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The voices of madness

An anthropologist confronts psychosis
Tanya Marie LUHRMANN
Cet article est une traduction de :
Les voix de la folie

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1The phenomenology of psychosis is notoriously difficult to grasp. I offer here a case study of psychotic voices in which neither words nor voice proper figures prominently. I reflect on the strangeness of these experiences, and then point to the features of voice-hearing which I take to be of central importance: not-me-ness, a different realness, and presence.

2When it begins, madness can feel like grace, or art. The dull everyday becomes iridescent. People sense wild swans, floating angels, shimmering sparks of light in the air. But for people with madness, the glory often soon comes with dread. The signs vibrate with meaning, and then they demand.

3Alan was 21 when things began to go sideways. He was a junior at an elite liberal arts school out west when he took a year off to explore how the world could be better. He became an intern at Bread and Puppet in Vermont to learn their blend of political theatre. Then he went in turn to a mountain sanctuary in Tennessee, a Zen Buddhist retreat in Florida, and a Jewish Kabbalah Ayurveda place in Arizona. At one point, he hitchhiked to San Diego and landed in Hillcrest, the center of gay politics in the city. He was just beginning to explore his own sexuality, but he never found a steady partner. He got a job at an organic pizza place but mostly he meditated. He could spend the entire day meditating, walking through the hills and canyons, attending to his breath. He began to think of the thoughts that came to his mind as things that come and go, as if they weren’t part of him, even though he knew of course that they were.

4One day, he felt a slight shift upwards, as if steam were rising, a small seismic shift in the substance of the air. It knew him. He felt – he struggled for words here – as if he were in a dark room and reached out, and his hand fit into a glove. It felt right, and he began to feel that it should happen again. When he did his yoga stretches, he’d extend a leg, and then wait for this – energy, he called it – to tell him how to move. The energy felt real and not real to him at the same time, as if he were choosing to play a trick on his mind. But he kept responding to it.

5Then he got fired from the pizza restaurant. He sat on a park bench and decided that he’d been living his life according to rational principles, and it hadn’t served him well. He decided he’d try having the energy make his decisions for him. He thought that if he did that, he would be able to sense things that had been hidden from him before. He did this by talking to his chakras, these points in his body where the energy could enter. He began to ask his chakras about the most basic decisions he had to make. “Should I turn right here, or left? Go home, or go on?”

6He started getting messages from a god. He knew this was odd, because he didn’t believe in God. He knew the spiritual world didn’t operate that way, as if there were intentional invisible minds with power. He knew he’d eventually find his way back to Buddhist-style meditation. Yet he also knew that for a time, this was a path he had to go down.

7The god never spoke. Alan never heard words. Yet there were words. The energy would pull him and guide him. It was like being a writer, he felt. He’d feel something, and then he would find language to interpret it in his mind and the words would be there. Now all his decisions felt like they mattered. He’d think it would be good for the earth if he crossed the street now, here, at this particular moment in the conjunction of everything. He’d gotten another job by this point, as a busboy in a sushi restaurant, but he quit. It felt that the stakes were too high to waste time as a busboy. He thought that if he could just do exactly what the energy wanted, he could heal the earth. But he kept failing. He knew he wasn’t getting it right.

8He began to hear a tinkling cascade in his ears. Little chimes. He knew they didn’t exist. At the same time, he thought it was what it was that energy healers heard, that the chimes told them where the energy was and when it was coming. When he heard them, he’d try to raise himself up by two inches to meet the energy, as if the energy were fishing horizontally, he said, and he had to reach up and grab the line. When he did that, he’d feel that he grabbed the message. There still weren’t words. But the message formed itself into words in his mind. He began to see light, a purple evanescent blob. When he saw it, he knew he was on the right path. He realized that he could receive energy, that it would come within him like power and be his. He began to feel that he could make things with his mind. He’d stare at the mirror, and he’d start to see an outline of something emerge that wasn’t him. The cavities around his face became golden. They would vibrate, and he began to feel that he had to take this fire and heal the world. The responsibility was terrifying. He’d be in a grocery store and think: “Which pear should I choose?” He started to feel that if he made the wrong choice, someone would die.

