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The Movember Foundation is a global organization known for changing the face of men’s health. This charity often uses unique ideas to advocate for sensitive topics regarding men’s health. They are most often recognized for starting the annual “No Shave November” campaign to promote cancer awareness. This article talks about the  Foundation’s most recent campaign for suicide awareness and prevention among the male population.

Three youtube clips were recently published prior to September 10 which is World Suicide Prevention Day. These youtube clips showed three different men each showing how to perform different activities associated with a typical male role: fishing, filling a gas barbeque tank, and changing a flat tire. There are subtitles that have each male explain how to perform the task. However, there is a hidden message behind each video if you un-mute the sound. If you listen to the voice, it tells a completely different story as each man confesses his insecurities and struggles against depression. These videos depict how many men are victims to societal stigma as they are pressured into conforming with the standards of masculinity. In addition to this, those with mental illnesses will tend to conceal their problems and emotions to avoid being further ridiculed. Therefore, the population of men with mental illness is at an elevated risk for experiencing feelings of isolation which can result in fatal outcomes.

As occupational therapists, we must keep these considerations in mind when working with various populations. Having an unbiased, open-mind is fundamental to best treat our patients. Asking genuine open-ended questions to build rapport can allow them feel comfortable confiding their concerns. We can advocate and refer them to additional resources and we can also help them to identify existing support systems within their existing network of family and friends.

References

Ruiz, R. (2017). Tough guy videos have a hidden message about men, mental health, and suicide. Mashable. Retrieved 14 September 2017, from http://mashable.com/2017/09/06/movember-foundation-mens-mental-health-suicide-prevention/#M0b.vSVDhmqj

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Individuals who have been sexually assaulted endure immediate physical and mental trauma as well as ongoing psychological challenges. If these challenges aren’t enough, some of these individuals are also the targets of “extreme victim-blaming, smear-campaigns and harassment, to the point where some survivors of sexual violence have taken their own lives” (Valenti, 2015). A strong stigma of being a rape victim carries on in the American culture—other than the added shame, “people frequently don’t even realize that their comments and reactions humiliate sexual assault victims” (Gluck, 2016). In the article that highlights the stigma of being a rape victim, Bethany Rivett, a rape survivor shared her experience saying “When I told people I’d been raped, I was faced with reactions of utter discomfort. Some people were scared to discuss it, some didn’t make eye contact while others said the necessary things in order to move on and change the conversation” (Gluck, 2016). Rivett also goes on to explain that even some of her friends and family commented saying she should share some blame for the rape. Questions they asked her included “What were you wearing? Were you drunk? What time of day was it?”. Additionally, the article challenged the question—“Why does American culture put the stigma of being raped on the victim rather than stigmatizing the perpetrator?” (Gluck, 2016).

One way we can support these clients and help them navigate misconceptions is being advocates for our clients and empowering them. We should help them recognize their dignity and worth through participation in occupations that allow them to express themselves and help restore their identity. We should also create a safe environment where these clients can talk freely about their experiences and validate their experience. If we feel that it is not in our scope of practice, we can always refer our clients to various organizations and support groups. On a higher level, we have the opportunity to join organizations such as the National Center on Domestic and Sexual Violence or Take Back the Night Foundation which raise awareness about all forms of sexual abuse and serves over 600 communities around the world.

Resources:

Gluck, S. (2016). Getting Raped: The Stigma of Being a Rape Victim. Forbes. Retrieved September 13, 2017, from https://www.healthyplace.com/abuse/rape/getting-raped-the-stigma-of-being-a-rape-victim/

Valenti, J. (2015). We can’t end rape stigma by forcing all victims to identify themselves. The Guardian. Retrieved September 13, 2017, from https://www.theguardian.com/commentisfree/2015/apr/08/end-rape-stigma-anonymity-victims

https://takebackthenight.org/

http://www.ncdsv.org/

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This article talks about suicide and depression.  Although nearly one in five adults experience some form of mental illness, the topic of mental health is not often talked about. In the article, the author speaks about his experiences with depression and self-harm behaviors throughout high school and college. Not once was mental illness talked about in any of his classes. As his depression worsened in college, he enrolled in a health and wellness class in hopes of learning more, but instead it focused more on nutrition, healthy relationships and conflict resolutions skills and never about mental illness or how to recognize or treat it . He mentioned that if only he knew about depression and that therapy was an option at a younger age, he would not have to stare at his scars. The author advocates others to be comfortable in learning more about mental health. As he mentioned, "we shouldn't be afraid to put a name to these illnesses. We should not be afraid to come forward or tell our stories about our struggles with these issues" (Rigo, 2017).

