Do You Hear What I Hear?

18 April 2016

“Imagine having a nightmare while you’re awake,” Elyn R. Saks – an esteemed professor, lawyer and psychiatrist – describes of her experience with the voices in her head.

Auditory hallucinations are false perceptions of sound, most commonly manifested as hearing voices. So what do we know about hearing voices?

Firstly, that it may be a symptom, but is not indicative, of schizophrenia. In the same way an isolated seizure doesn’t mean epilepsy and being skinny doesn’t mean anorexia, hearing voices doesn’t necessarily land you the label of ‘schizophrenic’.

Secondly, hearing voices is massively stigmatised. Often perceived as a sign of severe psychiatric disturbance, madness or insanity, the stigma is only perpetuated by the depictions we see in horror movies and psychological thrillers.

Thirdly, hearing voices is a surprisingly common experience. Studies estimate that 8-10 per cent of the general population will experience auditory hallucinations, yet only one per cent become psychiatric patients. This means that there are many healthy individuals hearing voices on the reg that are able to cope and function well.

So what’s it like to live with voices in your head? Michael Hedrick, photographer, writer and New York Times contributor, likens his experience to a “devil on your shoulder who whispers nasty stuff in your ear and no matter what you do, he won’t go away”. Another patient describes it as “like being surrounded by a gang of bullies”.

Although it can be a frightening experience for some, hearing voices can reflect a plethora of emotions, and many have no problems living with their voices. Natasha Merrick, who experiences both good and bad voices, explains to CBC Radio that “the good voices helped me get myself out of this negative place where I was being attacked to a more positive place”.

Merrick is not alone in her acceptance of her voices, standing alongside the approach taken by the international Hearing Voices Network (HVN). HVN considers itself part of a ‘hearing voices movement’ and mainly services through support groups found worldwide. The movement focuses on respecting the voices as a meaningful, although unusual, human experience.

This approach is far from psychiatric orthodoxy. Traditional practice in behavioural psychology involved distracting patients, encouraging them to ignore the voices and focus on what is ‘real’.

Current approaches mostly seek to eradicate the voices completely with anti-psychotic medication.

Psychiatry, therefore, has conventionally discouraged the discussion of voices, believing that they are inherently noxious and attending to them would be deleterious.

However, HVN – founded by Dutch psychiatrist Marius Romme – openly challenges this pathologisation. Instead it promotes acceptance, rather than eradication. Research shows that hearing voices is seldom synonymous with insanity and not necessarily indicative of a transition along the psychosis continuum, with only 10-20 per cent of voice-hearers requiring treatment and the rest able to self-manage and live independently.

HVN stresses that the voices themselves are not intrinsically destructive, it is more the distress that may occur in coping with them.

Also, given the ubiquitous and frequently innocuous nature of auditory hallucinations, HVN fights against the potent stigma.  Romme encourages the public to see it not as a sign of madness but an expression of powerful emotions, particularly as many voice hearers can pinpoint an antecedent traumatic event, such as sexual or physical abuse. Thus, denigrating it can invalidate the individuals’ experiences and antagonise their recovery.

In a society that values intelligence and stigmatises auditory hallucinations, hearing voices can make one anxious that they are going mad, when they may otherwise be able to cope.

Hearing voices is an unrelatable experience that is more often met with perturbation rather than empathy. It can be very isolating. Individuals may become insidiously consumed by their voices and detached from their friends or family, which only acts to make matters worse.

HVN provides a safe space for individuals to discuss their experiences and appreciates them for their richness and depth, looking beyond the diagnoses.

Although the knee-jerk response to encouraging people to accept and even listen to the voices in their head may be disconcerting, the movement has received been praised with many members supporting it with their anecdotal evidence.

The organisation’s mantra of acceptance, rather than avoidance or eradication, has aided many through their recovery process and learning to cope with their voices as something that may always be a part of their life.

That is not to say the movement’s approach is without contention. Advocates claim that it affords an opportunity for learning how to live normally with the voices, that current medical practice denies them.

While others argue that it sugar-coats the disturbing realities of psychosis and emphasises the dangers in encouraging patients who lack insight into their own psychotic disorder of listening to their voices. Particularly for those who have trouble differentiating between what’s real and what’s not real.

Despite criticisms of being anti-medication or anti-psychiatry, HVN doesn’t deny the need for pharmaceutical intervention. Many of its members remain on medication and HVN instead aims to provide an outlet for those in recovery to explore their voices in a way that makes sense to them.

It posits a new therapeutic angle that can work alongside existing ones. HVN regards itself as less of an alternative and more of a possible addition to current clinical practise and emphasises that it is not anti-science but anti-stigma.

Perhaps in a similar way to how homosexuality and left-handedness were once seen as pathological, the movement calls for a shift in society’s viewpoint to see it as not necessarily an illness. Although hearing voices can be a sign of psychosis or madness, it often isn’t. Society’s perception plays a pivotal role in how voice hearers will see themselves and the resulting pathway they take.

Charles Dickens, Sigmund Freud and Saint Joan of Arc are among the many voice hearers who achieved great things and it is important not to deny them the respect of their experience as a valid and significant one.


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