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Mental Health

Hearing Voices that are not Real

Advice for Consumers and Those who Want to Help

Cynthia Row

Reprinted from "Self-Management" issue of Visions Journal, 2003, 1 (18), pp. 27-28

Hearing voices that are not real can be a distressing experience, both for the person that hears voices and for those who want to help. Understanding the experience of hearing voices has been stifled by the traditional psychiatric approach, but thankfully there are resources now available to those who hear voices and those who want to help — resources that are the result of new approaches to the task of understanding and managing voices that are distressing.

The conventional psychiatric response to voices (otherwise known as auditory hallucinations) once sought to deny, suppress and ignore voices. It was believed that only people with schizophrenia heard voices. It was believed that voices made no sense, could not be understood, and therefore that there was nothing that could be done about them if they did not respond to medication. Furthermore, it was believed that talking about voices could only make them worse. Engagement of the voices was emphatically discouraged, on the theory that to engage the voices was a kind of buying in to the hearer’s delusional fantasies. The result of this approach was to further isolate the significant minority of voice-hearers who do not respond to medication or those who find medication intolerable.

For those who hear voices, one thing is clear: that voices can have a great deal of control over the person who hears them. Also, voices do make sense in that they often reflect issues that a person has in their life — and the voices can have a lot of power. As a result of this increased awareness, new approaches to coping with voices help the voice-hearer take control and gain understanding and power over the voices and their disruptive effects.

Contrary to the belief that only people with schizophrenia hear voices is the acceptance that hearing voices is a relatively common experience, and under certain conditions of duress (such as sensory deprivation, lack of sleep, or with drug use) anyone can have the experience of hearing voices. Have you ever heard your name spoken, only to turn your head and discover that no one is there? It is a starting point to understanding the experience of hearing voices and of being able to help.

Patricia Deegan has a PhD in clinical psychology and has heard voices most of her life. With the National Empowerment Center (NEC), a US-based consumer-run organization, she has developed the Hearing voices that are distressing curriculum for mental health professionals, a component of which replicates the experience of hearing voices in a simple but effective way. Participants wear headphones and listen to an audiotape that runs as they undertake a series of tasks, including social interaction and cognitive tests. The result is a dramatic experience of what it must be like to try to function as the voices are active.

I recently participated in the Hearing voices training. I must confess, I was disturbed by the sudden realization that I have been treating schizophrenia for four years, yet I’ve never known what it really was. I may have had the knowledge, but not the wisdom or true empathy until now.
— Jim Willow, MD, Psychiatric Resident, PsycHealth Centre (Winnipeg, Manitoba)

Another resource, Understanding voices: A guide for family or friends, provides written guidelines for those who want to help but may be unsure of what to do. The full guide, which includes a useful guide of dos and don’ts for caregivers can be found online at

While Hearing voices training and other resources are useful tools for caregivers, a significant amount of progress has been also been made in developing coping strategies directly for those who hear voices. Advances have been made especially by European researchers in the field of cognitive-behavioural therapy, and by networks of people who hear voices themselves.

This work has resulted in a number of potentially helpful strategies for people who hear voices that are distressing. Ingeneral, these approaches to managing voices involve the awareness of, tracking, and engagement of the voices in a way that improves one’s control over them. Suggestions that individuals can try, with the support of their treatment team, include:

  • Accept that the voices belong to you, and are not an external force that can read your mind or steal your thoughts. In the process of developing your own point of view and taking responsibility for yourself, an important and difficult first step is to take ownership of the voices.

  • Get to know the voices by keeping a diary, so that you can know when the voices come on and what might trigger them.

  • Make a contract with the voices, perhaps allotting a specific time when you will listen to them. In this approach, the voice-hearer exerts some control over the voices and lessens their impact.

  • Tell demanding voices that you want control of your own life; realize that despite what the voices are saying, they are a part of you, so you are in charge, and no harm will come to you when you don’t listen to them.

  • Engage in non-stressful, distracting activity such as gardening, listening to music etc., when the voices come on.

  • Experiment with ways of diminishing the voices, for example, by ‘shadowing’ the voices, that is by whispering the content of the voices under your breath, or by humming when the voices come on.

  • Avoid unhelpful strategies, such as:

    • passive activities (e.g., watching TV)
    • arguing with the voices
    • self-medication
    • social isolation
  • Make use of resources that suggest strategies and networks that connect voice-hearers.

Hopefully, the advice and resources in this article go some way toward achieving their aim, that is, to make the lives of those who hear voices easier and better understood.

About the author
Cynthia lives in Vancouver and has a background in freelance writing and broadcasting. She is also Editorial Assistant for Visions


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