Practical advice about hearing voices
People may hear voices inside or outside their head (or both). The gender and age of voices can differ, or voices can be genderless and not have an age and may not even seem human. They might be someone the person knows or not. Sometimes they have names, but not always. Some people hear sounds or noises rather than voices.
Sometimes people believe the voices are different parts of their personality; others that their voices are not from them (this can be helpful if the voices say things that are very upsetting and that the person does not agree with); Some people experience their voices as the thoughts of other people; or some think they are ghosts or entities.
Challenging these beliefs is not always reassuring for people. The impact voice hearing has on someone’s life can change over time. It may be confusing, frightening, exposing, comforting or amusing.
Lots of people can live a good life with voices without getting rid of them. The main issue is whether the person is distressed by them.
What issues sometimes go alongside voice hearing?
Risk: Sometimes voices encourage the person to hurt themselves, not look after themselves, avoid people or hurt others. This needs to be addressed with a specific crisis plan.
Substance misuse: Sometimes people can use substances to try to regulate or avoid their voices. At other times people’s voices can be triggered by such substances.
Diagnosis: The evidence mostly suggests that voices across mental and physical health conditions are more similar than they are different. Voice hearing alone is not sufficient for any diagnosis, nor is where it is experienced as emanating from (inside or outside head).
People fitting the dissociative disorder criteria often hear more child voices and start to hear the voices earlier in life than people fitting the criteria for the diagnosis schizophrenia. Voices that are less distressing often distinguish voice hearers not in mental health services.
What can I do to help someone who is hearing voices?
A normalising response is often the best first response. Reassure the person that many people hear voices and it does not mean they are ‘mad’. It is a common human experience to hear voices when ill, bereaved or when under great strain.
Give them information about peer support and encourage them to join a hearing voices group.
If the person is able to talk about their voices, the Maastricht interview may be useful to find out more about the voices’ function. This questionnaire was originally designed as a research tool to elicit information from people who hear voices. It has proved to be extremely useful in getting a much fuller picture of the shared experiences of voice hearers and the results have subsequently been used to develop a range of coping strategies that can help voice hearers to come to terms with their experience.
If the person is afraid or distressed they may need some strategies to cope, for example activities to distract them, learning to manage the stress.
It may be useful to work out what function the voices are playing, for example to keep them safe from further harm by telling them to stay indoors away from other people.
Be curious and don’t be confrontational, but do make sure that you offer to talk with the person about their voice hearing experiences. Talking about voices is generally helpful; it does not lead to increased risk, or ‘delusional’ beliefs, as was thought to be the case previously. Validating and understanding their impact is key.
Video
This 5-minute film below presents an alternative way of relating to experiences, which goes against the tide of traditional approaches and culturally engrained attitudes. Essentially, it charts the therapeutic progression of a young man, Stuart, from being tormented by his voices, through establishing safeness, to developing the qualities needed to engage with them through compassionate dialogue. For people with psychosis, this may have therapeutic value as a template or metaphor for their own recovery journey.