9His apartment burned down. The Italian restaurant a few doors down had hired men to work on the roof, and sparks jumped to nearby buildings. He thought it was nice, standing outside with everyone else, watching the blaze. It felt like a new beginning. The Red Cross offered him a room to stay in, but the energy said, “go north.” So he left. He got a lift from someone, went north 10 miles, and slept on the lonely, lovely beaches of La Jolla. He ran into a man who remarkably took him in (Alan’s father paid the rent) and even more remarkably lent him a car to follow the command to go north. At one point, the man called and insisted on getting his car back. Alan reluctantly turned around. As he drove back, he felt that he wasn’t listening to the energy, that what he was doing was wrong, and that now he had ruined his life.

10The sense of command grew more intense. A few weeks later, a bolt of red-hot energy hit him in the back of his head and he thought he was going to die. The energy knew no forgiveness. He had to follow it but he had to get rid of it. He began moving from hotel to hotel. He began to hear clicks as he walked. He began to feel that trees would talk to him – not out loud, but in feelings he interpreted into words in his mind. They were more commanding than kind.

11And then it stopped. He went home and found a therapist. Slowly, she persuaded him that the energy was something he had imagined, even that it might be a symptom, although even now he wants to think that there was some truth to it. She never gave him a diagnosis and he was never hospitalized. Over the next 10 years, he finished college. These days he does freelance tech work. He’d still like to be a teacher, although he hasn’t decided just how. He is not where he was before the energy beckoned, but he is not ill.

  • 1 Janet Malcolm, “Six Glimpses of the Past”, The New Yorker, 22 October 2018. Available at: https://w (...)

12Madness, Janet Malcolm remarks, is a mystery like a cry in the night.1

13I am an anthropologist who studies madness. Alan is one of many people I have come to know on the journey. Despite the precision of his words, despite my many hours with him and with so many others, I am humbled by how hard it is to understand. This is true of all human experience, of course. We are all cloaked from each other. But the felt experience of madness – in particular, of psychosis, the term we use for the state in which thoughts and perceptions seem radically askew – seems unusually difficult to grasp. Why?

14To be sure, there have been times I felt that I had a glimmer of understanding. There are moments when I have felt ajar, as if what once was real was no longer real. The first time that stands out was when I was waiting for someone at the wrong place on the London underground, at one of those stations with multiple entrances on different levels, a dirty layer cake of tile and steel. I was deep into a Penguin anthology of mysticism, and I was struggling to wrap my mind around the strange sensibilities and metaphors that seemed like fog. I was working hard to concentrate and to keep my bike safe from the tide of evening commuters, leaning against the bike against the wall, focusing in on the text. By the time I gave up to cycle home, I felt not quite connected, like when you are young and glassy-eyed with boredom, except that I was not bored. I stood in my studio apartment, gazing out at the wet pavement under the light, feeling as if the tectonic plates of my inner world had pulled just a bit apart.

15Another moment came out of a conversation with a young woman; let us call her a student. For a professor, in some sense all students are past made future – intellectual offspring who will carry forward your own way of seeing, remade. Some are more so. You write together. Your ideas mingle and you emerge with stronger, better theories. In some small (or large) way these young people enter your soul and change you, as you change them. With anyone with whom you work closely you do not have the emotional freedom to say: this is not me.

16So when I began to work side by side with this young woman who heard voices I felt voices differently. We spoke at my kitchen table, not in a shelter. I did not interview her; together, we interviewed other people, both of us on the same side of the relationship I have constructed so assiduously as an anthropologist throughout my life. When I read her own work, then, I looked without thinking for echoes of myself. I remember one afternoon reading her own account of the voices that came upon her unchosen, of how she could not control them, how her mind was not her own. For a moment, I felt that this had happened to me, and I felt a clutch of terror.

