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Wednesday, December 15, 2021

Voice-hearing across the continuum: a phenomenology of spiritual voices

Moseley, P., et al. (2021, November 16).


Voice-hearing in clinical and non-clinical groups has previously been compared using standardized assessments of psychotic experiences. Findings from several studies suggest that non-clinical voice-hearing (NCVH) is distinguished by reduced distress and increased control. However, symptom-rating scales developed for clinical populations may be limited in their ability to elucidate subtle and unique aspects of non-clinical voices. Moreover, such experiences often occur within specific contexts and systems of belief, such as spiritualism. This makes direct comparisons difficult to interpret. Here we present findings from a comparative interdisciplinary study which administered a semi-structured interview to NCVH individuals and psychosis patients. The non-clinical group were specifically recruited from spiritualist communities. The findings were consistent with previous results regarding distress and control, but also documented multiple modalities that were often integrated into a single entity, high levels of associated visual imagery, and subtle differences in the location of voices relating to perceptual boundaries. Most spiritual voice-hearers reported voices before encountering spiritualism, suggesting that their onset was not solely due to deliberate practice. Future research should aim to understand how spiritual voice-hearers cultivate and control voice-hearing after its onset, which may inform interventions for people with distressing voices.

From the Discussion

As has been reported in previous studies, the ability to exhibit control over or influence voices seems to be an important difference between experiences reported by clinical and non-clinical groups.  A key distinction here is between volitional control (ability to bring on or stop voices intentionally), and the ability to influence voices (through other strategies such as engagement or distraction from voices), referred to elsewhere as direct and in direct control.  In the present study, the spiritual group reported substantially higher levels of control and influence over voices, compared to patients. Importantly, nearly three-quarters of the group reported a change in their ability to influence the voices over time –compared to 12.5% of psychosis patients–suggesting that this ability is not always present from the onset of voice-hearing in non-clinical populations, and instead can be actively developed. Indeed, our analysis indicated that 88.5% of the spiritual group described their voices starting spontaneously, with 69.2% reporting that this was before they had contact with spiritualism itself. Thus, while most of the group (96.2%) reported ongoing cultivation of the voices, and often reported developing influence over time, it seems that spiritual practices mostly do not elicit the actual initial onset of the voices, instead playing a role in honing the experience.