Despite their association with mental illness, auditory hallucinations don't always torment those who hear them. In fact, only one out of every three so-called "voice hearers" requires psychiatric help. The other two don't experience difficulties and may even consider their voices supportive or inspiring.
"My voices know me better than anyone else, and they also protect and comfort me," says Jacqui Dillon, head of a London support group for voice hearers. She and other group members report that voices can alert them to oncoming cars and suspicious passersby, provide encouragement during stressful times, and offer reminders to pick things up at the grocery store.
Whether they threaten or soothe, auditory hallucinations usually begin after trauma: Seventy percent of people who hear voices first detect them following physical or sexual abuse, an accident, or the loss of a loved one. "The emotion they feel about their trauma complicates how they interpret the voices," says Sara Tai, a psychologist at the University of Manchester in England who studies why some hallucinators thrive while others end up in psychiatric care. Typically, the greater the trauma, the more likely voices will sound threatening.
Researchers haven't pinpointed the specific neural mechanisms at work, but brain scans show that areas of the brain that process sound and store memories appear more active during auditory hallucinations, as if previous experiences were being replayed.
For those terrorized by voices, anti-psychotic drugs help in only 30 percent of cases. Audrey Reid, a 35-year-old who hears seven different voices, says that five years of medication silenced her friendly, positive polyphony, but not the intimidating chatter. "The negative voices had more room to attack and bullied me even more," she says, recalling how they made sexually demeaning comments and criticized how she made coffee.
Self-help groups such as the Hearing Voices Network favor an alternative approach. Members view voices as a normal part of life, not a mental illness, and use coping strategies to help manage voices without necessarily eliminating them. Contrary to most psychiatrists' advice, HVN members believe people should engage with their voices.
Reid credits this approach with her ability to live comfortably with her voices. She has become so accustomed to their company that their temporary absence last year startled her: "I felt bereft and a bit lost without them."
Case Study: Audrey Reid, 35, of Dundee, Scotland
Reid believes that internal utterances improve her quality of life by:
Helping her assess people. Reid says her voices can accurately judge a person's character, which has been essential to starting and ending romantic relationships.
Reducing anxiety. She often becomes nervous before speaking at conferences. Her voices force her to breathe and to relax.
Providing entertainment. Her voices have different personalities, and Reid enjoys listening to them argue with one another. Sometimes she laughs out loud at their snide comments and running commentary on the outside world.
Helping make decisions. Reid says they analyze her options and advise her after reaching "group decisions."
Encouraging spirituality. The voices provide a moral compass and warn her when actions may harm her or others.