If mental experiences are inherently influenced by biological and psychological processes, then human experience is intrinsically subjective. Given that these limits apply to the cognitive processes of all human beings, no individual can claim to adopt a viewpoint that is truly objective[…] Rather than hallucinations being an aberration standing in contrast to a normal, objective experience of reality, skepticism can help us to see that all experiences of reality are subjective and contextualized within our own unique life-worlds. Our perceptions don’t just passively record external reality, but reveal the personalized dimensions of our own individual understandings of the world.“Skepticism, Psychosis, and Hallucinations as Evidence for Our Beliefs,” Bradley Astra Aldridge
In this thoroughly-researched essay, Bradley Astra Aldridge argues for the benefits of accepting voices as a meaningful part of subjective reality, approaching the topic from a philosophical perspective grounded in skepticism. Tightly argued and drawing on a wide body of literature – including philosophy, psychology, and anthropology – this thought-provoking article expands on the link between trauma and voice-hearing to propose that all perception is ultimately shaped by the personal beliefs and experiences of the perceiver.
About the author: Bradley Astra Aldridge is a voice-hearer and undergraduate philosophy student at the University of British Columbia. He has previously worked as a facilitator of hearing voices groups.
Skepticism, Psychosis, and Hallucinations as Evidence for Our Beliefs
By Bradley Astra Aldridge
Sextus Empiricus was a physician and ancient philosopher who argued that human beings should be suspicious of our capacity for knowledge, and of the means through which we commonly understand ourselves as acquiring knowledge. According to Sextus Empiricus, we should restrict the truth claims we make to the realm of appearances only. I will argue that this version of skepticism anticipates and is supported by 21st Century trauma-informed and enactive understandings of mental experience, and that the implications these theories have for the nature of differing perceptions–especially hallucinations–are similar to the implications of the argument presented by Sextus Empiricus. Drawing on recent innovations in psychosocial treatments for hearing voices, I will argue that the “tranquility” (Empiricus 5, par. 10) described by Sextus Empiricus as following from his way of thinking can be found in parallel form in the success of trauma-informed understandings of hearing voices that encourage participants to let go of making judgements as to whether or not the voices they hear are ‘objectively real’ or ‘not real,’ and instead to accept them as they appear to be. First, I will briefly outline some of the arguments made by Sextus Empiricus in support of his view, and then I will describe a potential objection to his view from exclusively biological understandings of hallucinations. I will then examine how trauma-informed and enactive critiques of an exclusively biological model support the views of Sextus Empiricus, and how the psychological benefits to voice-hearers from using these frameworks of understanding provide a modern example of tranquility following from skepticism.
Sextus Empiricus makes use of several examples to support his conclusion that human beings cannot comprehend reality beyond the level of mere appearances. He postulates that given our different bodies and minds, the sensory perceptions of human beings are distinct from the sensory perceptions of various animals, and he further speculates that the perceptions of animals must vary from species to species. An additional example is given of perceptions differing amongst human beings themselves. Some humans may experience a particular food as being pleasant, while others experience it as being repulsive. Furthermore, Sextus Empiricus argues that the perception of the exact same object may vary within the experiences of a single individual, depending on which sense is used to perceive the object. Sextus Empiricus gives the example of honey, which is “pleasant to the tongue” yet simultaneously “unpleasant to the eyes” (Empiricus 24, par. 92). Sextus Empiricus concludes that we cannot know whether honey is fundamentally pleasant or unpleasant, as there is equal evidence on either side. Additionally, Sextus Empiricus describes how some human beings enter altered mental states where they perceive things that are not perceived by other people. Rather than arguing that any of these conflicting perceptions represents objective truth, Sextus Empiricus argues that human beings should suspend our judgement about what is ultimately true, and instead speak in terms of appearances.
