What do hearing the voice of God, experiencing hallucinations, hearing voices, and suddenly feeling motivated to pray have in common? According to anthropologist Tanya Marie Luhrmann, Ph.D., they are all shaped by cultural influences. Luhrmann studies the way that ideas held in the mind come to seem externally real to people. In an upcoming Behavioral and Social Sciences Research lecture, she will discuss two research projects that demonstrate how cultural context shapes schizophrenia. Her general message is clear: social environment can deeply affect the course and outcome of serious psychotic disorder.
@TanyaLuhrmann Social environment can deeply affect the course and outcome of serious psychotic disorder.
In addition to schizophrenia, Luhrmann also studies hallucinations and sensory overrides, absorption, theory of mind, prayer and things of the spirit, psychiatric distress, and other topics.
Why Homeless Women Refuse Offers of Help
“The street will drive you crazy” is a phrase commonly heard among homeless people. However, while it seems straightforward on the surface, in order to fully understand what homeless women mean when they make this statement, we must also understand the context in which it is said.
Within the institutional circuit of supported housing, jail, hospital, homeless shelter, and the street, many people refuse offers of help, especially those extended by mental health services. Luhrmann conducted an ethnographic study of homeless psychotic women to find out why so many decline these offers.
@TanyaLuhrmann conducted ethnographic study of homeless psychotic women to find out why many decline housing offers.
In the homeless community, the word “crazy” has intensely negative connotations. In that context, it applies to people who are flagrantly psychotic and openly talking to invisible people. Many homeless persons also believe it is a permanent condition that indicates one is not strong enough to cope with the hardships of homelessness. Offers of help that are based on psychiatric disability, and which depend on a formal diagnosis, are viewed as being applicable only to so-called crazy people. Therefore, a homeless woman may decline such services because she doesn’t want to be labeled crazy. Luhrmann found that when women refused offers of housing, they did so largely on the grounds that they did not want to be viewed as crazy, even if they had previously articulated a strong interest in housing. In effect, the local homeless culture invites women to signal their strength by refusing care.
@TanyaLuhrmann Women refused offers of housing largely on the grounds that they did not want to be viewed as crazy.
Although health service providers often conclude that help is refused because of a lack of insight, it is important to understand the culture of the street to truly appreciate reasons behind refusals of help. With this understanding, it may be possible to revise the ways in which help is delivered (such as by downplaying the importance of an explicit psychiatric diagnosis), thereby increasing homeless people’s well-being.
Hearing Voices? What They Say, and How They Say It, Depends on Culture
The International Pilot Study of Schizophrenia, published in 1974 by the World Health Organization (WHO), reported that schizophrenic patients in Africa and India appeared to experience relatively less emotional suffering than people with schizophrenia living in various Western countries. This was true whether symptoms, disability, clinical profile, or the ability to do productive work was measured, and these results held at the two-year follow-up and again at ten years. As was the case for homeless women refusing help, the discrepancy is amenable to ethnographic examination since it has a large social influence.
In her 2007 paper, Social Defeat and the Culture of Chronicity: Or, Why Schizophrenia Does So Well Over There and So Badly Here, Luhrmann examines how cultural and social influences may explain the WHO finding. In the paper, she discusses the history of how schizophrenia has been conceptualized in the U.S. and the social impacts on schizophrenia globally. Luhrmann has also conducted her own research on voice-hearing experiences in people in South Bay, California; Accra, Ghana; and Chennai, India.
Differences in schizophrenic experiences have clinical implications due to malleability in voice hearing
Luhrmann found major differences in what Americans, Ghanaians, and Indians experience when they hear voices. For Americans, she found that subjects felt assaulted by the voices, that the voices were violent, and that the subject had no prior relationship with the voices. Every American she studied had a negative relationship with his or her voices. However, in Ghana and India, voices were attributed to spirits, to God, or to people the subject already knew, including kin. Half of Ghanaian subjects and over a third of Indian subjects reported a positive experience with their voices.
Such differences in schizophrenic experiences have clinical implications, as they suggest a dimension of learning and malleability to voice-hearing experience. Thus, new treatment could focus on teaching patients to interact with their voices and to explore their meaning.
Webinar and Speaker Details
Luhrmann will discuss these two topics, homeless women’s refusal of help and cultural dependency of schizophrenic voices, in her April BSSR lecture. She will highlight the importance of ethnographic and qualitative methods in research aimed at understanding psychiatric illness.
Title: Culture and Psychosis
Date: Monday, April 11, 2016 (Watch live)
Time: 2:00 p.m.–3:00 p.m.
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Speaker: Tanya Marie Luhrmann, Ph.D.
Watkins University Professor
Stanford University
Additional Resources
Tanya Marie Luhrmann’s Stanford faculty page
Tanya Marie Luhrmann’s author page
Photo Credit: Shutterstock/ Lucian Milasan