This article is a good example of how societal stigma of suicide keeps suicidal people from getting help. Most people see suicidal individuals as shameful, weak, or selfish. Individuals with depression often internalized this stigma and believe "I'm a failure, I'm no good" and prevent themselves from seeking help. To reverse these misconceptions, occupational therapists can help the client with improving their self-image and confidence through engaging in meaningful occupations. Also, it would be beneficial for the OT and client to openly talk about suicide with others to challenge the stigma that mental illness should be talked about more. This can encourage clients to feel more comfortable in discussing their depression and suicidal thoughts.

References

Rigo, R., (201 July 24). Let's talk about Suicide. New York Times. Retrieved from https://www.nytimes.com/2017/07/24/opinion/chester-bennington-linkin-park-suicide.html?rref=collection%2Ftimestopic%2FMental%20Health%20and%20Disorders&action=click&contentCollection=health&region=stream&module=stream_unit&version=latest&contentPlacement=31&pgtype=collection

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When I began self-harming I was in sixth grade. In my middle school health class we learned about nocturnal ejaculations and how pubic hair would soon be growing all over our bodies but we never talked about our mental health. In high school, as I was becoming more withdrawn, we learned how to put condoms on a banana, we discussed alcohol and drugs while watching a few episodes of "Freaks and Geeks" but we never defined illnesses like depression, anxiety, personality disorders, suicide or PTSD, or learned that 50 percent of lifetime cases of mental illness begin by age 14.

In college, I became even more depressed. I would cry myself to sleep. My weight fluctuated by 10 to 20 pounds each semester. I would drink to forget and in my drunken blurs I leaned far too heavily and unfairly on friends who were just as lost and scared as I was. During what felt like the worst period of my depression, I took a health and wellness class my junior year. In that class, we discussed nutrition, healthy relationships and conflict resolution skills. We even had a unit on "stress management and resiliency." But we never talked about mental illness or how to recognize or treat it.

And the truth is that everyone can benefit from learning about mental health. It shouldn't scare us; it should light a fire under us to ensure that people across the United States and the world can recognize these illnesses like they would high cholesterol or asthma or any other health condition.

We should not be afraid to put a name to these illnesses. Chester Bennington wasn't. We should not be afraid to come forward or tell our stories about our struggles with these issues. We should be open to learning the symptoms and the signs of mental health disorders. We should encourage everyone (not just those with mental health issues) to seek therapy because therapy is good for your mind just as exercise is good for your body.

If it was not for my family and friends, who knows what would have happened to me. But I do know that if I had learned about depression and anxiety, or even that therapy is an option, when I was 11, I wouldn't be staring at my faded scars as I write this. We must push the conversation about mental illness forward whether it be in the classrooms of public schools or with our families and friends. These issues are real and lethal, and the first means of prevention is acknowledging their existence.

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When I began self-harming I was in sixth grade. In my middle school health class we learned about nocturnal ejaculations and how pubic hair would soon be growing all over our bodies but we never talked about our mental health.

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The news article that I reviewed discussed how not just mothers, but fathers have an increased risk of experiencing postpartum depression as well if their testosterone levels drop nine months post birth.   This article examined 149 different couples within the Community Child Health Research Network and was interviewed multiple times after their child was born.  The couples would answer questions regarding depressive symptoms in addition to their satisfaction with their relationship and how they are dealing with parenting stress.  Results showed that fathers with low testosterone experienced more depressive symptoms than the mothers.  This article reveals a strong stigmatization that many people believe post-partum depression to be something that only the mother would experience and not the father.  It supports that fathers are also strongly susceptible to experiencing post partum depression themselves and it is not necessarily as Saxbe states a “mom thing”.  Societal stigma can affect our clients because it can cause them to have difficulty communicating their feelings and/or experiences as a client to a therapist.  For a client with a mental illness, it may be difficult for them to communicate and express themselves and their illness knowing that society has already developed a negative stigma towards it.  It is important that we as occupational therapists educate to society and advocate for our clients suffering from a mental illness.  If society came to an understanding that individuals with mental illness are not defined by their illness, then we can help navigate their misconceptions and guide society to become social supporters of mental ill individuals.

