Hearing voices

It is estimated that between 5% and 28% of the general population hears voices that other people do not.1

Hearing voices is an auditory hallucination that may or may not be associated with a mental health problem. It is the most common type of hallucination in people with psychotic disorders such as schizophrenia.2 However, a large number of otherwise healthy individuals have also reported hearing voices.

Symptoms

It is difficult to describe what it is like to hear voices, particularly if you’ve never heard voices yourself. Persons have described them as the voice of someone standing right next to them, or as voices that are thought-like. Some persons have reported experiencing a combination of both.The voices heard can be critical, complementary or neutral. They may give you commands that are potentially harmful. They may even engage you in conversation.4

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..

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.

For some voice hearers, the voices might be present all day and prevent them from doing things in their daily lives, while others may find ways of living with these voices. People who hear voices may not feel able to talk about them and may become isolated and withdrawn as a result.

Prevalence

Most people have had at least one experience of hearing a voice when there was no one around them. One study found that only around 25% of persons who hear voices also have a psychotic disorder.While children below the age of 12 have reported hearing voices, in 75% of cases, the voices stopped by the age of 13.Where the voices persist through to adolescence and adulthood, it usually is the case that there is an underlying mental health issue.

Causes

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.

Traumatic life experiences (e.g. sexual abuse , neglect, loss of a parent) are considered to be among the most significant triggers of auditory hallucinations, particularly among children. As many as 70% of participants in one study reported that hearing voices started following a traumatic or significant emotional event.7

Treatments

Conventional method of treatment uses 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.8
There are several other avenues that can help:

  • 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.

When to seek help

If you are hearing voices and they are causing concern, talk with your GP who will refer you to a psychiatrist if necessary.

References

1de Leede-Smith, S. and Barkus, E. (2013). A comprehensive review of auditory verbal hallucinations: lifetime prevalence, correlates and mechanisms in healthy and clinical individuals. Frontiers in Human Neuroscience, [online] 7. Available at: http://journal.frontiersin.org/article/10.3389/fnhum.2013.00367/full [Accessed 22 Sep. 2015].

2NHS Choices (2014). Hallucinations and hearing voices. [online] Available at: http://www.nhs.uk/Conditions/hallucinations/Pages/Introduction.aspx [Accessed 22 Sep. 2015].

3Woods, A., Jones, N., Alderson-Day, B., Callard, F. and Fernyhough, C. (2015). Experiences of hearing voices: analysis of a novel phenomenological survey. The Lancet Psychiatry, 2(4), pp.323-331.

4NHS Choices (2014). Hallucinations and hearing voices. [online] Available at: http://www.nhs.uk/Conditions/hallucinations/Pages/Introduction.aspx [Accessed 22 Sep. 2015].

5Johns, L.C., Nazroo, J,Y,, Bebbington, P., & Kuipers, E. (2002). Occurrence of hallucinatory experiences in a community sample and ethnic variations. The British Journal of Psychiatry, 180(2), pp.174-178.

6de Leede-Smith, S. and Barkus, E. (2013). A comprehensive review of auditory verbal hallucinations: lifetime prevalence, correlates and mechanisms in healthy and clinical individuals. Frontiers in Human Neuroscience, [online] 7. Available at: http://journal.frontiersin.org/article/10.3389/fnhum.2013.00367/full [Accessed 22 Sep. 2015].

7Romme, M. A. J., and Escher, A. D. M. A. C. (1989). Hearing voices. Schizophr. Bull. 15, 209–216. doi: 10.1093/schbul/15.2.209

8Intervoice (2011). Hearing Voices Amongst ‘Normal’ People. [online] Available at: http://www.intervoiceonline.org/2298/voices/positive-voices/hearing-voic... [Accessed 22 Sep. 2015].