Auditory hallucinations – commonly referred to as “voices in your head” – are a common symptom of some mental illnesses. There is a commonly understood and stereotyped view of what it means to “hear voices,” but many common beliefs about these experiences do not reflect the truth. Prejudices such as these are a particularly important problem in psychiatric research. It’s hard to figure out why people hear voices if we don’t really understand what these voices are like in the first place.
Hearing the Voice, a research group at the University of Durham in England, designed an exploratory study to find out where current research might be making incorrect assumptions. The group, which is home to a team of cognitive neuroscientists, psychologists, psychiatrists, medical humanities specialists and others, aims to investigate the causes and treatment of auditory verbal hallucinations.
They created a survey aimed at anyone who reports hearing voices, whether or not they received a clinical diagnosis. Participants were recruited through clinical networks, support groups, and mental health forums. The results, published in The Lancet Psychiatry, included both statistical analyzes and descriptions of participant responses, highlighting some potentially important departures from conventional wisdom, as well as some promising avenues for further research.
Surveys certainly have their shortcomings. The authors acknowledge this, but argue that very little research has been done that attempts to find out what people actually experience. Surveys are an important starting point.
A limitation in the existing literature is that it tends to focus only on a few disorders such as schizophrenia, where hearing voices is in fact associated with other disorders as well. The Hearing the Voice survey collected responses from 157 individuals and received responses from people diagnosed with post-traumatic stress disorder, bipolar disorder, and obsessive-compulsive disorder, among others.
Another problem with previous research was that the kind of language used in surveys could have elicited certain types of responses from participants, inadvertently excluding useful information. For example, a previous study found that 86 percent of participants reported “steady, commanding, and commenting” voices. These voices are generally believed to be “inherently violent or potentially harmful,” write the authors of Hearing the Voice.
The new survey used more open-ended questions that allowed participants to describe their experiences in their own words, and it produced very different results. Only five percent of the participants described voices that give harmful or negative commands. A number of people even say their voice gives helpful or benign instructions: “They’ll tell me to take out the trash or check the lock on the window or call someone,” one study participant wrote. This can partly be explained by different populations being studied, but it is also possible that fewer people have threatening voices than we previously thought.
“Hearing voices” doesn’t always literally mean hearing either. Only 44 percent of respondents described their experiences as auditory. Nine percent of the voices are entirely thought-like, and 37 percent of people experienced a mix of auditory voices. And a large number, about a fifth, said that ‘voice’ was not an adequate description of what they were experiencing. They used descriptions like “intuitive knowing” or “telepathic experience.”
A large majority (81 percent) said they heard multiple voices, and for a fifth of the participants, the voices were from recognized individuals. In many cases, the voices caused fear, anxiety, and stress; but contrary to the stereotype, about a third of the participants reported feeling neutral or even positive about their voice. Nearly half (45 percent) said they could influence the votes by talking to them.
This study was not intended to be conclusive or watertight. Rather, the goal is to provide new potential avenues for research. For example, existing research often assumes that auditory hallucinations are always perceptual events, where people literally hear voices. The data from the study suggests that this assumption needs to be reexamined, and exploring new possibilities here could lead to new discoveries about what causes these kinds of hallucinations.
Ultimately, this kind of research “provides no means of verifying the truth,” the authors write. There was no way to verify the participants’ reported diagnoses or experiences. And like many studies, the pool of participants was limited: largely white, predominantly female, and all from people with access to the internet. Participants were recruited using clinical networks, but acute care individuals would not have been able to respond, meaning their responses would not have been taken into account in the data.
Still, it’s a start. In a review of more than 300 research articles related to keyword search terms, the authors were unable to find one that included individuals with different diagnoses and used open-ended questions to explore the full extent of participants’ experiences. There is still a lot of work to be done here.
The Lancet Psychiatry2015. DOI: 10.1016/S2215-0366(15)00006-1 (About DOIs).