Hektoen International

A Journal of Medical Humanities

Culture frames the experience and response to psychotic delusions

Colleen Donnelly
Denver, Colorado, United States


Photo that may capture the experience of psychotic delusions
Photo by Camila Quintero Franco on Unsplash

Since the 1950s many people suffering from psychotic delusions have claimed that these were caused by contemporary technology such as electromagnetic and micro- waves or computer chips clandestinely planted during medical procedures or alien abductions. Such tightly held beliefs and anxieties have a long history, as shown by the following examples:

In the late 14th century, Margery Kempe, a deeply devoted woman and self-proclaimed visionary, developed post-partum psychosis after giving birth to one of the last of her fourteen children. She related how for over six months devils infiltrated her throat, cursing and threatening her, and bringing her to the verge of suicide as they insisted she blaspheme her family and God. At last, she said, Christ appeared to her, her wits returned, and she was able to resume her household duties.1 Margery and her society were convinced that she had been possessed as a fitting punishment for her prideful behavior.

As the 18th century drew to a close, James Tilly Matthew, a peace activist deployed by Britain to France during the Terror of the French Revolution, was accused of being an English spy and was imprisoned for three years in Paris. Believing he had been betrayed by English government officials, he entered the House of Commons on December 30, 1796, and accused Lord Liverpool of treason. Judged insane, he was sent to Bedlam. He explained that he was acting upon the delusion that Jacobin agents were employing an “Air Loom” which wove “airs” into a “warp of magnetic fluid” that he continually inhaled as he walked the streets of London. He described the machine as fueled by “fetid effluvia” of animals, utilizing the pneumatic chemistry popularized at the turn of the 19th century, torturing him with hallucinations he called “brain-sayings” and physical pain he described as “vital teachings” which left him unable to breathe.2 Despite his later docility and two doctors declaring him sane, Tilly remained interned until this death, as the director of Bethlam, John Haslam, insisted that “maniacs” must be broken and totally submit to his authority.

When the brilliant mathematician John Nash received the Nobel Prize for his work in game theory, his work on encryption-decryption may have fueled his auditory hallucinations about the dangers of crypto-communists. He saw himself as an enlightened messenger whose opponents, including President Eisenhower and the Pope were “unsympathetic powers” persecuting him and having him hospitalized through a coup d’état: “I envisioned a hidden world where the Communists and the non-Communists were into this thing—they were sort of schemers.”3 Later in life, Nash spoke about how through sheer will and support from family and friends, he gained control over his delusions, which he saw as “politically-oriented thinking that were a waste of intellectual effort.”4 Nash’s commitments were always involuntary, and he reported that the irrational thinking eventually waned without the medication he resisted. Research has affirmed that as people with schizophrenia age they can suffer fewer delusions.

Experiences of abusive, distressing, and demanding voices typifying the terrifying descent into madness, while quite common in Western industrial culture, are not universal. They can be quite different depending on the society to which an individual belongs and in which they have been nurtured. WHO studies found that schizophrenic patients living in less industrial countries had a much more favorable prognosis and higher rates of remission than patients living in more advanced Western countries.5 In less developed nations in Asia and Africa, where the biomedical model is not available or rejected, psychotic experiences manifest differently, having been shaped more by spiritual and collective experiences. For example, Shaman Somé of the Dagara people of West Africa explains that his culture treats delusions as a psychic phenomenon in which the spiritual world collides with everyday reality. Through ritual and collective support, the healer and the community work with the person to reconcile or bridge the worlds6 and integrate the individual back into society.

Anthropologist Tanya Lurhmann and fellow researchers found that while Americans most often experienced voices as bombardment, the Hindi of Chennai described the voices they heard as more benign, as kin or ancestors, some demanding, some playful. Those interviewed in Ghana, a culture which accepts the existence of disembodied voices as God or spiritual messengers, report a more interactive relationship with their voices and do not necessarily find them threatening or fear-inducing.7

In Muslim culture, hallucinations and delusions are attributed to jinn, spiritual beings capable of entering individuals, animals, and objects, and able to either exert positive influences or assail them. Islam encourages engaging religious leaders in ritual ruqyah, as well as having the family and community placate and fete tormenting spirits with gifts. In many communities, the suffering individual is accommodated within the family unit and often drifts back and forth between troubled periods and asymptomatic periods without exile from the community.8 Notably, Islam accepts the use of medications as a gift from God, but secular psychotherapy is more problematic as it often denies their cultural, religious beliefs that need to be acknowledged and accommodated.9

