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Psychosis

On Hearing Voices

Auditory hallucinations are not always signs of psychosis. They can be helpful.

Key points

  • Hearing voices with no one there is considered to be a sign of pathology, but this may not always be true.
  • Voices may be precipitated by disruptions in ego function and have both beneficial and detrimental sequelae.
  • They tend to be supportive rather than critical and may offer truths with a validity beyond the limits of the ego.

Auditory hallucinations are defined as the sensory perceptions of hearing noises without an external stimulus. (Thakur and Gupta, 2022)

Psychiatric reasoning, like medical reasoning in general, tends to be categorical. A certain symptom means a certain diagnosis. Hearing a voice coming from outside of one’s mind immediately places the person in the psychosis direction—schizophrenia, mania, psychotic depression, hallucinogens. For people who are disturbed enough by this experience to seek psychiatric help, this assumption is likely to be correct. However, some non-psychotic people do hear voices that seem to be coming from another person who is not physically present. (Thakur and Gupta, 2022)

Hearing voices that are easily recognized as one’s own commonly occurs. Negative self-talk or criticism of oneself by one’s inner critic may be the most common.

On the other hand, external voices have been reported to provide helpful guidance to normal people. According to Psychology Today blogger Joe Pierre M.D., it is well known that many historical luminaries were voice-hearers, including Socrates and Plato, Joan of Arc, Sigmund Freud, Carl Jung, and Martin Luther King, Jr. External voices are reported to increase in frequency after near-death experiences. (Greyson and Liester, 2004)

Writing in the Journal of Transpersonal Psychology, Liester clarifies the distinctions:

  • Non-pathological auditory hallucinations are similar to psychotic hallucinations in that they are heard in the mind rather than in the ears and yet appear to have an external origin. They speak in the experiencer’s native language, they may be precipitated by disruptions in ego function, and they may have both beneficial and detrimental sequelae.
  • Non-pathological auditory hallucinations differ from psychotic hallucinations in that they tend to be supportive rather than critical; they may offer truths with a validity beyond the limits of the ego; they generally enhance personal, interpersonal, and societal functioning; they usually speak in complete sentences or long discourses; and they are not associated with brain malfunctions. (Liester, 1996)

Three Cases

I report three case examples of meaningful coincidences between the advice of the voice and the resulting positive outcome from following that advice. They are coincidences because we have yet to understand how following the advice of an external voice leads to a positive outcome. They are meaningful because each led to positive outcomes.

1. The wife of one of my patients was visiting her sick mother in another state. As she was making a turn onto another road, she took the left lane as was indicated. However, she heard a strong, commanding voice that seemed to be coming from someone inside her vehicle telling her to get over in the right lane. There was no one else in the car. She quickly obeyed. Had she stayed in the left lane, she would have been hit by a truck barreling through the intersection.

2. Carolyn Pokres from Philadelphia reported this instance:

"While waiting for the public transportation bus to Temple University, something very unusual happened. I normally sat on steps adjacent to the bus stop, every day, while waiting. My routine never varied. This one day, I kept hearing a voice in my head telling me to go stand near the sign about 30 feet away. I ignored it for a couple minutes, but it was very insistent. I walked over to the signpost, and not 10 seconds later, a flatbed truck with a car on it came careening around the corner, causing the car to fly off and straight on to the steps where I had just been sitting!"

3. The experience that prompted me to write this post took place along the river in Charlottesville. I was sitting among the trees, wondering if I should go right, which led back to the parking lot, or left, which led to an open area. Thunder was getting louder: The darkening sky was a harbinger of rain. As I considered the two options, I heard a voice saying, “Go left.” I said to the voice, “Why?” The voice said, “You will see.”

So I went left and started to hear music. Great! I was ready to dance. Someone was doing a sound check on the outdoor stage. It was Devon Sproule, a singer-songwriter that I had wanted to see. She was going to open the first set. However, the ticket person told me that the concert was sold out, so I was left to linger outside the fence to listen.

A woman came over to me, offering a ticket. The ticket taker had told her that I wanted to get in, and the woman had an extra ticket. I met her husband, and the three of us had a great time together, so we went to dinner the following week. As our dinner ended, they asked me if I wanted to have a party to celebrate the publication of my new book Meaningful Coincidences: How and Why Synchronicity and Serendipity Happen. I readily agreed.

I had wanted to see Devon, having heard a lot about her but never seen her perform. I had wanted to find a way to publicize my book in my hometown of Charlottesville, and here I was presented with a good start. As the voice suggested, I did see. I saw two desired futures become realized.

Comment

Just as mental health professionals tend to label high-frequency coinciders (coincidence experiences) “psychotic,” we also tend to label voice hearers as psychotic. The tails of the bell-shaped curve suggest that outliers are likely to exist. And so it is with hearing external voices. Pathological diagnoses rely on whether or not the symptoms interfere with daily functions. Here are three examples in which an external voice saved the lives of two people and helped me find what I was looking for.

References

Thakur T, Gupta V. Auditory Hallucinations. [Updated 2022 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557633/

Greyson B, Liester MB. Auditory Hallucinations Following Near-Death Experiences. Journal of Humanistic Psychology. 2004;44(3):320-336. doi:10.1177/0022167804266281

Liester, M. B. (1996). Inner voices: Distinguishing transcendent and pathological characteristics. Journal of Transpersonal Psychology, 28, 1-30.

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