Voices are often a highly distressing symptom of schizophrenia. Many clinicians presume that the experience of these symptoms is more or less the same everywhere. This talk will present an interview-based comparison of the voice-hearing experience among persons with schizophrenia in six different countries: the U.S., Ghana, India, Thailand, China and Russia. The comparison is of necessity limited, because the sample sizes are small. Nevertheless we see differences which may be of interest. Most strikingly, the participants in the US sample reported more violent commands, and it seems that their voices felt more alien to them.

This work also draws on data from extensive fieldwork and from hundreds of interviews conducted across multiple countries to examine the prevalence and variability of these experiences. We will discuss what we know about the difference between the voices found in psychosis and in the general population, and the evidence that three factors (porosity, absorption and training) facilitate voices in the general population. People can in effect learn to hear voices—and this is terribly important in religious settings. This learning dimension has implications for the clinical management of psychosis as well.