Author Name: Sareem Athar
Qualifications: BA (Psychology, Mass Communication & Journalism, Literature), MSc Clinical Psychology, Diploma in Child Psychology
Designation: Former Admin Head, ACRO Mental Health Services.
Word count: 427 words
Reading time: 6 minutes
Reviewed & edited by: Ayesha Begum & Mariyam Mohammed.
Have you ever heard voices in your head? For many people with schizophrenia and possession, auditory hallucinations are a common and terrifying experience (1). These voices can be relentless and frightening, leaving individuals feeling powerless and alone (2). In this blog post, we will explore the link between schizophrenia and possession and the experience of auditory hallucinations. We will also examine the psychological and spiritual perspectives on this phenomenon.
Schizophrenia is a severe and persistent mental illness that alters a person's thoughts, feelings, and behaviours (3). Auditory hallucinations are a hallmark symptom of schizophrenia (4). These hallucinations can be perceived as voices that speak to the person, make comments about their behaviour, or give instructions (5). They frequently come with additional symptoms, like delusions and jumbled thinking, which can cause major distress and functional impairment (6,7).
Several theories have been put forth by researchers to explain how auditory hallucinations in schizophrenia first came to be (8). The "inner speech" model, a well-known theory, contends that people with schizophrenia have trouble telling their own thoughts apart from outside stimuli, which causes them to experience their own thoughts as external voices (9,10). The "hyper-activation" model is a different hypothesis that claims abnormalities in the brain's language processing regions cause internal voices to be heard as external voices (11,12).
Hearing voices is perceived as being possessed by spirits or demons in some cultures (13). Possession is a phenomenon where it is believed that a spirit or demon, for example, is controlling a person's behavior or mental state (14). In these cultures, exorcisms—which are thought to drive away the possessing entity and restore the person's mental and physical health—are frequently used to treat possession through religious or spiritual rituals (15,16).
Western psychiatry does not recognize possession as a legitimate diagnosis, so people who claim to have had possession experiences may instead be given a mental illness diagnosis, like schizophrenia (17,18). In light of this, it is crucial to consider cultural context when attempting to comprehend the experience of auditory hallucinations and possession (19).
In schizophrenia and possession, auditory hallucinations can be a terrifying and isolating experience. Numerous theories have been put forth by research to explain the psychological basis of auditory hallucinations in schizophrenia (20). Hearing voices is perceived by some cultures as being possessed by spirits or demons from a spiritual point of view. When attempting to comprehend the experience of auditory hallucinations and possession, it is critical to recognize the cultural context. We can comprehend this complicated and frequently misunderstood experience better by investigating both the psychological and spiritual perspectives on it (21).
(1)American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
(2)Larøi, F., Sommer, I. E., Blom, J. D., Fernyhough, C., Ffytche, D. H., Hugdahl, K., Johns, L. C., McCarthy-Jones, S., Peters, E., & Waters, F. (2014). The characteristic features of auditory verbal hallucinations in clinical and nonclinical groups: State-of-the-art overview and future directions. Schizophrenia Bulletin, 40(Suppl 4), S285–S294. https://doi.org/10.1093/schbul/sbu036
(3)Tandon, R., Gaebel, W., Barch, D. M., Bustillo, J., Gur, R. E., Heckers, S., Malaspina, D., Owen, M. J., Schultz, S., Tsuang, M., & Van Os, J. (2013). Definition and description of schizophrenia in the DSM-5. Schizophrenia Research, 150(1), 3–10. https://doi.org/10.1016/j.schres.2013.05.028
(4)Jones, S. R., & Fernyhough, C. (2007). Thought as action: Inner speech, self-monitoring, and auditory verbal hallucinations. Consciousness and Cognition, 16(2), 391–399. https://doi.org/10.1016/j.concog.2007.04.004
(5)Diederen, K. M. J., Daalman, K., de Weijer, A. D., Neggers, S. F. W., van Gastel, W., Blom, J. D., Kahn, R. S., & Sommer, I. E. C. (2012).
Auditory hallucinations elicit similar brain activation in psychotic and nonpsychotic individuals. Schizophrenia Bulletin, 38(5), 1074–1082. https://doi.org/10.1093/schbul/sbs004
(6)Bourguignon, E. (1976). Possession. San Francisco: Chandler & Sharp.
