Can you hear voices without being ill?
July 28, 2008 7:39 AM   Subscribe

I'm looking for scientific information on whether a person who is not suffering from mental illness can experience ongoing, coherent auditory hallucinations, specifically voices.

I'm trying to help a friend who is suffering from mental illness but refuses to get medical help. She claims that she hears voices but says that she is not ill. According to her, the voices are coherent and she can have conversations with them. She understands that hearing voices can be a symptom of mental illness but claims that if she was mentally ill enough to be hearing voices, she would be acting crazy in other aspects of her life, and she isn't. Therefore the voices are not an illness but are spirits.

Is she right about this? If you are talking to voices in your head because of mental illness, can you keep everything else together? How unwell must you be before you can have a conversation with the voices?

Peer-reviewed publications in scientific journals would be ideal. I'm not sure if a logical, reasoned discussion about this will work, but I'd like to try it. Even if my friend rejects good evidence that hearing voices is a sign of illness, that will tell me a lot about her attitude to getting help. Thanks.
posted by anonymous to Human Relations (26 answers total) 3 users marked this as a favorite
I doubt that there is a diagnosis that can be made exclusively from hearing voices, without some form of societal or financial impairment.

Two worrisome attributes of auditory hallucinations are: 1) do they issue commands? 2) Are they mood-incongruent, are they angry whens she is otherwise happy.
posted by StickyCarpet at 8:04 AM on July 28, 2008

Just an FYI, even if your friend were to agree to seek treatment a mental health professional wouldn't come at her denial head-on like you plan to. Probably the least effective engagement strategy in this type of situation is confronting someone who believes they aren't sick and telling them, "Yes you are, and here I have fifteen peer reviewed journal studies to support my assertion."
posted by The Straightener at 8:05 AM on July 28, 2008 [1 favorite]

"It can be argued that hallucination proneness and psychosis proneness do not overlap in the nonclinical population but can both cause distress separately."

From Hallucinatory experiences, delusional thought proneness, and psychological distress in a nonclinical population.
posted by cashman at 8:07 AM on July 28, 2008

I'm trying to help a friend who is suffering from mental illness

i don't understand. if you do know they're ill, but don't know whether hearing things alone is enough to label someone as ill, then there must be other symptoms (the ones you used to decide they were ill). can't you use those symptoms to show that their argument that they are otherwise ok is wrong?
posted by not sure this is a good idea at 8:10 AM on July 28, 2008

This book, Muses, Madmen, and Prophets: Rethinking the History, Science, and Meaning of Auditory Hallucination, speaks exactly to this issue. It's definitely a normalizing take on the phenomenon.

Oliver Sachs (the neurologist of The Man Who Mistook His Wife for a Hat fame) also takes up auditory hallucinations in his new book on music. Musicophilia. Sachs is always a good read because he has both a rigorous scientific background and a humanist point of view.

Hope this helps.
posted by MaddyRex at 8:15 AM on July 28, 2008 [1 favorite]

Mental illness is not a binary condition. It's a continuum that just about everyone on the planet inhabits at some point on the spectrum. Usually, the point at which professional help is needed is the point at which their current state of mental illness interferes with their live in negative ways.
posted by Freen at 8:17 AM on July 28, 2008

Point out that just because she's not "acting crazy" in other aspects of her life does not necessarily mean she doesn't have a brain lesion, tumor, or stroke damage occurring somewhere in her audio processing area.
posted by Benjy at 8:20 AM on July 28, 2008 [2 favorites]

Here is a recent radiolab episode about musical hallucinations. From what I remember, the people experiencing them have no other symptoms of mental illness. It is fascinating to listen to. I think Oliver Sachs may be interviewed in it.
posted by Shebear at 8:28 AM on July 28, 2008 [1 favorite]

Hallucinations aren't, in themselves, indicative of mental illness. Coupled with paranoia, delusions, emotional disruption (too much or too little), etc - then you're looking at something potentially serious.

My #1 concern would be the same as Benjy - tumors, strokes, and other things manifest themselves in odd ways sometimes. I would start there.
posted by unixrat at 8:35 AM on July 28, 2008

I'm also going to chime in and say that you don't have to be nuts to talk to the people in your head. I do it all the time- I carry on conversations with them; they carry on conversations with each other. On occasion, I laugh out loud at the things they're saying.

Occasionally, they've been disruptive enough to keep me from falling asleep, if they have an argument, or a particularly pressing bit of information they feel they must share. Then I write it down, because I'm a writer- that's my job.

I've had MRIs, CAT scans, and EEGs (for migraines,) which found no defect or lesion, and I've taken the Minnesota Multiphasic for the military, which deemed me nothing more than asocial. I'm provably, quantifiably not crazy- but i still talk to the people in my head.

