Psychiatric frameworks fail to capture unusual perceptions and voice-hearing in youth


A recent study indicates that conventional psychiatric frameworks might fall short in comprehending unusual perceptual experiences and thoughts (UPTBs) among young people.

Published in the Irish Journal of Psychological Medicine by researchers from the Royal College of Physicians of Ireland, the study underscores the necessity for a more nuanced comprehension of phenomena often labelled as psychotic experiences, particularly when they manifest outside 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 primary ways young people make sense of their UPTBs: by normalizing them, externalizing them, and distancing them from psychiatric explanations. The authors state:

“Findings from 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 young people.”

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


The study aimed to describe the lived experiences of UPTBs among young adolescents and investigate their interpretations. To achieve this, data was drawn 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 were determined to meet the criteria for UPTBs, forming the sample for the current study.

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

Out of 53 participants, 48 reported hearing voices. For 14, voice hearing was the only unusual perception noted. This experience was relatively rare; one-third of those reporting it had only heard voices on a few occasions. Most commonly, participants reported hearing multiple voices, often of adult timbre, rather than a single voice or childlike voices. Some even described voices that advised against dangerous actions.

The study identified three overlapping themes concerning how participants interpreted their UPTBs: normalizing, externalizing, and distancing from psychiatric narratives. ‘Normalizing’ was the most common approach, where participants viewed their experiences as figments of imagination, memories, or mind tricks. Almost three-quarters of participants used this explanation for at least one UPTB, and for about 40%, it was the sole explanation provided.

‘Externalizing’ was also prevalent, with participants attributing their experiences to external entities like gods, devils, ghosts, or aliens. Ghosts were the most commonly cited external force. While over half endorsed paranormal beliefs, 40% specifically attributed their UPTBs to non-human external forces. Although most were open to non-paranormal explanations, a minority were not. About one-third stated that friends and family shared their paranormal beliefs.

If participants’ explanations diverged from psychiatric theories, researchers coded this as ‘distancing.’ Nearly every participant exhibited some level of distancing, though 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 a tentative understanding of their experiences.

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

“We propose that a more nuanced understanding of the significance of different dimensions of early UPTB experiences may yield greater insights into how benign or clinically relevant differing phenomena may be, particularly in the context of high levels of paranormal beliefs underlying experiences, which have previously been found not to have strong associations with either psychopathology or impaired functioning.”

Prior research has shown that mental health professionals and patients often disagree about symptom causes. This aligns with the “distancing” theme identified here. Studies have recommended 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 treating adolescents in Ireland.



Coughlan, H., Healy, C., Humphries, N., Clarke, M., Kelleher, I., & Cannon, M. (2020). Phenomenological characteristics and explanations of unusual perceptual experiences, thoughts and beliefs in a population sample of early adolescents. Irish Journal of Psychological Medicine39(2), 173–184. (Link)


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Richard Sears teaches psychology at West Georgia Technical College and is studying to receive a PhD in consciousness and society from the University of West Georgia. He has previously worked in crisis stabilization units as an intake assessor and crisis line operator. His current research interests include the delineation between institutions and the individuals that make them up, dehumanization and its relationship to exaltation, and natural substitutes for potentially harmful psychopharmacological interventions.