Hearing voices: understanding and coping

This guide is psychoeducational content. It does not replace a consultation. Hearing voices always warrants medical advice: see sections 9 and 24. Seek help urgently if the voices order you to harm yourself or to harm someone else, if they are accompanied by confusion, fever or an abrupt change in general condition, or if you are thinking about dying: see section 20, and in case of immediate danger, call the emergency services. Never stop a treatment that has been prescribed for you on your own, and do not alter its doses: talk about it with the psychiatrist or doctor who is following you. Allow fifty minutes to read.

1. Before you begin

It may have started with your first name, spoken once, in an empty room. Or with a comment, while you were doing the washing-up, about what you were doing. Since then, you check whether someone has spoken, you put music on to cover it, and you have told no one, because you know what people think of those who hear voices.

Three things, straight away.

You are not alone, far from it. Surveys carried out in the general population show that a not inconsiderable proportion of people have heard a voice at least once in their lives, without ever seeking help and without it affecting their existence. Hearing a voice is a human phenomenon, not a rare anomaly.

Hearing a voice does not, on its own, tell you what is involved. It can accompany a psychotic disorder. It can also occur after a sleepless night, in grief, under the effect of a substance, during a fever, in the aftermath of a trauma, or in entirely harmless situations. That is why the first step is not to conclude, but to have things assessed.

What causes suffering can be worked on. This is the most useful result of research on this subject: the distress depends far less on the presence of the voices than on what one believes about them — their power, their intention, what ought to be done about them. Those beliefs can change, and life then becomes very different, even when the voices remain.

Who this guide is for

For you if you hear voices, whether for a long time or only recently.

For you if you have received a diagnosis and you are looking to understand and to act, alongside your treatment.

For you if you have never sought help, for fear of how you would be seen or of hospital.

For you if someone close to you hears voices and you do not know what to do or what to say.

2. What hearing a voice is

One experience, several forms

The word 'voice' covers very different experiences from one person to another.

• The number: a single voice, or several, sometimes speaking to each other.
• The location: outside, as if someone were in the room or behind the door; or inside the head, while still remaining distinct from one's own thoughts.
• The clarity: sometimes as clear as a conversation, sometimes an indistinct murmur or a hubbub.
• The identity: unknown, or recognised — someone close who has died, a parent, someone from the past.
• The content: comments on what one is doing, insults, reproaches, orders, conversations, sometimes neutral or even encouraging words.
• The frequency: a few times a year or permanently.
• The trigger: in quiet moments, in the evening, in noise, in public, under stress, at the moment of falling asleep.

What it is not

It is not the ordinary inner voice, the one with which everyone talks to themselves in silence. The difference held to by most of the people concerned is the feeling that the voice does not come from them: it cannot be commanded, it takes them by surprise, it says things they would not have thought.

It is not imagination in the sense that one would choose what one hears. The experience is genuinely perceived.

It is not necessarily madness, and that is the subject of the next section.

The other perceptions

Some people see, smell or feel things that others do not perceive. The same principles apply, and the same precautions: have things assessed, do not stay alone with it.

What it costs

The suffering rarely comes from the sound itself. It comes from the content when it is hostile, from the exhaustion of a permanent presence, from the difficulty in concentrating, from the fear of being found out, and from the isolation that secrecy imposes. These four dimensions can be worked on, separately.

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