The term “hearing voices” refers to the experience of hearing voices other people don’t hear. You might use or have heard other people use other terms to talk about this experience; for example, in a medical context, these voices are usually referred to as “auditory verbal hallucinations.” Other people might talk about the voices they hear as “parts,” “alters,” “spirits,” “headmates,” “ancestors,” “telepathic experiences,” “guardian angels,” “system members,” “flashbacks,” or something else entirely. The BC Hearing Voices Network uses the term “hearing voices” because it’s simple and descriptive, and doesn’t make assumptions about how people might understand or cope with their experiences.

Hearing voices can take many different forms, and everyone’s experience will be slightly different. Here are some different traits that the voices might have:

  • Voices that are heard outside of the head, and might be hard to tell apart from “normal” sounds
  • Voices that are heard inside of the head
  • Voices that seem to be coming from inside of the ears or another part of the body
  • Voices that sound like “loud thoughts”
  • “Voices” that don’t sound like speech; for example, hearing music, screaming, footsteps, or other sounds
  • “Voices” that send a message without using words
  • Voices that seem to be the hearer’s own thoughts, but spoken out loud
  • Positive, encouraging, or helpful voices
  • Negative, threatening, or insulting voices
  • Voices that tell the hearer what to do or how to act
  • Voices that narrate or comment on what the hearer is doing
  • Multiple voices that talk to each other
  • Voices that make embarrassing, violent, discriminatory, or “taboo” comments
  • Recurring voices that seem to have a specific age, gender, personality, or other traits
  • Voices that occur only once
  • Voices that sound like familiar people; for example, a family member, friend, partner, or abuser
  • Voices that repeat things the hearer heard in the past
  • Voices that say nonsense words or phrases
  • Voices that change depending on the emotions of the hearer; for example, becoming more aggressive in stressful situations

Hearing voices is not always distressing, and some people find their experiences to be comforting, meaningful, or helpful in some other way. Other people find hearing voices frightening, overwhelming, and confusing. For some people, hearing voices is a fleeting experience; for others, it can be nearly constant or last for long periods of time. The impact hearing voices has on someone’s life depends on these and other factors, like how much power the hearer feels their voices have over them. Often, people find that they can change their relationship to the voices they hear by finding new ways of thinking about and responding to the experience. There are many different ways of making sense of voices, and we’ll discuss some of them further down on this page.

“Hearing voices” as an umbrella term

Although we use the name “BC Hearing Voices Network” and refer to “Hearing Voices support groups,” not everyone who attends these support groups actually hears voices. We represent a diverse community of people with many different – but related – experiences, including unusual sensory experiences, unique beliefs, extreme or altered states, and/or experiences that might be described as psychosis in a medical context. This could mean hearing, seeing, tasting, smelling, or feeling things that others do not; having beliefs that seem strange to other people; or something else entirely.

Depending on their life history, culture, personal beliefs, identities, and ways of coping, people might use many different terms to talk about these experiences. They may have very different explanations for their experiences (for example, spiritual, cultural, psychological, trauma-related, neurological, or a combination of things), and if they think of their experiences as medical in nature, might associate them with a range of different diagnoses (for example, schizophrenia, dissociative disorder, post-traumatic stress disorder, mood disorder, or epilepsy). Some people might find their experiences distressing, while others might not. We believe that people have the right to define their own experiences – and determine for themselves which strategies help them to live well with and make sense of these experiences.

Why use such a broad definition of “hearing voices” for BC Hearing Voices Network support groups? We believe that although this definition encompasses a wide range of different experiences and explanations, it can still be helpful to connect with others who can relate to some aspect of what we are experiencing. We believe that although no strategy for coping with or understanding these experiences is universal, many strategies can be helpful even for people who define their experiences differently. We also believe that different definitions of and explanations for these experiences can coexist, and often overlap with each other. Importantly, we recognize that these diverse experiences have something in common: the stigma, shame, isolation and marginalization associated with them, at least in Western culture. We value creating spaces where people are able to speak freely and without judgment about their experiences, although they may not be exactly the same as our own.

