It's caused by a misfire in the brain that creates hallucinations that can be visual or auditory, but usually not both. Whichever you get, the result is often a waking nightmare, with some of the most common symptoms being audible voices that criticize or taunt the victim, or even tempt them to violence. Or at least, that's how it works in America. Travel around the world, and you get a different story altogether.
A Stanford study rounded up 60 adults with schizophrenia: 20 Ghanaians from Accra, 20 Indians from Chennai, and 20 Americans from San Mateo, California. The Americans all rated their audible hallucinations as negative, if not downright fuck-awful, and considered schizophrenia a disease. But some Indians reported their hallucinations as entertaining or playful, and over half perceived them as disembodied advice from their ancestors. Of the Ghanaians, half reported the voices as "predominantly positive" instant messages from God. They didn't even regard it as a disease.
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"Sometimes the voice God even sounds like James Earl Jones. It's dope."
But even among Americans, the assholish nature of our imaginary companions looks to be recent. Researchers compiled patient reports from an East Texas hospital from the 1930s and compared them to those from the same (almost definitely haunted) hospital in the 1980s. The inner voices of the Depression era were harmless and even uplifting, offering helpful messages like "Live right." In comparison, the hallucinations experienced during the Reagan years adopted a sinister tone, urging violent acts against oneself and others.