The Shaman and Schizophrenia, Revisited

This paper presents evidence that some-but not all-religious experts in a particular faith may have a schizophrenia-like psychotic process which is managed or mitigated by their religious practice, in that they are able to function effectively and are not identified by their community as ill. We conducted careful phenomenological interviews, in conjunction with a novel probe, with okomfo, priests of the traditional religion in Ghana who speak with their gods. They shared common understandings of how priests hear gods speak. Despite this, participants described quite varied personal experiences of the god's voice. Some reported voices which were auditory and more negative; some seemed to describe trance-like states, sometimes associated with trauma and violence; some seemed to be described sleep-related events; and some seemed to be interpreting ordinary inner speech. These differences in description were supported by the way participants responded to an auditory clip made to simulate the voice-hearing experiences of psychosis and which had been translated into the local language. We suggest that for some individuals, the apprenticeship trained practice of talking with the gods, in conjunction with a non-stigmatizing identity, may shape the content and emotional tone of voices associated with a psychotic process.

Voice hearing as a social barometer: Benevolent persuasion, ancestral spirits, and politics in the voices of psychosis in Shanghai, China

The comparative study of voice hearing is in its early stages. This approach is important due to the observation that the content of voices differs across different settings, which suggests that voice hearing may respond to cultural invitation and, ultimately, to learning. Our interview-based study found that persons diagnosed with schizophrenia in China (Shanghai), compared to those diagnosed with schizophrenia in the United States, Ghana, and India, reported voices that were strikingly concerned with politics. Compared to participants in the United States in particular, voices seemed to be experienced more relationally: Shanghai participants reported voices notable for a sense of benevolent persuasion rather than harsh command, and knew the identities of their voices more so than in the United States. The voices were striking as well for their religious content, despite the previous prohibition of religion in China. Our findings further support the hypothesis that voice hearing seems to be shaped by context, and we observe that this shaping may affect not only conceptual content but the emotional valence of the experience.

Hearing voices among Russian patients with schizophrenia

There has been relatively little work which systematically examines whether the content of hallucinations in individuals diagnosed with schizophrenia varies by cultural context. The work that exists finds that it does. The present project explores the way auditory hallucinations, or "voices," manifest in a Russian cultural context. A total of 28 individuals, diagnosed with schizophrenia, who reported hearing voices at the Republican Clinical Psychiatric Hospitals in Kazan, Russia, were interviewed about their experience of auditory hallucinations. The voices reported by our Russian participants did appear to have culturally specific content. Commands tended to be non-violent and focused on chores or other activities associated with daily life (byt). Many patients also reported sensory hallucinations involving other visions, sounds, and smells which sometimes reflected Russian folklore themes. For the most part, religious themes did not appear in patients' auditory vocal hallucinations, though nearly all patients expressed adherence to a religion. These findings support research that finds that the content, and perhaps the form, of auditory hallucinations may be shaped by local culture.

Porosity Is the Heart of Religion

When scholars and scientists set out to understand religious commitment, the sensation that gods and spirits are real may be at least as important a target of inquiry as the belief that they are real. The sensory and quasisensory events that people take to be the presence of spirit—the voice of an invisible being, a feeling that a person who is dead is nonetheless in the room—are found both in the foundational stories of faith and surprisingly often in the lives of the faithful. These events become evidence that gods and spirits are there. We argue that at the heart of such spiritual experiences is the concept of a porous boundary between mind and world, and that people in all human societies have conflicting intuitions about this boundary. We have found that spiritual experiences are facilitated when people engage their more porous modes of understanding and that such experiences are easier for individuals who cultivate an immersive orientation toward experience ( absorption) and engage in practices that enhance inner experience (e.g., prayer, meditation). To understand religion, one needs to explore not just how people come to believe in gods and spirits, but how they come to understand and relate to the mind.

To Believe Is Not to Think: A Cross-Cultural Finding

Are religious beliefs psychologically different from matter-of-fact beliefs? Many scholars say no: that religious people, in a matter-of-fact way, simply think their deities exist. Others say yes: that religious beliefs are more compartmentalized, less certain, and less responsive to evidence. Little research to date has explored whether lay people themselves recognize such a difference. We addressed this question in a series of sentence completion tasks, conducted in five settings that differed both in religious traditions and in language: the United States, Ghana, Thailand, China, and Vanuatu. Participants everywhere routinely used different verbs to describe religious versus matter-of-fact beliefs, and they did so even when the ascribed belief contents were held constant and only the surrounding context varied. These findings support the view that people from diverse cultures and language communities recognize a difference in attitude type between religious belief and everyday matter-of-fact belief.

The Understudied Side of Contemplation: Words, Images, and Intentions in a Syncretic Spiritual Practice

The science of contemplation has focused on mindfulness in a manner quite disproportionate to its use in contemplative traditions. Mindfulness, as understood within the scientific community, is a practice that invites practitioners to disattend to words and images. The practitioner is meant to experience things as they "really are," unfolding here and now in the flux of embodied sensations. Yet the use of words and images, together with intentions, is a far more common contemplative practice. The authors present ethnographic research with a syncretic contemplative tradition, Integral Transformative practice (ITP), which grew out of the Human Potential Movement of the 1960s. The authors focus on the practice of "affirmations," in which practitioners seek to actualize spiritual goals by imagining future possibilities. Our ethnographic account invites new avenues for psychological research to illuminate the role of words and images in contemplation.

