Hearing Voices

An interesting article in the New York Times questioned the unquestionable assumption that a person hearing voices in their head is pathological, mentally ill, in need of immediate treatment (Smith, D.B.: Can you live with the voices in your head? March 25, 2007). Auditory hallucination is the hallmark of schizophrenia, although some schizophrenics do not have auditory hallucinations, and they also occur in other psychoses as well, but generally, if you are hearing voices, you want to get rid of them – right away, by taking one of the antipsychotic medications that suppress or eliminate the voices (with substantial side-effects).

(Pic from http://uberpup.deviantart.com/)

According to the NYT article, there is a group based in Manchester, England, the “Hearing Voices Network (HVN), that advocates making friends with the voices instead of trying to get rid of them (www.hearing-voices.org). In group sessions, participants talk about their voices and how they relate to them. The goal is to accept the voices as part of “normal” consciousness.

Hearing voices is not fun, according to what we read in the psychiatric literature. It is extremely frightening, like having an alien within your body. Hearing voices is not like talking to yourself, because it is not your voice. The voice typically comments, often sarcastically and critically, on what you are doing and thinking. The voice is intrusive. You can’t read, can’t think. It won’t shut up. Often, according to patients, the voice urges you to commit suicide. Sometimes it is two different voices talking to each other, commenting on and criticizing the patient’s thoughts and actions in the third person. I’ve never read about a friendly, encouraging, helpful auditory hallucination. They’re always bad news.

The article describes a typical incident:

Angelo was walking home from the laboratory when, all of a sudden, he heard two voices in his head. “It was like hearing thoughts in my mind that were not mine,” he explained recently. “They identified themselves as Andrew and Oliver, two angels. In my mind’s eye, I could see an image of a bald, middle-aged man dressed in white against a white background. This, I was told, was Oliver.” What the angels said, to Angelo’s horror, was that in the coming days, he would die of a brain hemorrhage. Terrified, Angelo hurried home and locked himself into his apartment. For three long days he waited out his fate, at which time his supervisor drove him to a local hospital, where Angelo was admitted to the psychiatric ward. It was his first time under psychiatric care. He had never heard voices before. His diagnosis was schizophrenia with depressive overtones.

HVN disputes the assumption that hearing voices always indicates psychosis. They claim that many ostensibly normal people hear voices and live with them. Some interpret the voices as messages from a spirit world, some as thoughts from their own unconscious mind. The article did not present any evidence that normal people hear voices, or if they do, how prevalent that might be. It’s an interesting and plausible idea however that should be investigated.

I have heard a voice in my head that did not seem to be my own, when falling asleep, where the boundary between dreaming and wakefulness is not clear. It’s rare, but I have “heard” my name being called loudly and clearly, and was startled, only to realize “it was only a dream.” But what does that mean, “It was only a dream?” I heard a voice in my head; It was not my own voice; It called my name.” Why is that not an auditory hallucination? I can well imagine that some people might experience similar events throughout the day. There is wide variation in the quality of normal human consciousness.

When you have a tune in your head that keeps repeating, against your will, and you can’t get rid of it, isn’t that an auditory hallucination? It is, but it is so common that we accept it as a normal, albeit annoying part of life. But voices speaking sentences are not common so we pathologize that.

This is an amazing idea, that otherwise normal people might routinely hear voices. Julian Jaynes, in his weird book, The Origins of Consciousness in the Breakdown of the Bicameral Mind (1976) claimed that humans enjoyed two distinct, parallel conscious experiences, one in each hemisphere of the brain, until recently in evolution. His evidence ranged from none to sketchy, and I wasn’t convinced. But there may well be brain-based structural or biochemical factors behind hearing voices.

The idea promoted by HVN is that a person should accept the voices as meaningful and try to understand them, much as we try to interpret the meaning of dreams. I think that is a good idea. The brain does not manufacture sentences. Only a socialized mind can do that. So whatever the brain basis might be of the voices, their manifestation as language statements is an ego phenomenon and subject to meaningful interpretation.

I don’t think there is any reason to think that the voices are from angels, spirits, or aliens, although I can appreciate why sufferers might believe that. The voices are dissociative, that is, they seem ego-alien, or “not-self,” but they do come from within the psyche of the person and should be interpreted as clues to how that psyche operates.

Unfortunately, it seems like there is usually more than one brain malfunction going on – more than whatever cause the voices. Angelo, for example, was diagnosed also with depression, which may arise from another brain dysfunction, or maybe another aspect of the same one – who knows. In schizophrenia, there is a broad range of clinical symptoms, not just voices. So it may be next to impossible, in practice, to find much sense in the hallucinatory voices, since they may also be manifestations of other problems in the brain. It might nevertheless be possible to disentangle these multiple strands by careful analysis, the way a skilled mechanic can identify multiple problems in your car’s engine by isolating one thing at a time.