Academic studies conducted in Europe, New Zealand, and America during the past 20 years have shown that a significant minority of the world population—5% to 13%—hear voices that other people cannot[1]. This statistic includes people who do and do not suffer from a related physical or mental illness. [1]  

It is difficult to describe what it means to hear voices, because the experience comes in many different forms—so much so that to describe them as ‘voices’ is inaccurate for many who experience them.[2] In a mass, multifaceted study published in 2015, voice-hearers were interviewed in order to better understand their varying experiences.[2] Some participants described hearing a distinct voice of someone standing next to them, while others described experiencing very realistic thoughts rather than distinct articulations.[2] As well, some described hearing a single voice, while others described hearing multiple voices.[2]  

‘Voices’ itself is not an entirely accurate term, as voices do not have to be distinct linguistic expressions of a human. They may also be sounds, other forms of articulations, ideas, and can come in many other forms than voices.[2] In each of these instances, the voices are interpreted by the hearer as something foreign, coming from a source outside of themselves, and as different from a regular inner dialogue, but are heard only by themselves.[2]

In current clinical psychiatry, the term “auditory hallucination” is used to describe the experience of hearing voices.[3] However, Dr. Rufus May, a clinical psychologist from Britain, clarified that the term “hearing voices” more accurately expresses the personal experiences of voice-hearers. “Hearing voices” is also the preferred term of the the International Hearing Voices Network, a UK-based charity that fights to change perception of voice-hearing as an exclusive sign of mental illness, or as an automatically negative occurrence.[4] They feel that the term ‘hallucination’ “is inaccurate as it gives the impression that the experience is unreal and meaningless.” [4]

It is not currently known why these voices occur. There is research suggesting that voice-hearers tend to experience high levels of chronic stress in their lives, especially in their childhoods.[5] But voice-hearing is not a random experience completely unrelated to the hearer’s past or present life. More often than not, hearing voices is deeply personal, and many healthy and creative people experience them [13, 14, 15]. Neuroscientific studies also suggest that voice-hearing experiences arise in the right hemisphere of the brain, and that voice-hearing is possibly more likely for those who engage in activities dependent on this hemisphere, such as “music, art, poetry and spatial math skills”.[16] Such connections between creative activities and the way the brain works may partly explain why artists sometimes hear realistic voices, or feel creatively influenced by realistic perceptions or ideas.

One study of 15,000 voice-hearers suggested that one in three people who hear voices has a psychiatric disorder, whereas two out of three fit no diagnosis for mental illness. The study also found that the main difference between those with and without mental health diagnoses was their relationship to their voices.[8] Individuals diagnosed with psychiatric disorders tended to report that their voices were critical, malevolent, and frightening. However, individuals that had not been diagnosed with psychiatric conditions more often (but not exclusively) reported that their voices were kind, encouraging, and benevolent.[8]

Despite this, hearing voices can be a frightening experience, and can lead one to feel as though they are ‘losing their mind’.[9] Yet this fearful reaction is not always the case, and often seems to be particular to Western culture. This has been evidenced in a cross-national comparative study conducted by Stanford University in San Mateo, America, the Schizophrenia Research Foundation in Chennai, India, and the Accra General Psychiatric Hospital in Ghana, Africa. The three institutions published the study in 2015, to explore the experiences of hearing voices across each of these different cultures.[10]

The study found that Americans often used distinctly psychiatric language to describe their experiences, well-evidenced in one participant’s depiction: “I fit the textbook on Schizophrenia.” These participants also more often said that hearing these voices were very negative experiences, including hearing “screaming, fighting…[and voices saying] jump in front of the train.” Meanwhile, the individuals from India and Africa reported less violent voices. Citizens of Accra uniquely perceived hearing voices as the result of spiritual forces contacting them, and their experiences appeared overwhelmingly positive. One individual even stated: “[the voices] just tell me to do the right thing. If I hadn’t had these voices, I would have been dead long ago.”

The sample from Chennai reflected a balance of positive and negative perceptions of the voices. Unlike the individuals from San Mateo and Accra, 11 out of 20 voice-hearers from Chennai said the voices were of relatives who had died. These relatives reportedly made both critical and helpful comments. For example, one man heard the voices of his deceased sisters, which would would mock him at times, yet would also remind him to engage in certain mundane and healthy activities, like bathing. Eight of the 20 individuals studied from Chennai experienced the voices as highly positive.

But why are these interpretations so different across nations? One possibility is that differences in culture lead to different views of how the voice-hearing itself is commonly perceived by others. It seems that Western culture views individuals as being completely separate from one another, while other cultures (e.g. sub-Saharan African culture) place more importance on community, and interpersonal interaction.[10] This Western, individualistic perspective also tends to view private thoughts, emotions, and perceptions as purely biological events occurring solely within a human body.[10] Therefore, hearing voices that no one else hears tends to be seen as a problem arising within the individual, instead of the consideration that there might be something that exists that other individuals cannot perceive.

“In Western culture, hearing voices has no meaning,” says Dr. John Read, a clinical psychologist at the University of Auckland, New Zealand.

Indeed, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the only meaning they have is that they could indicate a psychological disorder. However, these experiences are deeply personal, and these voices express and reflect ideas and attitudes. As such, they can offer the voice-hearer an alternate perspective, or new ideas around dealing with life events. Dismissing these voices as devoid of any useful information, and claiming that they are indicative of a mental illness without looking at the content of the voices, may lead one to avoid addressing important concepts.

