Around one in 20 adults will hear a voice at some point in their life. For some, the voices are friendly, helpful or inspiring - they can be enriching experiences. But others hear voices that threaten or criticise them. These can be frightening, and incredibly disruptive to daily life.
While progress has been made in recent years to tackle stigma for common mental health problems, many people who hear nasty voices still suffer alone. In fact, voice hearers are six times more likely to feel lonely than those who don’t hear voices.
To learn why people hearing nasty voices can become lonely and isolated, we asked 15 volunteers what it was like for them to be around other people. We conducted in-depth interviews, which were analysed to look for themes. We asked participants questions about whether they hear voices when talking to other people, and what that experience is like for them.
We discovered many factors that can make it difficult for people who hear nasty voices to connect with others.
First, voices can directly disrupt conversations. Participants explained that focusing on a conversation when also hearing voices is difficult and tiring. It can be tough to work out who is speaking, and when voices are threatening it can be difficult to trust people.
People’s reactions to voices are also important. Many avoided talking about the voices for fear of upsetting loved ones. Kerry* explained: “I would rather it just scared me than scared anybody else.” Participants were also afraid of being ridiculed, labelled “mad”, or embarrassing love ones by being distracted by voices in public. Sadly, some participants had received negative reactions when they told people about the voices. Liam tried to make sense of this by explaining: “it’s difficult for anyone who hasn’t been through it to understand”. But these reactions were understandably upsetting, and could make the voices worse.
Because of the many obstacles to connecting, social isolation was common and particularly in the early days of hearing voices. Liam explained: “you withdraw, you don’t want to talk to people.” One person in our study who heard voices for fifteen years had not spoken to any family or friends about them.
But isolation was not a long-term solution, and could make the voices more difficult. Many participants explained that voices were more likely to come if they were alone. They were also more believable and difficult to ignore.
Over time, a number of voice hearers in the study had reconnected with people, and there were several things that helped. With practice, they learned to tune into conversations and tune out the voices. Connecting with other voice hearers allowed them to talk freely, and not worry about being judged, and over time they learnt to trust people again.
Participants put careful thought into how to explain their experiences to non-voice hearers, and learnt that people tended to react better than expected. But talking about voices often involved an element of self-acceptance first. Kerry realised that “it’s not me but it’s a part of me, why should I be ashamed of it?”
For several people social support was crucial in their journey of recovery. Anna explained “over time talking about it helped so much. Because I found the more I suppressed it, the worse it got”. Sharing the criticisms that voices made with other people helped participants to gain an alternative perspective and therefore learn that the nasty comments weren’t true. Socialising provided a distraction, and some made a particular effort to regularly meet people after working out that talking made the voices happen less often.
While social connection brought benefits, it wasn’t always easy. Some participants explained that there were still some days when the voices were just too tough, and it was better to stay at home.
Our research highlights the many challenges people who hear voices face when connecting with others. It is the first study to explain how social connection can help with managing voices. While there is support available already to help people with social recovery, we identified new avenues for building connections – such as learning to switch attention from the voices to the conversation, and finding the right words to explain voice hearing to other people. Further research will be needed to look into the full effect that social connection has on hearing voices.
We have made great strides in understanding and talking about mental health. But the experience of hearing voices is still often misunderstood. Being open to conversations about voices, and having a curiosity to learn what it’s like to hear them could help many people who hear voices. As Dan said: “the best thing I ever did was talk about it.”
*Pseudonymns are used to protect the anonymity of participants.
Bryony Sheaves is funded by a National Institute for Health Research (NIHR) clinical doctoral research fellowship (ICA-CDRF-2017-03-088) for this research project. This piece shares the results from independent research funded by the NIHR. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.