Hearing voices is a common symptom of severe mental illnesses such as schizophrenia.
Voices can be critical or they can be complementary and many people may be able to find ways to live with them. It's difficult to explain what it is like to hear voices, particularly if you've never heard voices yourself. However, the experience of hearing voices is not as alien as it is generally thought to be.
What's is like to hear voices?
First, it can be the same as hearing a voice in the normal way, through your ears; the difference is that the voice has no physical source. You may think you have never experienced this, but are you sure? You may have had the experience of hearing someone call your name only to find that there is no one there.
Indeed, research shows that, especially for recently bereaved people, it is not uncommon to hear the voice of someone who isn’t actually there speaking to you, or who may even be dead.
It's also common for people to hear voices as if they are thoughts entering their mind from somewhere outside themselves. This is not the same as a suddenly inspired idea, which people usually recognise as coming from themselves. These thoughts are not their own and would seem to come from outside their own consciousness, like telepathy.
A good example of this is the experience of recalling a rhyme or tune, which you find yourself repeating unconsciously under your breath and which keeps going through your head again and again. You can even find yourself humming it. You never took a decision to start thinking of it and it’s difficult to stop thinking about it.
The difference between the tune in your head and a 'voice thought' that appears as words in your mind is that the voice may go on to speak coherently to you and even engage you in conversation. You yourself are not responsible for it and you have no idea what this voice is going to say next.
There are many different ways to hear voices. Voices can be experienced in the head, from outside the head or even in the body. It may be one voice or many voices. The voice may talk to you or about you.
There are other ways to hear voices. Some people experience non-verbal thoughts, images and visions, tastes, smells and touch – all with no physical cause and all sensations that they didn’t call into being themselves.
Voices can be like dreams. We all dream and experience words, images and even sensations. When we are bored we can drift off and have a day dream. When we dream all sorts of strange things can happen to us, but we still believe they’re really happening to us. Hearing voices can be like that – a waking dream that is experienced as real.
For voice hearers, the voices might be present all day and prevent them from doing things in their daily lives. Voices may threaten to punish the voice hearer if they don’t do what the voice wants them to do. people who hear voices may not feel able to talk about them and may become isolated and withdrawn as a result.
Hallucination or human experience?
Hearing voices can be a very disturbing experience, both for the person who hears voices and family and friends. Until recently voices were regarded as a symptom of a mental illness and not talked about because of fear of stigma.
Hearing voices are still considered by psychiatry as an auditory hallucination and as a symptom of conditions such as schizophrenic disorders, manic depression and psychosis. The orthodox treatment is with major tranquillisers. These do not get rid of the voices.
In the past mental health professionals were taught not to let voice hearers talk about their voices as this was thought to be colluding with the person’s delusions and not helpful. Most often professionals sought to distract the voice hearer from their voices.
Research has shown that many people hear voices, and some cope well with their voices, without psychiatric intervention. It has also been found that many people who hear voices regard them as a positive part of their lives.
Throughout history and even today there are people who hear voices who find their voices inspirational and comforting. Many researchers, practitioners and voice hearers believe it is mistaken to regard voice hearing as part of a psychopathic disease syndrome. Rather, they consider it to be more akin to a variation in human experience - a special faculty or difference that definitely does not need a cure.
Finding meaning in voices
Sound research with many voice hearers, both within and outside of mental health services, has found that how voice hearers cope with their voices (or don’t) depends not on the content of the voice experience (which can be either abusive and devaluing or guiding and inspiring – or both) but on the nature of the relationship with the voices. If you believe the voices to be in control you can’t cope; if you believe you are stronger than the voices are, you can.
This means it is no longer a sustainable position to think of voices as part of a disease syndrome, such as schizophrenia. Instead hearing voices can be regarded as a meaningful, real (although sometimes painful, fearful and overwhelming) experience that speak to the person in a metaphorical way about their life, emotions and environment. For instance, people experiencing distress as a consequence of abusive or commanding voices can often recognise their voices as those of their actual abusers and the voices have the effect of attacking their sense of self esteem and worth.
