Source: The Times, 23/01/2007

By Michelle Kirsch

Four per cent of people in the UK are said to hear voices. A new trial could help them

We have all had the experience of seeing a person walking down the road, talking loudly to what appears to be him or herself. Before the advent of hands-free mobile phones, which gives the scene a “sane” context, we would have thought the person disturbed, speaking to someone who does not exist outside his own head. Now psychologists studying the phenomenon of hearing voices are asking us to consider two other possibilities: one is that people who hear voices may not be disturbed by them, and the other is that a person who appears to be speaking on a mobile phone might be speaking to one of his voices.

Pretending to speak on a mobile phone is just one strategy that makes life more bearable for the estimated 4 per cent of Britons who hear voices. The 4 per cent figure, as cited by the Hearing Voices Network, an educational and self-help registered charity for voice-hearers, is a conservative estimate. The real figure may be much higher, they say, because anyone who admits to hearing voices may be subjected to close, perhaps unwelcome, psychiatric scrutiny.

Dr Phillip Thomas at the University of Central Lancashire, who was a practising consultant psychiatrist for more than 20 years, explains: “There is a lot of evidence in the form of epidemiological studies to show that many people in the community who hear voices don’t present to psychiatrists. The thing that determines whether or not you become a psychiatric patient is not the fact that you hear voices, but because either you are distressed by the experience or your ways of coping with the experience upset other people.”

Forward-thinking psychologists in the field would like to disabuse us of the notion that hearing voices equals “crazy”, but this seems a huge leap of faith in a society that still largely regards voice-hearing as symptomatic of a psychotic illness to be treated with sedation and, often, inpatient care in a psychiatric unit.

To examine the differences between those who find the experience positive and those who do not, researchers at the University of Manchester department of psychology are looking for people who hear voices.

Dr Sara Tai, who is supervising the research, says: “My hypothesis is that hearing voices is like a signal; a sign that there is a problem in your life. Some people recognise the voice as a sign and attempt to solve the problem. These people are more likely to interpret their voices as non-threatening and perhaps even helpful.”

Ron Coleman, a voice-hearer who helps to train mental health workers in how to help people who hear voices, consults his voices when he is making major decisions about his work or his life. But the voices that now guide him used to torment him. He says: “I spent years in the psychiatric system because I heard the voice of a priest who had abused me and the voice of a partner whom I’d lost. It was scary and drove me to distraction. I didn’t respond well to medication, and at times suicide seemed like a way to get away from the voices.”

Coleman’s turning point came when he contacted the Hearing Voices Network. “For the first time,” he says, “I had licence to explore the voices and think about what they were trying to tell me. I hear seven voices and, of those, four are positive. One voice I call “the teacher”; another is my father. I don’t listen to the negative ones. I tell them to go to Hell.”

Coleman talks back to his voices, but only when he is on his own: “My wife says that I spend too much time talking to my voices and not enough time talking to her.”

Dr Thomas explains: “Most psychiatrists would regard anyone hearing voices as someone who potentially has a psychotic disorder, so what is foremost in the psychiatrist’s mind is whether it is a form of psychosis, or whether there is a physical basis — a form of epilepsy or a brain tumour. Once they are clear about the cause, a popular treatment would be neuroleptic medicine: major tranquillisers.”

For most, the medication dampens down the voices instead of turning them off entirely. Another treatment might be a course of cognitive therapy with a clinical psychologist. Dr Thomas says: “It tries to help people to modify their beliefs about voices and look for coping mechanisms.”

Coping mechanisms include speaking to the voice through a switched-off mobile phone, making it an acceptable thing to do in public — and, amazingly, making appointments to talk to the voices: pencilling them into a diary. Or, when the voices are causing great distress to the hearer, it is sometimes possible to tell them to go away.

Dr Thomas tells of a woman with whom he worked who was troubled by a voice that she identified as a devil, which told her to do terrible things. When she explored the meaning of the voice with Dr Thomas — most psychiatrists would not do this — they worked out that the voice was not unlike that of her late authoritarian father. The voice usually came to her in church, and she felt that she couldn’t answer it back.

Dr Thomas suggested that she leave the church when the voice came, and speak to it outside. “It was on a Good Friday,” he says. “She left the church and shouted at the top of her voice ‘Get lost!’ and the voice went away.” The voice returned days later but by then the patient had learnt to exercise some control over it.

Jacqui Dillon, of the Hearing Voices Network, says: “The aim is to get to a place where people are more able to incorporate their experience into everyday life so it is not distressing. If the voice is viewed as a symptom of illness it is meaningless, but there is meaning in it and by listening to their voices people can make sense of their experiences.”

While some sufferers can integrate their voices, others learn to appreciate them. Dillon says: “Some people say that their voices put them in touch with their creativity, and others say that voices have helped them to cope with some very difficult things.”

The notion of voices being helpful is based on the pioneering research of the psychologists Marius Romme and Sandra Escher, co-authors of the Mind publication Accepting Voices, which analyses people’s experience of hearing voices outside the illness model. Escher writes: “Almost all voice-hearers who have learnt to adjust to their experiences report that, with hindsight, the process has contributed to their personal growth.”

In the UK, those looking for support and acceptance outside the realm of the Hearing Voices Network and broad-minded psychologists will have a job of it. The idea that hearing voices equals psychosis is firmly embedded in our psyche. Dr Thomas speaks of one patient who started hearing voices when she was 5. “She said to her friend, ‘I hear voices. Do you?’ And the friend said, ‘Oh no; only loonies hear voices’.”

People interested in taking part in the research should phone 0161-275 2595 or 0161-306 0405, or e-mail voicesresearch@hotmail.co.uk Hearing Voices Network: 0845 1228641; www.hearing-voices.org

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