Cross-cultural experiences of schizophrenia

July 19, 2014 4:51 PM

A new study by Stanford anthropologist Tanya Luhrmann and others found that voice-hearing experiences of people with serious psychotic disorders are shaped by local culture – in the United States, the voices are harsh and threatening; in Africa and India, they are more benign and playful. This may have clinical implications for how to treat people with schizophrenia, she suggests.
posted by Rumple (23 comments total)

Hmm. Maybe the quality of the voices heard by schizophrenics tells us something about the nature of social relations in a given environment. As if the voices were there to express the general tone of the "They."
posted by homerica at 4:54 PM on July 19, 2014 [10 favorites]

I'd be interested to see the interrelation of culture and language here-- there's nothing about it in the article but I assume the study itself explains how or if they discounted the effect(s) of language on these findings.

(also it's kind of shitty that findings for Ghana are just assumed to be for All Of Africa by the article)
posted by shakespeherian at 5:25 PM on July 19, 2014 [1 favorite]

I read an interesting comment on these findings and Julian Jaynes.
posted by grobstein at 5:51 PM on July 19, 2014 [7 favorites]

I was thinking about this topic the other day... whether or not there are indeed cultural differences in cognitive psychology. Thanks for the link.
posted by KokuRyu at 6:11 PM on July 19, 2014

I'd be interested in knowing whether there are similar cultural differences in inserted thoughts. (Inserted thoughts are thoughts that psychotic individuals claim have been implanted in their heads by another person).

There are two major sorts of theory about how inserted thoughts arise. One sort of theory but not the other holds that thoughts are attributed to another when they are too horrible to self-identify with. These theories predict that "ego-syntonic" inserted thoughts (that is, thoughts that are in sync with one's self image) are impossible: psychotic individuals always have negative attitudes toward inserted thoughts. And this does appear to almost always be the case. But perhaps this impression is due to a selection bias and psychotic individuals in other cultures have positive attitudes toward their inserted thoughts. That would tell us something important about the way these symptoms come about.
posted by painquale at 6:15 PM on July 19, 2014 [3 favorites]

I remember seeing something about this in the New York Times earlier this year, though a quick scan of their archive of her columns doesn't bring it up (but shows some interesting articles about cross-cultural religious effects). Luhrmann's research has always fascinated me; I read her book on British magicians as an undergrad. Every time I've seen her name associated with a study or article, I've always wanted to know more.
posted by immlass at 6:52 PM on July 19, 2014 [2 favorites]

There has been a lot of interest over the past few years in building positive relationships with voices. I know the Icarus Project supports it, especially from a mystical or spiritual side; Rufus May also has a very respectful attitude to working with people and their voices.
posted by saucysault at 7:20 PM on July 19, 2014 [1 favorite]

I'd be interested in looking at whether the family's/culture's treatment of people with schizophrenia affects the quality of the audio hallucinations, too. A number of the people I work with who have schizophrenia have been dealing with feeling like failures for not living up to societal norms for careers, independence, relationships, and other US markers of successful adulthood, and I would suspect that feeling like a failure would negatively influence the content of the hallucinations. I would think in cultures where more interdependence was the norm, there might be less internal and external negative judgment about the functional aspects of mental illness.
posted by jaguar at 7:29 PM on July 19, 2014

I think about the role of potential Schizophrenia in shamanic societies and their function as a go-between for the village to the spirit realm for various purposes. Communicating with the spirits and voices to gain knowledge and information... I think Terence McKenna discusses this concept a bit, and it certainly fits within the point that many mental illnesses have at least some sense of cultural bias.

Some societies tend towards certain stressors/effects on behavior and that can cause individuals to act more towards one given way or another. Sometimes these might even go in cycles where a genetic component is selected for (if the society deems it as such a worthy trait or does not have other prohibitions on breeding by affected individuals (religious celibacy, eunicism or whatever else may be the case).

