Richard G. Petty, MD

The Irreducible Mind

I get a great many requests for recommendations for books and papers that either debate or provide support for the topics that I discuss on this blog and in my books and articles. That is why I’ve been constructing some reading lists at Amazon.com and linking them to this website.

A friend recently commented that she was surprised that the book and CD series, Healing, Meaning and Purpose that was created for a general audience, contains over 800 books and websites. My response to that was that I think that my readers and listeners are all grown ups who should be able to check everything that any author says!

The days of authors or speakers waving their hands about and making airy statements are finally coming to an end. If an author tells you that "science" proves what they are saying, they must show that they understand the topic themselves. I just saw yet another paper in which the writer said, "Quantum mechanics proves what I’m saying, but let’s not get into that." Well, that’s just the point: let us indeed get into that to see if what you are saying holds water!

Which brings me to a book that I’ve just read and reviewed. It is entitled Irreducible Mind: Toward a Psychology for the 21st Century and it is an extraordinary achievement. For the last century, the vast majority psychologists, psychiatrists and neuroscientists have believed that thoughts, emotions and consciousness are the product of physical processes in the brain. And , of course, the brain is heavily involved in many  mental phenomena. The question has always been if neurological activity is sufficient to explain the whole of human experience.

This new book presents the most comprehensive and critical analysis of phenomena normally ignored by psychology, including mystical experiences, the placebo response, stigmata and hypnotic suggestion, memories that survive physical death, near death experiences, automatic writing, out-of-body experiences, apparitions, deathbed visions and many more.

It comes to the inescapable conclusion that the mind is not generated by the brain but is instead limited and constrained by it. There is no hand waving, and no "science has shown that…" Instead everything is laid out in front of you. There are a hundred pages of citations and references. Despite that, it is an easy and enjoyable read.

I have no personal connection with the book, but the next time that someone says that there’s no proof for any of these phenomena, and that emotions, cognitions and consciousness are just byproducts of biochemical processes in the brain, refer them to this book.

And if Santa brought you any gift cards that you haven’t used yet, you might want to have a look at the book for yourself.

The History of Human Intelligence

There is a wonderful interactive map at Indiana University showing the history of influences in the development of intelligence theory and testing.

This is static picture of what it looks like.

If you click on the name of an individual in this map, you get a potted biography of each person.

If you interested in psychology it’s a great resource.

Enjoy!

Don’t Underestimate Your Attractiveness!

I wonder how many readers have ever been in a social setting and been a bit depressed by how good-looking everybody else seems to be? I’ve seen quite a number of people who by anyone’s standards were attractive individuals, but who were quite convinced that they were not.

At this point most proponents of pop psychology would jump in and say, “Well he’s got low self-esteem and we need to fix that.” They would probably recommend some exercise involving a mirror and telling him or herself how beautiful, attractive, valuable or special they are.

And they would be dead wrong.

This misperception about the attractiveness of other people is an evolutionary trick that will not be much helped by any number of affirmations.

A very interesting and well-executed study from the University of Texas will be published in next month’s issue of Evolution and Human Behavior. Sarah Hill, a psychologist in David Buss’ evolutionary psychology laboratory. Her research has shown that people of both sexes believe that the sexual competition that they face is stronger than it really is. She beieves that this is useful: it makes people try harder to attract or keep a mate.

What Sarah did was to show heterosexual men and women photographs of people. She asked them to rate both how attractive those of their own sex would be to members of the opposite sex, and also how attractive the members of the opposite sex were. She then compared the scores for the former with the scores for the latter, seen from the other side. Men thought that the men they were shown were more attractive to women than they really were, and women thought the same of the women.

She had predicted the outcome of the study based on a theory developed in the same laboratory by Martie Haselton and David Buss. It is called error-management theory: the idea that when people make errors of judgment hey always tend to make the error that is going to be least costly. Research has shown something to which many women can attest: men often tend to misinterpret innocent friendliness as a sign that women are sexually interested in them. Haselton and Buss reasoned that men who are trying to decide if a woman is interested sexually could err in one of two ways. They can mistakenly believe that she is not interested, in which case they will not bother trying to have sex with her; or they can mistakenly believe she is interested, try, and be rejected. Trying and being rejected comes at relatively little cost. However, form an evolutionary perspective, not trying at all could lead the major cost of not being able to spread their DNA around.

