User:B.Sirota/sandbox/Voic1

March 2023

Cross-cultural understandings of auditory hallucinations
According to research on hallucinations, both with participants from the general population and people diagnosed with schizophrenia, psychosis and related mental illnesses, there is a relationship between culture and hallucinations. Modern psychiatry recognizes that “transient hallucinatory experiences may occur without a mental disorder”.

A literature review from 2011 found that hallucinations of all types are not necessarily a symptom of “severe mental health”.<???> They might be more commonplace than generally assumed and experienced by people in the general population. In this review, which compared 17 studies from 1894 to 2007 from nine countries (United Kingdom, Philippines, United States, Sweden, France, Germany, Italy, Netherlands, and New Zealand), “differences in the prevalence of [voice-hearing in the adult general population] can be attributed to true variations based on gender, ethnicity and environmental context”.

The research review highlights that “studies that [analyzed] their data by gender report[ed] a higher frequency of women reporting hallucinatory experiences of some kind”. Although generally speaking hallucinations (including auditory) are strongly related to psychotic diagnoses and schizophrenia, the presence of hallucinations does not exclusively mean that someone is suffering from a psychotic or schizophrenic episode or diagnosis.

In another 2011 study of 1,080 people with a schizophrenia diagnosis from seven different countries of origin, including Austria, Poland, Lithuania, Georgia, Pakistan, Nigeria and Ghana, researchers found that 74.8% of the total participants disclosed having experienced auditory hallucinations in the last year than any other hallucinations from the date of the interview. Further, the study found the highest rates of both auditory hallucinations and visual hallucinations in both of the West African countries, Ghana and Nigeria. In the Ghana sample, auditory hallucinations were reported by 90.8% and visual hallucinations were reported by 53.9% of participants. In the Nigeria sample, (324), auditory hallucinations were reported by 85.4% and visual hallucinations were reported by 50.8% of participants. These findings are in line with other studies that have found that visual hallucinations were reported more in traditional cultures.

A 2015 study compared the experiences of three groups ( California, Ghana, and India) of 20 participants each who met criteria for schizophrenia. In this study, researchers found distinct differences among the participant’s experience with voices. In the CA sample all but three of the participants referred to their experience of hearing voices with “diagnostic labels, and even [used] diagnostic criteria readily”. They also connected “hearing voices” with being “crazy”. In the Ghana sample, almost no participants referenced a diagnosis and instead they spoke about voices as having “a spiritual meaning and as well as a psychiatric one”. In the India sample, similarly to the Ghana interviewees, most of the participants did not reference a diagnosis and for many of these participants, the voices they heard were of people they knew and people they were related to, “voices of kin”.

Another finding in this study is that “voice-hearing experience outside the West may be less harsh”. Finally, researchers found that “different cultural expectations about the mind, or about the way people expect thoughts and feelings to be private or accessible to spirits or persons” could be attributed to the differences they found across the participants. A qualitative 2018 study interviewed 57 self-identified Māori participants (subcategorized within one or more of the following groups including: “tangata Māori (people seeking wellness/service users), Kaumatua/Kuia (elders), Kai mahi (cultural support workers), Managers of mental health services, clinicians (psychiatrists, nurses and psychologists) and students (undergraduate and postgraduate psychology students)”). Rresearchers asked participants about:

“[1] their understanding of experiences that could be considered to be psychotic or labelled schizophrenic, [2] what questions they would ask someone who came seeking help and [3] they were asked about their understanding of the terms schizophrenia and psychosis”. The participants either had worked with or had experienced psychosis or schizophrenia. In this study, researchers found that the participants understood these experiences labeled “psychotic” or “schizophrenic” through multiple models. The researchers wrote that there is “no one Māori way of understanding psychotic experiences”. Instead, as part of understanding these experiences, the participants combined both “biological explanations and Māori spiritual beliefs”, with a preference for cultural and psychosocial explanations. For example, 19 participants spoke about psychotic experiences as sometimes being a sign of matakite (giftedness). One of the Kaumatua/Kuia (elders) was quoted as saying:"“I never wanted to accept it, I said no it isn’t, it isn’t [matakite] but it wouldn’t stop and in truth I knew what I had to do, help my people, I didn’t want the responsibility but here I am. They helped me understand it and told me what to do with it.”"

An important finding highlighted in this study is that studies done by the World Health Organization (WHO) have found that “developing countries (non-Western) experience far higher rates of recovery from ‘schizophrenia’ than Western countries”. The researchers comment that these findings may be due to culturally specific meaning created about the experience of schizophrenia, psychosis and hearing voices as well as “positive expectations around recovery”.

Schizophr Res //. 2019 Feb;204:353-359. // doi: 10.1016/j.schres.2018.09.020. Epub 2018 Sep 25. Hearing spirits? Religiosity in individuals at risk for psychosis-Results from the Brazilian SSAPP cohort

Alexandre Andrade Loch 1, Elder Lanzani Freitas  2 , Lucas Hortêncio  2 , Camille Chianca  2 , Tania Maria Alves  2 , Maurício Henriques Serpa  3 , Julio Cesar Andrade  2 , Martinus Theodorus van de Bilt  3 , Wagner Farid Gattaz  3 , Wulf Rössler  4