I think many of the reasons we're on so many medications is because we truly live in a society that breeds anxiety, depression and other such associated "illnesses". That's not to say that other societies don't experience these things, of course, but some of them may experience other "maladies" that aren't as common in our culture. It's hard to say how much is adaptive adjustment in a given society to "fix" an illness (I mean here, to consciously "fix"/solve a problem- that is: psychologizing, medicalizing, spiritualizing, technologizing or a blend of the four); how much is a reduction of factors due to a given societal structure's general effect (say, village based polygamous hunter-gatherer tribalism vs urbanized industrial consumerism with a nuclear family) -- these effects may or may not be conscious or tied into the mythos of a culture -- "We do x because it prevents y" Y may or may not be the actual thing that X prevents... Picture something along the lines of religious obligations where certain cultural expectations are demanded of participants - sometimes this might be seen as a method of ritualistically binding people to each other via social conditioning and patterns of behavior, other times they might be seen not just as in/out group enforcement mechanisms, but a way to protect more than mere identity, but physical safety - eating pork, for example. The same probably goes for mental issues as well as physical issues.

In this regards then, it wouldn't surprise me that certain societies have a more beneficial (or at least "benign" (in the medical sense)) approach to dealing with schizophrenia and its effects, but they probably have worse ways of dealing with other sorts of effects... Obviously this is just a generalization and I think there's a lot of room for research and study into this sort of thing.

I've always been of the opinion that mental issues are primarily issues insofar as they affect the ability of an individual to function in a given society. So long as they are able to maintain a certain level of quasi-harmonious existence they do not need to be "helped" - but at a certain point that relationship between the individual and the social space degrades and can be harmful for either the individual or the particular sphere in which their "disability" interacts with (for me, this is my given work environment and large public spaces, for example). So of course, the expectations and the beliefs of a given society will by nature affect what is seen as a dysfunction and affect how individuals cope and what resources are available to do said coping. Sometimes dysfunctions exist but are not named or acknowledge and can lead to attitudes that further hinder a holistic healing process for both the individual and society (here, I think of PTSD in returning vets and the views of some vets that I have seen in comments and such that the victims are "weak" and look down on the sufferers instead of seeing them as comrades who need help -- a lack of acknowledgement of their needs and the affect that war can have on not only PTSD sufferers but the supposedly "strong" survivors of war. A willful ignorance perhaps, at play, by those who are not affected).

Looking at Shamanism, it's interesting to see the idea of the Shaman as an outsider and their role as a hierophant and psychopomp in their society and how that's both co-aligned with how we treat our own sufferers of schizophrenia (shunt them aside, away from our vision), but different in the sense that they are empowered to act with regards to their experiences in a way that a Western Culturally based person with schizophrenia doesn't have the same "rights" (this isn't taking into account the sort of Otherizing/Glorification that people sometimes do in the West, which is a sort of shadow of what Shamanic societies do with their shamans). Of course, this is making an assumption that the given shaman has schizophrenia or similar hallucinatory or psychotic effects naturally. Certainly there are plenty of shamans who don't have such traits, or in the same way, the induction of mental states via imbibation of psychedelic substances and music and ritual is a way to enter into those states for those who find it more difficult and less natural to do so.

I think the sudafed I took is putting me in a state to write a long post, so... I should probably quite while I'm ahead. Look forward to reading this...
posted by symbioid at 8:08 PM on July 19, 2014 [7 favorites]

The 'Africa' part of the study was conducted in Ghana, for the record.
posted by BinGregory at 10:17 PM on July 19, 2014 [1 favorite]

A shaman's view.
posted by Obscure Reference at 5:48 AM on July 20, 2014 [2 favorites]

there's nothing about it in the article but I assume the study itself explains how or if they discounted the effect(s) of language on these findings

I'm not sure what effects language could have. It certainly wouldn't hurt to investigate--except that generally, when one is designing a study, one often has limited resources that need to be directed toward questions that are have some plausible theory behind them. The idea that what language you speak profoundly influences thought has failed to find support despite decades of research into the connection; at most everyone agrees that there are minor effects (such as quicker or more accurate identification of colors if one's language treats them as separate categories).

It is often difficult to control for these questions as well. Speaking a different language tends to come packaged with confounding factors: different cultures, different socio-economic status, and so on.

