how culture makes a difference to psychiatric experiences – Tanya Lurhmann

tanya-luhrman_0003Hearing Voices in San Mateo, Accra and Chennai

Fascinating and informative talk by anthropologist Tanya Lurhmann on the findings  of a study into does culture make a difference? to how people experience what, in the west, we call “psychiatry”.

The study looked at the differences in the experiences of three groups of people from three continents and three cultures: examining the different approaches, understandings and the effect on experiences of people who hear voices.

  • San Mateo, California, US
  • Accra in  Ghana, West Africa
  • Chennai in southeastern India.

What difference does culture make?

The first nine minutes Tanya Lurhmann sets out the  basis, design and format of the study, which set out to aks “what difference does culture make?”

She sets out the nature of the three samples, how people were recruited and the measures she took to assure herself that the three populations were sufficiently comparable.

Basically the study included three groups – one from each location. All people selected could be given a diagnosis of “schizophrenia”.
This enables her to say of the people included in the three samples:

“it seems to me that they were struggling with loosely  the same phenomena. “

“I was comfortable that there was a case to be made that people who could be diagnosed with schizophremia in these three settings could be compared with each other, but they had different experiences.”


Then she begins to share observations from the study.

Character of the differences

  • Americans heard horrible voices telling them they are worthless and should die.
  • Africans heard an audible God who tells them to ignore evil voices.
  • South Asians heard annoying relatives who told them to get dressed and clean up.



san mateo

Americans use the diagnostic label

this is really quite striking, people say things like…

    • “I fit the textbook for schizophrenia”
    • “that’s just their job to give us labels and then give us medication”
    • “I have schizophrenia from my grandfather. I its a hereditary illness of the brain”

and her favourite…

  • “I went into the hospital with depression, and I must have caught all that other stuff on the way out”

i went into hospital with depression

To Americans, hearing a voice means that you are crazy

  • “I didn’t tell them I’m hearing voices. I was afraid I might be called crazy”
  • “you tell people that you hear voices and they treat you differently”
  • [do you talk about hearing voices to your family?]                                    “No…we’re not supposed to have mental illness”
  • I don’t tell people about my personal life, because they might think I’m crazy or something. They judge me.”

In America, voices are often unknown

  • Fourteen of twenty do not know their voices
  • Two hear famous people – who the famous people were kept changing
  • Two hear people they knew who are not kin
  • Two hear father/ stepfather who molested them

In America voices are often violent

  • “Usually its like torturing people, to take their eye out with a fork, or cut someone’s head and drink their blood, really nasty stuff”
  • “they want to take me to war with them”
  • “you’re going to die”
  • “you’re gonna go to hell”
  • “my suicide voice”
  • “why don’t you end your life?”
  • one reported his voices were at  “war” with him

That doesn’t happen to nearly the same extent in the samples from Accra and Chennai.



    • Hearing voices does not mean that you are crazy
    • The common cultural idiom is of “spiritual attack” – voices can be attributed to witches or evil spirits trying to get at you.
    • “It is better to be the victim of a witch than to have a mental illness – everybody struggles with witchcraft.”

More known voices

    • seven out of twenty report that their primary voices are people that they know.
    • the voices they recognize are intimate to them, people whose quality of life they know.
    • e.g. nurse from hospital, boyfriend, sister, husband’s brother, manager; relatives; neighbour, siblings, boss

Positive voices 

    • half the sample reported good voices as their primary or only experience
    • for those who also have bad voices, the good voices tell them to not to pay attention.

 People report…

  • “mostly the voices are good”
  • “they just tell me to do the right thing”
  • “that’s what kept me alive till now, the voice of God I hear,”
  • “they want me to do good things”

The voices are more relational

    • “they keep me company”
    • people have conversation with the voices



Half hear the voices of kin

    • often good and bad
    • may have one voice that berates but others who support and are companions
    • kin scold, give talks, insist on good behaviour

Voices often Positive, even playful

    • relatives, ancestors, famous people,
    • “I like my mother’s voice”
    • often distinctly playful relationships with their voices to the
    • point the voices seem more like companions.
    • often identified as gods or famous people.

Sexual – talk about sex, something that is culturally embarrassing.



  • people adopt diagnostic language and understanding
  • “voices” mean “mental illness” – there is no other explanation
  • all intensely disliked experience of hearing voices
  • positive experiences are rare
  • few people reported rich back and forth relationships with voices.

 “They are comfortable using the word schizophrenia and it is a terrible word for them. I am increasingly struck by the costliness of this label for our american patients” 


  • diagnosis was not important – not talked about, not the way people make sense of experience
  • voice hearing often given spiritual interpretation
  • half reported predominantly positive experience
  • more voices are known/ identifiable
  • many report real back and forth relationship with voices, even if voice is negative


  • Diagnostic labels not particularly important,
  • voice hearing often given social or spiritual interpretation
  • more voices are known that either Accra or America
  • Many have dominant positive voices
  • Playfulness relationship with voice is striking
  • often an emphasis on sex which is regarded as shameful.

Why these differences?

Lurhmann’s hypothesis is that in there are different cultural invitations for thinking about our mind and self,  which direct the way people pay attention to mental events.
As she says, by that she means that there exists not just a different model for what happens in  the mind but a different invitation to pay attention to mental events.


mind is a place and is private – voices experiences are seen as extremely disconcerting.

South asia      

mind is a transactional process and is responsive to  social influence, and must be calm.


thought has a causal impact on the world independent of the thinker and people are very concerned to report that they have good thoughts.

Hearing Voices Movement

This material is consonant with the hearing voices movement – if we teach Euro-Americans to have a relationship with their voices then their voices will be better behaved: less caustic.

There is very little scientific research  [there is plenty but, as she is American everything is understood medically,  so she is referring specifically to randomized controlled trials] on this yet but I’d invite you to think that we could treat this work as a kind of “natural experiment” for taking seriously the possibility that having a relationship with your voices may be relevant to a more benign outcome .

Why should we care?

People living in Accra and Chennai do better,   more  often more quickly and with less cost to lives of individuals and families – and less cost to society and services than in US.


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3 Responses to how culture makes a difference to psychiatric experiences – Tanya Lurhmann

  1. Ivan Barry says:

    Totally! Thank you.


  2. fearlessanalyst says:

    Fascinating 🙂


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