The theory is that there is an opposite bias in women’s errors: They tend to undervalue signs that a man is interested in a committed relationship. The evolutionary argument would be that if she guesses wrongly about a man’s intentions, she might have to raise a child on her own.

However, when it comes to assessing physical attractiveness, man and women make the same errors.

We always need to be a bit wary about pushing the perspectives of evolutionary psychology too far. I think that they are valuable, but that we can get into trouble if we apply their insights too liberally: humans are complex creatures who are continuing to evolve rapidly. We are different in every way from the people of a thousand years ago.

But this is a very useful insight into why some many people feel to see themselves as they are.

The moral of the story: have courage in initiating new relationships, and look at the whole person: physical, psychological, social, subtle and spiritual.

And don’t forget to use your intuition: the surest guarantor of making the right steps in relationships.

“I never saw an ugly thing in my life: for let the form of an object be what it may, light, shade, and perspective will always make it beautiful.”
–John Constable (English Landscape Painter, 1776-1837)

Treating Posttraumatic Stress Disorder

There is an important article in this month’s issue of the journal Psychological Medicine.

Researchers from the University of Heidelberg in Germany carried out a systematic literature review concerning two treatments that are widely used in the treatment of posttraumatic stress disorder (PTSD): Eye movement desensitization and reprocessing (EMDR) and trauma-focused cognitive-behavioral therapy (CBT).

They identified eight publications between 1989 and 2005 describing treatment outcomes of EMDR and CBT in active–active comparisons. Seven of these studies were investigated in a meta-analysis.

What they found was this. Both trauma-focused CBT and EMDR seemed to be equally efficacious and any differences between the two forms of treatment are probably not of clinical significance. Our main focus now should be to attempt to establish which trauma patients are more likely to benefit from one method or the other. The authors comment that it remains unclear is the contribution of the eye movement component in EMDR to treatment outcome.

This paper is interesting in light of our recent discussions concerning brain laterality and PTSD. It seems likely that part of the mechanism of both forms of therapy is to re-wire the brain. I tend to think that the eye movements probably are of importance, since they are also used in thought field therapy which appears also to be helpful to many people with PTSD.

The Omnipresent Ohrwurm: Ten Secrets for Having an Idea Remembered

Last month I wrote something about a phenomenon that I’m sure that you’ve experienced: having a tune get stuck in your head. James Kellaris has used the term “Ohrwurm” to describe this phenomenon.

I made brief mention of the way in which research into the ohrwurm may inform other fields, such as addictions.

The other big topic that may be illuminated by the ohrwurm phenomenon is the way that ideas, trends and fashions gain traction.

Some successes are created: you may or may not like Madonna or Britney Spears, but both of them are talented. The question is this: why did they first make it? In some senses both had the right set of talents be molded into a highly successful products. People in the music business saw their potential and that both were just right for the market of the time. Thousands of similarly gifted people just never had the opportunity to be made into stars.

Some successes are the results of memes. I’m speaking here about memes with a little “M,” to differentiate them from the Memes of spiral dynamics. Ideas, fashions and trends spread through society like the measles.

But are there any characteristics of psychological or social ohrwurms? What is it about some ideas, concepts or products that just have a great big hook that makes them not just memorable but irresistible?

People have been asking that question for years, but now it begins to look as if we might be getting close to generating some sensible answers based not on market research or focus groups, but on neuroscience.

A book called Made to Stick will be coming out in the New Year and identifies some of the characteristics of ideas that become popular and stick in people’s minds. The authors’ have come up with:

  • Simple
  • Unexpected
  • Concrete
  • Credible
  • Emotional Story

I’m sure that they are on to something.

But I think that there is more.