17And there was the afternoon I spent with Katie. I met her in a homeless shelter, where I was trying to understand the lives of mad women on the street. Katie was the age of my youngest sister. I thought she was down on her luck, not mad. By nightfall the shelter would feel crowded and noisy, but in the afternoon it was quiet, even charming. There were tables with doilies and potted plants. She told me about the house she’d owned in Texas, how proud she was of it, and she took out pictures of her six kids. When I asked her how she’d come to the shelter, she said she’d been home in Texas and her husband came in and sat down and said, “Hon, I love you,” took out a pistol, and blew his head off. It turned out that they had done methamphetamine together for about five years straight. She thought that it wasn’t very good for the kids. The last baby – she’d had six – had died in childbirth. She’d drive the others to school in the morning, but on meth she wouldn’t sleep for days on end, and by the fourth or fifth day, driving wasn’t so easy. The kids sometimes got scared. Katie got scared too. She would lock herself in her daughter’s bedroom when her husband got into one of his rages. She’d be crying, her kids would be crying. Sometimes he’d be lovely for months, attentive and caring. Then he’d choke her, and leave handprints on her neck. It was confusing around the time he killed himself. She thought he was having lots of affairs, but then she wondered whether she was being paranoid. She found semen in his anus – how she didn’t say, but she was sure it was semen – so she thought some of the affairs were with men. She remembered that her husband had brought another woman over to the house and that he was going to do something awful to her, something terrible, and then she saw that the woman had her own mother’s face.

18Katie told me that her husband wasn’t really dead, that he was just playing dead. She thought that someone was planning to hurt the kids – by that point, they were in foster care – and her husband had gone into hiding to protect them. Weird stuff was happening. Her face changed when she looked at it in the mirror. Sometimes her head became sunken in, deformed, like the head of an experimental monkey. She heard voices, she said. She would hear someone saying, “I feel like chicken tonight,” and then someone else would say, “No, let’s have ham.” The voices said that her mom cheated on her dad, that her mother was a whore. They said that they were going to kill her. “I know,” Katie said, “that that’s not normal,” and she shrugged.

19Perhaps because she was the age of my youngest sister, perhaps because I had not thought of her as mad when we began to talk, perhaps just because I was tired, I was less prepared for the shift into a different reality. As Katie began to explain that her husband was not dead and that her face shifted into a monkey’s in the mirror, I felt my grip on the world twist sideways.

  • 2 Leslie Farber, Lying, Despair, Jealousy, Envy, Sex, Suicide, Drugs, and the Good Life, New York, Ba (...)

20In a famous essay, the psychiatrist Leslie Farber wrote that therapists who work with patients diagnosed with schizophrenia go mad themselves.2 I don’t think that is true. Despite these moments, despite my many interviews, I am anchored in the world. But I do think that when you listen to people closely enough to feel that sideways shift, you learn something. For one, you lose the view that madness is a category imposed from the outside. I can no longer imagine that the people we call mad are just misunderstood artists. You also lose the ease of settled categories. The word “voice” describes first and foremost a sound produced in the larynx and uttered through the mouth. We think of it as an audible event. You speak; I hear. The sound is made in the throat and captured by an ear. When we say that someone “hears voices,” we often have in our minds a person who hears the sounds of words in the absence of a speaker. When you spend time with people who are mad, you learn that these events are far more murky.

21And you also learn more about the nature of the shift. I have at this point listened to hundreds of people who meet diagnostic criteria for schizophrenia or its diagnostic cousins. I am struck by the range of their experiences. I find nonetheless that most have three features that help to explain why these experiences feel so alien. These features invite us to think differently about the very nature of the human mind.


  • 3 William James, Principles of Psychology, New York, Dover, 1950 [1890], p. 226.

22Our thoughts feel like ours. When we think, it just feels like something we have done. We no more wonder whether we thought a thought than we wonder whose legs carried us into the kitchen for our tea. To be sure, we are sometimes surprised by our thoughts. Sometimes they pop into our minds and startle us. But for most of us, most of the time, such moments – the unbidden memory of a rainy afternoon in winter; the rasp of your father’s voice; famously, the sudden sharp buttery scent of a madeleine – rarely feel as if they were thought by someone else. William James called this “myness” the most distinctive quality of thought. “The universal conscious fact is not ‘feelings and thoughts exist’ but ‘I think’ and ‘I feel.’”3

  • 4 David Copolov, Tom Trauer & Andrew Mackinnon, “On the Non-Significance of Internal versus External (...)

