Hearing Voices

In 1973, there occurred a notorious episode in the history of psychiatry. A psychologist named David Rosenhan did an infamous experiment in which he had a group of eight people present themselves to twelve hospital emergency rooms claiming that they were hearing the words, “Empty, “Dull” or “Thud.”

Most were admitted and given psychiatric diagnoses. The second part of the experiment consisted of asking staff at a psychiatric hospital to detect non-existent 'fake' patients. They did rather badly. A paper about this was published in the journal Science, with the title, “On Being Sane in Insane Places.”

 
In its day, this paper was considered a damning critique of psychiatry and a plank in the ant-psychiatry movement that was in full swing at the time. In truth, it tells us only that if you lie to doctors and nurses you may deceive them. And second it is only a criticism of bad psychiatry. The idea of diagnosing schizophrenia or any other mental illness on the basis of hearing a single word is absurd. At least 40% of the population will at some time hear their name being called, particularly in times of stress or after bereavement. And very many people in the general population will occasionally hear a word being spoken. It is diagnostic of nothing.

I sincerely hope that none of the people that I’ve taught in 45 countries around the globe would EVER diagnose schizophrenia or any other mental illness simply on the basis of hearing voices, a.k.a. auditory hallucinations. As I’ve stressed time and again, the only purpose in making a diagnosis is to guide treatment and prognosis. Simply hearing voices can guide neither.

This topic came up during one of the things that I was doing to advocate for patients, because September 14th 2006 was World Hearing Voices Day, and I received some very interesting information from a UK based organization, the Hearing Voices Network. (There's also a nice article here as well.)

There is some excellent research on people who hear voices yet are not mentally ill. Many of these people do not feel the need for any treatment and not only peacefully coexist with them, but regard them as a blessing. Most of the research has been done by Professor Marius Romme and Sondra Escher from Maastricht University in the Netherlands, Richard Bentall from the University of Manchester, and Gordon Claridge at Oxford.

About 4% of the general population hears voices, and most of them are not mentally ill. It is essential for us to understand the notion of dimensional rather than categorical diagnoses. I’m mentioning it again, because it prevents us falling into the error of labeling people for no readily apparent reason. For some people their voices are supportive and comforting.

One of several studies has shown that the form and content of auditory hallucinations is much the same whether someone has been labeled with a mental illness or not. Trauma and abuse can reactivate voices, or make them threatening.

The key to the hearing voices is whether or not they are causing distress to the individual or to those around them. There are four major coping strategies typically used by people who hear voices: distraction, ignoring the voices, selective listening to them, and setting limits on their influence.

The biggest danger for people who are hearing voices and are suffering from cognitive impairment or a mental illness, is that the voices may form the basis for delusions. As people are trying to make sense of their experiences, they may develop highly creative explanations.

I once worked with someone who was not hearing voices, but feeling odd sensations coursing along her limbs. She got a textbook of Chinese medicine, and became convinced that she was feeling the flow of Qi in her body. But because she also felt the sensations in places that were nowhere near the channels and meridians, she became convinced that it was her mission to redefine not just the courses of the channels, but to re-write the whole of Chinese medicine according to the sensations in her body.

Her attempt to make sense of her experiences made her grandiose and delusional. She became unable to care for herself, eventually became very distressed and was grateful to have some treatment which eradicated the sensations, which in turn caused the delusions to evaporate.

So treat each person as an individual and forget the unhelpful and stigmatizing labels.

Comments

[avryll]

At last some sense. There is also a link between hearing voices and demonic activity....and this kind of link is increasing...I would like to gather data concerning sane people falsely diagnosed mentally ill because they hear voices, whether controlling or otherwise....and who have been forced to take medication and/or reside in hospitals for the mentally ill because the medical fraternity is unwilling to accept that some humans hear voices, and they are intelligent, sane beings, not in need of medical intervention, but often would benefit from an understanding, knowledgeable, scripture based priest. In New Zealand as in other countries occult activities are on the increase and as a result there has been a corresponding rise in those hearing voices, whether permanently or intermitantly......I am a Christian concerned at the injustice of those sane persons being treated as mentally ill, and I would like to see whether those incarcerated persons would respond to a skilled priest removing the possible cause of the problem......This is obviously not the root cause in some cases, but my limited experience thus far has shown that it could be a major factor which is on the increase.....for those sufferers anything is worth a shot. I know several ultra sane persons, including a dedicated priest who has 'voices' and in all cases former activities have led them open to spirit attack, giving the appearance of mental illness.......so, data on those confined with hearing voices and diagnosed as mentally ill......then, data on those who were helped or relieved of the voices after working with a suitably qualified deliverer.........

All help and thoughts appreciated.....

[Richard Petty]

Dear Avryll,

Thank you so much for writing: you make some important points.

I have written elsewhere about the consternation caused by a number of referrals from the clergy and genuine psychics, which usually began with, "I am not sure if this person is psychotic or possessed."

Teasing apart the psychological and spiriual manifestations of a problem is tricky. That being said, I know many superb psychiatrists on five continents who have all told me about seeing people who were simply manifesting evil.

I may have mentioned in the past that when I first came to the United States, I stipulated that I needed a chaplain on my unit,simply becuase I had so valued their input when I was in Europe. I had some great ones, of many different denominations, and they all brought something special to the care of people whom we were trying to help.

The key is to ensure that the clergy also have a firm grounding in psychology.

Although I cannot prove it, there seem to be increasing numbers of people who hear voices or see things. Their experiences are often very different from the experiences typical of people with psychotic illnesses.

The key point remains that no psychiatrist would want to diagnose and treat someone simply because they are "hearing voices." It is a common phenomenon, and the majority of people who hear voices do not have any form of mental illness.

Kind regards,

RP