Auditory hallucinations—commonly referred to as "voices in your head"—are a common symptom of some mental illnesses. There’s a widely understood and stereotypical picture of what it means to “hear voices,” but many common perceptions about these experiences don’t hit on the truth. Preconceived ideas such as these are an especially important problem in psychiatric research. It’s difficult 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 Durham University in England, designed an exploratory survey to figure 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 explore the causes and treatment of auditory verbal hallucinations.
They created a survey that was aimed at anyone who reports hearing voices, whether or not they've 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 analyses and descriptions of participant responses, highlighting some potentially important departures from conventional wisdom, as well as some promising avenues for further research.
Surveys definitely have their shortcomings. The authors acknowledge this but argue that there has been very little research conducted that tries to get to the bottom of what people actually experience. Surveys are an important starting point.
One limitation in the existing literature is that it tends to focus only on single conditions like schizophrenia, where hearing voices is actually associated with other conditions as well. The Hearing the Voice survey gathered responses from 157 individuals and received responses from people with diagnoses of post-traumatic stress disorder, bipolar disorder, and obsessive compulsive disorder, among others.
A further problem with previous research was that the kind of language used in surveys could have prompted certain kinds of responses from participants, accidentally excluding useful information. For example, one previous study found that 86 percent of participants reported “constant, commanding, and commenting” voices. These voices are commonly assumed to be "inherently violent or potentially harmful," write the Hearing the Voice authors.
The new survey used more open-ended questions that allowed participants to describe their experiences in their own words, and it turned up very different results. Only five percent of participants described voices that issues harmful or negative commands. In fact, a number of people say their voices issue helpful or benign instructions: “They’ll tell me to take out the garbage or check the lock on the window or call someone,” writes one study participant. This could partly be explained by different populations being studied, but it's also possible that fewer people have menacing voices than we previously thought.
“Hearing" voices doesn’t always mean literally hearing, either. Only 44 percent of respondents described their experiences as auditory. For nine percent, the voices are entirely thought-like, and 37 percent of people experienced a mix of thought-like and auditory voices. And a large number, about a fifth, said “voice” wasn’t an adequate description of what they experienced. They used descriptions like “intuitive knowing” or “telepathic experience."
A large majority (81 percent) said they heard multiple voices, and for a fifth of participants, the voices belonged to recognized individuals. In many cases the voices induced fear, anxiety, and stress; but contrary to stereotype, about a third of participants reported feeling neutral or even positive about their voices. Nearly half (45 percent) said they were able to influence the voices by engaging with them.
This survey wasn’t intended to be conclusive or watertight. Rather, its purpose 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 survey suggest that this assumption should be re-examined, 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 to check the truth,” write the authors. There was no way to verify the reported diagnoses or experiences of the participants. And as with many studies, the participant pool was limited: largely white, predominantly female, and all drawn from people with access to the Internet. Participants were recruited using clinical networks, but individuals in acute care wouldn’t have been able to respond, which means that their responses wouldn’t have been taken into account in the data.
Still, it’s a start. In a review of more than 300 research articles associated with keyword search terms, the authors were unable to find any that included individuals with different diagnoses and that used open-ended questions to explore the full extent of participant experiences. There’s a lot of work still to be done here.
The Lancet Psychiatry, 2015. DOI: 10.1016/S2215-0366(15)00006-1 (About DOIs).
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