In the original piece about the ohrwurm I mentioned three characteristics of a tune that gets stuck in our heads:

  • Simple
  • Incongruous
  • Repetitive

The same principles and a few more are crucial in getting a message to resonate:

  1. Simplicity: It’s much easier to believe that the motivators of human behavior are pain and pleasure, or that Men are from Mars and Women from Venus, than getting into the messy realities of human motivations and interpersonal relationships
  2. Clarity: The simple idea must be expressed in a cogent and incisive way
  3. Incongruity: This is essential: we know that the brain is hardwired to respond to novelty. Yet despite being incongruous, the odd, strange, unexpected idea must afterwards fit into the rest of our knowledge and beliefs about the world. We can only take so much incongruity!
  4. Repetition: Few ideas – whether true or false – are embraced and adopted if they are only heard once
  5. Emotional resonance: You are unlikely to be interested in or remember something that has no emotional meaning for you
  6. Integrity: The idea or concept must have internal consistency
  7. Believability: The idea needs to come from a trustworthy source
  8. Consonant: The idea or concept needs to resonate with your own core beliefs or core values
  9. Practical: Most people need to be able to see simple, concrete actions that they can take
  10. Beneficial: There is a sliver of self-interest within all of us: something else that is hardwired. Unless we can see that we will derive some benefit from an idea, it is unlikely to have much traction

Now I am going to let you in on a secret. I do a lot of public speaking and I could not work out why my talks, lectures and speeches seemed to be so popular.

One day a friend from Canada told me that he had also been mystified by my popularity as a speaker. Then he told me that he had discovered my secret: I am a storyteller. It took me a while to grasp what he was saying, but then I realized that it was true. Whether presenting research data, ways to improve your life or an inspirational speech I constantly tell stories. And so does every other good speaker that I know. And the keys to telling good stories?

They are these ten points.

Try them out for yourself and see what you think.

“A man’s success in business today turns upon his power of getting people to believe he has something that they want.”
–Gerald Stanley Lee (American Professor, Writer and Lecturer, 1862-1944)

Hypnagogia: The Waking Dream

Most of us have experienced the brief transition between wakefulness and sleep as we fall asleep. This is the hypnagogic state, though it has been known by many names: “the borderland state," the “half-dream state,” the “pre-dream condition.” The name for these strange hallucinations is “hypnagogia.”

Although there are innumerable books about dreams, there is to my knowledge only one book in English that is dedicated to hypnagogia, by the psychologist Andreas Mavromatis. There are also not that many good websites dealing with the phenomenon, though I’ve found one or two really good ones. This is a little surprising, for the hypnagogic state is one of the most fascinating altered states of consciousness that we can experience without the use of drugs, and there are dozens of spiritual schools that encourage their students to work with these hypnagogic hallucinations. They are different form the hallucinations that may occur in neurological problems: those tend to occupy only one sense at a time, while the hypnagogic hallucinations, though sometimes no more that flashes of light or odd shapes, can be highly complex and involve multiple sensory modalities: what we call multi-modal hallucinations. Some people may feel as if they are floating, and it is not uncommon for people to kick out or grasp as they feel as if they are falling from a great height.

The term “hypnagogic” was coined by the 19th-century French psychologist Louis Ferdinand Alfred Maury, and is derived from two Greek words, Hypnos (Sleep) and agogeus (A guide, or leader). Some years later, the English poet, essayist and psychical researcher Frederic William Henry Myers coined the term, “hypnapompic,” to describe similar phenomena that may occur as we wake from sleep.

