JREF Swift Blog

Listening to Voices

Should you take medical advice from voices apparently coming out of thin air?

Cases of people “hearing voices”, whether spiritual or not, lies at the root of most religions with a litany of saints and prophets describing the apparently supernatural guidance they received. Still, modern neuroscience has indicated that many of these experiences can be due to different forms of brain pathology. Along with psychotic disorders such as schizophrenia, auditory hallucinations have also been linked to complex forms of epilepsy, injuries, or strokes involving auditory regions of the brain’s cortex.

Or possibly even a tumour.

A bizarre care reported in a 1997 issue of the British Medical Journal takes an intriguing look at the neurological roots of auditory hallucinations which actually helped medical doctors diagnosis illness. Written by Ikechukwu Obialo Azuonye, then a consulting psychiatrist at the Lambeth Healthcare NHS trust, the paper is titled, “A difficult case: Diagnosis made by hallucinatory voices.”

In the case history, an otherwise healthy woman referred to as “A.B” had been living in Britain since the 1960s and was a full-time homemaker when the events described in the article began in 1984. A.B. was reportedly sitting at home, reading, when she heard a voice in her head. The voice reportedly told her: “Please don't be afraid. I know it must be shocking for you to hear me speaking to you like this, but this is the easiest way I could think of. My friend and I used to work at the Children's Hospital, Great Ormond Street, and we would like to help you.”

A.B.’s response to this voice was about what you would expect. Frightened at what was happening, she tried to ignore the message but the voice reassured her by providing her with additional information about the hospital she would need to attend. Convinced by this point that she had gone mad, she consulted her family doctor who referred her to Dr. Azuonye.

After an examination, which showed no medical explanation for what A.B. had heard, he diagnosed her with a functional hallucinatory psychosis. Along with supportive counselling, she was also treated with thioridazine and the voices disappeared after a couple of weeks. Unfortunately, the voices returned several weeks later even though she was still taking the medication. This time, the voices were even more specific in directing her to the diagnostic imaging wing of a nearby London hospital. The voices then informed her that she had a tumour in her brain and that she needed a scan for proper diagnosis. They even told her the approximate location of the tumour (her brain stem).

Though Dr. Azuonye had found no evidence supporting the presence of a brain tumour, A.B. was distressed enough by this time that he ordered the scan done. This actually took some negotiating since a computerized tomography test is an expensive procedure and the lack of any apparent medical justification, aside from a hallucination, made the request hard to fathom. After considerable debate, the scanning was done. Sure enough, the scan showed evidence of a meningioma with a left posterior frontal parafalcine mass extending through the falx to the right side.

The neurosurgeon to whom Dr. Azuonye referred his patient gave A.B. and her husband the option of immediate surgery as opposed to waiting for actual symptoms to appear. After weighing the pros and cons, A.B. decided on immediate surgery (the voices were in full agreement).

The operation was carried out in May of1984 with no surgical complications. According to A.B., she heard from the voices one last time after regaining consciousness when she heard them say, “We are pleased to have helped you. Goodbye.” No post-surgical problems arose though she was kept on anti-seizure medication for six months after the operation as a precaution. The anti-psychotic medication was also discontinued.

According to Dr. Azuonye’s case study, A.B. remains symptom-free after more than twelve years following the operation. As virtually the only case of its kind reported in the medical literature, A.B.’s case was unique enough for Dr. Azuonye to present at a conference in 1996. Since A.B. attended the conference as well, participants were able to question both of them together about the circumstances of the case.

Given the nature of the questions posed both to A.B. and Dr. Azuonye, there was an interesting variety of opinions. One group, which he termed “the X-philes” in his paper, suggested that the case was an example of telepathic communication from well-meaning people who had psychically learned of the tumour and sent warning. The second group,“the X-phobes” suggested that A.B. had already been aware of her tumour before coming to the U.K. and had invented the story of hearing voices as part of a scheme to get free medical care under the National Health Service. Since she had already been living in the U.K. for fifteen years before hearing the voices, the facts do not appear to bear this out.

The third explanation offered, and the one that Dr. Azuonye endorsed, was that, despite the lack of any apparent symptoms from the tumour, the presence of a meningioma that size likely triggered enough residual sensations for her to be aware that something was wrong. The information that she was apparently provided by the voices likely came from her own knowledge of London’s hospitals of which she had not been aware. Considering that the voices had vanished completely after the tumour was removed suggests that her psychiatric symptoms were likely linked to her neurological disorder. That she has remained symptom-free in the years since her operation may well support this last hypothesis.

While not all cases involving auditory hallucinations can be so clearly linked to brain disease, the particular episode demonstrates that “hearing voices” is something that can strike at any time, whether there is evidence of mental illness or not. In another time or culture, a case such as A.B. might well have been used as “evidence” for divine intervention or visitations by supernatural beings (and patriarchs hearing the “word of God” have figured in most of the world’s religions at some point or other).

Though A.B.’s story represents an intriguing example of how the brain can help diagnose disease, the lack of other case histories like it suggests that such a phenomenon must be extremely rare in people without a psychiatric history. So, rather than waiting for voices, it would likely be better to just get regular check-ups instead.

Romeo Vitelli, Ph.D. is a psychologist in private practice in Toronto, Canada. He is an active blogger and a regular contributor to the Huffington Post and Psychology Today. Check out his blog, Providentia.