Hearing Voices? You’re Not the Only One

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Auditory hallucinations, including hearing voices, are one of the hallmarks of schizophrenia, as up to 80 percent of people diagnosed with schizophrenia report hearing voices. Auditory hallucinations can also accompany other mental disorders such as bipolar disorder and depression. It’s little wonder, then, that anyone who hears a voice in their mind worries that they might be “going crazy.”

Such experiences are, however, surprisingly common outside of clinical cases. A recent review published in Nature Reviews Psychology summarizes the evidence that shows how common it is and the different ways that people experience voices. The review also urges researchers to move away from a “deficit” model of voice-hearing, which only sees it as a symptom of a disease or pathology. Sometimes, voice-hearing can be neutral, or even beneficial.

The review was written by psychologists Wei Lin Toh, Peter Moseley, and Charles Fernyhough, of Swinburne University of Technology, Northumbria University, and Durham University, respectively, and they refer to these experiences as “voice-hearing,” to avoid the negative and medicalized connotations of “auditory verbal hallucination.”

Varieties of Voice-Hearing

Researchers typically study voice-hearing in people diagnosed with serious mental disorders (“clinical” cases). Many, however, experience voices in ordinary, non-clinical settings.

In some religious contexts, voice-hearing is deliberately cultivated through fasting, meditation, or psychotropic substances. In those contexts, voices are often experienced as useful or beneficial.

Many of us have had experiences of strange, fleeting voices while falling asleep or waking up. Last year, as I was falling asleep, I heard a voice call my name as if to warn me of impending danger.

Intense grief can set the stage for voice-hearing. Some people, in the midst of grief, “hear” a lost loved one speak to them. This can be a deeply comforting experience.

In a large 2014 study, one in seven respondents reported “hearing” the voices of fictional characters when they read, with the same vividness as a normal conversation, and over half of professional writers report “hearing” the voices of their fictional characters.

How Common Is Voice-Hearing?

The lifetime prevalence of non-clinical voice-hearing is somewhere between 5 percent to 15 percent of the general population. It’s hard to gauge more exactly because researchers use slightly different methods and definitions. Unlike clinical cases, in non-clinical cases, the voice-hearer has a greater sense of control. Voices occur less frequently, and the content tends to be neutral or even positive.

There are numerous possible causes of voice-hearing, but these remain controversial. One theory holds that voice-hearing results from the “misattribution” of inner speech as if it belongs to another person. Another theory holds that voices are uncontrolled, intrusive memories. Voice-hearing can also be precipitated by trauma or social isolation.

The authors point out that we shouldn’t assume that there’s only one cause, as voice-hearing might have different causes in different individuals. They also warn that explanations that focus only on the brain risk overlooking social and interpersonal causes.

Voice-Hearing and Cultural Expectations

The work of Toh and her colleagues raises an interesting question: What if the severity and unpleasantness of clinical voice-hearing are partly due to our negative cultural stereotypes about it?

Harvard anthropologist Tanya Luhrmann, who has studied voice-hearing across cultures for decades, has come to exactly this conclusion. She and her colleagues interviewed voice-hearers from the United States, Ghana, and India. All of the participants met the inclusion criteria for schizophrenia.

Luhrmann and her colleagues found that more than half of her Indian participants said they heard voices of kin, who were often trying to give guidance. Half of the Ghanaian participants described their voices as good, and the majority believed that God speaks to them. In contrast, American participants overwhelmingly described their voices as hostile, unfamiliar, and malicious.

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Luhrmann argues that the difference in content is partly due to differences in our widespread cultural beliefs and attitudes. People in the United States are more likely to think of inner voices as symptoms of a disease, and therefore as something to be shunned. Our expectations might partly explain why the experience of voice-hearing tends to be so negative.

In fact, some support networks, such as Hearing Voices Network (HVN), encourage voice-hearers to find more positive and useful ways of engaging with their voices. HVN has helped some to see their voices as carrying useful insights for them.

I look forward to a time when voice-hearing comes to be seen as part of the range of normal human experience, rather than as inherently pathological or dangerous.

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