Frequently Asked Questions
Who are we and what do we do?
What is the goal of Hearing the Voice?
Hearing the Voice aims to develop a better understanding of the experience of hearing a voice when no one is speaking. Many people think that voice-hearing is just a symptom of severe mental illness like schizophrenia or psychosis, but what they don’t know is that hearing voices can be an important aspect of many ordinary people’s lives. Our goal is to increase understanding of voice-hearing by examining it from different academic perspectives, working with clinicians and other mental health professionals, and listening to people who have heard voices themselves. There are many different aspects to our research. In addition to asking people what it is like to hear voices, we are investigating what happens to the information-processing mechanisms in the brain when someone has these experiences. We are also exploring the ways in which voice-hearing has been interpreted and represented in different cultures, religions and historical periods. In the long term, we hope to use the results of these three areas of research to inform mental health policy and improve therapeutic practice in cases where people do find their voices distressing and clinical help is sought.
How important is it to carry out research on this subject?
Voices are experienced by the majority of people with a diagnosis of schizophrenia, a distressing and disorientating condition that is much maligned and poorly understood. Many people who have been diagnosed with other psychiatric conditions also experience voices, and some people hear voices and live comfortably without the need for psychiatric help. We hope that, by providing a better understanding of voice-hearing, our research will help to raise awareness among the public and health professionals, reduce stigma and discrimination, and ultimately be of benefit to people who hear voices and those who care for and about them.
How many people are involved and from which fields of experience?
Our core research team, based at Durham University, consists of twenty academics from cognitive science, cultural studies, English literature, medical humanities, philosophy, psychiatry, psychology and theology. We also have an extended research network of over thirty collaborators and advisors that includes researchers from national and international institutions, and clinicians and mental health professionals from the Tyne, Esk and Wear Valleys (TEWV) NHS Foundation Trust and the Northumberland, Tyne and Wear (NTW) NHS Foundation Trust. Our team also includes artists, voice-hearers, and members of survivor networks like the Hearing Voices Network and Intervoice.
What is your relationship to the Hearing Voices Movement, which views voice-hearing as a meaningful human experience?
We’ve had the privilege of working closely with many members of the Hearing Voices Movement (HVM) throughout the course of our project, and our research has benefited greatly from their input and expertise. One of the key ideas behind our research, which we share with HVM, is the idea that we should move away from viewing hearing voices as a meaningless symptom of pathology. We also obviously share their anti-stigma agenda, and their commitment to providing support for people who hear distressing voices that is empowering and recovery focused. We are open and inclusive and do not seek to align ourselves with any particular movement or approach. Our goal is to combine as many different perspectives as possible in order to provide a better understanding of the experience of hearing voices. By drawing on insights from the medical, scientific, literary, cultural and political spheres, we aim to shed light on what it is like to hear voices, how and why the experience arises, and what it means.
Who funds us?
Hearing the Voice was funded by a Wellcome Trust Strategic Award from 2012-15. We have now been awarded a Wellcome Trust Collaborative Award in Humanities and Social Sciences, which will enable us to continue our research into voice-hearing until 2020.
What is voice hearing? How common is it?
Typically, what do people hear when they hear voices? How often do people hear voices?
Public perception is that people only hear voices that abuse, threaten, and command them to do dangerous or unacceptable things. But voices are as diverse as the conversations that we have every day. Some voices are distressing and malevolent; others are kind and encouraging, providing a person with an important source of comfort and support. Some people report hearing single words or phrases on an occasional basis, while others hear multiple voices that talk, joke or argue with each other almost constantly. Voices can also differ in terms of auditory qualities like loudness and clarity: that is, they can shout, whisper, be heard clearly, or sound muffled and be difficult to distinguish. People who hear voices may hear other sounds too, including rustling, banging, crying, screaming or music.
Do people actually hear voices or is it a hallucination?
Yes, people do hear voices, although technically speaking, hearing a voice in the absence of any external stimulus is a hallucination (and there are different definitions of that term). Many people who hear voices resist the suggestion that their experiences are unreal; they are very real to the voice-hearer and can often have important meanings for the individual.
What happens to people when they hear voices?
