Surprising new research on schizophrenia suggests, however, that people with mental illness may have stronger, stranger ties to their societies than we commonly assume. In a new article in the British Journal of Psychiatry, Stanford anthropologist Tanya Luhrmann explains that for schizophrenics experiencing auditory hallucinations, the cultures they live in shape the voices they hear in their minds. Most psychiatric research is conducted by scientists. Luhrmann argues, though, that the same psychiatric condition can express itself differently in different cultures, which is where anthropologists come in. For this study, she interviewed adults with schizophrenia who live in three different places: Chennai, India, Accra, Ghana, and San Mateo, California. She asked each person to describe his or her auditory hallucinations—how many voices they heard, what the voices said, where they felt the voices were coming from.
I wonder how they insured that they were really sampling comparable populations in these three places? I can't find a free version of the article online, but I'm a bit doubtful. Maybe people who have more persecutory hallucinations in Accra and Channai are dealt with in ways that kept them out of the study samples. As deficient as much of our treatment of psychotic disorders in the US is for so many people, consider what treatment could consist of for a person afflicted in Ghana. Perhaps those afflicted with more paranoid and persecutory hallucinations wind up in those settings.
Mind you, this isn't to dismiss the potential significance of the findings. If the differences they found reflect real differences in the broader populations of persons with schizophrenia, the implications are quite important and consistent with those who argue that we could be more helpful to patients experiencing auditory hallucinations by including innovative non-pharmacological therapies. I posted something on this subject a couple of years ago and, looking that post up, I see that I linked at that time to another article by Tanya Luhrmann, which is also worth a look.
By the time I was in graduate school, psychiatry had for the most part adopted a medication and minimalist supportive therapy approach, though my psychologist education still included introduction to non-pharm therapeutic approaches. Does anyone still read Ping-Nie Pao? The problem with non-pharm therapies that went beyond caseworker support was that they were lengthy and costly at a time when the insurance industry was rapidly moving toward a fast-and-cheap model.
Recently, Illinois passed legislation to put prescription pads in the hands of psychologists, so I imagine that will only lessen the interest in non-pharm, therapeutic intervention, at least among young psychologists around here who will no doubt gravitate toward more profitable prescription practice.