Overlapping experiences of hearing voices

As discussed above, hearing voices can take many forms and can have many different meanings for different people. Here, we’ll list a few different explanations people might have for hearing voices, as well as talking about how these explanations can overlap. These explanations are not mutually exclusive: that is, they aren’t necessarily “one or the other”. Many people find that more than one of these explanations applies to them, that one explanation complements another, or that different explanations work for them at different times.

Cultural: Culture influences every part of our lives, including how we think of experiences like hearing voices. For some people, hearing voices might be a commonly accepted part of their cultural practices or belief system. For other people, hearing voices might be an experience associated with culturally-specific health or spiritual problems and solutions. For example, they might find that seeing a spiritual healer helps with distressing voices. It’s important to remember that culture affects how ALL people think about health, illness, wellbeing, and distress – in that sense, you could say that every explanation on this list is a cultural explanation!

Spiritual or supernatural: Some people feel that their experience of hearing voices is spiritual or supernatural. For example, they might feel that voices represent spirits, deceased relatives, or the voice of a God or gods. These experiences might be part of an established spiritual practice or tradition, and might occur in a specific religious context (for example, while praying). Other people might experience hearing voices as related to a spiritual crisis, perhaps brought on by stressful life events, trauma, inner conflict, or uncertainty about the future. Some people might also feel that hearing voices has spiritual importance or meaning for them, even though they don’t believe the experience is supernatural in origin.

Social or political: Some people feel that their experience of hearing voices is related to their social environment and their interactions with friends, family members, partners, peers, authority figures, and the society they live in. For instance, some people connect their experiences of hearing voices to feeling socially excluded, experiencing racial or other discrimination, living in a very unequal society, or having a low level of trust in the people and systems around them. Sometimes, the voices people hear reflect their ideas about the world and other people in it. Feeling afraid, distrusting, or isolated from other people can cause some people to hear more distressing voices. Some people might also feel that their experience of hearing voices is political, because it is affected by policy decisions: for instance, they might hear more voices when they don’t have a safe place to stay, or access to healthy food to eat.

Cognitive or psychological: Hearing voices can also be related to how we think, feel, and process information about the world. Some voices may be caused by misattribution: that is, when the brain has trouble determining whether information is coming from you (for example, your own speech, thoughts, or imagined images) or from somewhere else. Some people who hear voices may have unusually vivid mental imagery, or perceive sights and sounds differently from most people. Another possibility is that hearing voices could be an extension of inner speech, the way that many people naturally “talk to themselves.” The voices people hear may also be related to their beliefs about themselves and the world they live in – for instance, their beliefs about how much control they have, or whether the world is generally a safe place. Hypervigilance, or the expectation of danger, might make some people more likely to hear things other people don’t. When we are expecting something (like angry speech), we might perceive it where it isn’t.

Dissociative or trauma-related: Some people feel that the voices they hear are related to past traumatic experiences, such as abuse or bullying. Some people may think of the voices they hear as traumatic intrusions: that is, a way of re-experiencing a traumatic situation from the past, similar to a flashback. Some others may think of the voices they hear as representing beliefs they developed in the past in response to trauma, such as the belief that other people are untrustworthy. Still others might think of the voices they hear as a coping strategy that they developed to mentally escape a traumatic situation, similar to daydreaming. Some people may also think of their voices as dissociated parts of themselves: that is, thoughts, feelings, memories, or identities that they have trouble recognizing as their own.

Neurological: Hearing voices can be caused by unusual activity in the brain, which can occur for many different reasons and in many types of medical condition – as well as in people who don’t have a medical condition at all (for instance, when people are very stressed or tired). Epilepsy, dementia, vision or hearing loss, an injury to the brain, using certain drugs, or certain mental health conditions could cause someone to hear voices. Several different systems in the brain are linked to hearing and seeing things other people don’t. For instance, for someone with epilepsy, a surge of electrical activity in the brain may cause them to hear voices or music. For others, how quickly their body produces and uses certain neurotransmitters (chemicals in the brain that send signals between cells) may play a role, by changing how the brain sends and receives messages. Some people may have a natural predisposition for their brain to work this way; for other people, it can be a response to factors like stress, injury, infection, or malnutrition.