Long before Maury, many writers commented on these odd experiences. Here are just a few that I’ve heard about:

  1. Aristotle spoke of the “affections we experience when sinking into slumber, and the images which present themselves to us in sleep.”
  2. Iamblichus of Chalcis, the third century Neo-Platonic philosopher, wrote of the “voices” and “bright and tranquil lights” that came to him in the condition between sleeping and waking, that he believed were a form experience sent by God.
  3. There is some evidence that the alchemists of the Middle Ages made use of a form of hypnagogia during their meditations, preparations and distillations. I’ve seen it suggested that the weird characters and eerie landscapes that seem to fill alchemical illustrations might have been the fruits of focusing on hypnagogic hallucinations, though they could just as easily have come from dreams or drugs.
  4. In 1600, the Elizabethan astrologer and occultist Simon Forman wrote of his apocalyptic visions. He saw mountains and hills that came rolling against him on the point of sleep and beyond which he could see vast boiling waters.
  5. Thomas Hobbes spoke of images of lines and angles seen on the edge of sleep accompanied by an “odd kind of fancy” to which he could give no particular name.
  6. Emmanuel Swedenborg the 18th century philosopher, scientist and visionary developed a method of inducing and exploring hypnagogic states, during which he claimed to have traveled to Heaven, Hell and other planets. He recorded several other techniques that he used to gain his insights, including a particular type of hyperventilation.
  7. The theosophical writer Oliver Fox used the hypnagogic hallucinations as a “doorway” through which he was able to go astral traveling.
  8. Rudolf Steiner, advised that the best time for communicating with the dead was in the period between waking and sleep. He claimed that if you asked the dead a question as you fell asleep, they would answer you the next morning His records look very much like hypnagogic hallucinations.
  9. The Russian writer and philosopher P.D. Ouspensky is someone else who made a detailed study of hypnagogia. Like many of the others that I’ve mentioned, he made a number of interesting discoveries about the Universe while in this state. It is these insights, and their similarities across cultures that suggest that there’s more to hypnagogia than random neuronal firing.

It is interesting that although hypnagogia can produce millions of different experiences. When people start using them for exploration, they seem to generate many similar insights. This is rather different from the mystical experience. In which peoples’ experiences have similar form, but different content.

The most widely used criteria of the mystical experience were assembled by the English philosopher W.T. Stace, who taught at Princeton for many years:

  1. Deeply positive mood
  2. Experience of Union
  3. Ineffable sense
  4. Enhanced sense of meaning, authenticity and reality
  5. Altered space and time perception/transcendence
  6. Acceptance of normally contradictory propositions

I shall have more to say about mystical experiences in another posting.

For now, if you are interested in doing some self-exploration, and you are not using either medications or alcohol, the hypnagogic state is a great place to start. Occasionally people find the exploration scary, so only do this if you are up to it, and don’t if you are given to nervous or psychological problems. When I’m working with people I always ensure that they are in tip top condition before trying ANY kind of psychological exploration.

Try becoming aware of the transition between wakefulness and sleep. At first you will fall asleep, but with a small amount of practice, most people can quickly begin to keep themselves in the state, and then start exploring. Many people find that they get some profound intuitions while in the hypnagogic state, and unlike the kinds of “insights” that people get while under the influence of drugs or alcohol, they make sense in the morning. Relax, keep a diary, take it in easy stages, and see what you can discover for yourself. If you come across anything unpleasant, stop, and we can try some different exercises.

Ohrwurm

I often think that I’m a lucky fellow to be bilingual in English and German. There are some priceless words in German that just don’t translate. It’s one of the reasons that so many books and papers translated from German become nonsensical when back translated. That is, translated from German into English and then back into German again.

There are some wonderful examples in the medical and psychiatric literature. English speaking psychiatrists are taught about “Schneider’s First Rank Features.” Which is a massive misquotation. And some of the collected works of Carl Jung are “interesting” in English.

There is a lovely German word – Ohrwurm – that can best be translated as “ear worm,” though in German it has a rather richer sense. The term was popularized by James Kellaris, a professor of marketing at the University of Cincinnati, to describe a song stuck in one’s head. Particularly an annoying one. I’m sure that we’ve all had them: some song or tune that you just can’t get out of your head.

Mark Twain wrote in a short story about an annoying ”jingling rhyme” that became indelibly lodged in the author’s mind until he passed the curse along to another hapless victim!

I first saw this research being talked about three years ago, in an article on the BBC website. At the time Professor Kellaris described the ohrwurm as "A cognitive itch is a kind of metaphor that explains how these songs get stuck in our head."