An objection to this argument can be found in biological models of mental illness and hallucinations. Sextus Empiricus argues that one of the reasons we do not have the ability to gain knowledge beyond mere appearances is because of the diversity in subjective human mental experience. Sextus Empiricus states that “people who are delirious or divinely possessed believe that they hear spirits, while we do not” (Empiricus 27, par. 101). In a biological model of human experience, a person hearing spirits that other people cannot hear can be classified as experiencing auditory verbal hallucinations, a symptom of a psychotic disorder, such as schizophrenia. In some conceptualizations of schizophrenia, auditory hallucinations are “a symptom of brain disease just like blindness or hemiplegia” (Stephane et al. 186). In this view, hallucinations cannot meaningfully tell us about the world because they are inseparable from the context of disease which produced them. Some theorists have gone so far as to describe the beliefs found in psychosis as not merely being false, but as not even being beliefs at all, as “empty speech acts that disguise themselves as beliefs” (Berrios 8). According to this view, Sextus Empiricus is mistaken in placing the perceptions of those who hallucinate spirits on equal footing with those who do not, for the seeing of spirits is not a perception, but a symptom. Finally, the biological view of hallucinations can be used to argue against skeptical claims that the average person could be hallucinating at any time. If schizophrenia is a genetic illness and hallucinations only occur within the context of such an illness, then it can be argued that there are no grounds on which the mentally healthy should fear that their reliable sensory perceptions are actually hallucinations.
A purely biological model of mental illness is, however, not without its critics. One such approach is enactive psychiatry, a framework of mental distress that emphasizes the environmental context in which the bodies that contain minds find themselves in, rather than considering the mind as a separate, self-contained entity. Just as Empiricus postulated that different animals see the world differently from each other and from us, one supporter of enactive psychiatry has written:
To us, for instance, a poised rattlesnake is dangerous and thus frightening, a dark-pink raspberry is delicious and thus attractive, and a cool lake on a hot day is refreshing and thus pleasing. For an eagle, the rattlesnake may be food and thus appealing when she’s hungry, whereas she might not even see the raspberries as they mean nothing to her.(de Haan 8)
In this enactive view of psychiatry, hallucinations are meaningful perceptions, because all perceptions of reality are inherently subjective. There is no objective external world, existing out there, waiting to be seen by accurate eyes, or misinterpreted by diseased minds. Rather, there is a complex network of stimuli that is always perceived from the unique perspective of the viewer. Neither the human perceiving a rattlesnake as frightening nor the eagle perceiving the rattlesnake as delicious are objectively correct in their perceptions of the rattlesnake. There is no objectively correct perception, as we can never step outside of our own mind, our own beliefs, our own past memories, or the way in which each of these factors actively influences our perceptions. This affirms the view of Sextus Empiricus that conflicting perceptions can both present equal–and opposite–evidence.
Another critique of understanding hallucinations as biological malfunctions without meaning comes from considering the philosophical implications of suggesting the experiences of those diagnosed with mental illnesses are biologically caused. First, let us consider a passage from Sextus Empiricus, in which he outlines why he accepts the perceptions of spirits as evidence. Sextus Empiricus rejects the idea of blaming aberrant experiences on the “mixing of certain humours,” pointing out that “healthy people too have mixed humours” (Empiricus 27, par. 102). While using the framework of humours to explain a human being’s mental experience is severely outdated, the underlying idea is not. The point Sextus Empiricus is making is that however different the experiences of the severely mentally distressed may be, they have the same variety of minds, bodies, and neurological processes as the rest of us. It would be contradictory to characterize the lives, decisions, and perceptions of those diagnosed with mental illness as being entirely caused by biological processes in their brains beyond their own control, while simultaneously characterizing those without diagnoses as being completely free agents and perceivers of objective reality, uninfluenced and unimpeded by their own minds. The thoughts, perceptions, emotions, and beliefs of the undiagnosed are also filtered through and influenced by biological processes in their brains. A strikingly similar argument to the one made by Sextus Empiricus about humours is presented in a contemporary discussion of the ethics of involuntary treatment, and whether or not patients are responsible for their behaviour: “[i]t would be an odd universe indeed if the will and choices of psychiatric patients in general were causally determined by their neurobiology, while those of other people were not” (Lundahl et al. 698). In other words, however much there may be genuine differences in the experiences of those diagnosed with mental illness and those who are not, surely the underlying processes at work–and whether or not those processes impact our perceptions–must be the same, even if in one case these processes are considered to be functioning optimally, and in another they are considered to have gone awry.
