Why we have written this guide

This guide has been written as an introduction to this different way of thinking about “hearing voices”. Hearing voices can be a very disturbing experience, both for the person who hears voices and family and friends. To date, very little has been written about this experience and its meaning, usually it is regarded as a symptom of a mental illness and is not talked about because it is a socially stigmatising experience.

In this guide we ask:

what is it like to hear voices?

why does it start?

and how can people cope better with this experience?

The information in this guide is based on research and practical work carried out in the Netherlands and the UK over the last seventeen years, which for the first time comes directly from the real experts, the voice hearers themselves.

Introduction: How work on the hearing voice experience has developed

What it is: What does it feel like to hear voices?

What the voices say: What do the voices tell you and what can they do?

How to zap voices: How do you zap a voice?

The movement: Professor Marius Romme gets a shock and founds a movement

What does the research mean for voice hearers?: The implications for psychiatric treatment and a hope of recovery?

Talk about it: A hearing voices checklist

Who is this guide for?

This guide is for voice hearers, family and friends, as well as being of interest to professionals working with voice hearers. We hope that when you read the guide you will be interested in finding out more. If you would like to, you can join INTERVOICE and keep in touch with developments as well as supporting our work.

1. Introduction

How work on the hearing voices experience has developed

How did it start?

The first UK Hearing Voices Group was formed in 1988. It began as a small planning group originating in Manchester, inspired by the pioneering work of Professor Marius Romme, a psychiatrist from Maastricht in the Netherlands, and the Dutch self help group Foundation Resonance which was established through this work. Members of the UK group have visited Maastricht many times and attended conferences organised by the Foundation and in return have hosted visits by the Dutch workers. In 1989 the Manchester group organised a speaking tour in the North of England for Marius Romme, Sandra Escher (science journalist) and Anse Streefland (a non-patient voice hearer and Chair of Resonance). The meetings were very well attended by voice hearers, their relatives, and interested professionals. This has become a regular annual visit.

Knowledge of the work has been spread by the publication of articles in specialist magazines and journals, local newspapers and the national media and is now the subject of the book Accepting voices published by Mind publications in 1993. This contact has continued to develop over the last nine years and in August 1995 the first international conference on the subject was held in the Netherlands.

What is the traditional belief about Hearing Voices?

Firstly, hearing voices has been regarded by clinical psychiatry as an auditory hallucination and as a symptom of conditions such as schizophrenic disorders, bipolar disorder (manic depression) and psychosis. The usual treatment – major tranquilliser – is administered in order to reduce the delusions and hallucinations. However, not everyone responds to this type of treatment.

Secondly, there are many people in the UK who hear voices, some of whom cope with their voices well without psychiatric intervention. This fact has been neglected. This guide asks if there is another way of thinking about voices?

Hearing Voices – A New Approach

Marius Romme (Professor of Social Psychiatry at the University of Limburg, Maastricht) in association with the UK Hearing Voices Network carried out research over nine years in the Netherlands and the UK and in his words:

“What this research shows is that we must accept that the voices exist. We must also accept that we cannot change the voices. They are not curable, just as you cannot cure left-handedness – human variations are not open to cure – only to coping. Therefore to assist people to cope we should not give them therapy that does not work. We should let people decide for themselves what helps or not. It takes time for people to accept that hearing voices is something that belongs to them.”

2. What it is?

What does it feel like to hear voices?

It’s hard to explain

It is difficult to explain what it is like to hear “voices”, particularly if you have never heard voices yourself. The word vocation, for instance means to “follow a calling”, in other words to hear a voice and act on it. This is not what most people mean when they say they have a vocation, but that is the root meaning of the word. Indeed, many historically important people claimed to have heard a voice that acted as their inspiration (see Some facts about voice hearing: 1).

For voice hearers, the voices might be present all day and have the effect of preventing them from doing things in their daily life. Voices might also punish the voice hearer if they do not do what the voice wants them to. Hearing voices is often regarded as dangerous because “voices” tell people to commit murders and to harm themselves, and there are sensational examples of this. It would seem that to hear voices makes you either a saint or a mad man – but is this always the case?

Some facts about voice hearing: 1 Some famous people who claimed they heard voices: Socrates, Moses, Jesus, Mohammed, Joan of Arc, Teresa of Avila, Swedenborg, Carl Jung, Anthony Hopkins, Zoe Wannamaker, and Ghandi.