Kellaris has identified three major influences on whether or not a song stays stuck in your brain:

  1. Repetition:
  2. Musical simplicity:
  3. Incongruity: This one is very interesting and gives us another clue about why ohrwurms form. When a song does something unexpected, it can also spark a cognitive “itch.” Kellaris cites examples like the irregular time signatures of Dave Brubeck’s "Take Five" or the song "America" from West Side Story. Unpredictable melodic patterns or an unexpectedly articulated individual note can have the same impact.

Marketers and writers of pop songs are very interested in understanding how and why some tunes just get stuck in our heads. There have been some songwriters and producers who have created a load of ohrwurms. You may remember the string of hits produced by Mike Stock, Matt Aitken and Pete Waterman  in the late 1980s and early 1990s. There is even some brain imaging work going on to try and unlock the mechanisms responsible.

The best cures for a nagging ohrwurm appear to be to listen to the whole tune or song. And at the same time to think of something annoying. It can also go away with the simple technique of gently tapping the side of your hand: it is sometimes a manifestation of psychological reversal.

One of the reasons for being interested in ohrwurms, is that it is interesting to find out why things get stuck in our heads. Understanding the lowly ohrwurm may have some important implications for understanding PTSD and some kinds of addiction.

So what’s you best or most irritating ohrwurm?

“I was in yoga the other day.  I was in full lotus position.  My chakras were all aligned.  My mind is cleared of all clatter and I’m looking out of my third eye and everything that I’m supposed to be doing.  It’s amazing what comes up, when you sit in that silence.  "Mama keeps whites bright like the sunlight, Mama’s got the magic of Clorox 2.”
Ellen DeGeneres (American Actor and Comedian, 1958-)

Walter Mitty Syndrome

Walter Mitty was a a fictional character in James Thurber’s short story The Secret Life of Walter Mitty, published in 1941. Mitty was a meek, mild man with a vivid fantasy life: in a few dozen paragraphs he imagined himself a wartime pilot, an emergency-room surgeon, and a devil-may-care killer. He has become such a standard for the role that his name appears in several dictionaries.

Regular readers might remember that in a post in April, I examined pathological lying from physical, psychological, social, subtle and spiritual perspectives.

The Walter Mitty syndrome is clearly related: people use fantasy to escape from their normal lives. They believe that their lives are humdrum and boring, never realizing what an enormous gift it is to be alive at all.

I’ve known countless people who have claimed to have noble blood from some obscure part of the former Eastern Europe. They would normally tell everyone that they would be rich and titled once the “communists” returned his or her lands. Most had, of course, never had either title or lands. One extraordinary example: someone whom I liked very much, told of the lands, money and titles that she would soon receive from the new government in Hungary. Except that Jewish people had not been allowed to own land in that part of Hungary for many centuries.

Another man -a homeopathic physician – told everyone that he met that he was engaged in secret experiments for the CIA. Which always seemed odd for an Englishman with no research background. And it never seemed all that secret if he was busily telling everyone about this work.

Nobody has yet added the syndrome to the canon of psychological lore, yet every clinician has seen cases, and the syndrome is sometimes used as a pejorative term, particualrly in the political arena.

I’ve recently seen an extraordinary case that was suspected for decades, but was only really confirmed after the person’s death. One tale built on another until we had an extraordinary life story that would have done credit to one of those blockbusters by Jeffrey Archer. Not a single piece of it was true. People, dates and places were all made up. This wasn’t a little fib; this was fantasy on the grand scale.

In the end, the fabulous tales usually hurt no one. But nobody will ever know what bits were true, and which not.

If you ever meet one of these great fabulists, ask them to write down their stories: they are often generated by the most wonderfully creative people. And more than one has gone on to collect high honors.

Challenging people like this is rarely helpful. They are spinning these yarns to protect and bolster themselves. Destroying their defences can be disastrous. There are a few who tell these tales because of grandiosity or narcissism, but most are just unfortunate people who feel the need to project a new image of themselves.

