A recent article published in Clinical Psychology & Psychotherapy examines the experience of young people who hear voices to understand the in-depth emotional and interpersonal dynamics of hearing voices.
British clinical psychologist Sarah Parry and co-authors analyzed interview data from 74 young people across the world in an attempt to explore the personal and sociocultural factors that influence the experience of voice-hearing in adolescence. Among other things, they found that social stigma profoundly influences young peoples’ willingness to seek out support and even alters the experience of hearing voices itself.
“Distressing voices could be predicted by adverse experiences such as bullying and trauma and intrapersonal factors such as low self-esteem, self-harm, and anxiety, alongside a lack of family support. Undertaking qualitative research with young people from across the adolescent age range is essential to understand the personal meaning-making, experiential mechanisms, and impact of hallucinations during this developmentally vulnerable period,” write Parry and co-authors Eve Loren and Filippo Varese.
The Hearing Voices Moment has, of course, been at the heart of many critiques of the biomedical paradigm within psychiatry, with groups like the Hearing Voices Network offering non-stigmatizing support to many who have had negative experiences in psychiatry.
Efforts to support young people who hear voices have recently gained traction, although there is still much to understand about the experience of voice-hearing and how it relates to cultural, familial, and personal factors.
In the current study, the authors interviewed 74 young people aged 13-18 across the globe to understand better the experience of voice-hearing and how it relates to these systemic influences. Of those interviewed, 28% were male, 61% were female, and 21% were transgender and gender non-binary. A critical narrative analysis was used to interpret the data from a qualitative survey consisting of 17 questions. This form of analysis aided the researchers in examining the socio-cultural and systemic factors affecting voice-hearing since culture is known to influence the development of the phenomenon.
The authors first discussed a theme in the interviews around “relational stigma.” Many participants expressed discomfort around telling people about their voice-hearing because of the expectation of negative reactions from friends and family. They did not want to be seen as “different” or abnormal. This was true even for positive experiences around voice-hearing, leading some participants to avoid talking to people or seeking help:
“Overall, the impact of judgments from others was profound, leading to the internalization of stress and stigma, which influenced help-seeking, self-perception, relationships, and voice-related distress.”
Participant accounts explaining the occurrence of voices did not always follow conventional psychiatric thinking. Alongside the explanation of “Trauma/Mental Illness” were things like loss of family members and that the voices were protective:
“Katy (14) explained: ‘Because I lost my sister and lots of other relatives and I’ve been through a lot, and I feel like this is my body reacting to it.’”
The authors describe “mirroring” processes in many participants’ accounts as well. For example, one 16-year-old female said, “he hates me, and I hate him,” in a case of mutual feeling mirroring. Meanwhile, a 15-year-old stated:
“I thought it [voice] was magic since I was so young, and now I’m being told it’s not normal the voices get angry.”
The authors describe this process as an “emotional ricochet” between the voices, the young people, and other people.
On a positive note, some participants described a “soothing” effect from the voices, such as being told they are safe and feeling as though the voices have something important to tell them.
This may relate to the notion of voices as “meeting relational needs.” Some participants described the voices as emerging out of loneliness or bullying experiences. Despite this, voice-hearing was reported to complicate interpersonal social experiences, sometimes making it hard to concentrate and reinforcing isolation because of stigma. On the other hand, one participant stated:
“I miss my old voices; they feel like my closest friends who I can’t talk to anymore.”
The authors found what they call a “triadic” model in terms of how the experience of voice-hearing interacted with others, including family. In this model, the young person, voices, and others influence each other, as in developmental changes over time where voices become more angry or negative because of stigma.
For participants who were able to share their experiences, results were mixed. Some expressed gratitude at not being judged, while others felt dismissed or that they were not believed.
In the final section, the authors discussed the importance of viewing voice-hearing as a continuum of experiences rather than a simplistic phenomenon. Some participants reported experiences that could qualify as mystical/spiritual. Others had multi-sensory experiences that included a sense of smell and visual hallucinations.
This multi-sensory aspect was true of coping methods discussed by participants as well:
“With many of the participants discussing creative means such as writing, drawing, storying, listening to music, meditation, and color breathing. Imagery was a powerful medium, especially for participants who experienced visions as well as voices: ‘Turn it into an imaginary setting and talk to them if they’re bothering you.’”
Some people, additionally, experienced the voices as more than just detached voices. Instead, they were experienced as separate persons inside the young person’s experience. The authors refer to this as an experience of “multiplicity.”
The authors conclude:
“In conclusion, further research reflecting triadic child–voice–other relationships and the exacerbating or mitigating role of family and peer appraisal and support seems advantageous. Critical explorations of gender differences with sociocultural power structures across larger populations could further refine our understanding of helpful interventions, particularly for girls who, in this study, seemed most adversely affected by adversarial voice content and relational oppression.”
Developing our understanding of the auditory and multisensory diversity within experiences for adolescents who identify as voice-hearing is crucial due to various experiences shared.
Parry, S., Loren, E., & Varese, F. (2020). Young people’s narratives of hearing voices: Systemic influences and conceptual challenges. Clinical Psychology & Psychotherapy, 1-12. (Link)