Further evidence that Sextus Empiricus is correct to classify hallucinations as part of the human experience comes from trauma-informed approaches to understanding psychosis. Recent investigations have found traumatic events, and childhood sexual abuse in particular, to be common in the life histories of those who hear voices. One author has summarized the findings of research by bluntly stating that “experiencing multiple childhood traumas is associated with voice-hearing to an extent comparable to the association of smoking with lung cancer” (McCarthy-Jones 133). Voice-hearing is also linked to trauma in individuals who do not meet the criteria for schizophrenia. One study found that as many as two thirds of a sample of combat veterans with PTSD reported hearing voices (Brewin and Patel 424). Voice-hearing is also commonly reported during bereavement, including in those without any psychiatric diagnosis whatsoever (Hayes and Leudar 194). There are also healthy individuals who hear voices in spiritual contexts, such as Evangelical Christians who report hearing an audible voice of God in response to prayer (Luhrmann, When God Talks Back 133-144) and some individuals working as psychics (Powers et al. 84).
In light of this new evidence, psychosocial approaches to hallucinations have been developed that intend to listen to the actual content of what is experienced. Voices are “assumed to be personally (and perhaps socially) significant experiences that are richly informed by and embedded in the external world, and can thus provide a valuable window of insight” (Higgs 134). In this framework, the significance of the difference between a ‘real’ experience and one that is hallucinated disintegrates, with the broader understanding that voices can “inspire such profound and fundamental changes in [the voice-hearer’s] social, emotional, and cultural experience as to possess the equivalent ‘primitive immediacy’ of a genuine sensory incident” (Longden et al. 28).
This trauma-informed approach challenges a purely biological model. If going to war, being sexually abused as a child, having a loved one die, or developing a spiritual practice can cause a person to hallucinate, then hallucinations cannot be considered as belonging to a fundamentally separate genetic domain. Hallucinations are a part of human experience as a whole, and the mentally healthy individual cannot appeal to a supposedly infallible mind that is incapable of hallucinating. All human minds are inherently subjective, and there is no purely objective experience of actual reality held by the undiagnosed, and distorted by the mental processes of the diagnosed. If mental experiences are inherently influenced by biological and psychological processes, then human experience is intrinsically subjective. Given that these limits apply to the cognitive processes of all human beings, no individual can claim to adopt a viewpoint that is truly objective and outside the influence of their own cognitive processes. Rather than hallucinations being an aberration standing in contrast to a normal, objective experience of reality, skepticism can help us to see that all experiences of reality are subjective and contextualized within our own unique life-worlds. Our perceptions don’t just passively record external reality, but reveal the personalized dimensions of our own individual understandings of the world.
This change in our understanding of reality from objective to subjective is not regarded as a loss by Sextus Empiricus. On the contrary, he regards it as a gain, or even a blessing. To be skeptical is to experience tranquility. Modern trauma-informed approaches to hearing voices demonstrate a practical example of this tranquility. In the previously discussed biological view of hallucinations, to hear a voice is to experience an absence. A voice is “a percept-like experience in the absence of appropriate stimulus” (Longden et al. 28). It is in a very literal sense not real. The controversial response of trauma-informed understandings is exactly the opposite: it argues for “accepting the voices as a real experience” (Corstens et al. 288). This is a radical statement. That which is caused by no known physical entity, that whose origin cannot be determined, that which appears to be a phantom, an illusion, a mirage, is real, is meaningful, is existing, is worthy of consideration.
