That Voice in Your Head

Recently our group at NAMI East Bay heard a panel of consumers¹ discuss their experiences with hearing voices. Two of them were from the Bay Area Hearing Voices Network, an organization that helps people with the “lived experience” of “hearing voices, seeing or sensing things that others don’t, or have extreme or unusual experiences and beliefs” come to understand and explore the meaning of these phenomena.

One of the panel members, who had taken prescribed medications to subdue the voices, found the side effects so distressing and the results so problematic that he preferred instead to live with the voices. A second panel member actively interrogated the voices and tried to understand them, asking whether they were ghosts, or pure energy from another dimension, or extraterrestrials. He would reason and debate with them when they told him to harm himself. A third felt that the voices were an inspiration, and he knew they came from outside his head because he could not feel the resonance in his skull when he himself spoke aloud. This man came to trust their answers when he needed to take an examination or make a business report.

The original Hearing Voices Network in the UK was founded in part by Ron Coleman, a consumer himself who is now in recovery and works to provide “recovery centered treatment” to other consumers. The principle seems to be that these experiences are not the symptoms of an illness but real events—as indicated by two of the panel members above—that the person feels he or she should explore in a positive way and that others—loved ones and family members—should be curious and supportive about rather than judgmental. The basic good that I can see in all this is that, if the phenomenon of hearing voices cannot be treated and eliminated with either medication or psychotherapy, at least it should not become a source of fear and anxiety for the patient. Support from and discussion with others who share the experience perhaps can approach this good result.

But I still don’t believe the voices are real—or anything more than a neurological or perceptual fault in the auditory processing centers of the brain.²

One of the panel members said that hearing voices is a common experience. He is right—in the sense that humans are a verbal species and routinely put our thoughts, however silently inside our heads, into words. We may not convert all of our sense impressions and internal thoughts into words, but we certainly try. For example, if I smell something familiar, I will usually try to identify it with a word: “This is ‘coffee.’ ” Or, “That’s ‘a rose.’ ” If I see an unusual shape, I will try to match it with a familiar shape and give it a name.

Many of the thoughts that pop into our minds are verbally arranged. For example, if I am doing something and sense it’s wrong, the thought may insert itself as a sentence: “This is a bad idea.” In the old Transactional Analysis, which was popular back in the late 1960s, the Freudian personality functions of superego, ego, and id were explained as the internalized voices of your Parent, your own Adult self, and your earlier Child self. The Adult makes rational decisions based on current needs, reason, and experience. The Parent issues decrees and warnings based on remembered authority. And the Child expresses needs and wants based on remembered emotional states. … Or something like that. The point is, these are learned and internalized reflexes that the person remembers from growing up as an immature version of self under the regime of a parent who is more mature and either guiding or punishing. Usually, these reflexes present themselves as verbal statements. When my mind generates the thought “That’s a bad idea,” it is usually in my mother’s voice.

I should note also that when I am writing, as now, the words are coming into my head as if I were speaking them aloud.³ And when I write fiction and generate dialogue, I imagine the two or three characters speaking and supplying their own favorite expressions, diction, preferred sentence structure, and even accents as they speak.

So this “common experience” of hearing voices can be pictured as a spectrum, and this matter of thinking in terms of words would be the “normal” end. It is normal in that most people are not alarmed by it, do not find it troubling, and accept it as the way their brain works. I should note that this end can have its alarming aspects. My mentor at the university, Professor Philip Klass, once told of a time he was driving faster than usual on an elevated freeway. He heard a voice in his ear say distinctly, “Slow down!” The voice was so real that he reacted instantly—and around the next turn was a wreck that, if he had not slowed, he would have plowed into. Was that voice the manifestation of a guardian angel? Or just his own mind cautioning him about driving too fast? Either way, he questioned whether the instance of hearing the voice, followed by the crash up ahead, could be mere coincidence.

Moving toward the less-normal parts of the spectrum, we have Professor’s Klass one-time warning voice, as well as the times when we hear a change of air pressure at a partially cracked window and think it’s a human moan or sigh, or the babble of the crowd in a busy restaurant suddenly resolves into an almost-familiar voice speaking our own name. Or—and I speak from experience here—sometimes a recent widower will hear a noise and imagine it’s the whisper of his dead wife. It may be imagination, but it sounds awfully real and there is a momentary pang of recognition and regret. The point is, in this part of the spectrum we are not at all sure, however briefly, whether the voice was inside our heads or not.

Toward the middle of this spectrum are the voice hearers, like the members of the panel, who hear voices that they know or believe are not their own and not coming from inside their heads. They can have it explained to them that their brains are malfunctioning and they are listening and responding to tricks of their own imaginations, but they will not believe it. The voices are too real. One of the panel members insisted that the different voices each had their own way of speaking and accents, and that was proof to him that the voice came from outside. Also, the voices often suggest something that the person would not normally do, such as inviting him or her to commit suicide. Whether the person is following the voice or resisting, he or she acts as if dealing with an alien entity.

And finally—or so I believe—the manifestation of a supposedly external voice with its own character, diction, and other qualities might become so embedded in the mind of the hearer that it develops an entirely separate personality or, in psychologists’ terms, a “dissociative identity.”⁴ While the causes of a brain or mind creating more than one personality or dissociating itself from the one it was born with are debatable, the condition often occurs in someone who experienced extreme trauma as a child. So, presumably, the second and other personalities develop in order to envelop and protect the tender ego. The fact that the core personality is usually not aware of these other personalities, their actions, and their intentions is where the dissociation comes into play. It appears that an alternate personality takes control of the brain and body at various times.

Normally, I would not think of putting dissociative personalities on the spectrum of hearing voices, except one of the panel members mentioned his own childhood trauma and being treated for post-traumatic stress disorder, or PTSD. So it is possible that stress and trauma play a part in the voice hearing as well as the dissociation of a personality.

On top of all this, we must remember that human beings, with our huge and vastly interconnected brains, are the “dream animal.” We live not just in the moment and inside our surroundings, as my dog does, but also in our imaginations, in our speculations, in the what-ifs and if-thens of our subjunctive language, and in the twilight realm of our dreams, where the wildest fantasies seem real and even plausible for a short period of time. Is it any surprise that this delicately balanced and incredibly complex mechanism occasionally slips a few gears and feeds us false information?

That’s just the nature of human existence.

1. “Consumer” is the new, more polite term to refer to people with a diagnosis of severe mental illness and is preferred by people in this situation to the earlier term “patient,” which implies that they have an illness. These people are consumers of mental health services.

2. One of the panel members at the meeting, who tried for a scientific understanding of the phenomenon, stated that functional MRI scans of people when they were experiencing voices showed activity in these processing centers.

3. The generation of this word stream is complex. Some of it comes from my front-of-brain thinking and deciding: here is how the article, argument, or story must go. And some of it comes from my subconscious and its intuitive sense of what the story or article might become. For more on the role of the subconscious in my writing, see Working With the Subconscious from September 30, 2012.

4. The old diagnosis of Multiple Personality Disorder has now become Dissociative Identity Disorder. Po-tay-to, po-tah-to.