So if your friend is not suffering, if she's not being implored to hurt herself or others, if she's not being convinced that people are out to get her, if she is functional in her job and her daily life - there's an excellent chance that she just has a really active imagination.
posted by headspace at 8:35 AM on July 28, 2008 [4 favorites]

There is apparently some research favoring her point of view:

Can Hearing Voices In Your Head Be A Good Thing?

Although hearing voices has traditionally been viewed as 'abnormal' and a symptom of mental illness, the Dutch findings suggest it is more widespread than previously thought, estimating that about 4% of the population could be affected.
posted by jamjam at 8:37 AM on July 28, 2008

This is a bit beside the point, but a person can experience vivid, ongoing, and coherent visual hallucinations without being mentally ill. See Charles Bonnet syndrome.
posted by astrochimp at 8:38 AM on July 28, 2008

I'll second the recommendation for Muses, Madmen, and Prophets.
posted by tdismukes at 8:50 AM on July 28, 2008

Concerning, yes, and it is indicative of mental illness, although 10-15% of people hear voices without other signs of mental illness. But if she's resistant to therapy, suggest she see a neurologist because it can indicate lesions. According to 'Nicolson SE, Mayberg HS, Pennell PB, Nemeroff CB (2006). Persistent auditory hallucinations that are unresponsive to antipsychotic drugs. Am J Psychiatry. Jul;163(7):1153-9', these can occur due to alterations in Broca’s area, the anterior cingulate, the superior temporal lobe, and the primary auditory cortex.
posted by kldickson at 9:19 AM on July 28, 2008

The NYT magazine did a very good article on this (I thought) in March 2008 -- entitled Can You Live With the Voices in Your Head?
posted by ClaudiaCenter at 9:38 AM on July 28, 2008

Does she wear hearing aids or have hearing loss? I wear hearing aids and take them out at night. Sometimes my brain "fills in" the noise that is absent. Mostly it sounds like a radio's been left on in another room, but sometimes I hear specific words. I don't, however, talk back. I suppose if I were really spiritually inclined I might interpret these voices differently, but these kind of auditory hallucinations are common in hearing-impaired people.
posted by desjardins at 10:50 AM on July 28, 2008

She claims that she hears voices but says that she is not ill. According to her, the voices are coherent and she can have conversations with them. She understands that hearing voices can be a symptom of mental illness but claims that if she was mentally ill enough to be hearing voices, she would be acting crazy in other aspects of her life, and she isn't.
One thing you have to understand is this: mental health diagnoses are, almost without exception, grounded in the fact that "mental illness" must cause some kind of disturbance to the person or to others. It must not only be abnormal, but it must also be maladaptive.
If your friend gets along fine with these voices, and they do not cause her nor her acquaintances any problems, then it is unlikely that it is "illness" per se, and why would you try to convince her otherwise? I think perhaps you should ask yourself: what do you have invested in getting her to seek medical attention? Why are you trying to impose your own attitudes on her?
posted by tybeet at 11:28 AM on July 28, 2008

here's a different tactic--try to get her to a neurologist. maybe she really is having auditory hallucinations due to a neurological problem (or can be convinced that she is). the neurologist can probably get her into treatment from there.
posted by thinkingwoman at 2:31 PM on July 28, 2008

There's nothing wrong with hearing voices per se and it doesn't even necessarily mean anything is wrong or that there's even a traceable pathology leading to the hallucinations.

If it's long term and persistent without significant change then I wouldn't even sweat it insofar as seeing a neurologist is concerned, constancy mostly means no danger (though not necessarily so).

If hearing voices is a new phenomena for her then I would urge her to consult a neurologist at her first convenience since onset of voices later in life is more likely to be indicative of some sort of trouble. If she's ever troubled by what the voices have to say or concerned about them otherwise those would also be great reasons to seek treatment regardless of their onset/duration.

The thing that probably sets the 'sane' voice-hearers apart from the rest is generally how they interpret and interact with the voices. People with a diagnosed mental illness which features hearing voices usually have the phantom vocalists trying to persuade them to do 'bad' things, making unfriendly remarks and so forth.

I knew a fellow a few years back through a poverty/mental illness/disability outreach program who had a problem with loud aggressive voices shouting at him about his worthlessness, his imminent death and how the voice was going to 'come in there and slit his throat'. This made it hard for him to sleep, so he would drink until he would pass out otherwise he would be too anxious and disturbed to sleep. In my opinion it seemed as if most of his symptoms (other than hearing voices) were the secondary and tertiary results of the behaviors he engaged in to cope with the message of the voices.

A persistent voice or chorus of voices urging us to, for example, kill ourselves would most likely have a negative effect on our mood and view of the world. But voices are not necessarily aggressive.