Reference

University of Southern California. (2017, September 5). Swings in dad's testosterone affects the family -- for better or worse -- after baby arrives. ScienceDaily. Retrieved September 13, 2017 from www.sciencedaily.com/releases/2017/09/170905145535.htm

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The article written by Andrew Solomon (2016) highlighted the stigma victims of mental illnesses still encounter today. Solomon was among the many that participated in petitioning the new attractions Cedar Fair Entertainment and Six Flags were set to introduce for Halloween in 2016. These two entertainment companies nearly introduced attractions that would have amused their consumers at the expense of these individuals by using marketing strategies which associated words such as “haunted” and “maniacal” with mental health in the effort to draw attention. Their actions would have strengthened the stigma that those with a mental health issue is dangerous or menacing (Solomon, 2016).

Solomon (2016) goes into detail of how such a social stigma could devastate clients and affected individuals. Not only would such an attraction further stigmatize these individuals, which may delay or derail recovery processes, but it may also empower unaffected individuals to continue pressing these demeanors. Such misleading information may consequently even lead to physical harm to these clients (Solomon, 2016). Solomon (2016) stresses that while he supports free-speech, targeting an already marginalized group should be avoided.

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According to Brown and Stoffel (2011), stigma is the marginalization of an individual due to an attribute he or she has. For those with a mental illness, stigma also assumes the perception that they or their family members may have been partly responsible for developing such conditions. The negative perception mental illness has in society correlates with affected individuals having difficulty receiving care and services, lower quality of health, and a lack of acceptance in their communities. In short, stigma would impair their process of recovery. Occupational therapists must, therefore, find ways to counter social stigmas which ostracize and restrict personal freedoms (Brown & Stoffel, 2011).

One method Burwash and Norell (2017) suggested that may help solve this issue can be applying contact-based stigma reduction intervention onto entry-level education. The researchers looked to see if introducing teaching instructors with lived experiences of mental illnesses can help change the attitudes and perceptions of these students during the course of their mental health class. Their results found that this form of intervention was helpful in reducing the students’ stigma regarding mental health (Burwash & Norell, 2017). Additionally, Burwash and Norell (2017) suggested that patient experience with occupational therapy can improve simply by correcting stigmas attached with mental health concerns, but more importantly may encourage future students to reconsider their choice of practice as a result.

I would take Burwash and Norell’s suggestion to another level by suggesting school districts to instill a number of teachers with lived experiences of mental illnesses to teach certain classes for grade school. It would not matter whether the classes the teachers taught were psychology or biology. The main focus is to have these students be in contact with these teachers on a regular basis so that they become more aware of the truth about mental illnesses. Applying contact-based stigma reduction intervention would not only help adolescents and children become more mindful of this particular population, but may motivate more students to pursue a field that assists with mental illnesses (Burwash & Norell, 2017).

References:

Brown, C., & Stoffel, V. (2011). Occupational therapy in mental health: A vision for participation. Philadelphia: F. A. Davis Co.

Burwash, S., & Norell, D. (2017). Tackling stigma: Learning from lived experience to be part of the solution. American Journal of Occupational Therapy, 71(4_Supplement_1). doi:10.5014/ajot.2017.71s1-po3132

Solomon, A. (2016, October 26). Opinion │ mental illness is not a horror show. Retrieved September 13, 2017, from https://www.nytimes.com/2016/10/26/opinion/mental-illness-is-not-a-horror-show.html?mcubz=3

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Caregiver Stigma

https://ajot-aota-org.prx-usa.lirn.net/article.aspx?articleid=2646915

https://www.hindawi.com/journals/cggr/2016/8316045/

Although there are people with mental illness who are completely independent, there are many in the older generations who require caregivers to help them in their day-to-day lives. Stigma is something that affects people with mental illness, as well as their caregivers. Caregivers of people with mental illness are stigmatized and studies have shown that they feel socially excluded and have feelings of shame and depression (Kahn et al., 2016). Stress and anxiety are also feelings caregivers have when they are faced with a sense of commitment of taking care of another person for a long period of their lives (Piersol et al., 2017). One of the studies suggest a stigma for female caregivers, in particular, stating, “female caregivers may have more homemaking responsibilities and that the addition of a caregiving role further adds to the burden of these responsibilities” (Kahn).

Before an OT can help them navigate misconceptions about this stigma, he/she must consider the numerous factors that come into play. The relationship and age difference between the caregiver and the person with a mental illness they are helping play a big role in how to approach intervention planning. As OTs, it would be beneficial to come up with strategies to reduce stigma at the personal, and societal level which in turn can help reduce caregiver burdens. I think at the societal level, OTs can advocate for caregivers and policy change to promote educational services to caregivers and their families. It is important for the families of caregivers (whether it is the same family as the person with the mental illness or not) to understand the burdens, and help support the caregiver.

