On Voice Hearing Simulations: Why They Should Be (Mostly) Banned


Countless times have I heard that someone has been through a “Hearing Voices training” only to learn that what they actually mean is that they’ve participated in one of those voice hearing simulations with headphones and recorded voices alternately screaming and whispering in their ears. These things are not equal. In fact, the simulations can be dangerous, especially when done in isolation, or led by people who misguidedly think that headphones ranting words at someone might somehow increase their ability to comprehend.

Voice hearing simulations are meant to increase understanding of and empathy for the experience of those who hear voices on the regular. (See the ‘Empathy Initiative‘ for just one of many examples.) When integrated into much longer trainings that discuss research, alternative perspectives, strategies, and ways that voice hearing can be part of a full life, that can be effective. However, the standard voice hearing simulations circling our nation — the ones that fail to unpack the meaning behind the exercise and discuss its various implications — miss the boat in several ways.

Voice Hearing Simulations are Sensationalism at Their Best

The most sympathetic folks who go through a voice hearing simulation tend to come out of it saying things like, “Wow. That was so hard,” or “I don’t know how I’d ever get through an actual day like that,” perhaps peppered with a few exclamations of “Those poor people!” It paints voice hearing as one of the most intense, disruptive experiences one could possibly have, and basically leaves others with a feeling of, “Oh, now I get why people who hear voices couldn’t possibly function right.” It pushes pity and a grotesque sort of awe more than understanding.

Voice Hearing Simulations Increase Fear and Hopelessness

About a year ago, I was co-facilitating a Hearing Voices training. Participants were almost entirely people working in peer roles, but not all of them had first-hand voice hearing experience. Now, as a part of that training, we routinely do a voice simulation exercise (though still not the headphone version). At the conclusion of the exercise in that particular round, a training participant spoke up and said, “Now that I’ve been through that, it’s hard to imagine how anyone hearing voices could ever have a job.” Fortunately, I was co-training with someone who had the presence of mind to retort something along the lines of, “Well, you are in a training where people who hear voices are not only working, but might just be training you on how to do your job!” Yet, I’ll never forget the lesson that comment conveyed: People will think that this sensational presentation of voice hearing at its relative worst represents the full picture of what voice hearing is like in its entirety.

Voice hearing simulations capture the experience of voice hearing at its worst, most frightening moments. The voices bank on catching you off guard. They are designed to be distracting, scary, and mean. Although they are certainly informed by what some voice hearing experiences are like, they represent only a fraction of the truth. They don’t do anything to teach how people work through that, the many effective strategies they use, or any of the benefits that some come to find in this way of being in the world. Voice hearing simulations are also very common among so-called sensitivity trainings for police officers, but it’s baffling to me why anyone would think that sending hordes of police officers through a training that reinforces the idea that folks who hear voices are completely unable to function or think clearly would somehow make them believe that individuals with this experience are less dangerous. Pity and fear aren’t great harbingers of compassion and kindness.

Voice Hearing Simulations are Rooted in the Idea That Voice Hearing is Bad

As aforementioned, voice hearing simulation exercises are designed specifically to make participants feel frightened, overwhelmed, and unable to function. The basis for these exercises seems to be caught up in that false dichotomy that tells us that all that gets labeled ‘mental illness’ is either ‘your fault for being weak and bad’ or ‘not your fault because you’ve got an illness over which you are powerless at least some of the time’. I suppose if all we’re aiming to do is train cops to understand that people aren’t necessarily being willfully combative or ignoring their demands, then that’s something (though the news and behavior of police officers at these sorts of trainings suggests its really not much at all). But voice hearing simulation fails miserably at teaching them that voice hearing itself doesn’t have to be feared. In fact, many people who hear voices have never sought out help for it, because it wasn’t a particularly frightening experience to begin with. In some cultures, voice hearing is the norm not the exception. And even with those for whom voice hearing started out as scary, many have come to a place where their voices help in myriad ways like keeping them company or reminding them of things they forgot.

