Voice-Hearing Across The Continuum: A Phenomenology of Spiritual Voices.

Voice-hearing in people with psychosis and in nonclinical spiritualist communities shows important similarities and differences. Nonclinical voice-hearers report less distress and more control over their voices, consistent with prior findings. They also often integrate multiple sensory modalities into a single entity, experience high levels of associated visual imagery, and perceive voices in locations that differ in relation to perceptual boundaries. Most nonclinical voice-hearers reported hearing voices before encountering spiritualism, indicating that onset was not solely due to deliberate practice. The study suggests that understanding how spiritual voice-hearers cultivate and control voices after onset may inform interventions for distressing voices in psychosis.

Study at a glance

Abstract

Voice-hearing in clinical and nonclinical groups has previously been compared using standardized assessments of psychotic experiences. Findings from several studies suggest that nonclinical voice-hearing 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 aspects of nonclinical voices. Moreover, such experiences often occur within specific contexts and belief systems, such as spiritualism. We investigated similarities and differences in the phenomenology of clinical voice-hearing and nonclinical voice-hearer (NCVH). We conducted a comparative interdisciplinary study which administered a semi-structured interview to NCVH individuals (N = 26) and psychosis patients (N = 40). The nonclinical group was recruited from spiritualist communities. We used content analysis and inductive thematic analysis to create a coding frame which was used across both spiritual and patient groups to compare phenomenological features of voice-hearing. The findings were consistent with previous results regarding distress and control. Additionally, in the NCVH group, multiple modalities were often integrated into 1 entity, and there were high levels of associated visual imagery, and subtle differences in the location of voices relating to perceptual boundaries. Most NCVHs reported voices before encountering spiritualism, suggesting that their onset was not solely due to deliberate practice. Nonclinical spiritual voice-hearing has important similarities and differences to voices in psychosis. 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 psychosis with distressing voices.