What do you think of when it is said that someone is ‘hearing voices’? For many people, nothing good comes to mind; mental illness, violence, a broken brain. Even in the wizarding world, J.K. Rowling tells us, hearing voices is not a good sign. But why do people, and wizards apparently, think this?
The media play a role. A recent study found 47% of news stories on voice-hearing associated it with violence towards others. This grossly over-represents the small proportion of instances in which voice-hearing and violence are entangled. People who live with voices unimpaired are rarely discussed, with 84% of news stories not mentioning that voice-hearing can happen in ‘normal’ people. The by-line of the story that voice-hearing is a biological illness has multiple authors. This story has been millennia in the making, but also three decades in the unmaking.
The past was a not a glorious country for voice-hearers. Once Church dogma had been established, prophecy was decommissioned and God deemed silent. Yet something continued to speak. This could have destabilised the Church. Although voice-hearing couldn’t be controlled, voice-hearers could. The easiest way to discredit people’s claims that God was speaking inconvenient truths was to label them ill. The Church of England did this during the English Civil War, when many people popped up claiming to hear God’s voice.
When psychiatry was born, centuries later, it didn’t disagree. Psychiatry’s biological approach seems commonsensical. Antipsychotic drugs can help some people’s voices. Voices erupt in MRI scanners in enticing technicolour. Research, including my own, has found voice-hearing is associated with changes to the wiring of the brain.
But just because something is associated with brain changes doesn’t make it an illness. Voices are associated with problems when they are frequent, nasty, uncontrollable, and start later in life. Just knowing whether someone hears nasty voices allows us to predict with an 88% probability whether they are a patient or non-patient. So why are voices nasty? One factor is culture. It turns out that hearing voices is cross-cultural, but how cross the voices are, is cultural.
For example, a recent study found voice-hearers from the USA typically hated their voices, a feeling that was apparently mutual, whereas Indian and Ghanaian voice-hearers had much better experiences. Why? The authors proposed that the Western sense of self as private and bounded caused those from the USA to experience their voices as an intrusion into their private world. People from India and Ghana were more likely to experience their voices as relationships, rather than as signs of a violated mind.
So, could a shift in how we think about voices, liberate voice-hearers? This is the promise of the Hearing Voices Movement (HVM). Born in 1987, the HVM encourages voice-hearers to explore and define their experiences for themselves. If voice-hearers find antipsychotics helpful, this is respected. Empowerment comes before ideology. However, the HVM suggests that accepting voices is often more helpful than attempting to suppress them, and that what voices say is typically not meaningless, but can often be related to traumatic life-events. The HVM has developed tools to attempt to decode the meaning of voices, often coming to conceptualise them as misunderstood messengers who have something to offer the hearer. Whilst this may not work for everyone, powerful individual testimonies of its benefits are now starting to be accompanied by preliminary scientific trials, although more definitive trials are needed.
So, what should we think of hearing voices? Hamlet knew there was something rotten in Denmark, because a phantom appeared and told him so. Many voices are telling us the same thing. There is a strong relation between voice-hearing and trauma. It is estimated that if we eliminated five types of child abuse we would prevent a third of cases of psychosis. This has led people such as Eleanor Longden to argue we should ask not “what’s wrong with you?” but rather “what happened to you?” If trauma is the basis for someone’s voices, this does not mean that biological changes aren’t present. Childhood adversity is associated with brain changes. The question is, what is the best level to understand such voices at, and to provide support?
For other people, a brain disease model may be the most appropriate level of understanding and assistance. For yet others, voices may be spiritual experiences, or just a benign quirk. Voices can be many things. People need information and the freedom to explore what their voices mean, in a supportive environment. In order to do this, neither the demonization of psychiatry nor the dismissal of voice-hearers’ insights is helpful. A respectful partnership, where expertise is recognised as diverse and distributed, is a way forward. Whether power and interest permit this, remains to be seen. History does not cause us to be optimistic, but the present does.
Dr. Simon McCarthy-Jones is an Associate Professor in the Department of Psychiatry at Trinity College Dublin, Ireland. Simon's new book, “Can’t You Hear Them? The Science and Significance of Hearing Voices“ has just been published by Jessica Kingsley, and is also available from Amazon and all good bookstores, £13.99.
To read another recent opinion piece by Simon in the Irish Times click here.