Not all that we don’t understand must be sectioned off and gotten rid of. Not everything that brings up big feelings must be numbed out.

Voice Hearing Simulations Paint Erroneous Pictures That All Voice Hearing Looks the Same Way and Doesn’t Change Over Time

For most people, voices change in some way over time. That might mean that the voices themselves change (their tone, their emotion, and/or their message), or it might mean that the recipient of the voice begins to understand things in a different way (e.g., understanding the message behind different words, and therefore being less scared of them, etc.). Often the two go hand-in-hand, and increased understanding and relationship between the voice hearer and the voices they’re hearing helps shift the content, too. Yet, voice simulations basically leave people with the impression that the whole experience is static. It teaches people that voices are likely always surprising, scary, and distracting. That moment in time becomes all someone participating in a voice hearing simulation may ever know.

In actuality, the Hearing Voices Movement — from which the most useful ‘hearing voices’ trainings are generally drawn — has long been talking about the shifting experience of hearing voices with great depth. For example, Hearing Voices Movement co-founder and psychiatrist, Marius Romme (together with Sandra Escher), has written at length about the “three phases” of voice hearing as discovered by research.

These phases include (in brief) the “startling” phase (during which voices tend to be most surprising), the “organizational” phase (during which people come to better understand and make meaning of the experience), and the “stabilization” phase (where balance — often in living with the voices — is regained). This framework is not meant to suggest that these are the only possible three phases, or that they necessarily work in any kind of order, and some feel critical of the phases because of their somewhat medicalized feel and wording. However, whether one resonates with the phases, or continues to reach for something even clearer and true, it’s evident that any sort of training that leaves everyone permanently subsisting at “startle” is a problem.

(Check out page 10 of this Australian Hearing Voices publication for more details on this topic.)

Voice Hearing Simulations Perpetuate the Idea That There Is and Can Be No Relationship Between the Voice and Voice Hearer

In reality, when someone hears a voice or sees a vision, it is typically related to their own experience, even if in a highly metaphorical sort of way. Meanwhile, the fact that pre-recorded simulations will be devoid of any personal meaning reinforces the belief that voices are typically meaningless; random misfirings of one’s brain. This is an especially problematic belief when one considers the fact that the way a voice hearer often gains a sense of control over a more difficult voice is to make meaning of it.

Similarly, the simulation does nothing to demonstrate the power of building relationship between the voice hearer and the voices they’re hearing. While this doesn’t work for everyone, many people do develop relationships — often amicable ones — with those voices that felt like they were once disconnected, meaningless ramblings.

I know, I know. Some of you will argue, “These voice simulations, they’re better than nothing!” But they’re not. Because sometimes “a step in the right direction” lands you in a ditch… usually one dug by people who never had any business attempting to be your guide in the first place. (And no, it doesn’t fix it when you develop a voice hearing simulation and then rope a voice hearer into loosely legitimizing it by having them stand at the front of the room in your stead.)

The idea that we can help people genuinely empathize with another person at the expense of any sort of respectful regard for their actual experience is kind of absurd at its root. In fact, if you think about it, that sort of “empathy” often seems to form the foundation for all the worst “diversity” and “sensitivity” trainings (i.e., the vast majority of “diversity” and “sensitivity” trainings) for every marginalized experience known to human kind.

We can do better. In fact, we have done better, although — as systems of oppression tend to work — those with the most marginalized voices remain overshadowed by the behemoths in the field (National Alliance on Mental Illness and so on) in spite of the higher quality and greater validity of what we have to offer.

Clearly we need to start pointing more people in the right direction.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


  1. Sera:

    I agree with you on most points however people who may experience disturbing voices on a daily basis may get blamed for being lazy and unproductive. Dealing with negative voices or intrusive thoughts/perceptions may require a lot of intense work and the work may appear to others as a character deficit because it takes away from a person’s ability to focus on activities that are group related. I’m sympathetic to the folks who claim that these simulations are ‘better than nothing’ Although I don’t completely agree with this statement, one of the points of the simulation is to elicit empathy from the general public. It would be better if your criticism came with an alternative public education plan. It’s not very practical to suggest that people supporting loved ones who hear voices in a home=based environment, enroll every household member in a four day IPS training. These trainings are financially beyond the reach families like ours. I think the point of the simulation is to create something that is within reach of most famlies.