(7)Al-Krenawi, A., & Graham, J. R. (2013). Culturally sensitive social work practice with Arab clients in mental health settings. Health & Social Work, 38(2), 109–116. https://doi.org/10.1093/hsw/hls054
(8)Luhrmann, T. M. (2015). Cultural psychiatry and the madness of culture. In A. M. Georgiadou & V. Bhugra (Eds.), Culture and mental health (pp. 15–25). Springer. https://doi.org/10.1007/978-3-319-17667-4_2
(9)Blom JD. Auditory hallucinations. The Human Auditory System - Fundamental Organization and Clinical Disorders [Internet]. 2015;433–55. Available from: https://pubmed.ncbi.nlm.nih.gov/25726283/
(10)Sommer IEC, Slotema CW, Daskalakis ZJ, Derks EM, Blom JD, van der Gaag M. The Treatment of Hallucinations in Schizophrenia Spectrum Disorders. Schizophrenia Bulletin [Internet]. 2012 Feb 24;38(4):704–14. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3577047/
(11)Hirano Y, Tamura S. Recent findings on neurofeedback training for auditory hallucinations in schizophrenia. Current Opinion in Psychiatry [Internet]. 2021 Feb 3;Publish Ahead of Print. Available from: https://pubmed.ncbi.nlm.nih.gov/33492005/
(12) Hugdahl K. Auditory Hallucinations as Translational Psychiatry: Evidence from Magnetic Resonance Imaging. Balkan Medical Journal [Internet]. 2017 Dec 1 [cited 2020 May 11];34(6):504–13. Available from: https://pubmed.ncbi.nlm.nih.gov/29019460/
(13) Alderson-Day B, Diederen K, Fernyhough C, Ford JM, Horga G, Margulies DS, et al. Auditory Hallucinations and the Brain’s Resting-State Networks: Findings and Methodological Observations. Schizophrenia Bulletin [Internet]. 2016 Jun 8 [cited 2021 May 12];42(5):1110–23. Available from: https://pubmed.ncbi.nlm.nih.gov/27280452/
(14) Miller EE, Grosberg BM, Crystal SC, Robbins MS. Auditory hallucinations associated with migraine: Case series and literature review. Cephalalgia [Internet]. 2014 Dec 5 [cited 2021 Aug 11];35(10):923–30. Available from: https://pubmed.ncbi.nlm.nih.gov/25480808/
(15)Choong C, Hunter MD, Woodruff PWR. Auditory hallucinations in those populations that do not suffer from schizophrenia. Current Psychiatry Reports [Internet]. 2007 Jun;9(3):206–12. Available from: https://link.springer.com/article/10.1007/s11920-007-0020-z
(16) Ratcliff K, Farhall J, Shawyer F. Auditory hallucinations: a review of assessment tools. Clinical Psychology & Psychotherapy [Internet]. 2010 Oct 27;18(6):524–34. Available from: https://pubmed.ncbi.nlm.nih.gov/22131297/
(17) Waters F, Badcock J, Michie P, Maybery M. Auditory hallucinations in schizophrenia: Intrusive thoughts and forgotten memories. Cognitive Neuropsychiatry [Internet]. 2006 Jan;11(1):65–83. Available from: https://pubmed.ncbi.nlm.nih.gov/16537234/
(18) Blom JD, Sommer IEC. [Auditory hallucinations. Nomenclature and classification]. Tijdschrift Voor Psychiatrie [Internet]. 2011 [cited 2023 Jun 23];53(1):15–25. Available from: https://pubmed.ncbi.nlm.nih.gov/21225575/
(19) Jiang WL, Cai DB, Sun CH, Yin F, Goerigk S, Brunoni AR, et al. Adjunctive tDCS for treatment-refractory auditory hallucinations in schizophrenia: A meta-analysis of randomized, double-blinded, sham-controlled studies. Asian Journal of Psychiatry [Internet]. 2022 Jul 1 [cited 2023 Jun 23];73:103100. Available from: https://pubmed.ncbi.nlm.nih.gov/35430496/
(20) Irmak MK. Schizophrenia or Possession? Journal of Religion and Health [Internet]. 2012 Dec 27;53(3):773–7. Available from: https://pubmed.ncbi.nlm.nih.gov/23269538/
(21) Westerink H. Demonic possession and the historical construction of melancholy and hysteria. History of Psychiatry [Internet]. 2014 Aug 11 [cited 2020 Mar 10];25(3):335–49. Available from: https://pubmed.ncbi.nlm.nih.gov/25114148/
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