A study published in the Community Mental Health Journal approaches the phenomenon of hearing voices in a non-pathologizing way and reviews the literature to locate concepts that might improve our understanding of voice hearing. The results of the systematic review reveal three concepts that need to be considered to comprehend hearing voices: “the role of the socio-cultural context, the role of language, and the role of the sense-making process and the functions the voice assumes.”
“Considering contextual and situational aspects in which particular hallucinatory experiences occur or are constructed can help us to understand them, by emphasizing these experiences’ meaning, function and the ways in which they are interpreted and find social acceptance,” write the researchers, led by Antonio Iudici from the University of Padova, Italy.
The experience of hearing voices is still more commonly referred to as a hallucination in western society. Hallucinations are defined as “experiences that occur in the absence of external stimuli, emerge mainly when the individual is in a state of vigilance and are not under voluntary control.” Because of their association with psychiatric disorders, individuals who experience hearing voices may not speak out because of the associated stigma.
“The hearing voices phenomenon highlights the problem and complexity of the relationship between auditory hallucinations and the diagnosis of psychiatric disorders and the risk of automatically categorizing hearing voices as a pathological experience,” the authors write.
Iudici and colleagues argue that there is a clear need for clinicians to comprehend better the phenomenon of hearing voices. Toward this aim, they conducted a literature review of psychological studies that approached the experience as a non-clinical entity. Within these articles, they sought to distill the concepts that help to elucidate the experiences of hearing voices. Iudici and colleagues note that the findings can support both hearers and providers, by postulating alternative explanations and starting points to understanding the hearer’s experiences.
The authors reviewed studies from several online databases between the years 1970-2017, resulting in 203 articles that fit within the research parameters. These documents were then analyzed and interpreted by the authors.
Ultimately, they found a “long scientific tradition in which hallucinations are considered a part of the continuum of normal functioning and in which it is therefore accepted that voices can be present in the absence of cerebral dysfunction or psychiatric disorder (see, for instance, Strauss 1969; van Os et al. 2000; Birchwood et al. 2005).”
Three concepts were identified as key criteria to consider for understanding the experience of hearing voices: the role of socio-cultural context, the role of language, and the role of the sense-making process.
The Role of Socio-Cultural Context
Western societies generally perceive hearing voices as negative, except under a “limited range of circumstances,” such as in certain religious situations. The culture of both hearer and provider should be taken into account when assessing the impact of the voices.
“Beliefs about the origin of hallucinations-including culturally determined beliefs-can play an important role in the social control of the production and content of hallucinations,” write the researchers. Thus, “a careful investigation of the socio-cultural context can become very useful to facilitate the understanding and management of hearing voices.”
The Role of Language
The ability to talk in an abstract way or about an abstract event “can be a determinant of whether the experience of hearing voices involves a hallucination or an unusual auditory experience,” e.g. “it is as if I heard…” or “I thought about seeing…” has a lower probability of being perceived as hallucinatory. Other research suggests further linguistic theories, such as faulty monitoring of inner speech and context processing errors. Another offers the idea of several forms of inner speech, and that “hearing of voices could reflect the disruption of the internalization of socially mediated, external dialogue.”
The Role of the Sense-Making Process and the Functions of Voices
Iudici and colleagues emphasize the process of meaning-making within a socio-cultural context, naming prior research that has “pointed out that the way in which hallucinatory phenomena are labeled can be influenced by the beliefs and oral sophistications of both the clinician and the patient. People who hear voices can attempt to make sense of their experience; to do so, they resort to whatever forms of knowledge available to them, whether philosophical, religious, paranormal, or medical.”
The individual’s access to interpretation may shape the relationship one has with the voices. For example, voices may be an attempted solution in the face of a problem, may be considered a form of salvation or persecution (Salvini and Bottini 2011), may give comfort (Freeman and Garety 2003; Hill and Linden 2013), may guide against stress (Evensen et al. 2011; Longden 2017) or disappointments (Kumari et al. 2013), or be an accompaniment to daily life (Hayward et al. 2011).
A limiting factor to this article is the tendency to differentiate between hearing voices for “healthy people” and hearing voices for people with diagnosable psychiatric disorders. This is a challengeable position, as it presumes that psychiatric diagnoses are separate, real entities, rather than patterns reified by specific psychiatric and pharmaceutical agendas.
Ultimately, Iudici, Quarato, and Neri’s study offers an exploration of the existing research on hearing voices which provides context for providers to grapple with when working with hearers, toward a more contextual, empowering approach.
“Some authors emphasize the value of exploring the ‘subjective culture’ surrounding the interpretations and discourses of hearers,” they write, “the clinician should therefore consider the influence of his or her professional group or the socio-cultural context when attributing sense and meaning to the patient’s lived experience.”
Iudici, A., Quarato, M., & Neri, J. (2018). 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. https://doi.org/10.1007/s10597-018-0359-0 (Link)
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.