political game between MH and the equally despicable insurance companies to box in a person who is experiencing some psyche crisis (either from use of mind-altering drugs, illicit or prescribed) or affected by a trauma they’ve experienced into some cookie-cutter label! Yes, now the ubiquitous ” bipolar” label reigns in America.
    Absolutely, as you correctly suggested to this researcher, people experiencing psychosis ( for whatever the cause) now receive the bipolar one or two label (depending on the severity of psychotic experiences) as opposed to 30 yrs ago, the dx would have than been SZ.
    Wish I would have not been brainwashed, myself, when an ” expert” in ’09-’10 cautioned me not to show my than 23 y/o son, who literally overnight developed bizarre, altered thinking ( of course as your videos clearly illustrate for some brains, today’s genetically altered hybrid cannabis plant which yields VERY high ratios of THC and low ratios of CBD can , and are, fueling psychotic-like symptoms ). I now understand much more and like to imagine your videos accessing every young person (and those around them who suffer not knowing what psychosis really represents) as it really can be so frightening to be living with someone actively in psychosis. Rather, I envision people instead being educated how these kind of experiences can be life-changing, spiritual, instead of the dark tainted labeling with a severe MI ( bipolar 1) as assigned my son. That label and stigma, ultimately took my son out. But I deeply believe, there were factors that triggered his two ‘episodes’ , 18 months apart, and the mind goes to this altered reality, where enlightenment and spiritual growth can occur IF the person is allowed to not be stigmatized and labeled and truthfully shunned like a leper.

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  4. I largely agree with Sean’s perspective, and am an American who had both good and bad “voices” / “psychosis.” In my case, all my “voices” / psychosis occurred after being put on psychiatric drugs.

    My first supposed “voice” (possibly caused by Wellbutrin withdrawal, exasperated by disgust at 9.11.2001, and a couple other pharmaceutical drugs), was not actually a “voice,” but a dream query. I wanted to know what a powerful dream about being “moved by the Holy Spirit” meant. The psychologist called the Holy Spirit a “voice,” according to her medical records. This resulted in a “bipolar” misdiagnosis (according to the DSM) and a psychiatrist’s, confessed in his medical records, “Foul up” with Risperdal.

    Two weeks after being put on the Risperdal, I suffered from a terrifying psychosis. It, too, related to the terror of 9.11.2001, but included a spiritual aspect. In retrospect, I now understand that indeed, if there is a God, He in fact did have numerous reasons for being angry with American corporations and religions on 9.11.2001.

    This “Foul up” with Risperdal was then covered up by a neurologist who spent 3 1/2 years whacking me out of my mind with several different drug cocktails that now have major drug interaction warnings stating they cause anticholinergic intoxication. These drug cocktails caused me to get three incessant “voices.” Oddly, the “voices” I got were of the people who wanted to cover up the sexual abuse of my child, and the psychologist’s records show proof that she had misdiagnosed me initially, based upon a list of lies and gossip from these child abusers. These drug induced “voices” were both abusive and intrusive. I never personally confused the “voices” with the real people, however my neurologist did.

    Thankfully, I was eventually weaned off the drugs, the neurologist even wrote in his medical records “Rec’d disorder.” The drug induced “voices” went away after I’d been taken off the drugs. But, I did end up suffering from drug withdrawal induced super sensitivity manic psychosis.

    This took the form of an awakening to the story from my dreams and a mid-life reflection on all the wonderful people I’d met in my life who did not agree with my neurologist’s claims that I was “irrelevant to reality” and “w/o work, content, and talent.” (The neurologist did finally look at my work and claimed it to be “work of smart female” and finally realized I was “insightful.”)

    I ended up doing largely what Sean advocates, and let the spiritual emergency run its course, rather than going back to doctors who had poisoned me. It was very similar to what others who claim to have gone through a spiritual emergency experience. It was about a connectivity to all. It was about having perfect timing with all other people and the universe. It was about Jesus “coming in the night like a thief,” and “killing me softly with his song, singing my life with his words.” I realized I can tell the entire story of my life and dreams in a compilation of music lyrics. It was actually a very cool experience, great makings for a “credible fictional story,” as my neurologist claimed my life to be, once he’d learned I’d been handed over medical evidence of the sexual abuse of my child and he was not just covering up ADRs to drugs and the misdiagnosis.

    Absolutely, in my case, the harassing “voices” were relevant to my real life problems. As to the psychosis, I still believe it relates to a spiritual emergency, and that God inspired a story (which is what the Risperdal pushing psychiatrist claimed was an impossibility).

    I hope some day we can get to a point where the psychiatric practitioners stop pretending they and they alone are in charge of dictating reality, stop brainwashing the world into believing in scientifically “lacking in validity” stigmatizations, stop trying to murder people to cover up easily recognized and complex iatrogenesis and sexual abuse of children for unethical psychologist’s pastors, and stop trying to murder Christians for belief in God and the Holy Spirit. None of what the psychiatric practitioners I dealt with did was legal, moral, or ethical in the US.

    What if there is a good and just God who wants the psychiatrists to stop iatrogenically creating “mental illnesses” in people for profit and for other unethical reasons? And I have concern God is not impressed with a mainstream medical community who is raping the economy for their malpractice insurance, but whose unrepentant “mistakes” are killing more Americans than have died in all wars combined. Hopefully, some day, America can go back to being a country where “all people are created equal” and “have certain inalienable rights,” such as the pursuit of “life, liberty, and happiness,” and get away from the greed inspired medical industrial complex attacks on innocent human beings.

    I guess my point is, at least in my case, my “voices” and “psychosis” were completely relevant to my personal real life concerns and real problems in our society as a whole. So I feel it’s ignorant, not to mention ungodly disrespectful, for psychiatric practitioners to ignore the potential meaning behind their patients’ “voices” and “psychosis.”

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  5. I haven’t read much about “hearing voices” among those who have been labelled by psychiatry, but I will approach the topic with the hypothesis that there is within the range of possible human experiences a continuum for hearing voices that cannot be accurately described from a purely reductionist stance which excludes
    meta-physical or spiritual types of dynamics. ” Naturally”, I base this on my own experience with hearing voices. For example, I once was awakened from my sleep by the sweet voice of my sister pleasantly calling for me, with a note of nearly music-like resonance, from over a dream context of social discord, as if she were searching for me. She was many miles away from me at the time. I responded with the thought that God must want me to pray for her-so I did. A few days later I inquired and discovered that she had been so sick with fever that my mother was praying over her. I conclude that I had participated in a spiritual dynamic which transcends reductionist explanations of life. To connect this thought to the larger topic, I would propose that all of human experience has spiritual significance and manifestation as some expression of our need or suffering or agency in a spiritually resonant world.

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    • Nice to see you bring this up, Daisy. Personally, I´ve found discussion of the spiritual dimension of mental disorders, in particular the work of transpersonal psychologists like Dr. Stan Grof, to be lacking not only on Mad in America, but also within the peer support movement as a whole. Ironically, it seems that, in the spirit of ‘diversity’, any sort of theoretical understanding of mental disorders, and/or any discussion of metaphysics gets quietly ignored.

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