While the experiences of those living in African and Asian communities may seem removed from us, a few situations in Western society resonate and are suggestive of the potential for less disabling psychotic experiences. Psychics, like many suffering from psychosis, also hear voices but perceive them as neutral or as positive insightful gifts. Forensic psychologists not only found that psychics scored equally to those with psychosis for true claims of hearing voices; they also found that the same areas of the brain were activated in both groups when they reported hearing voices.10 These individuals are often reared in religious, charismatic, or ethnic households or communities with more accepting, tolerant views and that are less willing to medicalize the hearing of ancestors or deceased relatives. What distinguished these experiencers from those whose lives are disrupted is their willingness to engage the voices and self-assuredness that they can garner some control over their occurrence.

We have also witnessed the growth of the international Hearing Voices Movement (HVM), which while acknowledging voice hearing is often a resultant survival strategy to trauma, challenges whether they need to be treated as symptoms of mental illness that must be eliminated or minimalized. Rather the “recovery” goal is to reduce the distress experienced by dealing with the voices. This may include continuing antipsychotic medication but allows individuals to engage their voices as complex, significant, and meaningful experiences. Jeannie Bass, a Board Member of HVM in the U.S., talks about negotiating with the voices: when they demand she self-harm, she appeases them by agreeing to pay attention for a specified period of time provided they refrain from their self-destructive demands.11 HVM acknowledges that some people do not want their voices to go away, finding comfort in their voices since their companionship means they never feel alone. What the movement strives to do is empower individuals to make choices for themselves and live their life to their fullest capacity rather than being paternalistically coerced to accept lifelong pharmacological and institutional psychiatric interventions.12 These broad-ranging historical and diverse cultural studies suggest that psychosis may better be addressed by considering societal and cultural perspectives that have influenced individuals and supporting them in determining what will best serve them to achieve a fulfilling future.



  1. Margery Kempe, The Book of Margery Kempe, ed. Barry Windeatt (New York: Penguin, 2000), 41-43.
  2. Mike Jay, A Visionary Madness: The Case of James Tilly Matthews and the Influencing Machine. (New York: North Atlantic, 2014), 20-38.
  3. Nash, John. “Interview with John Nash,” Retrieved June 9, 2021, https://www.pbs.org/wgbh/americanexperience/features/nash-interview/
  4. “John F. Nash Jr. – Biographical.” NobelPrize.org. Nobel Media AB 2021. Wed. 16 Jun 2021. <https://www.nobelprize.org/prizes/economic-sciences/1994/nash/biographical/>
  5. T. Padma, “Developing countries: The outcomes paradox,” Nature 508, S14–S15 (2014). https://doi.org/10.1038/508S14a
  6. Stephanie, Marohn, The Natural Medicine Guide to Schizophrenia (New: York: Hampton Roads, 2003), 178-189.
  7. Parker, Clifton. “Hallucinatory ‘voices’ shaped by local culture, Stanford anthropologist says.” https://news.stanford.edu/2014/07/16/voices-culture-luhrmann-071614/
  8. Ethan Watters, Crazy like Us (Free Press: New York, 2010) 151-154.
  9. Simon Dein and Abdool Samad Illaiee, “Jinn and mental health: looking at jinn possession in modern psychiatric practice,” Cambridge UP, (2018). https://www.cambridge.org/core/journals/the-psychiatrist/article/jinn-and-mental-health-looking-at-jinn-possession-in-modern-psychiatric-practice/
  10. Christopher Hoffman, “When researchers listen to people who hear voices,” Yale Medicine, Spring, 2019. https://medicine.yale.edu/news/yale-medicine-magazine/when-researchers-listen-to-people-who-hear-voices/
  11. “Hearing voices other can’t: How a growing movement fights mental health stigma.” https://www.nbcnews.com/think/video/hearing-voices-others-can-t-how-a-growing-movement-fights-mental-health-stigma-1384949315955/
  12. Laren Corrin, “Hearing voices: A human rights movement and development approach to voice hearing,” Counseling Today, March 12, 2020. https://ct.counseling.org/2020/03/hearing-voices-a-human-rights-movement-and-developmental-approach-to-voice-hearing/



COLLEEN DONNELLY specializes in medieval and twentieth-century literature, language, and linguistics. Returning to her earlier science training, she is currently conducting research in medical humanities on issues of mental illness, disability, and narrative voice.


Summer 2021  |  Sections  |  Psychiatry & Psychology

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