Hearing Voices

Hearing voicesMany people with psychosis hear voices. Such voices are considered “auditory hallucinations”, and they constitute one of the so-called positive symptoms of schizophrenia. In fact, many people in general hear voices. While schizophrenia is estimated to affect 1% of all people, the percentage of people who hear voices has been estimated to be as high as 25 per cent.

Psychiatry’s traditional approach to voices has been to reduce or eliminate auditory hallucinations by the application of antipsychotic medications. Sometimes this succeeds, albeit with the potential high cost of significant and often iatrogenic side effects. Sometimes this doesn’t succeed, leaving an individual who hears such voices hearing them still.

Perhaps a more benign alternative approach is to accept, accommodate, manage, redirect, and try to understand such voices. In addition to (or instead of) the possibility of voices resulting from biochemical imbalances in the brain, voices may also result from painful or disturbing associations in the mind, more specifically deeply seated and unresolved psychological stress arising from physical or psychological trauma. Thus it may be worth considering an alternative to heavy antipsychotic medication as a treatment approach to the presence of auditory hallucinations.

To help families and their loved ones who may hear voices research the issue of hearing voices, PsychOdyssey is pleased to present this page of resources.


Ellen Longden’s Ted Talk on Hearing Voices

Last August (2013) Ellen Longden of the UK presented a powerful testimonial about hearing voices in her TED talk below:

Hearing Voices Articles (with abstracts)

Bentall, R. P. (1990). “The illusion of reality: A review and integration of psychological research on hallucinations.” Psychological Bulletin 107(1): 82-95.

Hallucinations are among the most severe and puzzling forms of psychopathology. Although usually regarded as first-rank symptoms of schizophrenia, they are found in a wide range of medical and psychiatric conditions. Moreover, a substantial minority of otherwise normal individuals report hallucinatory experiences. The purpose of this article is to review the considerable research into the cognitive mechanisms underlying (particularly psychotic) hallucinations that has been carried out and to integrate this research within a general framework. The available evidence suggests that hallucinations result from a failure of the metacognitive skills involved in discriminating between self-generated and external sources of information. It is likely that different aspects of these skills are implicated in different types of hallucinatory experiences. Further research should focus on specific metacognitive deficits associated with different types of hallucinations and on treatment strategies designed to train hallucinators to reattribute thoughts to themselves.

Cheung, P., et al. (1997). “Violence in schizophrenia: role of hallucinations and delusions.” Schizophrenia research 26(2–3): 181-190.

The study examines the relationship between hallucinations/delusions and violent behaviour in a sample of long-stay inpatients with chronic schizophrenia. Thirty-one subjects defined as violent and meeting DSM-111-R criteria for schizophrenia were compared with 31 matched non-violent schizophrenia patients with respect to detailed phenomenologies of auditory hallucinations using the Mental Health Research Institute Unusual Perceptions Schedule (Carter and Copolov, 1993; Carter et al., 1995) and delusions using the Maudsley Assessment of Delusions Schedule (Taylor et al., 1994). Patients in the violent group were significantly more likely to experience negative emotions, tone and content related to their voices than those in the non-violent group, whilst patients in the non-violent group were more likely to experience positive emotions, tone and content related to their voices. Patients in the non-violent group were significantly more likely to report success in coping with their voices. There was no association between command hallucinations and violent behaviour. Patients in the violent group were more likely to hold persecutory delusional beliefs than those in the non-violent group, while patients in the non-violent group were more likely to hold grandiose delusions than those in the violent group. Patients in the violent group were also more likely to report that the delusion made them feel angry, while those in the non-violent group were more likely to report that the delusion made them feel elated. The results suggest specific aspects of the phenomenologies of hallucinations and delusions that should be clinically assessed to determine the likelihood of violence as a result of such psychotic symptoms.

David, T. and I. Leudar (2001). “Head to head: Is hearing voices a sign of mental illness?” The Psychologist 14(5): 256-259.