    • Madmom,

      I tend to agree more with Sera. My case may, or may not, be typical. Since my “voices” were created with the psychiatric drugs (via antidepressant and antipsychotic induced anticholinergic toxidrome).


      What percentage of voice hearers’ “voices” are created via antidepressant and/or antipsychotic (or other drug) induced anticholinergic toxidrome, is currently not even a subject of research. Despite the fact I personally believe it should be studied.

      Although I do understand why it’s not been, or being, studied. How embarrassing it would be for the medical field if it was learned that most of the evil “voices” that people are subjected to, are actually created with the supposed psychiatric “cures” … as was my experience.

      Nonetheless, I agree that teaching others to believe that “voices” are irrelevant to one’s personal experiences is unwise, and does not allow others to truly garner either true empathy, or insight, into the experience of hearing “voices.” My psychotomimetic “voices” were 100% in sync, and relevant, to what I later learned to be true.

      In 2005 I was handed over medical evidence of the abuse of my child. My psychotomimetic “voices,” of which I suffered from 2002 to 2005, were the “voices” of the alleged rapists of my child, and their pastor. Those satanic “voices” bragged incessantly about abusing my child. My psychiatrist told me not to believe them, so I ignored them, until the medical evidence of the abuse of my child was handed over.

      As it turned out, my psychiatrists’ belief my “voices” were not relevant to me or my family’s life were 100% incorrect. What he initially claimed was a “delusional religious conspiracy,” did become a real life medical/ religious “conspiracy” to cover up the abuse of my child in 2005. A real life medical/religious “conspiracy” that is oddly still on-going, and was in part confessed to by an ethical insider of my former religion’s synod offices in his 2007 book. I’d be one of the likely many “widows” mentioned in the Preface of this book. And I’ve learned recently that the seminaries are teaching, not just belief in the real Bible, but they’re still teaching belief in the now debunked as “invalid” DSM “bible.”


      And the research that Sera points out, that people do eventually develop a way to deal with the “voices,” or go from a “’startling’ phase (during which voices tend to be most surprising), the ‘organizational’ phase (during which people come to better understand and make meaning of the experience), and the ‘stabilization’ phase (where balance — often in living with the voices — is regained).”

      By 2005, I’d already gone through these phases, and with not just the original three “voices,” or souls, who I personally heard. But also supposedly with all those within the collective unconscious with whom I’d befriended during my lifetime.

      My many beloved friends within the collective unconscious were seemingly harassing the satanic pedophile “voices” by 2005, which did seem to minimize the satanic “voices” for me. And, thankfully, once I was finally weaned off all the psych drugs, once the anticholinergic toxidrome poisonings ended, so also ended the satanic pedophiles’ “voices.”

      So to teach people that “hearing voices” is totally irrelevant to one’s own life, as today’s psychiatrists believe, and as these “voice hearing simulations” do, is unwise. Because there is a chance the Jungians, and other psychologists who believe in a collective unconscious, may in fact be the wiser people within the “mental health” field. At least that is now my personal take on my odd, psychotomimetic “voice hearing” experience.

    • Madmom,

      Are you talking for yourself or just in general? I don’t know if you would accept any help from me, but I’ve had experience with my wife’s ‘voices’ for the last 11 years: how to engage and interact with them. I really don’t think someone needs an expensive class to do it, (sorry Sera) and I’d be happy to get you started. I think you would find it easier than you realize once you got going.

  2. I found some simulations on YouTube and mostly read the comments looking for what people who identify as schizophrenic had to say. One video had 15,928,626 views.

    Wile not schizophrenic and never heard voices I have been to psychosis hell and I know that is just something that can’t be simulated with audio video.

