The day before, Steve had been upset that spring wasn’t particularly warm or sunny in Northeast England, where he lived. Now, a voice had appeared to comfort him. “I remember distinctly thinking that it was unusual,” Steve, now 56, tells me. “It didn’t freak me out or anything. It was as real as my voice is to you now.”

When Steve was a little boy, around two or three, he heard the first voice. It came early in the morning, while he lay in bed. From across the room, a well-spoken English voice said, “Don’t worry Stephen, we’ve got a lovely, beautiful day for you today."

The difference might partly be explained by what Peters calls appraisals, or how an individual interprets their hallucinations and what meanings they give them. She believes that studying healthy appraisals could lead to novel therapy techniques for people troubled by their voices.

Healthy people can have auditory and visual hallucinations, she says, that are just as loud and vivid as those who need clinical help. “The people that we looked at have had fairly frequent hallucinations,” she says. “It’s not just a one-off, say in the context of a bereavement, but people who’ve had them for an average of 31 years. But they’re never problematic for them.”

Emmanuelle Peters, a clinical psychologist and researcher at King’s College London, has been interested in the spectrum of psychotic experiences since she began her career over 25 years ago. She says that though we call seeing and hearing things that aren’t there, “psychotic,” these hallucinations are actually very common in the general population, just over seven percent .

It was the first of many voices that Steve would hear throughout his life. But unlike some people with diagnoses of psychosis or schizophrenia—who hear voices that cause major disruptions in their daily lives—Steve’s voices never bothered him. He’s never been diagnosed with a mental illness, and never sought treatment from a therapist. Steve is a “ healthy voice-hearer ”, and some researchers are hoping to study people, like Steve, to understand why they can hear voices and live their lives without the need for clinical care, and others end up plagued by similar voices.

“From the work that Emmanuelle Peters has done, we know that the intensity of the voices that one person hears is not the most important factor in determining whether you suffer from the voices or not,” says clinical psychologist Lucia Valmaggia. “It’s much more the attributions that you give to the voices. Where you think the voices are coming from. Whether you think they have power over you, or not. Whether the power that they have, you think is positive or negative.”

In this experience, which was odd (but neutral) the clinical group still found it to be more threatening than the non-clinical group. Peters says this finding confirms their theories: that the way psychotic experiences are interpreted differs between people with and without a need for care.

Past work has had similar findings, but Peters says it was hard to tease apart the appraisal and the severity of the psychotic experience. In other words, perhaps a person interpreted their voices as more dangerous because the voice was more volatile. In their recent paper, Peters and her group also put their participants through an “anomalous task,”—where a person is placed in a strange experience. For example, in one task they played a card game, in which a computer or human tester seemed to be able to read the participants' minds.

In a study published in December in The Lancet Psychiatry, Peters and her colleagues interviewed a group who’d had psychotic experiences but never needed clinical help, another group who’d had psychotic experiences and did need clinical care, and a control group. They found that the clinical group was more likely to have paranoid or personalizing interpretations of their voices and visions. They thought their psychotic experiences were more dangerous, less controllable, and more negative overall.

“Traditional [cognitive behavioral therapy] is about having a more reality-based appraisal,” Peters says. “What we found was that people without clinical problems, the healthy group, were not necessarily appraising their voices as something that was just part of their mind, or something that they were generating themselves. They very much believed that there may have been spirits, there may have been outside forces, entities.”

So how do you arrive at positive appraisals? Peters says that many people who don’t need therapy grow up in families where hearing voices is accepted, or seen as a kind of gift. Many have spiritual or supernatural explanations for their voices; they think they are psychic or can commune with spirits. Regarding such spiritual explanations as valid could shift how therapy currently tries to address hallucinations. Rather than trying to eliminate them, therapists could try to change appraisals to anything that helps a person interpret their experiences in a positive way—even if it utilizes magical thinking.

"Obviously there are also some biological elements to psychotic disorders that can’t be ignored," Peters says, so it's not all about appraisals. "If you get really nasty voices who say nasty things all day long, that can be biologically determined, and you’re then more likely to end up having a psychotic disorder. iI’s not either or, but I think the cultural element and the social element is often gone underrated."

At King’s College London, Valmaggia uses virtual reality to try and understand why appraisals differ ; why certain people can view one situation with paranoia, and others without it.

Peters says that therapists shouldn’t need their patients to believe that their voices are coming from their brain, or are a product of mental illness. If they have an appraisal that works for them, a therapist should go with it, if it helps to make the voices non-threatening.

Steve has nicknames for the voices that he hears the most. “Young Posh Bird,” or Celia, is a young woman’s voice in her mid-20s. “She would make the Queen sound common,” he says. “Really cut-glass, Oxford University English.” There’s also “Old Posh Bloke,” a voice in his 70s, whom Steve says sounds like a college professor, and “Young Posh Bloke,” who Steve thinks is that first voice that appeared in his bedroom.

“Those three crop up time and time again,” he says. “They often say something that is within context. Sometimes very pointed. Sometimes, sounding a bit miffed.”

Voice like Young Posh Bird's sound distinctly like they’re coming from outside his body, he says. “It’s like you hear it with your ears,” he says. “You either hear it with your ears, or it seems to come from the middle of your head. More often with me, it’s slightly around my right shoulder, into my right ear. I can only remember one instance of it coming into my left ear.”