Hong, A., et al. (1998). “Auditory hallucinations: A comparison between patients and nonpatients.” The Journal of Nervous & Mental Disease 186(10): 646-651.

The form and the content of chronic auditory hallucinations were compared in three cohorts, namely patients with schizophrenia, patients with a dissociative disorder, and nonpatient voice-hearers. The form of the hallucinatory experiences was not significantly different between the three groups. The subjects in the nonpatient group, unlike those in the patient groups, perceived their voices as predominantly positive: they were not alarmed or upset by their voices and felt in control of the experience. In most patients, the onset of auditory hallucinations was preceded by either a traumatic event or an event that activated the memory of earlier trauma. The significance of this study is that it presents evidence that the form of the hallucinations experienced by both patient and nonpatient groups is similar, irrespective of diagnosis. Differences between groups were predominantly related to the content, emotional quality, and locus of control of the voices. In this study the disability incurred by hearing voices is associated with (the reactivation of) previous trauma and abuse.

Johns, L. C., et al. (2002). “Occurrence of hallucinatory experiences in a community sample and ethnic variations.” British Journal of Psychiatry 180: 174-178.

 Kreinin, A. (2013). ““Hearing voices” in schizophrenia: Who’s voices are they?” Medical Hypotheses 80(4): 352-356.

Paranoid schizophrenia is a subtype within the group of schizophrenia disorders. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), delusions and hallucinations are the first and second symptoms required for the diagnosis of schizophrenia. Empirical data and clinical observations allow us to present the hypothesis that paranoid schizophrenia can be divided into two subgroups: (1) Hallucinatory subgroup, patients with prominent hallucinations and delusions influenced by auditory hallucinations, (2) Delusional subgroup, patients with prominently impaired thought content, in which hallucinations are not significant clinical factors. Furthermore, we believe that auditory hallucinations are not disturbances of perception but rather of thought – or “pseudo-perceptions”. According to our hypothesis there are epidemiological and clinical differences between the hallucinatory and delusional subgroups of patients diagnosed with schizophrenia, paranoid type. Patients in the Hallucinatory subgroup have more severe positive and negative symptoms and greater functional impairment than the patients in the Delusional subgroup. A patient deep in thought might not realize that he is thinking (malfunction of thought) but is rather “hearing voices” without external stimulus. Thus, hearing voices is not a disturbance of perception but rather of thought – or “pseudo-perception”. The prognosis seems to be poorer for paranoid schizophrenia patients with prominent hallucinations, thus therapeutic rehabilitation programs for hallucinatory patients need to be developed accordingly. Further research is warranted to investigate additional aspects of these two groups.

Lakeman, R. (2001). “Making sense of the voices.” International Journal of Nursing Studies 38(5): 523-531.

Hearing voices is a common occurrence, and an experience of many people in psychiatric/mental health care. Nurses are challenged to provide care, which is empowering and helps people who hear voices. Nursing practice undertaken in partnership with the voice hearer and informed by a working explanatory model of hallucinations offers greater helping potential. This paper uses Slade’s (1976. The British Journal of Social and Clinical Psychology 15, 415–423.) explanatory model as a framework for exploring interventions which may assist people in exerting some control over the experience and which might be used alongside pharmacological interventions. Principles and practical ideas for how nurses might assist people to cope with and make sense of the experience are explored.

Martin, P. J. (2000). “Hearing voices and listening to those that hear them.” Journal of Psychiatric and Mental Health Nursing 7(2): 135-141.

This paper is concerned with the experience of service users of a mental health Trust. The shared experience of the particular service user group is that of auditory hallucinations. The paper argues that mental health practitioners have, traditionally, not listened effectively to the subjective experience of voice hearing. By creating an environment in which service users can discuss their shared experience, the mental health practitioner can facilitate learning from experience and the development of ‘common-sense’ management strategies. Such strategies do not demand, or require, text book answers from health care professionals, but emerge from service users, through living with voice hearing. The work is interpreted through Parse’s theory of human becoming and Marius Romme’s work with ‘Hearing Voices’.