Having discovered these kinds of relationships, psychiatrists and psychologists in the UK and the Netherlands are developing techniques to help voice hearers focus on their experience and get to know their voices better. The new approach helps the voice hearer to make space for the voices, to listen but not to necessarily obey, to engage, but in their own time and space - essentially to learn how to control them within their own explanatory framework. This acceptance of the voices is crucial to growth and resolution. Voice hearers who have learnt these techniques can now say, "I hear voices, they are part of me and I am glad they are".
Practical advice for those hearing voices
Hearing voices can be an overwhelming experience, making it very hard for the voice hearer to manage their life.
These are some of the things voice hearers say can be helpful.
- Talk to other voice hearers – this gives you the opportunity to share experiences and to learn from one another. You can join or set up a self-help groups, such as those established by the Hearing Voices Network throughout the UK.
- Voice hearers say it is important to discuss their voices. This helps you learn to recognise their games and tricks, as well as their good aspects, and to identify patterns that are specific to given situations. This can help you to be better prepared for future onset of voices. Voice hearers may think they are alone in hearing voices. This can lead to feelings of shame or the fear of going mad. Anxiety often leads to the avoidance of situations that might trigger the voices, stopping people leading a full and rewarding life. Anxiety severely restricts freedom of movement, and strategies of avoidance often seem to exacerbate the problem.
- Voice hearers seek explanations to account for their voices. Understanding where the voices come from and why, and what triggers them can be helpful in developing a coping strategy. Unless some meaning is attributed to the voices, it is difficult to establish a relationship with them in order to feel more in control. Approaches that discourage voice hearers from seeking mastery of the voices tend to yield the least positive results.
- In the process of developing your own point of view and taking responsibility for yourself, the essential first step is acceptance of the voices as belonging to you. This is one of the most important and difficult steps to take.
- Voices can express what the voice hearers are feeling or thinking – for instance, aggression or fear about an event or relationship. It is the feelings that are important here, not the voices. When the voices express such views, it can be valuable to discuss the messages with someone you trust.
- When you hear voices that are malicious it is difficult to accept the existence of a positive, helpful dimension to the experience. Contact with other voice hearers can lead to the discovery that positive voices exist, and the realisation that these can be detected, as a result of acceptance of your negative feelings. Imposing a structure on the relationship with the voices helps minimise feelings of powerlessness. It is valuable to see that you can set your own limits and restrain the voices from excessive intrusion on your life.
- Sharing experiences enables voice hearers to get to know what medicines others are using, how useful these are, and what their side effects may be. It is important, for example, to know whether a particular medicine is helpful in reducing the hearing of voices or easing anxiety and confusion.
- Sharing knowledge about voices with families and friends can be helpful. If family and friends can accept the voices they can be more supportive. This can make voice hearers’ lives easier, improving their confidence in social situations.
- Voice hearers who have learned to adjust to their experiences report that the process has contributed to their personal growth. Personal growth can be defined as recognising what you need in order to live a fulfilled life, and knowing how to achieve these ends.
- Communicating about voices has its disadvantages. Voice hearers can feel very vulnerable; some voice hearers find great difficulty in opening up about their experiences, although it can be easier with other voice hearers. Another drawback is that the voices may become temporarily more acute when you start talking about them. All in all, though, the advantages outweigh the disadvantages.
- Finally, it is most important to recognise the wide variety of individual situations and circumstances. The best advice is to try to increase the voice hearer’s influence over their voices, rather than intensify their powerlessness.
Practical advice for family, friends and mental health workers
To assist voice hearers, mental health professionals need to find out which frames of reference and coping strategies seem to be the most useful to the voice hearer. By doing so voice hearers can be supported more effectively in their attempts to deal with their experiences. Self-determination and self-knowledge are the key.
- Accept the voice hearer’s experience of the voices. The voices are often felt as more intense and real than sensory perceptions.
- Understand the different languages used by the voice hearer to describe and account for their experiences, as well as the language spoken by the voices themselves. There is often a world of symbols and feelings involved.
- Help the individual to communicate with the voices. This may involve differentiating between good and bad voices and accepting the voice hearer’s own negative emotions. This acceptance may make a crucial contribution to the promotion of self-esteem.
- Encourage the voice hearer to meet other people with similar experiences and to read about hearing voices, in order to help overcome isolation and taboo.