If there is any reputable research that suggests that language could influence how auditory-linguistic delusions in schizophrenia manifest, I'd be interested to read it--but I'd also be surprised. I can't imagine what the mechanism of action would be at the moment.
posted by Kutsuwamushi at 5:59 AM on July 20, 2014

Just a comment on the Rufus May link. The editing is disconcerting. The audio seems continuous, but the video is certainly altered. Is this the visual analog of soft piano music?
posted by xtian at 6:02 AM on July 20, 2014

I don't have schizophrenia, but I have experienced auditory and visual hallucinations (without being in an, um, enhanced state), apparently secondary to severe depression. I've been lucky I guess (in context of what this is saying about Western culture); I've never had an unpleasant one. Always benign. Weird as shit sometimes, but benign, never threatening, never dangerous to myself or others.

Intrusive thoughts (as opposed to insertive ones), however... ooooh boy. Those can be unpleasant. I suppose in a different mindset I'd attribute them to outside influences; maybe there's one dividing line between apprehending reality as-is and psychosis: with intrusive thoughts, no matter how disturbing, you know they're coming from somewhere within you. Insertive thoughts are ones your ego cannot process as having come from within your brain. And it's really very weird that intrusive thoughts are never, ever happy or even benign; they're always ugly, with sometimes serious consequences (for yourself or others) if acted upon. Hmmm.

If there is any reputable research that suggests that language could influence how auditory-linguistic delusions in schizophrenia manifest, I'd be interested to read it--but I'd also be surprised. I can't imagine what the mechanism of action would be at the moment.

I'd be interested in reading them too. But I suppose if your culture includes language indicating it's completely normal to hear voices--that you're hearing the divine, for example--I could certainly see how your interpretation would change. In North America we seem to have a nigh-on universal sense that hearing voices is always bad and will always be harmful. Cause or effect? Maybe it's one of those chicken/egg things.

Then again, large segments of Western culture (claim to) hear voices, the voice of the divine generally (God/Jesus/Axasir from Sirius B), and amass followers and create entire religions. I wonder sometimes how many of these people are genuine (obviously many are just outright fraudsters) in their beliefs, and are high-functioning schizophrenics who have a framework of positivity to anchor their hallucinations in? It seems like it would be easy to study that; get a bunch of such people, double-blind them into two groups and give one group antipsychotics. See what happens. (Obviously there are risks and serious side effects with antipsychotics, which would be a significant stumbling block. I can also see an ethical dilemma inasmuch as if these experiences are genuine and not just a way of making a quick buck, is it ethically and morally right to deprive people of something that brings them happiness and an ability to cope?)

At any rate this is some really fascinating stuff and I now have some interesting rabbit holes to delve into later today.
posted by feckless fecal fear mongering at 6:21 AM on July 20, 2014 [1 favorite]

And on second thought, maybe there's a continuum between intrusive and insertive thoughts, not an either/or proposition.
posted by feckless fecal fear mongering at 6:23 AM on July 20, 2014

The voices people hear in the West may have changed over time, too - perhaps even a very short time. Daniel Smith, in Muses, Madmen and Prophets, talks about how his grandfather heard voices that gave him great business advice. (They gave him horrible advice at the racetrack, though, since they'd all tell him to bet on a different horse.) His grandfather found it a comfortable, familiar, sometimes amusing experience.

His father, on the other hand, assumed that the voices he heard meant he was crazy. It turned into a very dark experience for him, with breakdowns and hospitalizations and fear.
posted by clawsoon at 6:58 AM on July 20, 2014 [2 favorites]

feckless fecal fear mongering: Then again, large segments of Western culture (claim to) hear voices, the voice of the divine generally (God/Jesus/Axasir from Sirius B), and amass followers and create entire religions. I wonder sometimes how many of these people are genuine (obviously many are just outright fraudsters) in their beliefs, and are high-functioning schizophrenics who have a framework of positivity to anchor their hallucinations in?

Wasn't that a big part of Jaynes' theory, alluded to in grobstein's comment above, in The Origin of Consciousness in the Breakdown of the Bicameral Mind? He points out that in really ancient literature - before 1800BCE or so - no one ever says, "And then I thought to myself...." They always say, "And then the god(dess) said to me...."

He argues (or so my crude summary goes) that this meant that people never did think to themselves; their thoughts always came to them as an external voice speaking to them. In that context - and in people who kept thinking like that even as it gradually died out in the general population - you wouldn't need to posit fraudsters as the source of most major religions.

