What’s voice-hearing?

Put very simply, voice-hearing involves hearing a voice in the absence of any speaker or when there’s no one around who could have said the thing that has been heard. It’s a sound that no one else can hear and is often beyond the hearer’s control.

This is a quite common occurrence that sits on a wide spectrum, with up to 60 percent of people experiencing it at least once in their life. For example, many have heard their name called when no one is around or have had similar experiences while they’re falling asleep or waking up.

However, about one percent of the population hear voices quite regularly but aren’t affected by them or can manage them adequately, the so-called non-clinical voice hearers. But there are also individuals who are quite troubled and stressed by these voices, which can be a real source of alarm and concern.

Voices can be loud and aggressive or comforting and supportive. Others are kind of neutral. Some people describe hearing voices when they actually don’t hear anything. They have a feeling of being communicated with rather than actually hearing any sound. And that’s led experts to postulate that hearing voices may be an experience of a social agent trying to communicate with a person but not necessarily using sound.

Some people who hear voices also have other experiences that accompany the phenomenon, like feelings of burning and tingling in the body.

How does it develop?

There are several theoretical approaches to this phenomenon.

One prominent theory says that voice-hearing is simply a form of inner speech, the process when people talk to themselves in their head. When voice hearers do inner speech, the theory goes, something goes wrong and they don’t recognise it as coming from themselves but from someone else.

Voice-hearing is also strongly related to trauma, particularly childhood sexual abuse and bullying. In this case, voices seem to be the re-enactment of unpleasant past experiences.

Another fashionable theory is that voice-hearing is caused by a wrong prediction made by the brain. In this circumstance, people expect to hear a voice and therefore create it in their head even if no actual sound is there.

There are lots of different theories around, and, since the phenomenon is so complex and varied, it’s very unlikely we’re going to find a single theory that explains everything.

Which meanings are usually attached to the experience?

In the past, voice-hearing was considered a sort of glitch in the brain requiring drugs to make it go away. However, over the last 25 to 30 years, the Hearing Voices Movement has been promoting the notion that voice-hearing is a meaningful experience that conveys an emotional message for the voice hearer. 

Though I don’t think this interpretation works for everyone, the change has been really liberating and empowering for lots of people, and it has allowed voice hearers around the world to give their own meaning to their experience without being told what to think by psychiatrists.

That being said, voice-hearing is still a poorly understood phenomenon getting a lot of bad press. It’s seen as a particularly strong sign of madness, and therefore it’s highly stigmatised. There’s a lot of misunderstanding about it. In particular, there’s a strong association in the public mind between hearing voices and violence, which is completely unfounded. A very small number of voice hearers actually act on any command the voices may make. Most people just hear the voices and ignore them, or they’ll find a way to sort it out. And people with any serious mental illness are much more likely to be victims of violence than perpetrators of it.

The website Understanding Voices aims to dispel these misconceptions by providing free online information about the many positive meanings voice-hearing can take on as well as the different ways voice hearers have learned to cope with it. Produced by Hearing the Voice, it’s a research project at Durham University that approaches the phenomenon of hearing voices through a wide range of academic disciplines, from theology and cognitive neuroscience to philosophy, linguistics, and medieval literature, because the topic is extremely rich and complex. 

One key finding is that voice-hearing has had different significances throughout history and across cultures, and, in some contexts, it’s also been seen as very meaningful.

Medieval mystics, for example, had various visionary experiences including voice-hearing, which was sometimes seen as positive because it had a spiritual and religious meaning. Today, a lot of people find it helpful to think of their voice-hearing in a spiritual context.

Voice-hearing has also been associated with positive things, like creativity. Several writers, like Virginia Woolf, heard voices, and some voice hearers find the information empowering and destigmatising. 

Do you have any advice on how to cope with distressing voices?

People who aren’t bothered by their voices shouldn’t seek help because they’re already doing fine. But those who feel distressed about the experience can try out a variety of coping strategies that have proved to work for some voice hearers.

Being compassionate towards voices, such as showing you are willing to listen to them, is one option. Another is to challenge them by saying no to their commands. Being with animals, connecting with others, keeping busy, and getting creative, like writing a diary or painting, can help others.

Taking care of yourself turns out to be really important as well. Being well nourished and getting enough sleep and some exercise make a difference.

There’s no one-size-fits-all strategy since people deal with voices, or any other difficult situation in life, in different ways.

Hearing voice groups are another important source of support because voice hearers can talk about their experiences among themselves without involving any psychiatrist or psychologist. 

What are the options available for those who want to seek medical care?

When you seek professional help, talking therapy is a very valuable option to make the experience of hearing voices less upsetting. Some find helpful art and dance therapies as well.

Though they are not the first-line approach due to their potentially adverse effects, medications can also play a stabilising role when people are in serious distress so that psychologically-based interventions can have their effect. On the project’s website, people can find detailed information on how to make an informed choice about the use of psychiatric medications for treating voice-hearing.

Dr Charles Fernyhough is a professor in the Department of Psychology at Durham University in the UK. He’s the principal investigator of the Hearing the Voice project.