The evidence for the value of this perspective on hearing voices is the impact it has on voice-hearers who believe it. Some voice-hearers report profound changes in their relationships to themselves, their voices, and other people as a result of accepting the voices as real experiences, rather than regarding them as an error to be eliminated (Gray 1007). This experience of recovery is not only perceived internally by voice-hearers themselves, but can be observed by outsiders. New evidence finds that in contrast to individuals who adopt exclusively biological views and as a result “perceive their experiences as globally destructive and causally independent from life-context[,]” have worse “long-term outcomes” than individuals who embrace “psychosis as internally generated, amenable to change, and a source of potential information about psychosocial conflicts” (Longden et al. 58). It would appear that with regard to voices, Sextus Empiricus is correct that a sense of peace can come from the suspending judgement as to whether or not our sensory experiences are real, and instead accepting them as being what we appear to be experiencing, regardless of what might be said to be objectively true.
Finally, there is some evidence to suggest that this principle applies in the opposite direction, that being concerned with what is real and what is not real can lead to distress. In her research on how people come to hear the voice of God in spiritual–rather than psychiatric–contexts, Luhrmann has found that “attend[ing] to the stream of their own consciousness like eager fishermen” leads some individuals to begin hearing God speaking (“The Art of Hearing God” 141). For individuals who desire and value the experience of hearing God’s voice, this is not a problem, but solution. However, there is evidence that similar psychological processes may be at play in distressing voices that the voice-hearer does not experience as having spiritual value. A review of studies comparing the capacity for monitoring the source of an experience as being internal or external in patients diagnosed with schizophrenia who hear voices, patients diagnosed with schizophrenia who don’t hear voices, and individuals without any diagnosis found that patients diagnosed with schizophrenia have more difficulty distinguishing between what external to them and what is produced by their own consciousness, and that patients who reported hearing voices had a greater difficulty than patients who did not report that experience (Waters et al. 745-746). The authors theorize that there are two crucial and interrelated processes involved in the formation of hallucinations: the “alienation” of self-experience, so that thoughts, sensations, or ideas produced by a mind are not recognized as being self-produced by the person whose mind produced those ideas, and “misattribution” of the same experience, wherein the disowned experienced is attributed to a distinct entity (Waters et al. 747). This could imply a similar type of mental process as Luhrmann hypothesizes for individuals who report enriching experiences of the voice of God, with the notable difference that this process can also produce distressing experiences. Being preoccupied with whether or not a voice-hearing experience is real could exacerbate the pre-existing cognitive processes which may have contributed to the voice-hearing in the first place. Being concerned with identifying hallucinations as though they were foreign invaders of the mind, and then suppressing them, may worsen the experience of hallucinations by reinforcing the underlying experience of alienation at the core of the process. By contrast, an approach to voices that encourages the voice-hearer to accept the voices as they appear, which is to say, as real, can bring about comfort and reduce the feeling of alienation by welcoming the voice experience back into the subjective world of the voice-hearer.
In summary, the ancient skepticism of Sextus Empiricus is relevant to contemporary understandings of hallucinations, particularly the experience of hearing voices. While exclusively biological views of mental distress support the idea that hallucinations are meaningless byproducts of an illness, competing psychosocial views of the experience situate hallucinations in a meaningful social context. Just as Sextus Empiricus argued that we cannot know whether the person who sees spirits or the person who doesn’t is correct, understandings of free will and responsibility in psychiatric patients compel us to realize that it would be contradictory for those with psychiatric diagnoses to be completely at the mercy of biological processes in their minds, while others are not. Enactive psychiatry provides an illustration of how all our sensory perceptions–hallucinations or not–exist within a subjective mental context. Trauma-informed understandings of the experience of hearing voices suggest the experience is not merely a symptom of an illness, but a messenger with meaning. The success of these trauma-informed approaches in bringing about recovery in the lives of voice-hearers further reinforces the truth in the skepticism of Sextus Empiricus. Accepting that voices appear as a real experience can lead to tranquility to voice-hearers, while designating them as an alien other to be monitored and suppressed can lead to distress. That tranquility can follow from withholding belief about the ultimate nature of reality and accepting voices as they appear to be, as in the framework of Sextus Empiricus, demonstrates that voice-hearing is an experience with potentially deep philosophical meaning for everyone, and not just the voice-hearer, and that contemplating the nature of this experience can lead to new perspectives on the nature of perceptions and reality in general.