News Article:
https://www.sciencedaily.com/releases/2015/01/150107123934.htm

References:

Piersol, C. V., Canton, K., Connor, S. E., Giller, I., Lipman, S., & Sager, S. (2017). Effectiveness of Interventions

for Caregivers of People With Alzheimer’s Disease and Related Major Neurocognitive Disorders: A

Systematic Review. American Journal of Occupational Therapy, 71(5). doi:10.5014/ajot.2017.027581

Kahn, P. V., Wishart, H. A., Randolph, J. S., & Santulli, R. B. (2016). Caregiver Stigma and Burden in Memory

Disorders: An Evaluation of the Effects of Caregiver Type and Gender. Current Gerontology and

Geriatrics Research, 2016, 8316045. http://doi.org.prx-usa.lirn.net/10.1155/2016/8316045

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Societal stigma impacts our clients in many ways. First, it impacts whether they acknowledge that something is wrong. Second, it impacts whether we seek treatment or help, or even if we share with our friends, family, and support group. Third, it impacts the world's view of an individual. Fourth, the stigma influences how we view ourselves. According to this article, we may express feelings of depression in our photos without even really knowing it. The colors of the photo, the faces shown in the photos, and the filters used on photos may indicate feelings of depression. The researchers who conducted this study hope that one day, it can be used to help diagnose or implicate individuals who may be struggling with depression (Chokshi, 2017).
As occupational therapists, one approach we use is to advocate for our clients. One way to advocate for our clients is to help them with the misconceptions of mental health and what occupational therapy does for mental health clients. There are so many misconceptions of mental illness, but starting with our clients is a good first step. By hearing the client's understanding of what mental illness is and how they view it, we can also help them understand how their own thoughts are misconceptions. From their own experiences and through conversation, we can start breaking down the misconceptions. It may also be helpful to give them statistics about how common mental illness is. Another way we can help our clients navigate misconceptions is to focus on their environment, specifically, their social environment. Creating an environment where the client can thrive and recover is key to recovery. Empowering, hopeful professionals can give the clients opportunities to take control of their lives and understand how to navigate through stigma (Brown & Stoffel, 2011).
References:
Brown, C., & Stoffel, V. (2011). Occupational therapy in mental health: A vision for participation. Philadelphia, PA: F.A. Davis Co.
Chokshi, N. (2017, August 10). Your instagram posts may hold clues to your mental health. Retrieved September 9, 2017, from https://www.nytimes.com/2017/08/10/science/instagram-mental-health-depression.html?rref=collection%2Ftimestopic%2FMental Health and Disorders&action=click&contentCollection=health®ion=stream&module=stream_unit&version=latest&contentPlacement=7&pgtype=collection

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Depressed participants were more likely to post photos containing a face. But when healthier participants did post photos with faces, theirs tended to feature more of them, on average.

As revealing as the findings are about Instagram posts specifically, both Mr. Reece and Mr. Danforth said the results speak more to the promise of their techniques.

"This is only a few hundred people, and they're pretty special," Mr. Danforth said of the study participants. "There's a sieve we sent them through."

To be included in the study, participants had to meet several criteria. They had to be active and highly rated on Amazon's Mechanical Turk platform, a paid crowdsourcing platform that researchers often use to find participants. They also had to be active on Instagram and willing to share their entire posting history with the researchers. Finally, they had to share whether or not they had received a clinical diagnosis of depression.

Out of the hundreds of responses they received, Mr. Reece and Mr. Danforth recruited a total of 166 people, 71 of whom had a history of depression. They collected nearly 44,000 photos in all.

The researchers then used software to analyze each photo's hue, color saturation and brightness, as well as the number of faces it contained. They also collected information about the number of posts per user and the number of comments and likes on each post.

Using machine-learning tools, Mr. Reece and Mr. Danforth found that the more comments a post received, the more likely it was to have been posted by a depressed participant. The opposite was true for likes. And depressed users tended to post more frequently, they found.

Though they warned that their findings may not apply to all Instagram users, Mr. Reece and Mr. Danforth argued that the results suggest that a similar machine-learning model could someday prove useful in conducting or augmenting mental health screenings.

"We reveal a great deal about our behavior with our activities," Mr. Danforth said, "and we're a lot more predictable than we'd like to think."

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Your Instagram Posts May Hold Clues to Your Mental Health

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Depressed participants were more likely to post photos containing a face. But when healthier participants did post photos with faces, theirs tended to feature more of them, on average. As revealing as the findings are about Instagram posts specifically, both Mr. Reece and Mr. Danforth said the results speak more to the promise of their techniques.

