Meaning in the madness: Is content and development of psychotic experience important to its understanding?

Psychosis can be a distressing experience, especially when symptoms such as hallucination can catch individuals by surprise and in unexpected circumstances, e.g. on the morning commute to work (although with the trains on the central line having been intricately designed around an oven, I still wouldn’t think this experience was unusual). But does the content and meaning of hallucination and delusion have any use for the treatment of psychosis or the understanding of the mind? Very little or no research has tried to address the issue. This research gap will be discussed briefly, as well as discussing the benefits of taking a meaningful and cultural approach to the phenomenon of hallucination. With our culture and experience of the world in the ‘West’ being traditionally founded on the concept of dualism, are we already subscribing ourselves to having experiences of self/other divisions?

A recent paper by Wood et al. (2015) took a qualitative (although also very quantitative) look at classifying auditory hallucinations in the general population, and essentially found that the range of experience was larger than expected. This is yet another piece of interesting evidence toward hallucination being a more common place phenomenon than once thought In psychiatry. However, the research didn’t necessarily touch upon or speculate into the meaning the each individuals placed upon their hallucinatory experience, or even to what degree they felt their hallucinations had power over their every day cognition and reasoning.

Meaning in hallucinatory and delusory content has traditionally been shunned in the psychiatric world, and often a lot of clinical ‘side-stepping’ is attempted to get the service user away from talking about the possible meaning of hallucinatory and delusory experience. However, research into hallucinatory and delusory meaning and content may give psychiatry some qualitative grounding into similarities or differences between recurrent themes different individuals’ may experience, and how this may relate to the cultural values and beliefs of the individual, thereby potentially improving practical understanding. Clinically, this may work to better understand the context of hallucination, and indeed understand the context of the individuals’ general experiences and outlook on life. Culture has definitely been an aspect of mental health which has been previously overlooked, and indeed recent thought has suggested that more of an emphasis on cultural education within clinical professions can lead to a greater understanding of mental function and disfunction, and the context of how function may be falsely perceived as disfunction (Kleinman & Benson, 2006). In some cultures, the content and meaning of hallucinatory experience may be important, and even totally benign to individual well being. Understanding individual interpretation of experience can therefore essentially create an environment where the individual feels heard and accepted, and this may work to more accurately inform diagnosis.

Taking a cultural and anthropological perspective, let’s take a speculative look at how our perception of experience may be changed in regard to our social constructs, and take a brief look at possible different cultural values that may potentially influence our experience:

Culturally, and historically, Western thought has been typically framed around Abrahamic concepts of the human relationship to the profound, or God, if you’ll allow the metaphor. This adopts a strong Cartesian approach of subject/object relations. For example, religions such as Christianity, Islam, and Judaism delineate a clear division between concepts of the Infinite and human beings: human beings went through the process of the fall, and now have to work on the relationship to get back to ‘perfection’, and beyond our ‘flawed’ humanity (Campbell, 2011). However, Eastern mythologies and frameworks, such as Hinduism and Buddhism, don’t claim to have gone through this process, or even identify the division: humans are manifestations of the divine, and therefore to reach it, we must only search within ourselves, beyond unitary thought (Campbell, 2011). From this Eastern concept of identity, the Self/Other devision is irrelevant and remarkably illusory, and indeed takes the view point that our experience of a ‘unitary self’ is infact false (Garfield et al, 2015).

These cultural discrepancies represent vastly different philosophical contexts of self/other or self/no-self, and indeed may shape the entire way we view our selves within a social and cultural context. If values toward division of self/other are internalised into our thought, it may cause mis-identification of strange conscious experience as objective reality, and hence impose heavily upon our perception of self agency by viewing it as external to who we are.

Indeed from a cultural perspective, if we already think of ourselves as separate from a place transcendent of our self, and attach ourselves to our specific narrative, its not too unreasonable to speculate that experiences and behaviours may place huge importance and weight to moments when we might not act perfectly. Further, if hallucinatory and delusional experience is a construct of our own conscious experience, investigating its meaning may give insight into the way in which an individual narrative is subjectively oriented.

Research definitely needs to look into this with greater depth and with varying cultural, anthropological, developmental and phenomenological angles, and indeed neuropsychological evidence may be a supporting field that can give some insight into the neural processes associated with internal representations of the self. At any level, understanding and exploring cultural differences can provide clinical practice, research, and philosophy with a more encompassing view of perception and mis-perception, and concepts of how we experience our sense of self.

References :

Campbell, J. (2001). Thou art that: Transforming religious metaphor. New World Library.
Campbell, J., & Kudler, D. (2003). Myths of light: Eastern metaphors of the eternal (Vol. 6). New World Library.
Garfield, J. L., Nichols, S., Rai, A. K., & Strohminger, N. (2015). Ego, Egoism and the Impact of Religion on Ethical Experience: What a Paradoxical Consequence of Buddhist Culture Tells Us About Moral Psychology. The Journal of Ethics, 19(3-4), 293-304.
Kleinman, A., & Benson, P. (2006). Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS Med, 3(10), e294.

Woods, A., Jones, N., Alderson-Day, B., Callard, F., & Fernyhough, C. (2015). Experiences of hearing voices: analysis of a novel phenomenological survey.The Lancet Psychiatry, 2(4), 323-331.



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