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Hearing voices: Listening clearly to psychosis

When someone "hears a voice" what is really happening? Can we all understand what it means to hear voices?

Approaching the phenomenon of hearing voices from an anthropological perspective — rather than a traditional psychiatric point-of-view — offers a different take on the puzzling and alienating experience, said Nev Jones, PhD, director of research and evaluation at the Felton Institute in San Francisco, and a former postdoctoral fellow at Stanford. She spoke recently in the Stanford Department of Anthropology's Cultures, Minds, and Medicine seminar series.

Jones recounted an interview with a young adult with a recent onset of psychosis. His voices take the form of nanobots and terrorists, but he doesn’t convey this information to his treatment team. “Why should I?” he asked. “She [his psychiatrist] told me she didn’t know anything of computers or math, and that was the end of it.” The young man felt that his doctor wouldn't understand, Jones said. That patient's experience illustrates the importance of listening with an open mind, she pointed out.

The inability to communicate a personal experience is not unique to people with psychosis, Jones said. She asked audience members to recall a conversation with a friend. How did you convey an experience that was foreign to your friend? It's challenging to provide enough detail — and emotion — to allow them to understand what you were thinking, what you felt, and what was happening. The exercise illustrated that it is not easy to share a complete portrait of your experience using language.

It's also important to reexamine the role of the patient, Jones said. “Our assumption, built off a very biomedical way of thinking about illness and disorder, is that [psychosis] is completely passively experienced,” Jones said. The patient's experiences aren't easily sorted into disordered and healthy. Without that understanding, it's possible that physicians and therapists may inadvertently discourage a patient from sharing experiences or feelings that don’t follow strict diagnostic predictions, she said.

Listen openly and question your biases and assumptions about people who hear voices, Jones urged. Then, you may be able to truly hear their voices.

Previously: New thinking on schizophrenia, it's the mind, body and social experience, Resilience: Jessie and Glenn Close on mental illness and stigma, and Imagining voices: A look at an alternative approach to treating auditory hallucinations
Photo by Dmitry Ratuhny

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