Recent American research estimates that around four or five percent of us are hearing voices at any one time. While this makes voice hearing more common than asthma amongst adults, it remains a hidden issue whose causes are fiercely debated. We find out why. 

A popular psychiatric explanation for hearing voices or ‘auditory hallucinations’ is that they are often a symptom of a mental illnesses such as schizophrenia or severe depression. However, there is mounting evidence that suggests voice hearing can affect any of us who are experiencing some form of mental stress. The psychosis experienced by drug users (especially amphetamine and cocaine users) and by people suffering from extreme thirst, malnutrition, sleep deprivation or sensory deprivation are well known, but unresolved personal issues such as a trauma, bereavement or abuse are also now thought to be common causes of voice hearing.

Whatever the causes, those who experience voice hearing are often living in a lonely and at times frightening world — hearing voices that others can't hear is a very real experience. The voices maybe of someone you know or someone you don't recognise. They may talk calmly, whisper or shout. They can make concentration and listening very difficult. They can be abusive. They can tell you to do things and can lead to or exacerbate confusion, stress, anxiety and depression. They can make life a misery for the hearer and for those around them. Without support, it may be difficult for a voice hearer to come to terms with their experiences, to know how to react and cope with them, to identify their cause and, very importantly, to understand that the voices come from within themselves and cannot make anything bad happen.

The Hearing Voices Network

A lack of public awareness or understanding, combined with the mental health profession's historically blunt instrument approach to treatment, has left voice hearers in an unenviable position. On a visit to the small but busy national office of the Hearing Voices Network (HVN) in Manchester, several voice hearers described some of their experiences to me.

"Psychotic illnesses don't leave you with a lot of dignity," explains one member of the group. "I'm seen as an illness first and a person second. Everything I do or say is interpreted around my 'illness'. If I cry its because I'm ill. If I'm angry its because I'm ill. If you are crying or angry, people might try and comfort you. With me, they get nervous and suggest medication. We are not allowed to express ourselves, as any form of expression or emotion is seen as part of the pathology.

"She's experienced nine different drug treatments, repeated hospitalisation and encounters with the public and police that have done little to help her. "There's a terror I can't describe – the voices are in you so there's nowhere to go. What psychiatrists can't understand is that the voices are one hundred percent real."

The reality of the voices is what HVN takes as a starting point. In recognising them as real and as coming from within themselves, voice hearers can start to take responsibility for their situation. Much of the advice HVN offers is very simple and practical, but it’s what makes a real difference. Voice hearers learn to identify what makes things better or worse and how to cope with their experiences. There’s no preferred explanation of hearing voices at HVN, each member has their own definition. Members have often previously been diagnosed as having schizophrenia, but as they explore different theories and hear of other people's experiences, many of them identify their own causes and solutions.

One HVN member I met has identified anxiety as the likely cause of her voice hearing. She's now embarking on a drug free route to recovery using a range of therapies and support (including a friendly community psychiatric nurse). She'll have to pay for most of the therapy herself and she knows she's taking a risk, but she's determined: "Each drug treatment has left its mark on me." As she speaks, she demonstrates the different side effects of a range of drugs: clenched fists, a sagging head, repetitive body movements, slurred speech… side effects so well known that people often mistake them for mental illness itself. For others in the group, some form medication is more acceptable: all explanations and treatments for voice hearing are accepted, including the medical model.

HVN’s reputation is growing as the extent of voice hearing and the limitations of a purely medical approach become better known. Some psychiatrists find HVN's open-minded approach difficult, insisting that a non-psychiatric definition could be dangerous. Many others though are finding HVN's approach to be of real value. HVN's training, conducted by voice hearers, has proved invaluable to other voice hearers, support workers, families, friends, carers, medical professionals, academics, landlords and many others.

Groups of voice hearers are springing up across the country. Their group meetings can be very difficult and heavy at times, but they attract ever more members. Their aim is to provide safe space, understanding and mutual aid for voice hearers and those around them. One group member described her first meeting as making more sense than a lifetime of sessions with psychiatrists. The groups are very mixed: men, women, young, old, working class, middle class, gay, straight, bi-sexual and people from all ethnic groups and religions. There are people with no education and people with degrees. Some of the regulars have been through a lifetime of drug therapies and hospitalisation while others while others went through childhood, their teens, university and work before experiencing any problems.

HVN also produces a newsletter for those unable to attend meetings, and for friends, families, carers, groups and organisations interested in voice hearing.

With the support of their friends in HVN, people change from being 'patients' and victims to getting on with their lives in an everyday kind of way. Many are still hearing voices, many are still troubled, but they understand themselves a little better. And they are no longer alone.