Psychiatric: Some people who hear voices may receive a psychiatric diagnosis, and may find that mental health treatment such as counselling, medication, peer support, or occupational therapy helps them. They may feel that receiving a psychiatric diagnosis provides a useful explanation for their experiences or affirms that their distress is real and not their fault. Some psychiatric diagnoses that people may relate to their experience of hearing voices include psychotic disorders, like schizophrenia or schizoaffective disorder; mood disorders, like bipolar disorder or major depression; post-traumatic stress disorder (PTSD); borderline personality disorder (BPD); and dissociative disorders such as dissociative identity disorder (DID).

Response to stress or part of the grieving process: Some people find that they hear voices only during certain parts of their lives, such as during a time of major life transition, stress, or the loss of a loved one. For some people, hearing the voice of the deceased is a normal part of grieving. Other people might find that they hear voices throughout their lives, but that the voices become more frequent, more distressing, or harder to control during times of stress or loss. On the other hand, some people may find that they hear positive voices in times of stress, such as an ancestor offering reassurance.

Difference or diversity: Some people think of hearing voices as a natural part of who they are, and of voice-hearing as just another way people can be different from each other, like having red hair. They may identify as neurodivergent: that is, someone whose mind or brain “diverges” from the norm. This is part of the idea of neurodiversity: the concept that just like the rest of our bodies can look many different ways without being “bad” or “wrong”, so can our brains. Voice-hearing is a spectrum, and many people who don’t identify as voice-hearers will nonetheless hear voices at some point in their lives, however briefly. Some people who hear voices consider them a normal, neutral, or unremarkable part of how they experience the world. For other people, hearing voices is an important part of their identity, or something they consider a special sensitivity or gift.

Further reading

Intervoice – International network for voice-hearers, offering articles and resources

Understanding Voices – Educational website developed by the Hearing the Voice project at Durham University in collaboration with voice-hearers

References:

