- ‘Hearing voices’ can occur in asylum seekers.
- The voices may arise from traumas they suffered in the country they fled.
- They may also arise from fears caused by the asylum system in the country they seek refuge in.
- What the voices say can make sense, given what the person is going through.
- Safety and community are central to mental health.
“Fear” writes Veronica Roth in Divergent, “doesn’t shut you down; it wakes you up”.†
But it may also awaken others within you.
I say this in the context of having just read a report on the effects of the asylum procedure on asylum seekers’ mental health.
The authors are clear that prolonged legal insecurity, the obligation to move from one center to another, and isolation, among other factors, contribute to mental health deterioration.
Trauma and hearing voices
It is well known that many refugees suffer post-traumatic stress disorder (PTSD) as a result of traumas they experienced in the country from which they fled. This often includes ‘hearing voices’.
For example, a Danish study found 17% of refugees with PTSD, most of whom had experienced torture and imprisonment, heard voices. Such findings have previously led me to argue that hearing voices should be recognised as a potential symptom of PTSD.
We tend to focus on the potential for voice-hearing to arise from events that happened in the country from which the person is fleeing . Yet this should not obscure a potential role for events that happen to them in the country to which they flee.
Take, for example, this quote from a paper by Richard Bentall and Charles Fernyhough:
“Incidence rates [of psychosis] are greatest in those immigrants who are living in neighborhoods in which they form a clear minority, suggesting that discrimination, experiences of social defeat and powerlessness, and/or lack of social support may be important in conferring risk of illness.”
Indeed, the report I just read highlights that the stresses of the asylum seeking process in the ostensibly safe country a person flees to, may also lead to hearing voices.
What is also notable about this report is that they quote a psychologist describing voice-hearing in this context as a normal reaction to a frightening situation. This portrays hearing voices not as a sign of madness, but a manifestation of fear.
In the report, this happens in the case of Dilraj.
Dilraj was a 30-year-old Indian asylum seeker referred to a center for victims of torture in Greece. His doctor said he had “a clear case of post-traumatic stress disorder.” Dilraj was living alone in hotel room in an old building used to house asylum seekers.
He felt socially isolated and was scared to leave his home as he didn’t know many other members of the Sikh community. Due to personal financial reasons, he was forced to move out of his small hotel room.
Put into shared accommodation, he accused his roommate from Pakistan of spying on him. Voices and paranoia began, and he was hospitalized as a result.
Many of the voices he heard were those of authority figures, including officials in Greece. The authors note that Dilraj seemed to be as scared of the Greek authorities as he was of the people who tortured him in his country of origin. He was unsure of whether or not asylum would be granted to him, and this made him even more afraid.
Given his situation, it is not a puzzle why the voices said what they did. One voice said: “You will be homeless you will be homeless.” Another said: “They will not believe you, they will send you back to India.”
His psychologist stated “What he hears is normal, it’s his fear”
Safety and mental health
This situation is unlikely to be limited to PTSD. People with other diagnoses, such as schizophrenia and borderline personality disorder (and even some with no psychiatric diagnosis), may also have their voices rooted in their fears.
Indeed, the hypervigilance theory of voice-hearing proposes that some people’s voice-hearing may be rooted in the way our threat-detection system evolved to work.
For example, imagine you are in the woods and hear a twig snap behind you. You may panic and think it is a bear. If you turn out to be mistaken (a ‘false positive’), you may feel a bit foolish as a result. But if you had just carried on walking, assuming it wasn’t a bear, when it actually was (a ‘false negative’), then the cost of your mistake would be much greater.
Evolution is prejudiced – it favours those who don’t get eaten – and as a result we have a threat detection system that is going to result in a lot of false positives. The hypervigilance theory of voice-hearing proposes this contribute to people’s tendency to hear threatening voices even when they are not actually there.
More generally, we may ask how many people’s mental health could be facilitated simply by making them feel safer?
Many, it would appear. Indeed, perceived safety has often been linked to mental health, such as in the manner below (taken from this paper):
However, as usual, the answer may not be as straightforward as one imagines. One study (referenced here, but which I can’t track down) reported that people suffering from psychosis who lived in areas with high perceived community safety actually had higher hospital readmission rates. This was proposed to be because of low community tolerance of unusual behaviour.
Nevertheless, it is clear that Dilraj’s experiences of the asylum system in Greece had a negative effect on his mental health.
Dilraj sought safety and was given fear.
Society needs to do better.
You can read the report at: http://nccr-onthemove.ch/highlights-2/highlights-2-5-2/
† Of course, in reality, there are a range of responses to fear – see here for more.
I give a fuller discussion of ‘hearing voices’, as well as their links with trauma, in my book “Can’t You Hear Them? The Science and Significance of Hearing Voices“