- Berrios, G. E. “Delusions as ‘Wrong Beliefs’: A Conceptual History.” British Journal of Psychiatry, vol. 159, no. S14, Nov. 1991, pp. 6–13., doi:10.1192/s0007125000296414.
- Brewin, Chris R., and Trishna Patel. “Auditory Pseudohallucinations in United Kingdom War Veterans and Civilians with Posttraumatic Stress Disorder.” The Journal of Clinical Psychiatry, vol. 71, no. 04, 9 Mar. 2010, pp. 419–425., doi:10.4088/jcp.09m05469blu.
- Corstens, Dirk, et al. “Emerging Perspectives from the Hearing Voices Movement: Implications for Research and Practice.” Schizophrenia Bulletin, vol. 40, no. 4, 13 June 2014, pp. 285–294., doi:10.1093/schbul/sbu007.
- De Haan, Sanneke. “An Enactive Approach to Psychiatry.” Philosophy, Psychiatry, & Psychology, vol. 27, no. 1, Mar. 2020, pp. 3–25., doi:10.1353/ppp.2020.0001.
- Empiricus, Sextus. Outlines of Scepticism. Edited by Julia Annas and Jonathan Barnes, Cambridge University Press, 2007.
- Gray, B. “Hidden Demons: A Personal Account of Hearing Voices and the Alternative of the Hearing Voices Movement.” Schizophrenia Bulletin, vol. 34, no. 6, 9 Aug. 2008, pp. 1006–1007., doi:10.1093/schbul/sbn099.
- Hayes, Jacqueline, and Ivan Leudar. “Experiences of Continued Presence: On the Practical Consequences of ‘Hallucinations’ in Bereavement.” Psychology and Psychotherapy: Theory, Research and Practice, vol. 89, no. 2, 16 July 2015, pp. 194–210., doi:10.1111/papt.12067.
- Higgs, Rory Neirin. “Reconceptualizing Psychosis: The Hearing Voices Movement and Social Approaches to Health.” Health and Human Rights, vol. 22, no. 1, June 2020, pp. 133–144.
- Longden, Eleanor, et al. “Dissociation, Trauma, and the Role of Lived Experience: Toward a New Conceptualization of Voice Hearing.” Psychological Bulletin, vol. 138, no. 1, Nov. 2011, pp. 28–76., doi:10.1037/a0025995.
- Luhrmann, T. M. “The Art of Hearing God: Absorption, Dissociation, and Contemporary American Spirituality.” Spiritus: A Journal of Christian Spirituality, vol. 5, no. 2, 2005, pp. 133–157., doi:10.1353/scs.2006.0014.
- Luhrmann, T. M. When God Talks Back: Understanding the American Evangelical Relationship with God. Vintage Books, 2012.
- Lundahl, Antoinette, et al. “Against Ulysses Contracts for Patients with Borderline Personality Disorder.” Medicine, Health Care and Philosophy, vol. 23, no. 4, 16 July 2020, pp. 695–703., doi:10.1007/s11019-020-09967-y.
- McCarthy-Jones, Simon. Can’t You Hear Them?: The Science and Significance of Hearing Voices. Jessica Kingsley Publishers, 2017.
- Powers, Albert R., et al. “Varieties of Voice-Hearing: Psychics and the Psychosis Continuum.” Schizophrenia Bulletin, vol. 43, no. 1, 7 Oct. 2016, pp. 84–98., doi:10.1093/schbul/sbw133.
- Stephane, Massoud, et al. “The Internal Structure of the Phenomenology of Auditory Verbal Hallucinations.” Schizophrenia Research, vol. 61, no. 2-3, June 2003, pp. 185–193., doi:10.1016/s0920-9964(03)00013-6.
- Waters, Flavie, et al. “Self-Recognition Deficits in Schizophrenia Patients with Auditory Hallucinations: A Meta-Analysis of the Literature.” Schizophrenia Bulletin, vol. 38, no. 4, 8 Dec. 2010, pp. 741–750., doi:10.1093/schbul/sbq144.