Dancers perform on stage as the English National Ballet rehearse 'Coppelia' at the Coliseum on July 22, 2014 in London, England. Photo: Ian Gavan/Getty Images
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Hearing disembodied voices as violent or helpful depends on culture, study finds

A Stanford study has found that those who hallucinate voices are influenced by the culture they live in, with differences in mood and tone depending upon where in the world they live.

Ethan Watters's 2010 book Crazy Like Us: The Globalization of the American Psyche details how mental health conditions around the world have changed thanks to globalisation. What the American medical establishment understood as the model of an illness, its causes and even its symptoms, became how it was experienced elsewhere.

For example, Sing Lee, a psychiatrist in Hong Kong, spent much of the late 1980s and early 1990s studying anorexia. His patients did not deliberately avoid eating - in fact, “they complained most frequently of having bloated stomachs”. Then, in 1994, a teenage girl collapsed and died in the middle of a busy street, and the local papers reported her anorexia with language straight from American medical dictionaries:

Western ideas did not simply obscure the understanding of anorexia in Hong Kong; they also may have changed the expression of the illness itself. As the general public and the region’s mental-health professionals came to understand the American diagnosis of anorexia, the presentation of the illness in Lee’s patient population appeared to transform into the more virulent American standard. Lee once saw two or three anorexic patients a year; by the end of the 1990s he was seeing that many new cases each month. … By 2007 about 90 percent of the anorexics Lee treated reported fat phobia. New patients appeared to be increasingly conforming their experience of anorexia to the Western version of the disease.”

While cultural conditioning is an easily acceptable notion, the idea that our mental health is similarly conditioned can feel a little strange. This is because it belies our understanding of illness, especially mental illness - with modern medicine, we’re accustomed to thinking of the human body as a machine, and treatment for disease as akin to the physical repair of a worn-out mechanism. Our inability to completely model a human brain means we’re also groping in the dark when it comes to modelling mental health as only a physiological phenomenon.

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders is the most infamous example of this problem - in theory, the definitive catalogue of mental health, and the standard reference for any psychiatric diagnosis. In practice, it conflates everyday personality traits with disorders, relying on changeable mood to decide whether those traits are bad or not. In response to the publication of the most recent edition, DSM-V, the British Psychological Society issued a statement criticising its premise:

The putative diagnoses presented in DSM-V are clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements, with little confirmatory physical 'signs' or evidence of biological causation. The criteria are not value-free, but rather reflect current normative social expectations. Many researchers have pointed out that psychiatric diagnoses are plagued by problems of reliability, validity, prognostic value, and co-morbidity."

The manual also “misses the relational context of problems and the undeniable social causation of many such problems”. (This was best skewered by Sam Kriss, who reviewed DSM-V as if it’s a Borgesian dictionary of the dystopian, written by an anonymous author intent on dehumanising its subjects.)

It’s within this context that we should welcome a study, led by anthropologist Tanya Luhrmann of Stanford University, which has found that the nature of aural hallucinations change relative to the local culture of the person experiencing them. Americans who hear disembodied voices are more likely to report them as violent, or “bombardment”; Indian and Ghanian participants more often reported the voices they heard were “playful” or even “entertaining”.

All of the participants in the study had been diagnosed as schizophrenic, with 20 each from San Mateo in California, Accra in Ghana and Chennai in India. All participants, from all three locations, reported both positive and negative experiences with hallucinated voice - yet while the Ghanaians and Indians reported predominantly positive experiences, the Americans all said their experiences were mostly negative.

Crucially, too, Americans perceived their hallucinations as symptomatic of a deeper disease, whether innate or because of a traumatic experience - while 11 of the Indian participants described their voices as deceased relatives giving advice or commands, and 16 of the Ghanaians reported hearing the voice of God.

The voices were treated as a “magic”, “playful” or “entertaining” more often than not, and only some participants saw them as manifestations of a mental illness; the Americans, in contrast, heard voices describing violent imagery, “torturing people” or a “bombardment”, an “assault”, or even a “call to war”. “[The] harsh, violent voices so common in the West may not be an inevitable feature of schizophrenia,” Luhrmann said in a statement.

The study, published in the British Journal of Psychiatry, It gives extra weight to criticisms of mental illness which don’t take account of external, social factors - and to the influence of a model of mental health on the manifestation of an illness. Luhrmann said: “The difference seems to be that the Chennai and Accra participants were more comfortable interpreting their voices as relationships and not as the sign of a violated mind.” As the interpretations didn't seem to correlate with either religious belief or urbanisation, she suspects the underlying cause for this is that Americans were less community-minded than the others. This is speculation, and requires further investigation, but it does point the way to new possibilities in treating schizophrenia and disembodied voices, with the possibility that "befriending" them could lessen their impact.

