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
Show Hide image

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.

Getty
Show Hide image

Theresa May's offer to EU citizens leaves the 3 million with unanswered questions

So many EU citizens, so little time.

Ahead of the Brexit negotiations with the 27 remaining EU countries, the UK government has just published its pledges to EU citizens living in the UK, listing the rights it will guarantee them after Brexit and how it will guarantee them. The headline: all 3 million of the country’s EU citizens will have to apply to a special “settled status” ID card to remain in the UK after it exist the European Union.

After having spent a year in limbo, and in various occasions having been treated by the same UK government as bargaining chips, this offer will leave many EU citizens living in the UK (this journalist included) with more questions than answers.

Indisputably, this is a step forward. But in June 2017 – more than a year since the EU referendum – it is all too little, too late. 

“EU citizens are valued members of their communities here, and we know that UK nationals abroad are viewed in the same way by their host countries.”

These are words the UK’s EU citizens needed to hear a year ago, when they woke up in a country that had just voted Leave, after a referendum campaign that every week felt more focused on immigration.

“EU citizens who came to the UK before the EU Referendum, and before the formal Article 50 process for exiting the EU was triggered, came on the basis that they would be able to settle permanently, if they were able to build a life here. We recognise the need to honour that expectation.”

A year later, after the UK’s Europeans have experienced rising abuse and hate crime, many have left as a result and the ones who chose to stay and apply for permanent residency have seen their applications returned with a letter asking them to “prepare to leave the country”, these words seem dubious at best.

To any EU citizen whose life has been suspended for the past year, this is the very least the British government could offer. It would have sounded a much more sincere offer a year ago.

And it almost happened then: an editorial in the Evening Standard reported last week that Theresa May, then David Cameron’s home secretary, was the reason it didn’t. “Last June, in the days immediately after the referendum, David Cameron wanted to reassure EU citizens they would be allowed to stay,” the editorial reads. “All his Cabinet agreed with that unilateral offer, except his Home Secretary, Mrs May, who insisted on blocking it.” 

"They will need to apply to the Home Office for permission to stay, which will be evidenced through a residence document. This will be a legal requirement but there is also an important practical reason for this. The residence document will enable EU citizens (and their families) living in the UK to demonstrate to third parties (such as employers or providers of public services) that they have permission to continue to live and work legally in the UK."

The government’s offer lacks details in the measures it introduces – namely, how it will implement the registration and allocation of a special ID card for 3 million individuals. This “residence document” will be “a legal requirement” and will “demonstrate to third parties” that EU citizens have “permission to continue to live and work legally in the UK.” It will grant individuals ““settled status” in UK law (indefinite leave to remain pursuant to the Immigration Act 1971)”.

The government has no reliable figure for the EU citizens living in the UK (3 million is an estimation). Even “modernised and kept as smooth as possible”, the administrative procedure may take a while. The Migration Observatory puts the figure at 140 years assuming current procedures are followed; let’s be optimistic and divide by 10, thanks to modernisation. That’s still 14 years, which is an awful lot.

To qualify to receive the settled status, an individual must have been resident in the UK for five years before a specified (although unspecified by the government at this time) date. Those who have not been a continuous UK resident for that long will have to apply for temporary status until they have reached the five years figure, to become eligible to apply for settled status.

That’s an application to be temporarily eligible to apply to be allowed to stay in the UK. Both applications for which the lengths of procedure remain unknown.

Will EU citizens awaiting for their temporary status be able to leave the country before they are registered? Before they have been here five years? How individuals will prove their continuous employment or housing is undisclosed – what about people working freelance? Lodgers? Will proof of housing or employment be enough, or will both be needed?

Among the many other practicalities the government’s offer does not detail is the cost of such a scheme, although it promises to “set fees at a reasonable level” – which means it will definitely not be free to be an EU citizen in the UK (before Brexit, it definitely was.)

And the new ID will replace any previous status held by EU citizens, which means even holders of permanent citizenship will have to reapply.

Remember that 140 years figure? Doesn’t sound so crazy now, does it?

0800 7318496