Vanessa Beaven, a clinical psychologist, interviewed 50 voice-hearers in an attempt to understand what deeper meanings the voices may carry.[11] Most of the people interviewed described the content of the voices as personally meaningful, and saw connections between what they were going through during that time and the voices’ comments. Many of them also had a personal relationship with the voices, similar to the relationships one has in everyday life. The voices seemed real to the participants, and, in this study, they were able to identify them as specific people or characters, such as a parent, a grandparent, a friend, a demon, or God. Participants also said that hearing voices impacted them emotionally, in positive and negative ways.

Interpretations of voices can greatly influence what they mean to the voice-hearer. Dr. Simon McCarthy-Jones, an established researcher and author in the field of voice-hearing, recounted an example of these underlying meanings in his book, Hearing Voices. He detailed a conversation with Dr. Marius Romme, another well-known researcher and a prominent scholar in the study of voice-hearing. Romme explained the story of an individual who heard a voice repeatedly saying, “you might as well be dead”.[12] After exploring his experience, and reflecting on the meaning of voices, the voice-hearer understood that the voice was actually telling her that she was not taking care of herself enough, and that, if this continued, she “might as well be dead”.[12] As McCarthy-Jones says, “Voices may thus help us find parts of ‘ourselves’ which we cannot consciously access, and further study of this may help shed light on the creative process”. [12]

As well, Dr. May suggests that hearing voices is similar to dream analysis; just as dreams can inform us about our wishes and our challenges, so can voices.[9] Similarly, dreams can also be created narratives based on one’s own life, and paying attention to their content may be helpful and telling – at least for some people. Of note is that the voice-hearers themselves are generally able to differentiate when hearing voices disrupts their lives versus when these voices are not a problem and may even be helpful.[9]

So, what should we do if we or a loved one hear voices? Both Dr. John Read and Dr. Rufus May suggest not to be afraid and to try and understand the experience. Dr. Rufus May also says that curiosity is a best friend in this situation, and mentions the word “crisitunity ” – a word he invented – to show that an event can be both a crisis and an opportunity. Dr. John Read says that those who hear voices need to show interest in them, and view them as a normal variation of human experience.

 

By: Ioana Arbone

 

References:

[1] Beavan, V., Read, J., & Cartwright, C. (2011). The prevalence of voice-hearers in the general population: A literature review. Journal of Mental Health, 20, 281–292. doi:10.310 9/09638237.2011.562262

[2] Woods, 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.

[3]  Moskowitz, A. & Corstens, D. (2007). Auditory hallucinations: Psychotic symptom or dissociative experience? The Journal of Psychological Trauma, 6(2/3), 35-63.

[4] CYMRU, Hearing Voices Network, Wales. (2016, August 13). Hearing Voices Network. Retrieved from: http://hearingvoicescymru.org/positive-voices/famous-voice-hearers/creative-people

[5] Read, J., Perry, B.D., Moskowitz, A. & Connolly, J. (2001). The contribution of early traumatic events to schizophrenia in some patients: A traumagenic neurodevelopmental model. Psychiatry, 64(4), 319-345.

[6] Shergill, S. S., Brammer, M. J., Williams, S. C., Murray, R. M., & McGuire, P. K. (2000). Mapping auditory hallucinations in schizophrenia using functional magnetic resonance imaging. Archives of General Psychiatry, 57(11), 1033-1038.

[7] Tien, A.Y. Soc Psychiatry Psychiatr Epidemiol (1991) 26: 287. doi:10.1007/BF00789221

[8] Honig, A., Romme, M. A. J., Ensink, B. J., Escher, S. D. M. C., Pennings, M. H. A., & Devries, M. W. (1998). Auditory  hallucinations; a comparison between patients and nonpatients. Journal of Mental and Nervous Disease, 186, 646 – 651.

[9] Kalhovde, A. M., Elstad, I., & Talseth, A. G. (2014). “Sometimes I walk and walk, hoping to get some peace.” Dealing with hearing voices and sounds nobody else hears. International Journal of Qualitative Studies on Health and Well-being, 9(1). doi:10.3402/qhw.v9.23069

[10] Luhrmann, T. M., Padmavati, R., Tharoor, H., & Osei, A. (2015). Hearing Voices in Different Cultures: A Social Kindling Hypothesis. Topics in Cognitive Science, 7(4), 646-663. doi:10.1111/tops.12158

[11] Beavan, V. (2011). Towards a definition of “hearing voices”: A phenomenological approach. Psychosis, 3(1), 63-73.

[12] McCarthy-Jones, S. (2013). Chapter 12 – The Struggle for Meanings. In S.  McCarthy-Jones, Hearing Voices: The Histories, Causes and Meanings of Auditory Verbal Hallucinations (pp. 315-354). USA: New York: Cambridge University Press.

[13] Ability Magazine. (2016, August 13). Brian Wilson — A Powerful Interview. Retrieved from Ability Magazine: http://www.abilitymagazine.com/past/brianW/brianw.html

[14] CYMRU, Hearing Voices Network, Wales. (2016, August 13). Creative People including writers, artists and musicians. Retrieved from CYMRU, Hearing Voices Network, Wales: http://hearingvoicescymru.org/positive-voices/famous-voice-hearers/creative-people

[15] Carson, S. H., Peterson, J. B., & Higgins, D. M. (2003). Decreased Latent Inhibition Is Associated With Increased Creative Achievement in High-Functioning Individuals. Journal of Personality and Social Psychology, 499-506.

[16] de Leede-Smith, S., & Barkus, E. (2013). A comprehensive review of auditory verbal hallucinations: Lifetime prevalence, correlates and mechanisms in healthy and clinical individuals. Frontiers in Human Neuroscience(JUN). doi:10.3389/fnhum.2013.00367