Listen politely; don’t commit yourself, and let them carry on. Unless they are using their tales to “con” people, it is often best to leave them alone.

The Barnum Effect

Whoever would have thought that the quintessential nineteenth century showman Phineas Taylor Barnum, best known for his claim that, “There’s a sucker born every minute,” would one day lend his name to a psychological principle known colloquially as the Barnum Effect or more accurately as the Forer effect.

Barnum was a marketing genius long before Madison Avenue had been built. Born in Bethel, Connecticut in 1810, by 1835 he purchased an 80-year-old slave and displayed her as the 161-year-old former nurse of George Washington. He went on to create “The Greatest Show on Earth,” in which he displayed everything from performing elephants to people with an array of medical maladies displayed for the masses.

The Barnum Effect is a term said to have been coined by the psychologist Paul Meehl, to describe a very real psychological phenomenon in which people tend to accept as accurate a general statement about themselves, especially a flattering one. Even though the statement could describe just about anyone. Add a few numbers, letters or aspects to the statement, and it is accepted even more quickly, because then it appears to be in some way scientific.

The original experiment was done by Bertram Forer in 1948. He gave his students a personality test, and then gave them an analysis supposedly based on the test’s results. He invited each of the students to rate the analysis on a scale of 0 (very poor) to 5 (excellent) as it applied to themselves: the average was 4.26. He then revealed that each student had been given the same analysis.

What he wrote for the students is worth duplicating, because you may have seen similar things written about you, and it is very easy to be taken in. This is what Forer said:

  • “You have a need for other people to like and admire you, and yet you tend to be critical of yourself. While you have some personality weaknesses you are generally able to compensate for them. You have considerable unused capacity that you have not turned to your advantage. Disciplined and self-controlled on the outside, you tend to be worrisome and insecure on the inside. At times you have serious doubts as to whether you have made the right decision or done the right thing. You prefer a certain amount of change and variety and become dissatisfied when hemmed in by restrictions and limitations. You also pride yourself as an independent thinker; and do not accept others’ statements without satisfactory proof. But you have found it unwise to be too frank in revealing yourself to others. At times you are extroverted, affable, and sociable, while at other times you are introverted, wary, and reserved. Some of your aspirations tend to be rather unrealistic.”

I recently saw this in action when I was persuaded by a friend and life coach to pay almost $50 to do an online evaluation, which turned out to be valueless. Though P.T. Barnum would have been proud of it! Let me explain.

Questionnaires and rating scales can be fun and interesting. After all, books and magazines are full of them. But it is essential not to take most of them too seriously. Designing a rating scale is a huge job. We first begin with an aim for the scale, so that we can later test its face validity: the degree to which it has succeeded in meeting that aim.

After we create it we have to test it and see whether different people can agree on the results. The next step is to see if the findings can be generalized to men and women and different ethnic groups. And finally we have to see whether the results actually tell us anything meaningful from which we can adopt a course of action.

When someone tells me that, “I did a Gnobbly-Komonsky rating scale and it made me see my relationship in a completely new way!” the chances are that the rating scale has nothing to do with it. The only things that can make you see something in a new way is you. Unless validated, tests and scales are rarely more than catalysts. It does not matter if the test has been administered to a million people. If it has not gone through all of the steps to see if its okay, it will never be anything more than a piece of fun that may or may not help catalyze change.

So how do you protect yourself against the Barnum Effect?

  1. First, be skeptical, second be very skeptical, and third be very very skeptical
  2. Whenever you are given a personal interpretation, whether it comes from a psychologist or astrologer, have a look to see how specific are the interpretations?
  3. Next see whether any parts of the interpretation would apply to someone else. (You can test this by taking a horoscope in a newspaper, cutting out the twelve interpretations, without the title, “Virgo, “Scorpio” and so on. Then shuffle them and see which apply to you. Pop astrology is very different from a detailed and personalized evaluation by an intuitive who happens to be using astrology.)
  4. Ask how the test was created, and in whom it was tested? Not how many people have taken it, but what independent measures have been used to validate it?
  5. Don’t take any action on what you are told until you have objective, external validation.
  6. Research has shown that people with higher indices of neuroticism are more likely to fall for the Barnum Effect. If you have fallen for it, see if some of the balancing techniques that I describe on the website might help protect you from making the same msitake again.