23Voices are defined more by their not-me-ness – the person feels they did not generate the voice – than by their location in the outer world. People do make both distinctions. I have heard people utter sentences like: “I have two inner voices and three outer ones. The inner voices are meaner but the outer ones are evil.” There is a famous scientific paper by David Copolov and colleagues that finds that there is no difference between these more inner and outer experiences, at least from the perspective of the degree of illness.4

24I don’t think this is quite right.

25A better way to say this is that in madness the lines between perception, thought, and language just break down. The tree uses words and it also speaks, but somehow not from outside the mind. And then the words stutter with meaning and explode. I remember a man whom I met when he was in his forties, living in Chicago and working on his doctorate. He had been very ill, but when we spoke he was well enough that he could describe his symptoms with a naturalist’s eye.

When I was first getting psychosis, I would remember conversations and I can remember the person’s voice in the conversation and so that was when I was first getting ill and then that turned into like having multiple meanings and then the multiple meanings turned me into this chase for meaning and I’d think one meaning and then I would change to another meaning and then I’d go to the next thing and it would have a meaning and then it would change. And I would just go through a progression of all that. But it sounded like I had perceived with my ear, I can perceive with my mind. It feels like a perception inside my head, yes.

26People sometimes use the phrase “audibly in my mind.” They seem to use the phrase to signal how much not-them the voice was, how clear and different. The voice spoke to them. They didn’t think it. It was like a thought imposed from the outside.

A different realness

  • 5 Eugen Bleuler, Dementia Praecox, or Group of Schizophrenia, New York, International Universities Pr (...)

27In 1911, Eugen Bleuler described the experience of hearing voices as a kind of “double book-keeping.”5 Someone could seem utterly convinced of her belief – and yet act as if the belief were not true. She could believe with great confidence that she had killed her psychiatrist, and yet know that she was talking to him, and that he sat five feet away. To the person hearing the voice, the voices feel real, and yet that same person also knows in some basic way that they are not.

  • 6 Matthew Ratcliffe, “The Feeling of Being”, Journal of Consciousness Studies no. 12/8-10 (2005), pp. (...)
  • 7 Carney Landis, Varieties of Psychopathological Experience, New York, Holt, Rinehart and Winston, 19 (...)

28We usually define “real” as existing in the physical world, and not just in someone’s imagination. Reality is an existence claim. The voice did speak; I didn’t make it up. Yet it is also true that, as the philosopher Mathew Ratcliffe points out, we experience realness in many ways as a feeling.6 We feel angry or sad. We also feel lonely, complete, at home, at ease. Ratcliffe calls these “existential” feelings that describe our relationship to the world. For most of us, the sense of realness is usually untroubled, except for moments when we wake up confused out of a vivid dream. The psychiatrist Carney Landis comments that profound reflection on philosophical topics can have the same effect.7 Thus Wittgenstein’s remark in the notebooks that became On Certainty;

  • 8 Ludwig Wittgenstein, On Certainty, New York, Harper & Row, 1969, §467.

I am sitting with a philosopher in the garden; he says again and again “I know that that's a tree”, pointing to a tree that is near us. Someone else arrives and hears this, and I tell him: “This fellow isn't insane. We are only doing philosophy.”8

29Those who are psychotic often have the sense that the voice feels real in this existential sense, and yet they know that the voice did not come from a speaker outside of them and that no one else can hear. They hear someone speaking. At the same time, they often don’t quite believe that there is a person there. So the very evidence of their senses feels unreliable, the way you feel when your new glasses are fitted accidentally with the wrong prescription and, wearing them, you see the world pitch sideways and you know it doesn’t and yet you cannot trust yourself to step off the curb.


  • 9 Vaughan Bell, “A Community of One”, PLOS Biology, no. 11/12 (December 2013), e1001723. https://doi. (...)
  • 10 T.M. Luhrmann, R. Padmavati, H. Tharoor & A. Osei, “Differences in Voice-Hearing Experiences of Peo (...)

30Voices are persons. That’s why so many people interpret them as gods and spirits. Something with a mind is commenting, and the one being spoken to can’t see them. At least, those who hear often cannot see the speaker, although sometimes they then identify one that speaks. Still, they often know who the speaker is. In studies in the west between a third and two thirds of those who hear voices identify specific speakers: family members, celebrities, gods.9 When someone falls ill outside of the west, they are even more likely to hear someone they know in the flesh.10 Others recognize the voice, but give the voice a new name: the Entity, or simply “M.” Some hear an anonymous crowd. But they are other minds, and mostly people.

