Trauma can contribute to voice-hearing but is not necessary for it. This article uses ethnographic and other data to show multiple pathways to voice-hearing in both clinical and nonclinical populations, excluding known causes like drugs or epilepsy. Trauma sometimes plays a major role, sometimes a minor role, and sometimes no role at all. Distinct phenomenological patterns in voice-hearing may reflect different salience of trauma for those who hear voices.
People with psychosis actively struggle to decide whether their experiences come from the real world or a disordered mind. In interviews with 19 individuals diagnosed with psychotic disorders, most described ongoing efforts to weigh secular and supernatural explanations, often blending different frameworks. This syncretic process shaped not only the content of delusions or hallucinations but also the reasoning used to justify interpretations. The findings challenge oversimplified ideas about insight and suggest that the polarization between biomedical and psychosocial explanations may not reflect patients' real-world experiences.