Voice-hearing experiences: moving beyond the clinical lens

Marius Romme and Patsy Hage discussing Voice Hearing on Dutch TV program, “Sonja Op Maandag,” 1987, https://romme-escher.nl/

I'm always interested in research that normalizes the breadth of human experience rather than pathologizes it. Recently, I came across a systematic review by Baumeister et al. (2017) that does exactly this for voice-hearing experiences. The researchers examined 36 studies comparing people who hear voices but don't seek clinical care with both those who receive treatment for voice-hearing and those who don't hear voices at all.

While the study uses terms like "auditory verbal hallucinations" (AVHs) and distinguishes between "healthy" and "clinical" voice-hearers, it's worth noting that this terminology itself can perpetuate a pathologizing view. The word "hallucination" implies a departure from reality, and the "healthy" versus "clinical" dichotomy may oversimplify the diverse spectrum of voice-hearing experiences. These experiences have different meanings across cultures, spiritualities, and contexts that medical language often fails to capture.

What the research shows

The review found that the actual perceptual experience of voices—their loudness, location, and clarity—is remarkably similar between those who receive treatment and those who don't. The key differences appear to be in:

• Frequency and content: Those who don't seek treatment tend to hear voices less frequently and with less negative content

• Control and relationship: They report having greater control over their voices and experience much less distress

• Beliefs about voices: They hold less threatening beliefs about their voices and are more likely to integrate these experiences into broader spiritual or meaningful frameworks

• Age of onset: For many who don't seek treatment, voices begin in childhood or early adolescence, potentially allowing for better adaptation

What I find particularly interesting is that while people who hear voices may experience some differences in their daily lives compared to people who don't hear voices, many live fulfilling lives without clinical intervention. This matches what I have seen in real life and suggests that voice-hearing itself isn't inherently problematic—it's the relationship with and intensity of the experience that matters.

Why this matters

This research supports a view of voice-hearing as existing on a continuum rather than a strictly categorical model that sorts people into "ill" and "well" categories. It suggests that voice-hearing exists as a diverse experience in the general population, with many people experiencing it without distress.

For those who do struggle with distressing voices, there's hope in these findings. The factors that distinguish non-distressing voice-hearing—particularly beliefs about voices, perceived control, and engagement rather than resistance—can inform supportive approaches. Learning from those who successfully integrate these experiences might help others develop more positive relationships with their voices.

Peer-led approaches

These findings align beautifully with approaches developed by and for people who hear voices. The Hearing Voices Network, an international collaboration of people who share voice-hearing experiences, has long advocated for understanding voices as meaningful experiences rather than simply symptoms to be eliminated. Their peer support groups create spaces where people can explore their voice-hearing experiences without judgment or pathologization.

Similarly, the Maastricht Interview approach, developed by Dr. Sandra Escher and Professor Marius Romme in collaboration with voice-hearers such as Patsy Hage, focuses on understanding the content and context of voices rather than just reducing them. This approach explores the relationship between life events and voice-hearing, acknowledging that voices often emerge in response to trauma or emotional distress.

These peer-led frameworks validate what this research suggests: that developing a different relationship with voices, understanding their meaning, and finding community with others who share similar experiences can transform how people experience voice-hearing.

Moving forward

This research invites us to reconsider how we think about diverse mental experiences. Rather than automatically viewing differences through a medical lens, we might ask what we can learn from those who experience phenomena like voice-hearing in non-distressing ways.

Of course, this doesn't diminish the very real suffering of those who experience distressing voices. Their needs for support remain vital. But broadening our understanding of voice-hearing beyond the clinical context may reduce stigma and open new pathways to wellbeing.

I believe this research ultimately encourages a more compassionate, nuanced view of the diversity of human experience. And that feels like a step in the right direction.

Reference

Baumeister, D., Sedgwick, O., Howes, O., & Peters, E. (2017). Auditory verbal hallucinations and continuum models of psychosis: A systematic review of the healthy voice-hearer literature. Neuroscience & Biobehavioral Reviews, 82, 807-814. https://doi.org/10.1016/j.neubiorev.2016.10.032 [PMCID: PMC5240854] [PMID: 27866082]