Public understanding of different kinds of voice-hearing experiences: Causal beliefs, perceptions of mental illness, and stigma.

Objective: Voice-hearers tend to face a high degree of stigma that can impact subjective well-being and social functioning. However, researchers have hypothesized that the content of the voice-hearing experience and its cultural context are relevant to stigma responses. This study experimentally tested how perceptions of voice-hearing experiences change as a function of the voice's content and the perceiver's characteristics. Method: In total, 143 nonclinical participants were presented with vignettes describing people who heard voices that were attributed to either "God" or "Abraham Lincoln" and were described as either complimentary/encouraging or insulting/threatening. For each vignette, participants were asked about the likelihood that the voice-hearer had schizophrenia or mental illness. The Causal Beliefs Questionnaire was also delivered, with two new subscales added to test for belief in positive and negative religious causes for the voices. Stigma was measured by perceived dangerousness and desire for social distance. Results: Voice-hearing experiences elicited greater stigma from participants who endorsed greater likelihood that the voice-hearer was mentally ill, greater belief in biological causes of the voice-hearing, negative religious causes, psychosocial causes, socialization causes, and causes related to personal responsibility. Endorsing positive religious causes was associated with lower stigma. Participants who were more religious were more likely to attribute voice-hearing experiences to negative religious causes (possession, lack of/misguided faith), except when the target was described as hearing the voice of God saying positive things. Conclusions and Implications for Practice: The stigma of voice-hearing experiences depends upon what the voice is saying and perceptions about the cause of the voice.