In a nutshell

There are many prejudices and difficulties to overcome if one attempts to explain. However, the experience of hearing voices is not as alien an experience as it is generally thought to be. Firstly, it may be the same as hearing a voice in the normal way through your ears, the difference being that the “voice” has no physical cause. But like normal voices there is variety, and every experience has its differences. For example; leaving a party on their say so; not being able to talk about the voices; becoming silent, and as a result, isolated from other people. You may think you have never experienced this, but are you sure? (see Some facts about voice hearing: 2)

You may have had the experience of hearing someone call your name only to find that there is no one there. Indeed, research shows that, especially for people recently bereaved, it is not an uncommon experience to hear the voice of the recently deceased person. That is not the only explanation of what it is like. As well as hearing voices through the ears, people also hear voices as if they are thoughts entering the mind from somewhere outside themselves. This is not the same as a suddenly inspired idea, which people usually recognise as coming from themselves, rather the thoughts are not their own and would seem to come from outside their own consciousness, like telepathy.

A good example of this is the experience of recalling a rhyme or tune, which you find yourself repeating unconsciously under your breath and which keeps going through your head again and again. You can even find yourself humming it. You never took a decision to start thinking of it and it is difficult to stop thinking about it. The difference between the tune and “voice thought” which appears as words in your mind is that it may go on to speak coherently to you and even engage you in conversation. You, yourself are not responsible for it and you have no idea what this “voice” is going to say next.

Thoughts without words. Visions, smells, tastes and dreams…

There are many different ways to hear voices. Voices can be experienced inside the head, from outside the head, or even in the body. It may be one voice or many voices. The voice may talk to you or about you. There are other ways to hear voices, some of them make the phrase “hearing voices” a poor description and perhaps one day we will have to come up with a better one – because it is never the same for everyone. Some people, for instance, experience non-verbal thoughts, images and visions, tastes, smells and touch. All with no physical cause and all sensations they did not call into being themselves.

Voices can be like dreams. We all dream and experience words, images, and even sensations. When we are bored we can drift off and have a short dream. When we dream all sorts of strange things can happen to us, but we still believe they’re really happening to us. Hearing voices can be like that – a waking dream – but something that is experienced as real.

Some facts about voice hearing: 2 Voice hearing is not an uncommon experience. Many people hear voices and have never been a psychiatric patient, this is already a well known but neglected fact. It has been known for some time that a high percentage of the general population experience brief and occasional voices, particularly at times of bereavement, divorce and separation. It is also the case for people in extreme circumstances, for instance, 80 per cent of those who have endured torture have hallucinated during their ordeal (Amnesty International) and the phenomenon is also seen amongst long-distance yachtsmen (Bennett, 1972). In cases like these, there is no evidence of the presence of mental illness – indeed, often quite the contrary. More recent epidemiological research in Baltimore, in a population of 15,000 people, found that 10 – 15 per cent of those interviewed reported that they had heard voices over a long period of time, only a third of those interviewed reported experiencing negative effects (Y. Tien). Further research in 1991 revealed that many cases of hearing voices did not meet the criteria for a psychiatric diagnosis (Eaton). Significantly, Romme’s latest research of both non-patient and patient voice hearers showed that both groups hear negative and positive voices at about the same level. The difference is mainly in how the two groups react to the voices, with the non-patients not experiencing fear of the voices and experiencing far less upset from them than the patients.

3. What the voices say

What do the voices tell you and what can they do?

Lots of different voices

What do voices say? What messages do they bring? Usually there is not just one “voice” that says the same sort of things all the time. There can be a number of voices that may be different from each other. One could say pleasant things and be on your side while another might not. Sometimes a voice can have a complete personality and be instantly recognised by the person hearing the voice as some particular person, dead or alive, or some known spirit or being such as God or the Devil. Other voices may not have much of a personality and the person hearing what is said may not put it down to some particular person or being. Hearing the “voice” is like hearing random snatches of conversation.

The worst news

Some “voices” are more pleasant then others. The less pleasant ones may abuse the person hearing them, saying that this person is no good, of no account, evil, stupid, worthless. They may say this sort of thing monotonously and continually. The voices may also give people orders that they felt they have to obey because the voices control the person’s body. For example, the voices might also cause them to have a fit, or experience pain.