  3. I am always struck by the fact that it isn’t what’s happening inside someone’s head that’s the issue. The real issue is how they react to it. If it makes them fearful or distracted or otherwise disturbed, then it’s a problem that society must fix for the afflicted through the arena of psuedoscientific psychiatric medicine. But for those people whom it doesn’t bother, no one outside of that persons head may ever know.

    I’ve always steered clear of psychedelics precisely because I knew seeing or hearing things that weren’t objectively real would be upsetting to me. I suspect that the people who are less bothered by that type of phenomena are also less likely to have suffered the types of severe trauma that can lead to psychosis.

    Interesting point of personal experience, I once asked my mom in my early 20s how I get my brain to shut up and get some peace and quiet. (Because the monotony of constant thoughts in your own voice is boring.) Her response was that she didn’t know, that she had the same “issue” but that it didn’t bother her. So my complaint of intrusive thoughts was her evidence that she was a thinking person who had plenty of things to ponder and never got bored. And so it boils down to differences in personality and how we each interpret both inner and outer experiences.

    • I’ve always steered clear of psychedelics precisely because I knew seeing or hearing things that weren’t objectively real would be upsetting to me.

      Not to be overly tangential, but that’s not what actually happens in a psychedelic experience. But this is a discussion that can be postponed till the next “psychedelic therapy” blog.

      • Wish my first shrink had proposed psychedelic drugs. My parents would not have become so enamored with them. Mom wouldn’t have kept shrieking, “Rachel, shut up and take your LSD.”

        See, fun drugs are naughty. If they make you feel lousy and the dealer wears a pretty white coat they’re good for you.

        Fun=naughty drugs
        Feeling like crap=life saving meds

        Very strict home. No booze ever! Yet my folks wanted me to take mind altering drugs due to the faux respectability. Sigh.

  4. I think the schizophrenic artwork should be banned as well. ” Look at that crazy art that crazy person made!” Further convincing “normal” people how crazy , the person named crazy is. We do not know the circumstances the artist was under when they use all purple for skin color. M.I.A. uses this art as well. https://en.wikipedia.org/wiki/Schizophrenia

    Another example is the writing on the wall some mad people do.
    “Look at that mad rambling” people say. Did he/she have anything to write on, like paper? No ? So what can a person write on when they feel the need to write/do art? Besides does anyone like looking at a blank white (jail-that-isn’t-a-jail) wall? https://www.123rf.com/photo_6339633_an-image-of-a-depressed-prisoner-sitting-in-his-prison-cell-marking-days-on-the-wall.html

  5. My experience is different from many here. But I started hearing evil voices at age 9. My family was homeless and I blamed myself for offending Dad’s employers I was expected to kiss up to. (I was an ornery kid who knew stuff I shouldn’t. My folks were always being blamed for not keeping me under control and punishing me severely enough.) After a year or two I willed my inner bullies away. But at 14 we were homeless for several months again. Bullying/sexual harassment in my new high school drove me bonkers again.

    Anyhow, after a bad reaction on Anafranil keeping me awake for 21 days straight the voices came back. The drugs made them worse–like I could no longer push them away or filter them. The neuroleptics destroyed my ability to control my feelings or imagination.

    Off the crap finally! I have processed my painful feelings finally. No “therapist” necessary. The drugs did NOT make the voices leave–they amplified them and weakened me so I couldn’t fight them like I normally could have.

  6. Hi Sera

    our son lives in Waltham. Sometimes I wish I could swing by and meet you and we could find a point of collaboration. We may not see everything identically, but I appreciate much of what you have to say. I keep hoping some day to find someone who realizes we SO’s hold a vital part of the key to changing this battle of perspective and also keeping our loved ones out of the system…when we know what is needed…I keep hoping to empower other SO’s to understand they don’t need an ‘expert’ do the overwhelming majority of things our loved ones need to feel safe, loved and begin to heal.

