Religion and Spirituality in Psychiatry

Delusions and Hallucinations 89hallucinatory experience is therefore favored bythe reduction of cognitive dissonance.Th e most common type of hallucinationis auditory. About 60 percent of patients withschizophrenia experienced auditory hallucinations.(57)However, most people experiencingminor auditory hallucinations have no psychiatricdisorder and are not in need of psychiatrictreatment.(51, 61, 62)So, what are the factors that differentiatevoice-hearers with psychiatric disorder fromvoice-hearers without psychiatric disorder? Tworelated factors are at stake: the characteristicsof auditory hallucinations and how the subjectreacts toward them. Romme and Escher developeda therapeutic approach for voice-hearersbased on the differential functioning of patientand nonpatient voice-hearers. As for the characteristicsof the hallucinations, both patients andnonpatients hear positive and negative voices.But the big difference between them is the effectof the voices. Nonpatients (i.e., those withoutpsychiatric disorder) feel their experiences asmainly positive, whereas patients are scared,upset, and disrupted in their daily life by thosevoices. For patients, they present a social-emotionalproblem that they are not able to solve.This leads to emotional distress, social isolation,and behavioral problems. Voice-hearers producemany different theories to explain their experience,which vary according to their own view onlife and religion and their cultural background.Psychiatry and psychology consider the voicesas within the person. But to the hearers, it betterdescribes their experience to say the voices layoutside of themselves. Some may view them asa symptom of disease, but for others, they comefrom other living people, from spiritual entities(God, ghosts, angels, evil spirits) or may indicatespecial spiritual powers (gift of mediumship or,telepathy). The attribution of the source of thevoices leads to specific coping strategies. Someof those theories are shared by various subcultures.(63)According to Chadwick and Birchwood, (64)auditory hallucinations are a trigger. The persongives a meaning to his or her hallucination,which then leads to emotional and behavioralreactions. What causes despair and maladjustedbehavior is a dysfunctional meaning attributedto the voices in terms of malevolence andomnipotence.2.5 Association of Delusionsand HallucinationsDelusions and hallucinations often go togetherboth in patients and in the general population.(65) This association may be partly dueto some delusions generated to give meaningto hallucinations. Another hypothesis for thisassociation lies in their common underlyingpsychological mechanisms: a basic cognitivedisturbance leads to an anomalous consciousexperience (for example, heightened perception,actions experienced as unintentional, racingthoughts, thoughts appearing to be broadcasted,thoughts experienced as voices, two unconnectedevents appearing to be causally linked).Such anomalous experiences are puzzling andassociated with anxiety and depression, andthey required explanations. Those explanationsare influenced by cognitive bias and metabeliefs.Hence, delusions are dysfunctional attempts tomake sense of anomalous perceptual experiences.(66) For Morrison, (49) metacognitive beliefsare an underlying factor for both delusions andhallucinations.All psychiatric and psychological theories ofhallucinations postulate the misattributionof an internal event to an external cause. Inthat, clinicians, like voice-hearers, developstrong convictions about the meaning of suchexperiences – meaning rooted in their culture.The DSM-IV-TR (27) points out the roleof culture in the definition of hallucination –“Hallucinations may also be a normal part ofreligious experience in certain contexts” – anddelusion – “The belief is not one ordinarilyaccepted by other members of the person’s cultureor subculture (e.g., it is not an article ofreligious faith).” We will now explore how tomake sense of these studies for application toclinical practice.