If you are interested in going into this in a bit more detail, there is quite a nice article on how to read a medical journal article, that looks at some of the better known fallacies.

Finally here are some more Barnum-isms:
“More persons, on the whole, are humbugged by believing in nothing than by believing in too much.”

“Every crowd has a silver lining.”

Hearing Voices

In 1973, there occurred a notorious episode in the history of psychiatry. A psychologist named David Rosenhan did an infamous experiment in which he had a group of eight people present themselves to twelve hospital emergency rooms claiming that they were hearing the words, “Empty, “Dull” or “Thud.”

Most were admitted and given psychiatric diagnoses. The second part of the experiment consisted of asking staff at a psychiatric hospital to detect non-existent ‘fake’ patients. They did rather badly. A paper about this was published in the journal Science, with the title, “On Being Sane in Insane Places.”

 
In its day, this paper was considered a damning critique of psychiatry and a plank in the ant-psychiatry movement that was in full swing at the time. In truth, it tells us only that if you lie to doctors and nurses you may deceive them. And second it is only a criticism of bad psychiatry. The idea of diagnosing schizophrenia or any other mental illness on the basis of hearing a single word is absurd. At least 40% of the population will at some time hear their name being called, particularly in times of stress or after bereavement. And very many people in the general population will occasionally hear a word being spoken. It is diagnostic of nothing.

I sincerely hope that none of the people that I’ve taught in 45 countries around the globe would EVER diagnose schizophrenia or any other mental illness simply on the basis of hearing voices, a.k.a. auditory hallucinations. As I’ve stressed time and again, the only purpose in making a diagnosis is to guide treatment and prognosis. Simply hearing voices can guide neither.

This topic came up during one of the things that I was doing to advocate for patients, because September 14th 2006 was World Hearing Voices Day, and I received some very interesting information from a UK based organization, the Hearing Voices Network. (There’s also a nice article here as well.)

There is some excellent research on people who hear voices yet are not mentally ill. Many of these people do not feel the need for any treatment and not only peacefully coexist with them, but regard them as a blessing. Most of the research has been done by Professor Marius Romme and Sondra Escher from Maastricht University in the Netherlands, Richard Bentall from the University of Manchester, and Gordon Claridge at Oxford.

About 4% of the general population hears voices, and most of them are not mentally ill. It is essential for us to understand the notion of dimensional rather than categorical diagnoses. I’m mentioning it again, because it prevents us falling into the error of labeling people for no readily apparent reason. For some people their voices are supportive and comforting.

One of several studies has shown that the form and content of auditory hallucinations is much the same whether someone has been labeled with a mental illness or not. Trauma and abuse can reactivate voices, or make them threatening.

The key to the hearing voices is whether or not they are causing distress to the individual or to those around them. There are four major coping strategies typically used by people who hear voices: distraction, ignoring the voices, selective listening to them, and setting limits on their influence.

The biggest danger for people who are hearing voices and are suffering from cognitive impairment or a mental illness, is that the voices may form the basis for delusions. As people are trying to make sense of their experiences, they may develop highly creative explanations.

I once worked with someone who was not hearing voices, but feeling odd sensations coursing along her limbs. She got a textbook of Chinese medicine, and became convinced that she was feeling the flow of Qi in her body. But because she also felt the sensations in places that were nowhere near the channels and meridians, she became convinced that it was her mission to redefine not just the courses of the channels, but to re-write the whole of Chinese medicine according to the sensations in her body.

Her attempt to make sense of her experiences made her grandiose and delusional. She became unable to care for herself, eventually became very distressed and was grateful to have some treatment which eradicated the sensations, which in turn caused the delusions to evaporate.

So treat each person as an individual and forget the unhelpful and stigmatizing labels.

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