    For me, I never saw my wife as crazy, but she always said that just meant I was weird and not normal like most people, lol. I guess that’s a good thing. But after living 11 years with her florid d.i.d., I realized that there really is very little that is different between me and her…just a matter of degrees mostly, and in fact, I learned a lot about myself by observing how the various girls interacted. Even the ‘extreme’ states associated with d.i.d. really don’t seem that extreme nor that far out of my own experience once I began to look for points of similarity.

    Take care,

  7. According to William Glasser hearing voices is “creative symptoming” or the imagination run amok to cope with emotional pain. Thomas Szazs referred to it as “believing a lie.”

    The way I choose to deal with them is a little like Will Hall’s method. But significantly different.

    It’s not scientific but it works for me. I wouldn’t recommend it for everyone. Not fully effective til I went off the pills though.

  8. I never have found these simulations very realistic. Of course, I’ve never had the experience, but some of them seem to be designed by other people who are totally speculating and have no such direct experience themselves. How real are these simulations? Do people who actually KNOW what it’s like participate in making them? How many are dedicated to the purpose of compassion and understanding and how many are designed to sell drugs?

    • Steve and Rachel,
      Even if they did have an individual “conduct the orchestra” and come up with a recording that accurately represents that person’s voice-hearing experiences, they’d still be making a huge error in trying to generalize that person’s experience to everyone else, as if “hearing voices” is the same experience for everyone, as if the “voices” mean no more than intrusive white noise. Trying to present “the experience” as if there is such a thing only serves to reinforce all those attitudes they love to refer to as “stigma.” And, it reinforces their mis-understanding, “oh yes, I understand hearing voices- I took the training” and since they now know all about it, there’s no getting them to listen.

  9. Love Love LOVE it when people tell me how to share my experiences with others, that I shouldn’t mention if it’s difficult or scary, that sometimes I Do think of acting out. This is tantamount to the lgbt civil rights protests where they wanted protesters to dress in suits so they didn’t look so flamboyant. Always best to share the sunny side of psychosis I guess.

  10. I think another piece of this project I dislike is that it’s very one dimensional. The experience of psychosis can encompass so many more phenomena than just voices, (visions, beliefs, sensory feelings, etc) and it comes in such a wide range of severity. I’m afraid someone would take this simulation and it’s scariness to portray all non objectively real experiences as frightening and unwanted or disabling intrusions.

    The fact is that everyone experiences things that aren’t there, unexplained physical sensations or thinking you see a bug out of the corner of your eye, or thinking you’ve heard something. Feeling phantom phone text sounds or vibrations are ubiquitous. Everyone with a smart phone has experienced this. Our new apartment has keyless entry doorlocks that beep when they’re unlocked. Every time I hear a similar beep, my first thought is that someone is unlocking the door. Does that make me crazy or just mean I am habituated to beeps meaning door opening? It’s classic Pavlovian training and response but an argument could be made that I look at the door out of paranoia if one was ignorant of Pavlov’s experiments, I suppose.

    So portraying hearing voices in such a scary way means those people getting this training are likely to walk away feeling fearful of and perhaps pity for the poor mental patient when what we really need is a public service project that aims to make people more aware of the widespread nature of altered experiences, how completely normal they actually are, and humanizing those who are disturbed by severe psychosis.

  11. I do wonder if a better way to teach others empathy for hearing ‘voices’ is to help people see the similarities in their own internal communications. Like I said before, after watching the 8 girls in my wife’s system interact and helping them to heal and dealing with lies associated with the original trauma and oft repeated things, I began to wonder if my own internal communication was just a milder version of what she/they were experiencing. I also wondered if the dissociation was a factor for my wife: that as the dissociative walls began to come down, new areas of her mind began to release ‘pent up’ memories and associated words, sounds and such and these would feel very foreign to her at first until she began to accept them as part of her larger self.

    idk…watching her taught me to learn to listen to myself better and recognize and validate those things that I had previously ignored for a variety of reasons…maybe this makes no sense to anyone else, but it seemed to help me empathize with her and listen to myself better…a win/win