People can have a range of different reactions to hearing voices. A common reaction is fear and the thought that ‘I must be mad’. But hearing voices is not in itself pathological; rather, research suggests that it is the stress associated with negative interpretations of this experience and struggling to cope that can cause the most distress. See, for example, Bak, M., Myin-Germeys, I., Delespaul, P., Vollebergh, W., de Graaf R. & van Os, J. (2005). ‘Do different psychotic experiences differentially predict need for care in the general population?’ Comprehensive Psychiatry, 46, 192–199 and Romme, M. & Escher, S. ‘Hearing voices’ (1989). Schizophrenia Bulletin, 15, 209–216.
Are the voices identifiable to them? Can they be people who are or were in their lives?
People can hear voices that are like the voices of people they know, or they can be the voices of complete strangers. For example, if someone has been abused, they may hear the voice of the person who abused them, undermining them and ordering them to harm themselves, or do things that they know to be morally wrong. It is also very common for someone who is bereaved, and has lost a close relative or friend, to hear the deceased talking to them and find great consolation in this experience.
Are voice-hearing experiences always auditory experiences?
No. While many people say that the voices they hear are similar to hearing somebody speaking in the same room, some voice-hearers describe experiencing purely ‘thought-like’ or ‘soundless voices’ with no acoustic properties whatsoever. Others experience ‘mixed’ voices that have both thought-like and auditory characteristics. Deaf people can also experience ‘voices’. As recent research by Jo Atkinson has shown, deaf people describe a range of communicative experiences under the term ‘voices’, that can include visual imagery of sign-language or of disembodied lips. What kinds of experiences deaf people report seems to depend on their early experience of language. For more information please see: 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. Atkinson, J.R., Gleeson, K., Cromwell, J. O’Rourke, S. (2007). ‘Exploring the Perceptual Characteristics of Voice-Hallucinations in Deaf People.’ Cognitive Neuropsychiatry, 12(4), 339-361.
How many people in Britain hear voices?
This is a hard thing to put a number on, and largely depends on how the experience of hearing voices is defined. Pooling the results of several different studies, a reasonable estimate is that between 5 and 15% of people report having had an occasional experience of hearing a voice when there was no one around. A smaller proportion, around 1%, have more regular voice-hearing experiences in the absence of any psychiatric illness. A separate 1% will have a diagnosis of schizophrenia, and the majority of these will hear voices. For more information, see Beavan, V., Read, J., Cartwright, C., ‘The prevalence of voice-hearers in the general population: a literature review’ (2011). Journal of Mental Health 20 vol. 3, 281-292.
Which notable figures in history heard voices?
History is populated with great leaders, thinkers, writers, artists and musicians who reportedly heard voices. The list includes Socrates, Joan of Arc, Sigmund Freud, Ludwig van Beethoven, William Blake, Salvador Dalí and Virginia Woolf.
Voices aren’t just a symptom of psychosis
What disorders are hearing voices associated with? It is associated with schizophrenia but how accurate is this association?
People who hear voices may have a diagnosis of psychosis, schizophrenia, bipolar disorder, borderline personality disorder, PTSD, anorexia or severe depression. But it is a common misconception that all people who hear voices have a mental health problem. For example, auditory verbal hallucinations have long been considered a ‘first rank’ symptom of schizophrenia, but we now know that voices appear across a much wider spectrum.
What about those people who hear voices but do not have a psychiatric diagnosis? What is their experience like?
A recent study examining forty members of a Pentecostal church in North-East London sheds some light on this question. In this community, as in many Evangelical Christian groups, voice-hearing is openly embraced as an important aspect of spirituality. Those who report hearing the voice of God recall having to learn to distinguish His voice from their own thoughts. Some of these people liken God’s voice to a human voice, and many experience His voice as coming from an external location. God may issue commands, but in this community, most instances of divine communication are associated with a feeling of comfort, forgiveness or knowledge, rather than distress.
To read more about this study, please see Dein, S. and Littlewood, R. ‘The Voice of God’ (2007). Anthropology and Medicine 14 vol. 2, 213-228.
Many writers also report experiencing the presence, agency and voices of the characters they create in their work. For more information about what their experience is like, please see our Writers’ Inner Voices project.
Research into voice-hearing in people without a psychiatric diagnosis is at a very early stage, and we need to know much more about these experiences before we can draw any conclusions about whether they are the same or different to the voices experienced in clinical cases.
Can hearing voices be a positive thing?