Jaynes' thesis may be completely incorrect, but it's fascinating.
posted by clawsoon at 7:14 AM on July 20, 2014 [5 favorites]

I was thinking more of the "I am the reincarnation of Cleopatra and I talk to a spirit entity from the 7th vibration" sort of Newage (rhymes with sewage) types. Also L Ron Hubbard, that Heaven's Gate asshat, Raelians, etc. We are too far removed in time from Moses, Jesus, Buddha etc to opine on whether they held sincere beliefs, whether they were suffering what we would know today as schizophrenia, or whether they saw a chance to make a quick buck.
posted by feckless fecal fear mongering at 7:21 AM on July 20, 2014

a much larger but much shallower WHO survey study in the 1990s suggested that the schizophrenics in developing countries ( the low income sample group were India , Nigeria, Colombia; the high income group included the US IIRC) were 3 times more likely to commit violent assault than those in developed countries.

The study itself is gated, so I'm wondering to what extent the research methodology controlled for this-- i.e., how did the authors ensure that they were interviewing a somewhat representative and unbiased sample of people with schizophrenia from each locality? In a culture where low-functioning forms of schizophrenia are quite likely to lead to incarceration or violent death, you'd expect that the patients who avoid those fates and end up, for instance, in hospital would naturally be those with more benign, higher-functioning forms of the disease-- which might well include nicer-sounding voices.
posted by Bardolph at 8:28 AM on July 20, 2014 [3 favorites]

L Ron Hubbard's deep hatred of psychiatry makes me wonder if he did sometimes actually hear voices or have visions; maybe it wasn't all a quick buck for him. One of the few services that Scientology seems to provide to its members even if they're not completely paid up is to get them out of mandatory psychiatric treatment as fast as the law allows.
posted by clawsoon at 9:17 AM on July 20, 2014

I came across this, or very similar studies, before and its fascinating. Set and setting has an incredibly strong effect on the nature of the experience of psychoactive drug use, its not surprising that culture can have a strong effect on how psychiatric disorders manifest.

For example, early studies on the effects of LSD provided a comfortable and safe setting and the subjects almost invariably had very pleasant "trips." "The world is a beautiful place" was an extraordinarily common description of the experience.

Then you have highschool kids dropping acid and freaking out and having "bad trips" where the walls are melting and the table was trying to eat them.

Having done LSD, it was nothing like I expected. Intense feeling of euphoria and visual hallucinations were merely extreme versions of pareidolia. Yes, for a moment I felt that I saw a murder of angry gargoyles flying out of the sky but I was able to shift my perception and, "oh, its just those darker clouds that the wind was blowing my way."

Another example; marijuana use. People talk about feeling paranoid after they toke up. In my experience, this usually only affects teens and Americans (before the legalization/decriminalization thing recently) to whom the use of marijuana is a taboo with criminal/disciplinary consequences if discovered.
posted by porpoise at 2:21 PM on July 20, 2014 [2 favorites]

This is actually very interesting, as I was just talking the other day to someone about their experiences being accosted on the street by obviously mentally ill people, and how many times, the horrible things that those people say are incredibly misogynistic or just plain hateful things.

I posited a question of whether or not those things were a reflection of the culture in which the mentally ill person was raised, or the environment in which they were sadly situated in that provided the framework in which their mental illness manifested itself. Interesting to see if that is truly the case, or merely a circumstantial secondary effect of the altered brain structures involved.
posted by daq at 10:45 AM on July 21, 2014

We are too far removed in time from Moses, Jesus, Buddha etc to opine on whether they held sincere beliefs, whether they were suffering what we would know today as schizophrenia, or whether they saw a chance to make a quick buck.

It doesn't have to be either/or, though. Perhaps people like Hubbard and the other modern religious founders you mention both had some form of schizophrenia and were also fraudsters, believing part of their own message but lying about or exaggerating other elements.

I could definitely see someone noticing they're having weird experiences, not quite believing they were religious or divine in nature, but seeing them as opportunities to scam others who might believe.
posted by Sangermaine at 12:15 PM on July 21, 2014