31You can see the person-ness in the sense of command that so often comes with the voice. The human hears an imperative: “Do this, do that.” “Pray.” “Clean your plate.” “Put on the shirt.” “Jump.” A command is not entirely the same as a presence. I ask people whether the voices are present even when they do not speak. Often, though not always, they say yes. Presence is the strong sense of another being there – maybe watching, maybe sleeping, but an awareness of which you are aware. Sometimes a voice is just a sound made of words. But the voices of madness often command, and command implies an awareness that is not only present but seeking control. If you act, it has won. And so the command feels like a force, pushing, insisting, sometimes always there.

32When I began to teach about psychosis, I would use an old video cassette designed to introduce undergraduates to so-called abnormal psychology. I wanted students to feel the emotional quality of these experiences that are in some ways so familiar and in some so alien. The video illustrated Bleuler’s double book-keeping with a woman screaming full throttle at a man behind a desk, who then broke off to say hello to her doctor – and returned again to screaming. I rarely had time to show the full film. I showed the part I found most moving, about a young man, a musician, who broke both his ankles when he jumped out of a second-story window because the voices told him to jump. They had commanded and commanded, and he kept saying no. Eventually he jumped because they just wouldn’t stop. “I don’t know why it happened,” I remember him as remarking wearily, shaking his head. “In the end I guess you could say that I jumped just because we had a misunderstanding.”

33The voices of madness teach us, I think, that the mind is not a vast immaterial internal universe, or a storage chamber for knowledge, Augustine’s caverns of the mind, but rather an instrument to search for other minds. Madness shows us this search at its most existential. The sense of that search may be one reason madness seems so alien to us. In fact, it should teach us something of who we are.

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1 Janet Malcolm, “Six Glimpses of the Past”, The New Yorker, 22 October 2018. Available at:

2 Leslie Farber, Lying, Despair, Jealousy, Envy, Sex, Suicide, Drugs, and the Good Life, New York, Basic Books, 1976.

3 William James, Principles of Psychology, New York, Dover, 1950 [1890], p. 226.

4 David Copolov, Tom Trauer & Andrew Mackinnon, “On the Non-Significance of Internal versus External Auditory Hallucinations”, Schizophrenia Research, no. 69 (2004), pp. 1-6.

5 Eugen Bleuler, Dementia Praecox, or Group of Schizophrenia, New York, International Universities Press, 1950 [1911], pp. 127-130.

6 Matthew Ratcliffe, “The Feeling of Being”, Journal of Consciousness Studies no. 12/8-10 (2005), pp. 43-60.

7 Carney Landis, Varieties of Psychopathological Experience, New York, Holt, Rinehart and Winston, 1964, p. 352.

8 Ludwig Wittgenstein, On Certainty, New York, Harper & Row, 1969, §467.

9 Vaughan Bell, “A Community of One”, PLOS Biology, no. 11/12 (December 2013), e1001723.

10 T.M. Luhrmann, R. Padmavati, H. Tharoor & A. Osei, “Differences in Voice-Hearing Experiences of People with Psychosis in the USA, India and Ghana: Interview-Based Study”, The British Journal of Psychiatry no. 206 (2015), pp. 41-44.

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Tanya Marie LUHRMANN, « The voices of madness », Terrain [En ligne], 76 | mars 2022, mis en ligne le 03 mai 2022, consulté le 20 mai 2022. URL : ; DOI :

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Tanya Marie LUHRMANN

  Tanya Marie Luhrmann is the Albert Ray Lang Professor at Stanford University, in the Stanford Anthropology Department (and Psychology, by courtesy). Her work focuses on the anthropology of mind, and the way different representations of mind affect spiritual and psychiatric experience – in particular, the voices of spirit and the voices of madness. She was elected to the American Academy of Arts and Sciences in 2003 and received a John Guggenheim Fellowship award in 2007. She is the author of Of Two Minds (Knopf 2000) and How God Becomes Real (Princeton University Press, 2020), and is currently at work on a book entitled Voices.

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