Hearing voices (auditory hallucinations)

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 of them make the phrase "hearing voices" a poor description and perhaps one day we will have to come up with a better one - because it is never the same for everyone. Some people for instance, experience non verbal thoughts, images and visions, tastes, smells and touch. All with no physical cause and all sensations 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 short 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 - but something that is experienced as real.

For voice hearers, the voices might be present all day and have the effect of preventing them from doing things in their daily life. Voices might also punish the voice hearer if they don't do what the voice wants them to do. For example; leaving a party on their say so; not being able to talk about the voices; becoming silent and as a result isolated from other people.

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Are voices a symptom of illness or a variety of 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 they are regarded as a socially stigmatising experience.

Hearing voices are still considered by clinical psychiatry as an auditory hallucination and as a symptom of conditions such as schizophrenic disorders, manic depression and psychosis. The usual treatment - major tranquillisers - are administered in order to reduce the delusions and hallucinations.

However, not everyone responds to this type of treatment. Psychiatrists, nurses and other professionals have been taught that there is not a lot an individual can do for themselves to cope with the voices. Indeed, in the past professionals were taught not to engage voice hearers about the content of their voice experience as this was thought to be "buying in" to the patients' delusions and not helpful. Most often professionals sought to distract the voice hearer from their voices.

Research has shown that there are many people who hear voices, some of whom cope with their voices well without psychiatric intervention, it has also been found that there are many people who hear voices who can cope with their voices and regard them as a positive part of their lives. Neither is it the case that voices have always been regarded as a negative experience. T

Throughout history and even today there are people who hear voices who find their voices inspirational and comforting. These are facts that on the face of it are hard to square with the extremely negative way that the experience is regarded by psychiatry. The researchers, practitioners and involved 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 - if you like, a faculty or differentiation - something like homosexuality, that it is definitely not open to cure.

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Finding meaning in voices

This view may sound radical, but is based on sound research involving questionnaires and interviews conducted with many voice hearers, both within and outside of psychiatry. What was found, was most surprising, voice hearers cope with their voices (or conversely don't), not because of the content of the voice experience (which can be either abusive and devaluing or guiding and inspiring - or both) but because of the nature of the relationship with the voices. Bottom line, this means that if you believe the voices to be in control you can't cope - if you believe you are stronger then the voices are, you can.

As a result of these findings 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) event, that speak to the person in a metaphorical way about their lives, 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 assist voice hearers focus on their experience and get to know their voices better. The new approach requires the voice hearer to make space for the voices, to listen but not to necessarily follow, to engage, but in their own time and space - essentially to learn how to control them in their own terms, according to their own beliefs and 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"

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Practical information for people who hear voices

Voice hearers can find themselves experiencing an overwhelming world and their power of reason may be virtually extinguished making it impossible to go about their lives. Open discussion with others offers a means of helping you to accept your voices.

• Communication between voice hearers gives you the opportunity to share experiences and to learn from one another. This can be achieved by joining or setting up self help groups, such as those established by the Hearing Voices Network throughout the UK.

• Voice hearers say it is important to discuss voices, in the process, it is possible to learn to recognise their games and tricks, as well as their pleasant aspects, and to identify patterns which 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 makes the experience unpleasant and produces feelings of shame or the fear of going mad. Anxiety often leads to the avoidance of situations which might trigger the hearing of voices, and this seriously blocks self development. 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. A personal approach to understanding can be helpful and there are many disparate perspectives used by voice hearers. An explanatory theory is essential to the development of a coping strategy. Unless some meaning is attributed to the voices, it is difficult to begin to organise a relationship with them in order to reduce anxiety. Perspectives which 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 oneself, the essential first step is acceptance of the voices as belonging to me. 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. When voices offer information in this way, the challenge posed by their presence is less significant then the reason for the feeling. When the voices express such views, it can be valuable to discuss the messages with some one you trust, this can often be a friend, a nursing staff member etc.

• 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, though it can be easier with other voice hearers. Another drawback is that the voices may occasionally become temporarily more acute. All in all, though, the advantages outweigh the disadvantages. Finally, It is most important to be fully aware of the wide variety of individual situations and circumstances. The best advice is to try to increase the voice hearers influence over their voices, rather than intensifying their powerlessness.

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Practical information for family, friends and mental health workers

To assist voice hearers it is important for mental health professionals to examine in detail 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.

The steps in this process are as follows:

• Accept the voice hearers 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 issues of differentiating between good and bad voices and of accepting the voice hearers 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.

Self determination and self knowledge are the keywords.

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Written in 2000