Hearing voices – reducing stigma

Key messages

Up to 28% of the general UK population experiences auditory hallucinations.

In Western cultural contexts, hearing voices is often associated with mental illness.

The negative connotations of hearing voices are not universal and do not necessarily reflect the experiences of voice hearers.

Initiatives that allow voice hearers to discuss and define their voice-hearing in more positive terms can help reduce stigma.

The issue

Hearing voices that cannot be heard by others is an auditory hallucination experienced by between 5% and 28% of the general population in the UK. The experience of hearing voices may differ significantly in terms of intensity and frequency from person to person. For some, the voices are neutral or complimentary. For others, they are critical or may even encourage harmful behavior.

Today, voice hearers are often stigmatized in the West. Hearing things that others do not, clashes with individualistic values such as independence and rationality. ‘Normal’ individuals are expected to see themselves as separate from others, define themselves based on their personal traits, and see their characteristics as relatively unchanging. The intrusion of another person’s voice into the individual’s head does not fit well with this individualistic concept of the self and is, therefore, one of the reasons why it is often associated with mental illness.

Indeed, hearing voices is one of the most common symptoms of psychotic disorders such as schizophrenia and psychosis. However, the classification of voice hearers as mentally ill is neither an objective nor universal notion.

Cultural contexts

Voice-hearing is a feature of human experience that crosses cultures, continents and historical periods. In collectivistic cultures in which people see themselves as connected to metaphysical entities, define themselves in terms of their relationships with others, and see their characteristics as changing across different contexts, hearing voices may not be considered a problem to the same extent as it is in Western contexts.

On the contrary, voice-hearing may often be experienced in positive terms – e.g. as a way of communicating with deities or the dead. Qualitative studies in Chennai, India, and Accra, Ghana, have shown that auditory hallucinations often remind people of friends and family or are considered playful and entertaining. Even in the UK, not all voice hearers find their voices unpleasant.

Thus, hearing voices might not necessarily always be considered a bad experience. In fact, some research suggests that it is even possible to improve people’s relationship with their voices by teaching them to name, respect and interact with their voices.

Besides, hearing voices is not reserved exclusively for people with mental illness. A large number of otherwise healthy individuals report hearing voices on occasion. As such, one study in England and Wales found that only around 25 % of people who heard voices met the criteria for having a psychotic disorder – irrespective of their ethnicity.

Thus, the classification of voice hearers as mentally ill and suffering solely on the basis of the experience is culturally specific and misguided. In fact, it may even be harmful as the stigma surrounding voice-hearing in the UK prevents people from talking about their experiences. To make matters worse, conventional treatment methods prioritize the use of tranquilizers and antipsychotics over interaction with the voices. Many mental health professionals have been taught not to let voice hearers talk about their voices, as this was thought to be colluding with the person’s delusions.

Thus, voice hearers often think they are alone in hearing voices. This can lead to feelings of shame, anxiety and social isolation which may aggravate potential mental health issues.

Policy implications

The realization that hearing voices may not necessarily have anything to do with mental illness or be a bad experience could be significant to the well-being of voice hearers as it could help destigmatize or even improve the experience of voice-hearing.

Voice hearers should be encouraged to share their experiences of hearing voices in a non-judgmental setting whereby voice-hearing is normalized. For instance, the British branch of the international ‘Hearing Voices Movement’ brings together voice hearers in peer support groups which also teach people the techniques to recognize their voices’ games and tricks as well as to identify their good aspects.

Links for further reading

  1. Luhrmann, T. M., Padmavati, R., Tharoor, H. & Osei, A. (2014). Differences in voice-hearing experiences of people with psychosis in the USA, India and Ghana: interview-based study. The British Journal of Psychiatry 211(5).
  2. Busch, S. (2015). Hearing Voices: Perceptual Realities and Rational Choices. In V. Steffen, S. Jöhncke & K. M. Raahauge (eds.) Between Magic and Rationality: On the Limits of Reason in the Modern World. Museum Tusculanum Press.
  3. http://www.intervoiceonline.org
  4. https://www.mentalhealth.org.uk/a-to-z/h/hearing-voices
  5. http://hearingthevoice.org/frequently-asked-questions
  6. Larøi, F., Luhrmann, T., Bell, V., Christian, W. A., Deshpande, S., Fernyhough, C., Jenkins, J., and Woods, A. (2014). Culture and hallucinations: Overview and future directions. Schizophrenia Bulletin, 40, S213-S220.
  7. Johns, L., Kompus, K., Connell, M., Humpston, C., Lincoln, T., Longden, E., Preti, A., Alderson-Day, B., Badcock, J. C., Cella, M., Fernyhough, C., McCarthy-Jones, S., Peters, E., Raballo, A., Scott, J., Siddi, S., Sommer, I., and Larøi, F. (2014). Auditory verbal hallucinations in persons with and without a need for care. Schizophrenia Bulletin, 40, S255-S264
  8. Fernyhough, C. (2016). The Voices Within: The history and science of how we talk to ourselves (Profile, 2016). US edition (Basic Books, 2016). Translated into Dutch, German, Italian, Spanish, French, Korean, Turkish and simplified Chinese.
  9. Johns, C. J., Nazroo, J. Y., Bebbington, P. & Kuipers, E. (2002). Occurrence of hallucinatory experiences in a community sample and ethnic variations. British Journal of Psychiatry, 180:174-178.
  10. Coffey, M. & Hewitt, J. (2008). ‘You don’t talk about the voices’: voice hearers and community mental health nurses talk about responding to voice hearing experiences. Journal of Clinical Nursing, 17(12):1591-1600.