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MacDermott
Please post your response to the article in the comments: What is the impact of societal stigma on our clients and how do we help them navigate misconceptions?

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The ways some "healthy voice hearers" cope might be able to help people with psychotic disorders.

Sarah Jung

Jessica Dorner was lying in bed at her cousin's house when her grandmother, a "pushy lady" in an apron who had been dead for several years, appeared in front of her. "I know you can see me," Jessica heard her say, "and you need to do something about it."

It was a lonely time in Jessica's life. She was living away from home for the first time, and she thinks her grandmother was drawn by some sense of that. She eventually told her parents what happened, and according to her they were concerned, but not overly panicked. "My parents are probably the least judgmental people I know," she said.

As Jessica tells it, over the next two years, spirits visited her every now and again. Her brother-in-law's deceased father began forming before her, ghostlike, just as her grandmother did. And while the experiences were intense and at times made her feel "crazy," she said, they were infrequent, and insists that they were never a real source of suffering.

Testing the therapies of the future
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Jessica later moved back home and got a job as a pharmacy technician, all the while figuring out how to cope with what was happening to her. At a co-worker's suggestion, she went to the Healing in Harmony center in Connecticut. In 2013, she says, she enrolled in classes there that taught her to use her "gift." A self-described psychic medium, Jessica tells me she hears voices that other people do not (in addition to sometimes seeing people others do not see), at varying intensity, and mostly through her right ear.

Meeting others like her at the center gave Jessica a sense of relief. "Just being around people who are going through similar things-that helps a lot, because I could talk to anybody about those things and not feel like I was crazy," she said.

It was through a friend from the center that Jessica ended up in the lab of Philip Corlett and Albert Powers, a psychologist and a psychiatrist at Yale. In a study published last fall in Schizophrenia Bulletin, Powers and Corlett compared self-described psychics with people diagnosed with a psychotic disorder who experience auditory hallucinations.

"A lot of the time, if someone says they hear voices, you immediately jump to psychotic illness, bipolar disorder, schizophrenia," Corlett said. But research suggests hearing voices is not all that uncommon. A survey from 1991-the largest of its kind since-found that 10 to 15 percent of people in the U.S. experienced sensory hallucinations of some sort within their lifetime. And other research, as well as growing advocacy movements, suggest hearing voices isn't always a sign of psychological distress.

The researchers at Yale were looking for a group of people who hear voices at least once a day, and had never before interacted with the mental-health-care system. They wanted to understand, as Corlett put it, those who do not suffer when "the mind deviates from consensual reality."

What Corlett calls consensual reality-the "normative shared experience we all agree on"-is probably not something you spend too much time thinking about. But you know when it's being violated. The sky is blue, the sun is hot, and as Corlett points out, most would generally agree that people don't receive extrasensory messages from one another.

Jessica was quite frank with me about the way some people may view her. "We know these experiences are weird and they're seen as weird," she said. "You just can't go into a room and say 'Hey, I'm a psychic medium' and people are gonna accept you."

Finer points of what counts as reality can change over time, and vary based on geography or culture. For centuries people walked the earth believing the sun orbited around them, which today would be considered unreasonable. Who decides that consensus, and where along its boundaries voice hearers fall, depends on a wide range of circumstances.

The anthropologist Tanya Luhrmann, who has studied voice hearing in psychiatric and religious contexts, has written that "historical and cultural conditions ... affect significantly the way mental anguish is internally experienced and socially expressed." Noting that there is no question psychiatric distress and schizophrenia are "real" phenomena that call for treatment, Luhrmann adds that "the way a culture interprets symptoms may affect an ill person's prognosis." Every psychiatrist I spoke to shared the belief that unusual behavior should only enter into the realm of diagnosis when it causes suffering.

On the other hand, Luhrmann tells me "it's a terribly romantic idea" to overinterpret the effects of culture. To say, for instance, that "anybody who would be identified with schizophrenia in our culture would be a shaman in Ecuador" is, in her mind, a clear mistake: "Flagrant psychosis" exists in some form in every culture where anthropologists have looked.

