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Effects of Culture on Hallucinatory Voices and Directions for Neuroscience

by Daina Crafa

August 1, 2014

Popular culture commonly describes people as “hearing voices in their heads” as a kind of shorthand for mental illness. In reality, auditory hallucinations are frequently symptoms of psychotic episodes and disorders like schizophrenia. Recent studies suggest that areas of the brain associated with speech generation and perception are involved in these hallucinations (e.g., see here and here). However, like so much research from the neurosciences, the neural activity that’s measured depends on the experimental sample and design. It reportedly varies in patients with schizophrenia and as a function of aesthetics — with pleasant voices processed differently in the brain than unpleasant ones.

The experience of hearing voices also appears to vary across cultural contexts. Dr. Tanya Luhrmann, an anthropologist from Stanford University, recently reported that culture influences whether people with schizophrenia hear friendly or menacing voices. Through a series of interviews, Dr. Luhrmann found that patients in India and Ghana are much more likely to experience harmless, playful voices, while patients in the United States commonly hear more threatening voices. She also observed that people in India and Ghana were more likely to develop complex relationships with their voices and were less likely to think of them as biomedical problems. In contrast, U.S. interviewees tended to consider these hallucinations in medical terms, describing them as psychiatric symptoms. Dr. Luhrmann concludes that whether or not voices are distressing to the patient may influence clinical outcomes and severity of psychosis. She suggests that clinical interventions should be tailored to accommodate diverse patient experiences. For more details about these findings and their implications, check out her original article and compelling interview with the Stanford News.

Dr. Luhrmann’s findings may have implications beyond the clinic — particularly for cultural neuropsychiatry. If culture influences the positive or negative valence of voices, does it also influence the brain activity of the patients experiencing them? An initial review of the literature suggests that the answer may be “yes.” Negative voices are likely to evoke negative emotions for many patients, while positive voices may evoke positive emotions. This type of emotional valence is processed differently in the brain. If the valence of auditory hallucinations is influenced by culture, then corresponding neural activity may be too.

Such research has the potential to provide valuable clinical information regarding psychiatric patients from diverse backgrounds. It may also demonstrate culture’s ability to shape human neurobiology and provide clues to potential causes. This is one example that illustrates why neuroscience and anthropology should work together to understand mental health.

How to cite this post: Crafa, D. (2014, August 1). Effects of Culture on Hallucinatory Voices and Directions for Neuroscience. Retrieved from

©Daina Crafa, 2014. All rights reserved.

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