Still not good

Alternatively, the voices could simply be constantly or occasionally interrupting with meaningless and valueless comments, such as “that’s not a good idea”, “that’s not going to work”, “he’s one of them” and so on. The voices may also discuss something with apparent omniscience and wisdom – apparently they know everything – but the voice hearer can find that the information is false. For example, the voices tell you that if you send someone a letter asking for something, that person will do what you want. When it does not happen it can be very disillusioning.

The good news

There can be a pleasant side to hearing voices. Sometimes the apparent wisdom is real and the voices, or some of them, can seem intelligent. Voice hearers report that they have been told things they did not know or could not work out for themselves and the voices have been of real assistance. For some people this experience is considered a gift, something that is like a valuable insight or even extra sensory perception (ESP), and the voices can be trusted.

Voices can be intelligent, witty, funny and incisive. They can in themselves be a coping mechanism. What the voices say corresponds with the effect that the social and emotional world is having on the voice hearer. The voices will often comment on how the voice hearer is experiencing the world and in this way the voices can be a defence mechanism against overwhelming or forbidden feelings. Voices are often related to life history, such as recent or childhood trauma and the voices speak of powerlessness and injustice.

Some facts about voice hearing: 3 Three phases found among people who hear voices The startling phase Most voice hearers describe the onset of the experience as being quite sudden, startling and anxiety provoking, and can vividly remember the precise moment they first heard a voice. The age of the onset of the initial experience of voices varies widely, as does the intensity of the startling phase, which appears to be most severe when it occurs during adolescence. The confusion seems to be less when voices are heard from an early age, or did not make an appearance until later in adulthood (In a survey 6 per cent heard voices before the age of 6; 10 per cent between 10 and 20; 74 per cent after 20). Voices are often triggered by traumatic or emotional events such as accidents, divorce or bereavement, illnesses, psychotherapy sessions. The impact of the voices fall into two types: Some people perceive the voices as helpful and they evoke a feeling of recognition. These people feel the purpose of the voices is strengthening them and raising their self-esteem. The voices are experienced as positive and as an understandable aspect of their internal selves. Others experience the voices as aggressive and negative from the very beginning. For these people the voices are hostile and are not accepted as part of themselves. They suffer from negative voices that can cause chaos in their minds, demanding so much attention that communication with the outside world is extremely difficult. The phase of organisation: coping with the voices Voice hearers often become confused by their voices and want to escape from them. For some, this urge lasts only a short time (weeks or months), for others, it can be many years. However, to come to terms with the voices on any level or to organise them successfully, requires some form of acceptance to take place. Denying the voices does not work. During this phase, voice hearers understandably seek ways of controlling or coping with the voices, strategies include:- ignoring the voices (distraction)

listening to them selectively

entering into willing dialogue with them

making specific appointments with them Attempts at distraction and ignoring rarely work, although this is a strategy many voice hearers attempt, it seems the effort involved often leads to a severe restriction of life style. Unsurprisingly, initial feelings of panic and powerlessness are replaced with a period of anger at the voices, this anger does not appear to be part of a useful coping strategy. The most useful strategy described by voice hearers is to select the positive voices and listen and talk only to them, and to try to understand them. An important element in coping successfully with voices is to accept them. This appears to be related to a process of growth towards taking responsibility for one’s own decisions. You have to learn to think in a positive way about yourself, your voices, and your own problems. Another strategy is to set limits and structure the contact with the voices, sometimes accompanied by rituals or repeated actions. The phase of stabilisation People can and do learn to cope with their voices and find a kind of equilibrium. In this state of balance, people consider the voices as part of themselves and their lives, and capable of a positive influence. During this phase, the individual is able to choose between following the advice of the voices or their own ideas, and can say “I hear voices and I’m happy about it”. NB: The information in this section is taken from the results of questionnaires sent to voice hearers and from subsequent interviews carried out over ten years (see Accepting voices).

What voices do

Voices can vary from the very pathological and undesirable to being considered a faculty or gift. Many people, even those troubled by their voices would not like to stop hearing voices – voices may be pathological for some people but they may also fill a useful psychological function.