Ian Steadman is a staff science and technology writer at the New Statesman. He is on Twitter as @iansteadman.

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Is Google Maps discriminating against people with disabilities?

Its walking routes are not access-friendly.

“I ended up having to be pushed through a main road in London, which was really scary.” Three weeks ago, Mary Bradley went to London to visit her daughter Belinda, who is just finishing her first year at university there. Her other daughter joined them on the trip.

But what was supposed to be an enjoyable weekend with her two children turned into a frustrating ordeal. The apps they were using to find their way around kept sending them on routes that are not wheelchair-friendly, leading to time-consuming and sometimes frightening consequences.

Bradley has been using a wheelchair – when having to go longer distances without a vehicle – for over a year, due to a 45-degree curve in her spine, severe joint facet deterioration in her back, and other conditions.

She lives in Weston-super-Mare in Somerset, and has made the trip up to London to visit her daughter a handful of times. Each visit, they use Google Maps and the transport app Citymapper to find their way around, as neither of them know London particularly well.


Belinda and Mary Bradley. Photo: Belinda Bradley

“It was just horrible,” says Bradley of her most recent trip to the capital. “We’re following the maps, and we go along, then find we are faced with a footbridge, and realise there was no way I was going to get over it, so we had to go back the way we’d come. At one point, we were faced with a strip of narrow pavement the wheelchair couldn’t go down. That was something we found all weekend.”

While Google Maps did highlight accessible Tube stations, they found that once they had alighted to do the rest of the journey to their destination on foot, “it took us three times as long, because the route that it takes us just wasn’t passable”.

They ended up having to try different routes “having no real idea of where were going”.

“It meant that it took so much longer, the girls ended up having to push me for longer, I got more and more embarrassed and frustrated and upset about the whole thing,” Bradley tells me.

At one point, her daughters had to take her down a main road. “Being pushed on a road, especially in London, is scary,” she says. “It was scary for me, it was scary for the girls.”

When they returned home, Belinda, who is a 19-year-old Writing and Theatre student at the University of Roehampton, was so furious at the situation that she started a petition for Google Maps to include wheelchair-friendly routes. It hit over 100,000 signatures in a fortnight. At the time of writing, it has 110,601 petitioners.


Belinda's petition.

Belinda was surprised that Google Maps didn’t have accessible routes. “I know Google Maps so well, [Google]’s such a big company, it has the satellite pictures and everything,” she says. “So I was really surprised because there’s loads of disabled people who must have such an issue.”

The aim of her petition is for Google Maps to generate routes that people using wheelchairs, crutches, walking sticks, or pushing prams will be able to use. “It just says that they’re a little bit ignorant,” is Belinda’s view of the service’s omission. “To me, just to ignore any issues that big needs to be solved; it needs to be addressed almost immediately.”

But she also wants to raise awareness to “make life better in general” for people with disabilities using navigation apps.

Belinda has not received a response from Google or Citymapper, but I understand that Google is aware of the petition and the issue it raises. Google declined to comment and I have contacted Citymapper but have not received a response.

Google Maps does provide information about how accessible its locations are, and also allows users to fill in accessibility features themselves via an amenities checklist for places that are missing that information. But it doesn’t provide accessible walking routes.

“There’s no reason that they couldn’t take it that bit further and include wheelchair accessible routes,” says Matt McCann, the founder of Access Earth, an online service and app that aims to be the Google Maps for people with disabilities. “When I first started Access Earth, I always thought this is something Google should be doing, and I was always surprised they haven’t done it. And that’s the next logical step.”

McCann began crowdsourcing information for Access Earth in 2013, when he booked a hotel in London that was supposed to be wheelchair-friendly – but turned out not to be accessible for his rollator, which he uses due to having cerebral palsy.

Based in Dublin, McCann says Google Maps has often sent him on pedestrian routes down cobbled streets, which are unsuitable for his rollator. “That’s another level of detail; to know whether the footpaths are pedestrian-friendly, but also if they’re wheelchair-friendly as well in terms of the surface,” he notes. “And that was the main problem that I had in my experience [of using walking routes].”

Access Earth, which includes bespoke accessibility information for locations around the world, aims to introduce accessible routes once the project has received enough funding. “The goal is to encompass all aspects of a route and trip,” he says. Other services such as Wheelmap and Euan's Guide also crowdsource information to provide access-friendly maps.

So how long will it take for more established tech companies like Google to clear the obstacles stopping Mary Bradley and millions like her using everyday services to get around?

“You can use them for public transport, to drive, you can use them if you’re an able-bodied person on foot,” she says. “But there are loads of us who are completely excluded now.”

Sign Belinda Bradley’s “Create Wheelchair Friendly Routes on Google Maps" here.

Anoosh Chakelian is senior writer at the New Statesman.