I grew up in South Africa and many studies and articles that tout the idea that voice hearers are shamans and ‘mental illness’ does not exist do not examine the full context. It MAY SOMETIMES be true that IF your tribe feels you are communicating with spirits, your experience of hearing voices is made less traumatic because the community around you “believes” that a connection with ancestors has value. (That is an absurdly narrow view that ignores the bigger context in which it takes place. It is based on a rose colored view of a belief IN something (for which there is ZERO evidence of benefit beyond the rose colored view). The problem is… – Almost all ‘traditional’ (the term used here in S Africa) belief systems worldwide include a belief in BOTH good and evil ‘spirits’ – And have rituals for APPEASING the good spirits and WARDING OFF the evil characters —- YES, in many traditions ‘good’ spirits need work, to keep them on your side, ‘favors’ which often involve HARMFUL (especially to animals) and cruel rituals. The belief requires that ancestors be considered in decision making, a drag on the rate of social change or improvement. When things go wrong in the family, it may be that the ancestors are upset (a belief, entirely devoid of real evidence) and effort and resources are expended to solve a problem in the spirit world in the hope that it bounces back into the real world. (Good luck putting the evidence together for that – people will see what they believe and simply keep reinforcing the belief system). – The poor voice hearer now shaman has a new role and responsibility – voices have determined his/her future. Yes, the experience (of voices) MIGHT be less traumatic because it is without stigma, even valued, but what happened to the right to craft a life of choice? The experience of life, with implications for a whole tribe, has been dramatically altered and GIVES voices power IN THE COMMUNITY. Without any PROVENANCE whatsoever!! WORSE… Pick up any newspaper aimed at an audience with tribal roots here in SA and you will find a page or two in the classifieds section, where so called ‘traditional healers’ offer services, achieved by engaging the help of the spirit world, for a fee, usually with a ritual… that include: – finding the love of your life – enlarging your penis or improving the sexual satisfaction of your partner – becoming rich (overnight usually) – making your traffic fines disappear – winning that upcoming court case (favors that spirits supposedly can endow) OR… – PLACE A CURSE ON YOUR ENEMY! Yes, the evil spirits can be coaxed into harming someone you don’t like, presumably because that is what they like to do. Imagine the poor man or woman who believes that a curse has been placed on them by an enemy unknown and who hears voices that are the evidence of that curse. – the ‘WITCH’ who has placed the curse is at risk in the community – and a few (or their homes) are burned or stoned to death in SA every year (WITHOUT evidence, only the say so of someone in a community, gang justice by violent means, because the solution to spirit problems must be pretty radical, for certainty) The benefits of a subset (some are KNOWN to be harmful) of herbal remedies passed along with the tradition pale into insignificance when the belief system creates a culture in which harmful practices are ignored for fear of criticizing a belief system because we assign a higher power to it. Says who? Show me how! It is also NOT TRUE that tribal cultures do not see some voice hearers as ill, or ‘cursed’ (they usually have an equivalent term)… they DO generally have a much more supportive and community based response. – Open Dialogue works from the same principle – ensure that reliable, empathetic, support is in place, no matter what – without the problems associated with beliefs in spirits, where ANY belief can take root and gather steam in a crowd or perpetuate itself by declaring itself to be above common sense and/or scientific evaluation. HUMAN rights come first. Every SYSTEM of beliefs that GIVES provenance to spiritual powers is HARMFUL – we have loads of evidence of the HARM voices have caused, of how ‘spirits’ have INTERVENED in our lives through history, causing lasting conflict – we have zero evidence of the ‘good’ in the spirit world —- other than the BELIEF IN a greater good that we have come to associate with a ‘spirit world’ The belief itself may have some value, but belief in a greater good does not require a belief in a spirit world, in fact, a belief in each other would be more reliable and tangible. That became a little bit of a rant… studies that ignore the bigger picture of belief systems are poorly designed and of doubtful value.