Romme, M. A., et al. (1992). “Coping with hearing voices: an emancipatory approach.” The British Journal of Psychiatry 161(1): 99-103.

A questionnaire comprising 30 open-ended questions was sent to 450 people with chronic hallucinations of hearing voices who had responded to a request on television. Of the 254 replies, 186 could be used for analysis. It was doubtful whether 13 of these respondents were experiencing true hallucinations. Of the remaining 173 subjects, 115 reported an inability to cope with the voices. Ninety-seven respondents were in psychiatric care, and copers were significantly less often in psychiatric care (24%) than non-copers (49%). Four coping strategies were apparent: distraction, ignoring the voices, selective listening to them, and setting limits on their influence.

Ruddle, A., et al. (2011). “A review of hearing voices groups: Evidence and mechanisms of change.” Clinical Psychology Review 31(5): 757-766.

As a heavily stigmatized group, voice hearers often value the chance to meet others with similar experiences. As a result, Hearing Voices Groups (HVGs) are becoming increasingly common in both inpatient and outpatient settings. Where resources are constrained, HVGs are frequently viewed as a desirable alternative to individual therapy and are often preferred by service users themselves. HVGs often vary in their content and structure, with four common approaches: CBT, skills-training, mindfulness and unstructured support groups. This review evaluates the evidence for HVGs and the mechanisms of change for successful interventions. CBT was the only approach with evidence from well-controlled studies. However, several evidence-based treatments share ‘key ingredients’ which evidence suggests help reduce distress. Successful groups supply a safe context for participants to share experiences, and enable dissemination of strategies for coping with voices as well as considering alternative beliefs about voices. Future research should focus on isolating mechanisms of change and predictors of outcome in order to refine HVG approaches, rather than polarizing them and setting them against one another in efficacy trials.

Thornhill, H., et al. (2004). “Escape, enlightenment and endurance.” Anthropology and Medicine 11(2): 181-199.

This paper reports findings from a study which analysed the narratives of individuals who described themselves as recovered or recovering from psychosis, a term referring to experiences such as hearing voices other people do not hear, seeing or sensing things other people do not see or sense, holding unusual beliefs (delusions) or beliefs about the malevolent intention of others which seem unwarranted (paranoia). A narrative approach was taken since it allows for a focus on the construction of meaning and it is the breakdown of shared meanings which, at least in part, defines psychotic experience. It was also anticipated that the way the individual narrated their experience would offer important clues as to how they (and others) had facilitated the recovery process. This paper reports on the analysis of genre, tone and core narratives. Three distinct genres emerged from the analysis: narratives of escape, enlightenment and endurance. There was a relationship between genre, tone and core narrative. The study raises questions about how psychosis is experienced, understood and treated by the individual, by mental health professionals and by society.

Weddings, S., et al. (2006). “Are hearing voices groups effective?” Intervoice Online. from http://www.intervoiceonline.org/wp-content/uploads/2011/03/Voiceseval.pdf.

This study sought to examine the effectiveness of a hearing voices group . The present study found that after attending the hearing voices group, members’ hospital bed use decreased and there was a trend for less formal admissions. Two people reduced or discontinued their medication.People used far more coping strategies and were able to talk to far more people about their voices after attending the group. Learning coping strategies was something people valued about the group and one of the common topics was to explore and experiment with different coping strategies.

Whitfield, C. L., et al. (2005). “Adverse childhood experiences and hallucinations.” Child Abuse and Neglect 29: 797-810.

Other Hearing Voices Resources

http://www.mentalhealth.org.uk/help-information/mental-health-a-z/H/hearing-voices/ The Mental Health Foundation (UK)

www.hearingvoicesusa.org: Hearing Voices Network USA

www.intevoiceonline.org: The International Community for Hearing Voices

http://groups.yahoo.com/group/voice-hearers: Voice Hearers Support Group




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