In the past decade, researchers have taken a greater interest in the experience of hearing voices outside the context of psychological distress. In his book The Voices Within, the psychologist Charles Fernyhough traces the way thoughts and external voices have been understood by science and society throughout time.*

Reflecting on Fernyhough's book, Jerome Groopman notes that in the early parts of the Bible, the voice of God gave direct commands to Adam, Abraham, and Noah. It spoke to Moses through the Burning Bush, going by the Book of Esther, making itself known again to the apostle Paul in the New Testament. Socrates, who wrote nothing down, heard a "sign" from childhood. The voices of three saints guided Joan of Arc as she rebelled against the English. Groopman cites Martin Luther King, Jr.'s autobiography, in which he describes "the quiet assurance of an inner voice" telling him to "stand up for righteousness."

The social context in which these people lived can impact how they're seen. It's impossible to say how the prophet Ezekiel was understood within his cultural moment. But in most places today, if a person claimed-as Ezekiel does-that he ate a scroll because the Lord commanded him to do so, some eyebrows might be raised. In a community where a personal, verbal relationship with God is normal, the reception may be different.

Powers and Corlett's work orbits the idea that schizophrenia is, as Powers put it, an "outmoded" label that describes a cluster of different symptoms rather than a single unified condition, he says.

"Goodness knows what psychosis actually is," Luhrmann said. "There are clearly different kinds of events in the domain we call psychosis," and when it comes to the relationship between voice hearing and psychosis, she says, "there's so much we don't understand."

Many now antiquated psychiatric diagnoses reified fear, misunderstanding, or prejudice toward people at society's margins. At the time of the women's suffrage movement in London, hysteria was leveled as a charge against women who broke social codes. A Mississippi psychiatrist in the 19th century proposed that slaves who attempted escape suffered from "drapetomania." And until 1973, homosexuality was considered a disease of the mind rather than an accepted way of being in the United States-and was only fully removed from the Diagnostic and Statistical Manual of Mental Disorders in 1987.

In his book Hallucinations, the late Oliver Sacks details a controversial experiment in which eight participants showed up at hospitals throughout the U.S. in the early '70s and complained only of "hearing voices." All of them were immediately diagnosed with a psychotic disorder and hospitalized for two months, despite reporting no other medical symptoms, family history, or signs of personal distress. The single symptom, Sacks writes, was seen as cause enough.

People with psychiatric disorders do hear auditory hallucinations in relatively high numbers. According to Ann Shinn, a psychiatrist at Harvard Medical School and McLean Hospital, 70 to 75 percent of people with schizophrenia or schizoaffective disorder and between one-third and one-tenth of people with bipolar disorder report hearing voices at some point in their life.

In the case of voice hearing, culture may also play a role in helping people cope. One study conducted by Luhrmann, the anthropologist, found that compared to their American counterparts, voice-hearing people diagnosed with schizophrenia in more collectivist cultures were more likely to perceive their voices as helpful and friendly, sometimes even resembling members of their friends and family. She adds that people who meet criteria for schizophrenia in India have better outcomes than their U.S. counterparts. She suspects this is because of "the negative salience" a diagnosis of schizophrenia holds in the U.S., as well as the greater rates of homelessness among people with schizophrenia in America.

The influence of social context was part of what motivated Corlett and Powers: The two were interested in whether the support of a social group can help them understand where disorder and difference intersect. When they set out to design their study, they needed an otherwise healthy group of people who hear voices on a regular basis, and whose experiences are accepted in their social group.

Next, they needed to find some psychics. Corlett told me he got the idea to reach out to a Connecticut-based organization for psychics after noticing the ads for psychics and tarot-card readers on his daily bus route. When the two interviewed those participants, they noticed something striking: The psychics described hearing hearing voices of similar volumes, frequencies, and timbres as the patients. Powers and Corlett took this to mean that the psychics were actually hearing something. The two also vetted their participants with the same techniques that forensic psychiatrists use to determine whether a person is pretending to experience psychiatric symptoms, giving them more reason to believe what they were told.

Compared to their diagnosed counterparts, more of the psychics described the voices as a force that "positively affects safety." And all of the psychics attributed the voices to a "god or other spiritual being." The patients, meanwhile, were more likely to consider their voices a torment caused by a faulty process in their brain. Many of them described the voices as "bothersome," and also claimed that the first time they told anyone what they were hearing, they received a negative response.

Just like Jessica, the psychics were more likely to say that they received a positive reaction the first time they spoke about their experience. Jessica's mother, Lena, told me she maintained a supportive, nonjudgmental attitude toward her daughter's accounts, just as she did when her other daughter converted to Scientology. She waited for Jessica to bring them up and discussed them with an open mind. She says she was happy Jessica found the center, adding that her only concern was that Jessica's experiences did sometimes seem to be distressing her and leaving her "drained."

