Psychiatric frameworks fail to capture unusual perceptions and voice hearing in young people

A recent study indicates that conventional psychiatric frameworks may be insufficient in understanding unusual perceptual experiences and thoughts (UPTBs) among young people.

Published in Irish Journal of Psychological Medicine Conducted by researchers from the Royal College of Physicians in Ireland, the study underscores the need for a more nuanced understanding of the phenomena often labeled as psychotic experiences, especially when they manifest outside of clinical settings.

Led by Helen Coughlan, the researchers sought to describe the characteristics of UPTBs in young adolescents and examine how these individuals interpret their experiences. The study identifies three main ways in which young people make sense of their UPTBs: normalizing them, externalizing them, and distancing them from psychiatric explanations. The authors state:

“The results of this study offer new insights into the phenomenological qualities and characteristics of UPTBs in young adolescents. They also reveal that early adolescents may not make sense of their experiences within a psychiatric framework. These findings highlight the need to develop a more phenomenologically sensitive and nuanced approach to studying UPTBs in youth.”

The researchers call for an anthropologically informed and culturally sensitive approach to understanding these experiences.

The study aimed to describe the lived experiences of TBUP among young adolescents and investigate their interpretations. To accomplish this, data were extracted from the Adolescent Brain Development Study, a longitudinal research project in Ireland. Initially, 211 participants were interviewed about UPTBs. Three researchers independently reviewed these interviews. After a consensus meeting, 53 participants who met the criteria for UPTBs were determined, forming the sample of the present study.

The clinical interview notes of these 53 participants were categorized into four types: auditory verbal phenomena (hearing voices), non-verbal auditory phenomena (hearing other sounds), non-auditory perceptual phenomena (experiencing images, smells and tactile sensations) and unusual. thoughts and beliefs. The researchers then discerned themes about how participants understood their UPTBs.

Of the 53 participants, 48 ​​reported hearing voices. For 14, voice hearing was the only unusual perception observed. This experience was relatively rare; a third of those who reported it only heard voices on a few occasions. More commonly, participants reported hearing multiple voices, often of adult timbre, rather than a single voice or children’s voices. Some even described voices that advised against dangerous actions.

The study identified three overlapping themes about how participants interpreted their UPTBs: normalization, externalization, and distancing from psychiatric narratives. “Normalization” was the most common approach, where participants saw their experiences as figments of imagination, memories or mind tricks. Nearly three-quarters of participants used this explanation for at least one UPTB, and for about 40% it was the only explanation provided.

‘Externalization’ was also prevalent, with participants attributing their experiences to external entities such as gods, demons, ghosts or aliens. Ghosts were the most cited external force. While more than half endorsed paranormal beliefs, 40% specifically attributed their UPTBs to non-human external forces. While most were open to non-paranormal explanations, a minority were not. About a third said friends and family shared their paranormal beliefs.

If participants’ explanations diverged from psychiatric theories, the investigators coded this as “distancing”. Nearly all participants exhibited some level of detachment, although only two explicitly stated it. The authors suggest that this may be because young adolescents have limited exposure to psychiatric concepts.

An additional theme of “uncertainty” was found in many participants’ explanations. About 66% were unsure about the origins of their UPTBs, leading to an attempt to understand their experiences.

The study had limitations, including the use of interview notes rather than audio recordings and a small, localized sample size, which restrict its wider applicability. Participants used were all young adolescents recruited for a research study in Ireland, significantly limiting generalizability to other populations. The authors conclude:

“We propose that a more nuanced understanding of the meaning of different dimensions of early UPTB experiences may yield greater insights into how benign or clinically relevant different phenomena may be, particularly in the context of high levels of paranormal beliefs underlying the experiences, which were previously found no strong associations with psychopathology or impaired functioning.”

Previous research has shown that mental health professionals and patients often disagree about the causes of symptoms. This aligns with the “distancing” theme identified here. Studies recommend that effective treatment of psychosis in Pakistan requires understanding local supernatural beliefs. Given the paranormal explanations endorsed in this study, a similar understanding may be essential for the treatment of adolescents in Ireland.


Coughlan, H., Healy, C., Humphries, N., Clarke, M., Kelleher, I., & Cannon, M. (2020). Phenomenological features and explanations of unusual perceptual experiences, thoughts, and beliefs in a population sample of precocious adolescents. Irish Journal of Psychological Medicine, 39(2), 173184. (Link)

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