The experience of auditory hallucinations (or ‘hearing voices’) occurs when a person hears or receives communication, in the form of spoken words or sentences, in the absence of a source observable by others. It is one of the characteristic features of schizophrenia. About 70% of those with schizophrenia report hearing voices. One third of individuals with schizophrenia try to commit suicide and approximately 20 percent attempted suicide because they heard voices that ordered them to do so.
Psychiatric science has recently discovered that there are apparently healthy voice-hearers—that is, people who hear voices frequently (once a week or more) but who do not appear to have a need for care (Peters 2016). However, it is not clear whether these healthy voice hearers are people who are vulnerable to psychosis but have somehow managed to control their symptoms, or whether their voice-hearing may have a different pathway (Luhrmann 2017). If it seems that they may be similar to those who experience psychosis but that through cultural expectations or through practice they have learned to manage their symptoms so that the symptoms do not become debilitating, this is of great interest, given that the difficulty of controlling voices for those who have schizophrenia is formidable.
In order to understand whether the voice hearing experiences are fundamentally different in phenomena between individuals with and without a need for care or whether cultures and religions help transform as well as influence meanings attributed to their voice hearing experiences, this study has begun by interviewing 25 healthy voice hearers without a need for care in London, United Kingdom. The specific purpose of the work is to interview people who do not meet the criteria for psychotic disorder but who persistently and frequently hear voices. Our goal is to understand their experiences more deeply and to understand whether these experiences conform to a psychosis-like phenomenology or not, whether there appear to be different patterns of voice hearing, and whether there are cultural meanings or specific practices that may help them in managing their voices.
The research methods included a semi-structured interview which asked specific questions about the phenomenology of the voice hearing experience (the Varieties of Individual Voice-Experiences Scale (VOICES) questionnaire), the Tellegen Absorption Scale that assessed a person’s responses to engaging stimuli that enable them to get caught up in their inner worlds, demographic information, and more open-ended discussion with individuals about the ways in which they experienced their voices. Each interview lasted approximately two hours.
The preliminary results of the data have shown that healthy voice hearers without a need for care can usually control the onset and offset of their voices; that they report that they have received positive and helpful guidance from the voices that usually spoke clearly and mostly comprehensibly with the same loudness as their own voices, believe that the voices have good intentions towards them, have trusting and supportive relationships with the voices that get better overtime, lack paranoid and threatening appraisals (i.e., the voices giving orders, insulting or putting down the voice hearers, trying to cause problems, making the person feel ashamed, stressed or threatened), and are less distressed by their voice-hearing experiences and found them to be pleasant compared to persons with psychosis. Generally, they hear one voice at a time. If they hear multiple voices at once, one is usually prominent, and the voices do not converse with one another. Some healthy voice hearing individuals in the study have reported that they have learned to make sense of their voices from spiritualist or psychic churches, conferences or trainings from fellow voice hearers. They say that they learned to control their voices by knowing that they are and will always have control over them, that it is a gift to hear voices, and that hearing voices is part of normal human experience. Some also mentioned that they have heard of negative voices amongst the predominantly positive ones, but they have attributed the negative voices to bad spirits and learned to not pay attention to them while trusting and building good relationships with the positive voices who have their best interests in mind. There also appear to be distinctive patterns of voice-hearing, although more analysis is needed to determine them.
It is striking that the trainings received and described by some of these healthy voice hearing participants seem to align with the teachings of a new approach to voice-hearing in Europe, the Hearing Voices movement. This new approach asks voice-hearers to name the voices, to respect what the voices have to say, and then to negotiate with them. The goal is to turn the voice into something closer to a person with whom one can have a reasonable and positive relationship.
This project is a small piece of a bigger, broader rethinking of schizophrenia that may lead eventually to different treatments.