When Jessica tells me about the people and things she hears, she describes a range of experiences rather than one consistent phenomenon. Her most meaningful episodes of voice hearing are those like the visits she had from her grandmother and her brother-in-law's father. But she also describes things like hearing the number a friend is thinking, and the persistent and vivid presence of a childhood imaginary friend (her mother told me Jessica demanded the table be set for him at every meal). To Jessica, these experiences differ in degree rather than kind from the ghosts of the dead who appear in front of her with persistent messages for her and for others. Though these might not all fit into the popular conception of a psychic, she understands them to exist along that same continuum.

In his book, Fernyhough describes a series of experiments meant to provide evidence for the connection between inner speech and hearing voices. In one, participants were played recordings of other people's speech alongside recordings of their own, disguised and distorted, and told to mark whether the voice was their own or someone else's. Those who experienced hallucinations were more likely to misidentify their own altered voices. A much older experiment found a kind of unconscious ventriloquism among a group of people with schizophrenia: When participants began to hear voices, researchers noted "an increase in tiny movements in the muscles associated with vocalization." The voices they heard came, in some sense, from their own throats.

These experiments suggest that auditory hallucinations are the result of the mind failing to brand its actions as its own. Watching what the brain does during these hallucinations may clarify how that works, and what differences in the brain create these experiences.

"When your brain signals to generate a movement," Shinn, the psychiatrist at Harvard, told me, "there is a parallel signal [known as an efference copy] that basically says 'this is mine, it's not coming from outside.'" This helps creates the sense of where a person is in space, that their hand belongs to them and it is moving from point A to B. In this way, the body labels its motions, and a possible parallel may exist for speech and thought. When people hear voices, they may be hearing 'unmarked' thoughts they do not recognize as their own.

Beyond that, Shinn told me, what is understood about the experiences of people who hear voices is limited. She sees Corlett and Powers's study as part of a growing interest in the lives of "healthy voice hearers"-an interest spurred, in part, by the Hearing Voices Movement. A network of advocacy groups, the Hearing Voices Movement presents an alternative to the medical approach based on the belief that the content of a person's voices can reflect the hearer's mental and emotional state. The groups encourage an approach in which, with the help of a facilitator or counselor, hearers listen to, speak back to, and negotiate with the messages they hear in hopes of learning to cope.

The hearing-voices advocate Eleanor Longden has said she considers her voices "a source of insight into solvable emotional problems" rooted in trauma rather than "an aberrant symptom of schizophrenia." As Longden tells it, that's how her own experiences with voices were understood when she first sought treatment for anxiety. Her psychiatrist told her how limited her life would be by her voices, she says, and the voices grew more adversarial.

Many mental-health-care providers-Shinn, Corlett, and Powers included-seem receptive to the Hearing Voices Movement's critiques, including an overemphasis on medication and an imperative for patient-focused treatment. Shinn credits the network with encouraging an approach that treats voice hearing as more than a checklist item adding up to a diagnosis of schizophrenia, and helping to reduce the stigma attached the experience of voice hearing.

But "there are certainly a lot of people for whom that will not be enough," she says. For some patients, voices can be impossible to reason with, and the burden of other symptoms of psychosis-disordered thought, delusions, the inability to feel pleasure-can be too great. And Powers and Corlett expressed concerns that the Hearing Voices Network may promote a false divide: the idea that the voices' perceived roots in trauma-rather than some accident of biology-means hearers should avoid medication. Biology and experience, they say, can't be so neatly separated. (Longden has written that "many people find medication helpful," and that the International Hearing Voice Network advocates for "informed choice.")

While Powers and Corlett don't believe the psychics and patients are experiencing the exact same thing, the two are cautiously hopeful that about a potential lesson in the greatest difference between those groups: the ability to control the voices they hear, which is something the psychics, including Jessica, showed in greater number than their counterparts. "When I'm in certain situations, I'm not open," Jessica said. For instance, when she's at work, the voices "can come in," she says, they "can hang out, but I'm not gonna talk right now. ... I still have to live this human life."

While learning control was a major part of Jessica's experience, so was learning to summon the voices she heard. Before training as a medium, she heard voices sporadically, she says, and began to hear them every day only after intentionally practicing at the center. Powers and Corlett acknowledge this general trend in their study: The psychics they spoke tended to seek out and cultivate the voice-hearing experiences.

