I gave this young woman a psychosis scale to see if she would meet a schizophrenia diagnosis. Tanya Luhrmann: People I came to know in the United States, mostly in California and Chicago, are often exceptionally aware of the nature of diagnosis and the terms. How is the relationship between psychiatric diagnosis and social identity in the US and different from other places, like India? Listen to the audio of the interview here.Īyurdhi Dhar: Your work crosses both disciplinary and geographical boundaries. The transcript below has been edited for length and clarity. She also takes on big questions: What does it mean when a person with high scores on psychosis scales is functional in one culture but not in another? Are auditory hallucinations shaped by cultural experiences? Are they always a source of distress? In this interview, she talks about the damaging effects of a diagnostic identity and the often-unseen challenges that peer counselors can face. Throughout these writings, she has challenged many assertions of mainstream psychiatry, often to the annoyance of leading figures in the field. It spreads across academic fields and geographical terrain – from anthropology to psychiatry on one side and Chicago to Chennai on the other. Luhrmann describes herself as someone who is interested in different types of “realnesses.” Given that she grew up surrounded by different worldviews, it is not surprising that her work reflects this diversity of interests. Her newest book, How God Becomes Real: Kindling the Presence of Invisible Others, was published by Princeton in 2020. Recently, Our Most Troubling Madness: Schizophrenia and Culture was published by the University of California Press. Luhrmann’s book When God Talks Back was New York Times’ Notable Book of the Year, and she has written numerous articles on psychosis, medical anthropology, and spiritual experiences. She also turns the lens on the practice of Western psychiatry itself, investigating how the field represents the mind and how these representations influence our collective understanding of reality. Her work explores how cultural contexts shape the experience of mental distress, particularly voice-hearing and the symptoms associated with psychosis. As the patient begins to understand that hallucinations are related to dysfunctional thoughts, we can help correct them.Tanya Luhrmann is a Watkins University Professor in the Anthropology Department at Stanford. That said, calling auditory hallucinations “voice-thoughts,” rather than “voices,” reduces stigma and reinforces an alternate explanation behind the delusion. When people hear voices, the brain’s speech, hearing, and memory centers interact. When patients ask why they hear strange voices, explain that many voices are buried inside our memory. PET scans have shown that auditory hallucinations activate brain areas that regulate hearing and speaking, 4 suggesting that people talk or think to themselves while hearing voices. Briefly explain the neurology behind the voices. 3 Have the patient practice these exercises at home and notice if the voices stop for longer periods.ĥ. If the voices stop-even for 2 minutes-tell the patient that he or she has begun to control them.
If unsuccessful, try reading a paragraph together forwards or backwards.
Ask the patient to hum a song with you (“Happy Birthday” works well). Use in-session voices to teach coping strategies. If a patient hears command hallucinations, assess their acuity and decide whether he or she is likely to act on them before starting CBT.Ĥ. humming or singing a song several timesĪsk which methods worked previously and have patients build on that list, if possible.Your list should include the possibility that the voices are real, but only if the patient initially believes this. Patients often agree with several explanations and begin questioning their delusional interpretations. List scientifically plausible “reasons for hearing voices,” 2 including sleep deprivation, isolation, dehydration and/or starvation, extreme stress, strong thoughts or emotions, fever and illness, and drug/alcohol use.Īsk which reasons might apply. Ask: “When did the voices start? Where are they coming from? Can you bring them on or stop them? Do they tell you to do things? What happens when you ignore them?”Ģ. Engage the patient by showing interest in the voices. 1 Use the following CBT methods alone or with medication.ġ. Cognitive-behavioral therapy (CBT) can help patients cope with auditory hallucinations and reshape delusional beliefs to make the voices less frequent.