Beyond Trauma: A Multiple Pathways Approach to Auditory Hallucinations in Clinical and Nonclinical Populations

That trauma can play a significant role in the onset and maintenance of voice-hearing is one of the most striking and important developments in the recent study of psychosis. Yet the finding that trauma increases the risk for hallucination and for psychosis is quite different from the claim that trauma is necessary for either to occur. Trauma is often but not always associated with voice-hearing in populations with psychosis; voice-hearing is sometimes associated with willful training and cultivation in nonclinical populations. This article uses ethnographic data among other data to explore the possibility of multiple pathways to voice-hearing for clinical and nonclinical individuals whose voices are not due to known etiological factors such as drugs, sensory deprivation, epilepsy, and so forth. We suggest that trauma sometimes plays a major role in hallucinations, sometimes a minor role, and sometimes no role at all. Our work also finds seemingly distinct phenomenological patterns for voice-hearing, which may reflect the different salience of trauma for those who hear voices.

Differences in voice-hearing experiences of people with psychosis in the U.S.A., India and Ghana: interview-based study

BACKGROUND

We still know little about whether and how the auditory hallucinations associated with serious psychotic disorder shift across cultural boundaries.

AIMS

To compare auditory hallucinations across three different cultures, by means of an interview-based study.

METHOD

An anthropologist and several psychiatrists interviewed participants from the USA, India and Ghana, each sample comprising 20 persons who heard voices and met the inclusion criteria of schizophrenia, about their experience of voices.

RESULTS

Participants in the U.S.A. were more likely to use diagnostic labels and to report violent commands than those in India and Ghana, who were more likely than the Americans to report rich relationships with their voices and less likely to describe the voices as the sign of a violated mind.

CONCLUSIONS

These observations suggest that the voice-hearing experiences of people with serious psychotic disorder are shaped by local culture. These differences may have clinical implications.

Culture and hallucinations: overview and future directions

A number of studies have explored hallucinations as complex experiences involving interactions between psychological, biological, and environmental factors and mechanisms. Nevertheless, relatively little attention has focused on the role of culture in shaping hallucinations. This article reviews the published research, drawing on the expertise of both anthropologists and psychologists. We argue that the extant body of work suggests that culture does indeed have a significant impact on the experience, understanding, and labeling of hallucinations and that there may be important theoretical and clinical consequences of that observation. We find that culture can affect what is identified as a hallucination, that there are different patterns of hallucination among the clinical and nonclinical populations, that hallucinations are often culturally meaningful, that hallucinations occur at different rates in different settings; that culture affects the meaning and characteristics of hallucinations associated with psychosis, and that the cultural variations of psychotic hallucinations may have implications for the clinical outcome of those who struggle with psychosis. We conclude that a clinician should never assume that the mere report of what seems to be a hallucination is necessarily a symptom of pathology and that the patient's cultural background needs to be taken into account when assessing and treating hallucinations.

Making God real and making God good: some mechanisms through which prayer may contribute to healing

Many social scientists attribute the health-giving properties of religious practice to social support. This paper argues that another mechanism may be a positive relationship with the supernatural, a proposal that builds upon anthropological accounts of symbolic healing. Such a mechanism depends upon the learned cultivation of the imagination and the capacity to make what is imagined more real and more good. This paper offers a theory of the way that prayer enables this process and provides some evidence, drawn from experimental and ethnographic work, for the claim that a relationship with a loving God, cultivated through the imagination in prayer, may contribute to good health and may contribute to healing in trauma and psychosis.

"The street will drive you crazy": why homeless psychotic women in the institutional circuit in the United States often say no to offers of help

Many people who struggle with psychotic disorder often refuse offers of help, including housing, extended by mental health services. This article uses the ethnographic method to examine the reasons for such refusal among women who are homeless and psychiatrically ill in the institutional circuit in an urban area of Chicago. It concludes that such refusals arise not only from a lack of insight but also from the local culture's ascription of meaning to being "crazy." These data suggest that offers of help-specifically, diagnosis-dependent housing-to those on the street may be more successful when explicit psychiatric diagnosis is downplayed.

Social defeat and the culture of chronicity: or, why schizophrenia does so well over there and so badly here

The history of the way schizophrenia has been conceptualized in American psychiatry has led us to be hesitant to explore the role of social causation in schizophrenia. But there is now good evidence for social impact on the course, outcome, and even origin of schizophrenia, most notably in the better prognosis for schizophrenia in developing countries and in the higher rates of schizophrenia for dark-skinned immigrants to England and the Netherlands. This article proposes that "social defeat" may be one of the social factors that may impact illness experience and uses original ethnographic research to argue that social defeat is a common feature of the social context in which many people diagnosed with schizophrenia in America live today.

Partial failure: the attempt to deal with uncertainty in psychoanalytic psychotherapy and in anthropology

The paper identifies and tries to explain a style of argument that can be found in recent psychoanalytic writing and anthropological writing. In particular, it seeks to explain why similar styles of argument (which emphasize narration, interpretation, uncertainty, and the professional's incomplete knowledge of the patient or field subject) are presented in these different fields with such different effect. The paper suggests that these differences might arise from the different moral goals of the disciplines and, specifically, from the differences between a clinical and a non-clinical enterprise.