T. M. Luhrmann

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.

Differences in voice-hearing experiences of people with psychosis in the USA, 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.

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.

A Hyperreal God and Modern Belief Toward an Anthropological Theory of Mind

This article argues that there is an epistemological style associated with much American evangelical Christianity that is strikingly different from that found in never-secular Christianities. This epistemological style is characterized by a playful, self-consciously paradoxical framing of belief-claims in which God’s reality is both clearly affirmed and qualified. One can describe this style as using an “epistemological double register” in which God is described as very real—and as doubted, in some way. The representation of God generated by this complex style is a magically real or hyper-real God, both more real than everyday reality and in some way fictive. The article goes on to argue that these epistemological features can be understood as generated by and generative of particular theories of mind. The article argues for the development of an anthropological theory of mind in which at least four dimensions are important: boundedness, interiority, sensorium, and epistemic stance.

The Zone of Social Abandonment in Cultural Geography: On the Street in the United States, Inside the Family in India

This essay examines the spaces across societies in which persons with severe mental illness lose meaningful social roles and are reduced to “bare life.” Comparing ethnographic and interview data from the United States and India, we suggest that these processes of exclusion take place differently: on the street in the United States, and in the family household in India. We argue that cultural, historical, and economic factors determine which spaces become zones of social abandonment across societies. We compare strategies for managing and treating persons with psychosis across the United States and India, and demonstrate that the relative efficiency of state surveillance of populations and availability of public social and psychiatric services, the relative importance of family honor, the extent to which a culture of psychopharmaceutical use has penetrated social life, and other historical features, contribute to circumstances in which disordered Indian persons are more likely to be forcefully “hidden” in domestic space, whereas mentally ill persons in the United States are more likely to be expelled to the street. However, in all locations, social marginalization takes place by stripping away the subject’s efficacy in social communication. That is, the socially “dead” lose communicative efficacy, a predicament, following Agamben, we describe as “bare voice.”

The Cultural Kindling of Spiritual Experiences

In this paper we suggest that it is important for the anthropology of Christianity and the anthropology of religion more generally to develop a comparative phenomenology of spiritual experience. Our method is to distinguish between a named phenomenon without fixed mental or bodily events (phenomena that have specific local terms but are recognized by individuals by a broad and almost indiscriminate range of physical events); bodily affordances (events of the body that happen in social settings but are only identified as religious in those social settings when they afford, or make available, an interpretation that makes sense in that setting); and striking anomalous events. We demonstrate that local cultural practices shift the pattern of spiritual experiences, even those such as sleep paralysis and out-of-body experiences that might be imagined in some ways as culture free, but that the more the spiritual experience is constrained by a specific physiology, the more the frequency of the event will be constrained by an individual’s vulnerability to those experiences. We will call this the “cultural kindling” of spiritual experience.

Yearning for God: Trance as a Culturally Specific Practice and Its Implications for Understanding Dissociative Disorders

ABSTRCT This paper suggests a tentative hypothesis to explain the apparent paucity of dissociative disorder patients between the 1920s and the 1970s: that the trance phenomenon that is now so characteristic in patients who struggle with childhood trauma may be a manner of handling emotional distress specific to certain periods in American history. The paper argues that trance is learnable; that there are specific periods in American history in which trance is encouraged in religious experience and that we are now in one such period; that in such periods, trance becomes incorporated into a complex behavioral practice in religious settings in which the boundary between the perceptually real and unreal may be blurred; and that the prevalence of this practice in religious settings may influence the symptom expression of those who struggle with the aftermath of trauma.

Beyond the sensory: Findings from an in-depth analysis of the phenomenology of “auditory hallucinations” in schizophrenia

Objective: Research concerning the subjective sensory qualities of auditory hallucinations (AH) in people diagnosed with schizophrenia is scarce. Our goal was to investigate the “auditoriness” of AH and their overlap with symptoms grounded in alterations of thought rather than perception. Method: We undertook a detailed analysis of phenomenological interviews with 80 schizophrenia-spectrum voice-hearers. Results: We coded the dominant voice patterns of our subjects and found that only a minority (17.5%) reported a dominant pattern of AH which were experienced as literally auditory. Of dominant AH patterns, 11.3% were instead described as only quasi- or partially auditory, 28.8% as involving a combination of distinctly auditory and thought-like voices, and 15% as unambiguously thought-like. In addition, 5% reported exclusively simple, short-duration AH (e.g. hearing a single word), 12.5% the misperception of actual speech or sounds, and 10% predominantly multisensory voices. We also found substantial overlap between voices and symptoms traditionally considered abnormalities of thought rather than sensation. Conclusion: We believe these findings challenge common assumptions about AH in people diagnosed with schizophrenia, draw attention to potentially important but under-recognized characteristics of voices, and suggest a need for greater recognition of the heterogeneity of voices and the potential clinical as well as theoretical risks of conceptual over-simplification.

“Did I push myself over the edge?”: Complications of agency in psychosis onset and development

Objective: To investigate the subjective experience of agency in the onset and early development of psychosis. Method: We conducted 19 in-depth interviews with a sample of individuals with self-reported diagnoses of schizophrenia and/or affective psychosis. Interviews focused on participants’ experiences of agency and control in the onset and development of positive psychotic symptoms. Interviews were coded and transcripts analyzed by service-user researchers. Results: The majority of participants reported multiple ways in which they experienced their own agency or intentionality as involved in the initial onset of psychosis, in self-conscious engagement with symptom structure and content, and in their elaboration and development. For many, the moral implications of these felt experiences were considerable, at times leading to shame or guilt. Conclusion: Clinical accounts often stress the imposed, involuntary experience of symptoms and onset. Our project suggests that at least a subset of subjects with psychosis instead experience themselves as partly or fully “responsible” for onset, and actively involved in the shaping and elaboration of positive symptoms. In both clinical practice and future research, we argue that such complications should be explored and grappled with rather than downplayed.

Lord, teach us to pray: Prayer practice affects cognitive processing.

Abstract A secular observer might assume that prayer practice affects those who pray by making the cognitive concepts about God more salient to their lives. Those who pray, however, often talk as if prayer practice – and in particular, kataphatic (imagination-based) prayer – changes something about their experience of their own minds. This study examined the effect of kataphatic prayer on mental imagery vividness, mental imagery use, visual attention and unusual sensory experience. Christians were randomly assigned to two groups: kataphatic prayer or Bible study. Both groups completed computerized mental imagery tasks and an interview before and after a one month period of practice. The results indicate that the prayer group experienced increased mental imagery vividness, increased use of mental imagery, increased attention to objects that were the focus of attention, and more unusual sensory experience, including unusual religious experience, although there were substantial individual differences. These findings suggest that prayer practice may be associated with changes in cognitive processing.