If we instead imagine a friendly benevolent phantom vocalist who constantly cheered us on and reminded us that the people around us love us and care for us (etc.) we could reasonably assume that we could benefit from the voice (rather than be impaired).
posted by Matt Oneiros at 4:22 PM on July 28, 2008 [2 favorites]

Is she just misunderstanding her internal monologue for voices?
posted by gjc at 6:22 PM on July 28, 2008

Short answer: yes, healthy people can experience auditory hallucinations. Part of this is recognizing that it's a hallucination, but explaining the experience as spirits is a delusion and brings the phenomenon into the realm of mental illness.

If she can get a grip on them, they can be extraordinarily fun and beneficial.
posted by cmoj at 7:10 PM on July 28, 2008

Mental illness, even more so than other illness, is definitional. Hearing voices of people who are not present fits some definitions of mental illness, so by those definitions your friend is mentally ill. For instance, some psychiatrists would classify all otherwise unaffected voice-hearers, like your friend, as "298.9, psychotic disorder not otherwise specified."

Peer reviewed studies in journals do not attempt to investigate the question of whether the definition is correct; they start with a definition of the condition under study, and investigate questions relevant to people who do or do not fit the definition. The psychiatric literature, then, cannot really answer your question.

If your question is whether spirits exist and whether people can communicate with them, you should have said so more explicitly. The answer to these questions is 'no.'

Checking out the Wikipedia article on psychosis, I found a link to this article, which divided voice-hearers into 3 groups: patients with schizophrenia, patients with dissociative disorder, and "nonpatient voice-hearers." This neatly ducks the question of whether all nonpatient voice-hearers are medically ill.

The DSM criteria allow a person to hallucinate for up to 6 months in the wake of an acute grief reaction before it becomes "pathologic," which is another word for "fitting the definition of mental illness."

In my experience, which is that of a neurologist who often asks his patients the specific question "Are you hearing voices of people who are not actually present?" I have uncovered several people who answer "yes" to that question without other objective evidence of mental illness. These people did not seem to need treatment, and I actually withheld treatment from a few of them. They seemed to do fine. I do not know what is going on with these people. I do not even know if they are truly experiencing the phenomena they are reporting to me, much less whether they have paranoia that is causing them to conceal from me the negative effects of these phenomena on their lives.

Far more common - for every one like the above I see a hundred of these - are people who hear voices that say frightening things, such as suicidal or homicidal commands. These voices are often abusive, terrifying, and incessant and the people who hear them suffer greatly. That kind of person benefits greatly from treatment.

I hope this has been useful. I have been interested in this topic for a long time - since my first med school encounter with a person with schizophrenia, and maybe even before then - but I still have a lot of unanswered questions about it.
posted by ikkyu2 at 9:39 PM on July 28, 2008 [1 favorite]

Not trying to be trite, but I think both you and your friend might want to watch (or re-watch) this classic movie.
posted by Asparagirl at 8:05 AM on July 29, 2008

While you're at it, check for carbon monoxide in her home. Carbon monoxide poisoning is quite common in homes with gas heat or gas stoves and can cause hallucinations. You can buy detectors at a hardware store or big store like Walmart, usually shelved with the smoke detectors. Everyone should have one anyway.
posted by Jacqueline at 5:22 PM on July 29, 2008

I think you're being a total asshole about it. Maybe she's crazy, maybe she's not? Maybe she's not right now but is going to be or maybe it'll turn out she was right all along?

You are her friend and you're alarmed and I would never dismiss that... But on the other hand you're really narrow minded, huh? If I told you something private and then spent 3/4 of that conversation trying to point out how I'm clearly not crazy and then you came back at me with purely biased and one sided 'proof' that I absolutely was - I would know you were an asshole and tell you nothing ever again.

But if you were a friend and said "Look I think you might have the beginnings of crazy written all over you but let's leave that explanation 'til last. I really want to know what it is? Where it's from? Why? Why? Why? Aren't you curious?" (I'm curious! This is what you're OP could have been about, instead!) Then at least, worst case scenario, you'll be trusted and in the loop. Because right now you are just wrong. Take all the evidence, experts you like and you are still wrong. Actually exploring the possibilities with her is the only way you will gain the credibility to maybe change her opinion on that... (And learn about things yourself?)

But in answer to your question - Yes I think you can. I have a friend who likens it to having extra people working as a cohesive unit. Multitasking? Working or resting in the background with the most appropriate one at any time manning the shop so to speak. Don't get me wrong I'm a cautious person. I'm keeping an eye out for any cracks and I'll be the first to say "Nope, you know what? This is now crazy and not the good kind!" But until that day I can only watch all that they accomplish and be both happy and extremely jealous.
posted by mu~ha~ha~ha~har at 7:05 AM on July 30, 2008

This is maybe a real longshot, but has she had any dental work in the recent past? If she has had cavities either filled or replaced, and especially repaired, the differences between two metallic amalgams can cause AM radio signals to be demodulated. You can actually receive AM radio in your mouth, and hear it. You don't get any choice of the channel, though.

She might want to go to a dentist.
posted by vilcxjo_BLANKA at 8:44 AM on August 1, 2008

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