Yes. Many voice-hearers report experiencing positive voices that provide support and encouragement during times of stress. There is also a close link between voice-hearing and creativity, with many artists, writers and musicians reporting hearing voices or other sounds that inspire great works of literature, art and music. Hearing negative or distressing voices can also have a positive outcome on a person’s life, providing them with the opportunity to learn more about themselves, develop resilience and cultivate coping strategies that can be useful in other situations. For example, a young person who has learned to cope with commanding or critical voices can use these skills to stand up to bullies and resist peer pressure.
Voices: Explanations and Interpretations
What are the reasons for people hearing voices?
Essentially, we do not know why people hear voices. There are many different kinds of voice-hearing experiences, and it is likely that these will have different causes and explanations. Many of the researchers on our project are investigating the link between voice-hearing and what psychologists call ‘inner speech’: the inner voice that accompanies thinking, as when you say to yourself ‘Remember to buy coffee’ while heading for work in the morning. One of the theories we’re exploring is the idea that voice-hearing experiences arise when someone mistakenly attributes an episode of inner speech – i.e. one of their own thoughts – to an external source. Other voices seem to require different explanations. For example, it’s plausible that some voices are best understood as having their roots in memories of early trauma such as neglect, bullying, and physical, sexual and emotional abuse.
What is the difference between someone hearing their own inner voice and hearing a different voice?
Unlike instances of our own inner voice which clearly belong to us, most people report that hearing a voice in the absence of any speaker has an ‘alien’ quality to it, so that it doesn’t feel like it comes from the self (see, for example, Hoffman et al., 2008). In some cases, people may distinguish voices from their own thoughts by means of the content. For example, if the voices are derogatory, they might say ‘I would never think that’ and attribute the experience to an external source. Interestingly, it is not the case that voices are always distinguished from thoughts by virtue of their perceived location: whether or not they are experienced as coming from ‘inside’ or ‘outside the head’. Some people experience voices that sound as if they are coming from the external environment, but many voices are experienced as internal in the same way that our own inner voice is. (Equally, loudness and clarity are not generally things that people use to distinguish voices from their own thoughts.)
For more information on the criteria people use to distinguish voices from instances of their own inner voice, please see Hoffman, R. E., Varanko, M., Gilmore, J., and Mishara, A. L., ‘Experiential features used by patients with schizophrenia to differentiate ‘voices’ from ordinary verbal thought’ (2008). Psychological Medicine, 38, 1167-1176.
Do we know what happens to the brain when someone is hearing a voice?
So far, the evidence we have suggests that many of the typical “language centres” of the brain are active when someone hears a voice. What we don’t know yet is why they are active – why it is that some people hear a voice when no-one is present. One possibility is that the answer will be found in how these language centres are connected to other parts of the brain, such as the motor cortex and areas linked to long-term memory.
Support Information
What kind of help is out there for people who hear voices? What advice would you give to them?
Voice hearing experiences are fairly common and are not in themselves necessarily a cause for concern. If you find that these experiences continue to cause significant distress or interfere with your relationships or daily activities, you should seek the advice of your GP or family doctor and seek other sources of sympathetic support. In the UK, the Hearing Voices Network offers information, support and understanding to people who hear voices and those who support them. Voice Collective in London also provides some excellent online resources aimed at young people experiencing voices and visions. You might also find it helpful to engage with other people who hear voices. If you live in the North-East of England, and are looking for a support group in the region, you may find our map of Hearing Voices groups helpful. This can be found on our ‘Looking for Support?’ page.
What is the role of medication in helping people cope with distressing voices?
People who find their voices distressing and seek clinical help may be prescribed anti-psychotic medication in order to help them cope. The medication does not necessarily make the voices go away, but it can make them seem more distant and less noticeable. Some anti-psychotics have serious side effects, such as movement disorders (e.g limb stiffness, tardive dyskinesia) and weight gain, which can lead to other health problems like diabetes and cardio-vascular disease. Many people who experience distressing or disruptive voices find taking medication helpful, while others find that ‘talking therapies’ and attending a peer support group are more beneficial. If you have been prescribed medication to help you cope with distressing voices, it is important not to stop taking this without the help of your care team. Stopping medication suddenly can be dangerous and can make you feel worse – for example, by leading to withdrawal symptoms or ‘rebound psychosis’. If you do wish to stop taking your medication, you should talk to your care team about devising a programme of gradual withdrawal. Useful reading: Allen J. Francis, ‘Hearing Voices: A Dialogue with Eleanor Longden’ , Psychology Today, September 2013 Joanna Moncrieff, ‘Models of Drug Action’, November 2013.
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