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Differences in voice-hearing experiences of people with psychosis in the USA, India and Ghana: Interview-based study

  • T. M. Luhrmann (a1), R. Padmavati (a2), H. Tharoor (a2) and A. Osei (a3)
Abstract
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 USA 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.

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Copyright
Corresponding author
T. M. Luhrmann, Stanford University, 441 Gerona Road, Stanford, CA 94305, USA. Email: luhrmann@stanford.edu
Footnotes
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Declaration of interest

None.

Footnotes
References
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Differences in voice-hearing experiences of people with psychosis in the USA, India and Ghana: Interview-based study

  • T. M. Luhrmann (a1), R. Padmavati (a2), H. Tharoor (a2) and A. Osei (a3)
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eLetters

RE: What are the real nature of voice hearing experiences?

We read the article with interest(1). The title is eye-catching & fascinating. The term “voice-hearing experience“replaces the term auditory hallucinations. We wonder whether it is an attempt by a non-psychiatrist colleague to normalize the phenomena of auditory hallucinations.

The study aimed to investigate the pathoplastic effects of culture on the content of phenomenon of auditory hallucinations. But it is important to establish the form of phenomenon before we can truly investigate the content. Authors have used appropriate instruments based on Lender –Thomas Voices Pragmatics Assessment Interview2 and Mastricht interview schedule3 to elicit the phenomenon of hallucinations. But it seems that this effort is somewhat diluted as is evident from the examples given, especially for the sample from San Mateo. These examples depict more of thought process. This brings in two issues:

1 Are we comparing two different phenomena i.e.thought (self ) versus hallucinations (voices from “outside”).

2. Are we comparing two different phenomena in patients from different cultures?

Authors draw our attention towards important implications of this study. However, implication of this study are also limited by the fact that the groups compared are not homogenous in many ways i.e. diagnosis, co morbid substance abuse in many patients, chronicity, duration of treatment and the treatment received.

Culture, no doubt is important. But all these factors can also alter the experience of “hearing voice” especially one`s “relation” to these voices, and thus the adaptation and tolerance.

REFERENCES

1.Luhrmann TM, Padmavati R, Tharoor H, Osei A. Differences in voice-hearing experiences of people with psychosis in the USA, India and Ghana: interview-based study. Br J Psychiatry 2015; 206: 41-44.

2.Romme M, Escher S. Making sense of Voices. Mind, 2004.

3.Leudar I, Thomas P. The Verbal Hallucinations Pragmatics Assessment Schedule. Department of Psychology, University of Manchester, 1995.

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Conflict of interest: None Declared

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Do certain biases limit the implications of the study?

Nikhil Jain, Assistant Professor, Department of Psychiatry
26 February 2015

I read the study by Luhrmann and colleagues with interest. The finding described about differences in voice-hearing experiences in three different cultures may have profound implications. However, some points of the methodology require clarification before firm conclusions can be drawn.Firstly, the three groups studied do not seem to be comparable. The Chennai group was drawn from both out patient and in patient populations, while the other two groups were drawn from in patient populations only. Itis possible that the patients requiring hospitalization were more severelyill and hence the difference in phenomenology.Secondly, the treatment status of participants is not clear. Inadequate psychoeducation can be a variable leading to less 'labeling'. Similarly, antipsychotic administration can also alter the quality and quantity of voice hearing experience.Clarification on the above mentioned concerns would be welcome.

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Conflict of interest: None declared

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