In her work, Luhrmann has come across groups of people who-unlike Jessica-hear voices only as a result of practice. She gives the example of tulpamancers: people who create tulpas, which are believed to be other beings or personalities that co-exist along inside a person's mind along with their own. "Somebody in that community estimated to me that one-fifth of the community had frequent voice hearing experiences with their tulpas, that their tulpas talked in a way that was auditory or quasi auditory," Luhrmann said, a practice that she was told takes two hours a day to develop."That's connected to work. Psychosis is not connected to effort. It happens to people."

Longden, the Hearing Voices Network advocate, describes how she later learned to extract metaphorical meaning from the sometimes disturbing messages the voices had for her. Once when the voices warned her not to leave the house, she thanked them for making her aware that she was feeling unsafe, and firmly reassured the voices-and by extension, herself-that they had nothing to fear.

Though Jessica has a different understanding of her voices' source, it's hard not to hear echoes of Longden's account when she speaks about the sense of control she's developed. Longden talks to the voices as aspects of herself that call for a response, while Jessica addresses them as visitors who need to learn the rules.

Instead of tying these experiences to a discrete diagnosis, Powers and Corlett imagine a new kind of frame for voice hearing. Drawing a parallel with Autism Spectrum Disorder, the two are interested in the extent to which the psychics they saw "might occupy the extreme end of a continuum" of people who hear voices. "Much of what we perceive and believe about the world is based on our expectations and our beliefs," Corlett said. "We can see hallucinations as an exaggeration of that process, and the psychics as a sort of way-station on that continuum, and slowly but surely we can creep towards a better understanding of the clinical case and therefore better treatment. We haven't had new treatment mechanisms in schizophrenia for many years now."

The two freely admit the gaps between their ambitions and what they know so far. The study is preliminary, qualitative work-a follow-up brain-imaging study is in the works-and they did only interview a small number of people. Psychics, they say, are not so easy to come by.

Luhrmann speculates that most of the psychics are experiencing something separate from psychosis: "I think it's also true that there are people who have psychosis who manage it such that they don't fall ill and avoid this stigma and who really function effectively." This difference aside, she says, "it may still be possible to learn from people who have more control over their voices. .... to think about how to teach people."

At least as subtext, Powers and Corlett's study might suggest a kind of chicken-or-egg question: Were the psychics insulated from suffering because they were socialized to accept and cope with their voices, and were the psychotic patients suffering because they weren't? The better question is: to what extent were the two groups experiencing the same thing?

Shinn believes the fact that far fewer diagnosed participants were employed at the time of the study (25 percent, versus 83 percent of the psychics), and that the diagnosed participants experienced more symptoms of psychosis, suggests that they were suffering beyond the point of being useful comparisons. She thinks, rather, that a "constellation" of symptoms-not just auditory hallucinations or the stigma associated with auditory hallucinations-explain the difference in functionality. "The Powers study provides interesting results with potentially helpful clinical implications," she added, "but they compare very different groups."

Shinn, Powers, and Corlett are all adamant that people who hear voices and experience psychological distress shouldn't turn away from conventional psychiatric treatment, and that a "symptom"-in this case, voice hearing-only calls for clinical attention if it is a cause of suffering. But for those who are distressed, the level of understanding of their experience and the treatments available to them are still lacking. As Powers notes, many of psychiatry's more effective drug treatments were developed by accident. Shinn likens the current body of knowledge of schizophrenia to a group of people describing different parts of an elephant while looking through a high-power lens: There are robust bodies of work on the trunk, the tail, and the ear, but no clear picture of the entire animal.

Shinn's all too aware of the ways in which the diagnosis can overshadow the patient. "There have been psychiatrists," she says, "who will tell a patient: You have a diagnosis of schizophrenia and you need to modify or adjust your goals in life, forget grad school, forget that Wall Street career," Shinn said. "And that absolutely can be compounding and impairing. I don't disagree that that's a problem."

As Luhrmann put it: "Are those cultural judgments the cause of the illness? Absolutely not. Do those cultural judgments make it worse? Probably."

Jessica doesn't live near the center anymore. While she'd love to find fulltime work as a medium, she says, she's focusing on her graduate studies to become a dietitian for now.

Still, she's grateful for the community she found at the center, she says, and for the help they gave her. "I cannot imagine having no control over this," she told me. "I don't know, if I never went to the center, maybe I'd be diagnosed with schizophrenia."
*This article originally stated that Charles Fernyhough hears voices himself. We regret the error.

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Psychics Who Hear Voices Could Be On to Something

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The ways some "healthy voice hearers" cope might be able to help people with psychotic disorders. Jessica Dorner was lying in bed at her cousin's house when her grandmother, a "pushy lady" in an apron who had been dead for several years, appeared in front of her.