  • Daalman, K., Boks, M. P. M., Diederen, K. M. J., de Weijer, A. D., Blom, J. D., Kahn, R. S., & Sommer, I. E. C. (2011). The same or different? A phenomenological comparison of auditory verbal hallucinations in healthy and psychotic individuals. The Journal of Clinical Psychiatry, 72(3), 320–325. https://doi.org/10.4088/JCP.09m05797yel
  • Foote, B., & Park, J. (2008). Dissociative identity disorder and schizophrenia: Differential diagnosis and theoretical issues. Current Psychiatry Reports, 10(3), 217. https://doi.org/10.1007/s11920-008-0036-z
  • Iudici, A., Quarato, M., & Neri, J. (2019). The Phenomenon of “Hearing Voices”: Not Just Psychotic Hallucinations—A Psychological Literature Review and a Reflection on Clinical and Social Health. Community Mental Health Journal, 55(5), 811–818. https://doi.org/10.1007/s10597-018-0359-0
  • Jarvis, G. E., Iyer, S. N., Andermann, L., & Fung, K. P. (2020). Culture and Psychosis in Clinical Practice. In J. C. Badcock & G. Paulik (Eds.), A Clinical Introduction to Psychosis (pp. 85–112). Academic Press. https://doi.org/10.1016/B978-0-12-815012-2.00004-3
  • Jessop, M., Scott, J., & Nurcombe, B. (2008). Hallucinations in Adolescent Inpatients with Post-Traumatic Stress Disorder and Schizophrenia: Similarities and Differences. Australasian Psychiatry, 16(4), 268–272. https://doi.org/10.1080/10398560801982580
  • Kaiser, B. N., & Weaver, L. J. (2019). Culture-bound syndromes, idioms of distress, and cultural concepts of distress: New directions for an old concept in psychological anthropology. Transcultural Psychiatry, 56(4), 589–598. https://doi.org/10.1177/1363461519862708
  • Kirmayer, L. J., Corin, E., & Jarvis, G. E. (2004). Inside knowledge: Cultural constructions of insight in psychosis. In X. F. Amador & A. S. David (Eds.), Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders. Oxford University Press. https://oxfordmedicine.com/view/10.1093/med/9780198525684.001.0001/med-9780198525684-chapter-010
  • Larøi, F., Luhrmann, T. M., Bell, V., Christian, W. A., Jr, Deshpande, S., Fernyhough, C., Jenkins, J., & Woods, A. (2014). Culture and Hallucinations: Overview and Future Directions. Schizophrenia Bulletin, 40(Suppl_4), S213–S220. https://doi.org/10.1093/schbul/sbu012
  • Luhrmann, T. M., Alderson-Day, B., Bell, V., Bless, J. J., Corlett, P., Hugdahl, K., Jones, N., Larøi, F., Moseley, P., Padmavati, R., Peters, E., Powers, A. R., & Waters, F. (2019). Beyond Trauma: A Multiple Pathways Approach to Auditory Hallucinations in Clinical and Nonclinical Populations. Schizophrenia Bulletin, 45(Supplement_1), S24–S31. https://doi.org/10.1093/schbul/sby110
  • McWade, B., Milton, D., & Beresford, P. (2015). Mad studies and neurodiversity: A dialogue. Disability & Society, 30(2), 305–309. https://doi.org/10.1080/09687599.2014.1000512
  • Mertin, P., & Hartwig, S. (2004). Auditory Hallucinations in Nonpsychotic Children: Diagnostic Considerations. Child and Adolescent Mental Health, 9(1), 9–14. https://doi.org/10.1046/j.1475-357X.2003.00070.x
  • Parry, S., Loren, E., & Varese, F. (2020). Young people’s narratives of hearing voices: Systemic influences and conceptual challenges. Clinical Psychology & Psychotherapy, n/a(n/a). https://doi.org/10.1002/cpp.2532
  • Powers, A. R., Kelley, M., & Corlett, P. R. (2016). Hallucinations as Top-Down Effects on Perception. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 1(5), 393–400. https://doi.org/10.1016/j.bpsc.2016.04.003
  • Shah, J., Mizrahi, R., & McKenzie, K. (2011). The four dimensions: A model for the social aetiology of psychosis. The British Journal of Psychiatry, 199(1), 11–14. https://doi.org/10.1192/bjp.bp.110.090449
  • Sommer, I. E., Daalman, K., Rietkerk, T., Diederen, K. M., Bakker, S., Wijkstra, J., & Boks, M. P. M. (2010). Healthy Individuals With Auditory Verbal Hallucinations; Who Are They? Psychiatric Assessments of a Selected Sample of 103 Subjects. Schizophrenia Bulletin, 36(3), 633–641. https://doi.org/10.1093/schbul/sbn130
  • Stahl, S. M. (2018). Beyond the dopamine hypothesis of schizophrenia to three neural networks of psychosis: Dopamine, serotonin, and glutamate. CNS Spectrums, 23(3), 187–191. https://doi.org/10.1017/S1092852918001013
  • Stanton, K. J., Denietolis, B., Goodwin, B. J., & Dvir, Y. (2020). Childhood Trauma and Psychosis: An Updated Review. Child and Adolescent Psychiatric Clinics of North America, 29(1), 115–129. https://doi.org/10.1016/j.chc.2019.08.004
  • van Os, J., Linscott, R. J., Myin-Germeys, I., Delespaul, P., & Krabbendam, L. (2009). A systematic review and meta-analysis of the psychosis continuum: Evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychological Medicine, 39(2), 179–195. https://doi.org/10.1017/S0033291708003814
  • Waters, F., Blom, J. D., Jardri, R., Hugdahl, K., & Sommer, I. E. C. (2018). Auditory hallucinations, not necessarily a hallmark of psychotic disorder. Psychological Medicine, 48(4), 529–536. https://doi.org/10.1017/S0033291717002203
  • Woods, A. (2015). Voices, identity, and meaning-making. The Lancet, 386(10011), 2386–2387. https://doi.org/10.1016/S0140-6736(15)01203-9