A hallucination is defined as a sensory experience of something that does not exist outside of the mind. Hallucinations can occur in any of the five senses – sight, hearing, taste, smell and touch. However, auditory hallucinations, or hearing sounds that are not really there, are one of the most common types of hallucinations, especially in individuals with mental health conditions like schizophrenia or bipolar disorder.
In this article, we will explore what auditory hallucinations may sound like, common features of hallucinated voices or sounds, the proposed origins of auditory hallucinations in the brain, and the impact these phantom noises can have on an individual’s mental health and quality of life. Understanding the subjective experience of those who suffer from troublesome auditory hallucinations can help us better empathize with their struggles.
What Do Auditory Hallucinations Sound Like?
Of course, hallucinations are by definition idiosyncratic and purely subjective experiences, so there is no single answer to what they “sound” like. However, some common themes and characteristics emerge when reviewing first-hand accounts of auditory hallucinations:
– Hearing voices when no one else is around. These voices may sound like they are coming from outside the head or internally.
– Voices conversing or commenting on the individual’s thoughts and behaviors. For example, “Don’t do that…” “You should go to bed now” or “I know what you’re thinking…”
– Sounds ofmultiple voices talking at once. Sometimes described as crowds of people whispering or muttering.
– Hearing unfamiliar voices versus recognizable voices of people the individual knows.
– Voices with distinct personalities and emotional tones. Some may sound angry, frightened, reassuring, or threatening.
– Noises that sound real, such as sirens, slamming doors, ringing phones, or animal sounds. But no source for the sound exists.
– Inability to control when voices or sounds occur or how long they last. Voices may start and stop abruptly.
– Hallucinated voices/sounds perceived as outside the individual’s control. They are “imposed” upon the auditory experience.
– Difficulty distinguishing hallucinated voices from real perceptions or imagined thoughts.
While the subjective experience varies, what ties these accounts together is the vivid, perceptual nature of auditory hallucinations. The voices and sounds are not just “thoughts” – they are perceived as having a real presence and occurring involuntarily in the external environment or “inside the head.” This makes them extremely disturbing and feels like a loss of control over one’s own mind or reality.
Common Characteristics of Auditory Hallucinations
Though the specific content may differ, researchers have noted some typical qualities and patterns when it comes to auditory verbal hallucinations:
Location:
– External space – Voices seem to come from outside the head or from a certain direction.
– Internal space – Voices sound like they are coming from “inside” the head.
Identity:
– Strangers – Voices do not sound familiar.
– Familiar people – Voices sound like known people in the person’s life.
– Self – Voice sounds like one’s own voice or thoughts.
Number of voices:
– Single voice
– Multiple voices – Sometimes a crowd or chorus of voices.
Frequency:
– Occur frequently throughout day.
– Only occur occasionally.
– One persistent voice versus multiple voices that come and go.
Clarity:
– Clear, distinct voices.
– Mumbled or muttered voices.
– Loud voices versus soft, whispery voices.
Tone and content:
– Positive – Complimentary, encouraging, or reassuring.
– Neutral – Simply commenting without judgment.
– Negative – Angry, threatening, frightening, or critical.
– Commanding – Telling the person what to do/not do.
– Conversational – Voices discussing amongst themselves.
While these categories help us break down the components of auditory hallucinations, each person’s encounter with voices is unique. These qualities may also shift and evolve over time for an individual as well.
What Causes Auditory Hallucinations?
There are a few key theories that provide clues into what is happening in the brain when someone experiences auditory verbal hallucinations:
– Misattribution of inner speech – Some researchers propose that hallucinated voices may arise from one’s own subvocal thoughts that are misattributed as coming from an external source. Rather than experienced as internal dialogue, the speech is perceived as voices outside of conscious control.
– Dysfunctional activation of language networks – Brain imaging studies point to abnormal activation in language centers of the brain (like Wernicke’s area) when auditory hallucinations occur. This may reflect wider network connectivity issues.
– Hypervigilance – The tendency those prone to hallucinations have to monitor the environment for threats and odd occurrences may prime the brain to detect patterns that are not really there.
– Disinhibition – Without proper inhibition or reality-monitoring, imagined speech and sounds may be released into conscious awareness rather than suppressed.
– Memory intrusions – Past memories of conversations, noises, music, etc. may spontaneously reactivate and be perceived as coming from external space rather than internal memory.
Role of emotions – Changes in emotional state may trigger hallucinations, which in turn amplify and reinforce the emotions. Fear, anxiety, and stress seem particularly linked to voices.
Of course, there are likely multiple overlapping causes. The current thinking is that auditory hallucinations reflect impairments in how the brain distinguishes between internally versus externally generated perceptions – and fails to accurately identify the source as being internal.
Impact of Auditory Hallucinations
Living with constant or recurring auditory hallucinations can exert a significant psychological burden on mental health and quality of life. Common consequences include:
– Distress – Hearing voices and sounds that do not exist is inherently distressing and fearful. Individuals often feel terrorized or persecuted by the voices.
– Sleep disturbances – Voices may prevent falling asleep or wake someone up at night. Exhaustion can follow.
– Difficulty concentrating – Hard to focus with voices providing running commentary or interrupting thoughts. Can severely impact work/school functioning.
– Social isolation – Social interactions are challenging when voices insert disruptive comments or if trying to hide the experience. Stigma discourages sharing.
– Low mood – Constant noise and negativity of voices can trigger depression, low self-esteem, and hopelessness. Risk of suicide ideation.
– Behavioral issues – In severe cases, voices may command the person to act out in dangerous or erratic ways. Substance abuse can be a coping method.
Coping methods like ignoring voices, arguing back at them, or social support can lessen the impact. But untreated or recurring hallucinations take their toll. Getting an accurate diagnosis and accessing treatment tailored to the individual’s needs is important for managing troubling hallucinations.
Treatments for Auditory Hallucinations
While auditory hallucinations can be persistent and difficult to treat completely, there are a range of interventions aimed at reducing severity and impact:
– Antipsychotic medications – Used to suppress excess dopamine activity linked to psychosis and hallucinations. Options include olanzapine, risperidone, quetiapine, and clozapine.
– Cognitive-behavioral therapy (CBT) – CBT teaches coping techniques to resist reacting to voices and distress caused by hallucinations. Aims to modify unhelpful thought patterns.
– Acceptance and commitment therapy (ACT) – ACT focuses on accepting hallucinations as mental events while still acting in line with one’s values and goals.
– Compassion-focused therapy – Works to develop self-compassion as an alternative to harsh, critical voices. Uses mindfulness and imagery.
– Coping Strategy Enhancement – Individualized approach to analyze how person responds to voices and develop new coping methods.
– Neurostimulation – Techniques like repetitive transcranial magnetic stimulation (rTMS) activate underactive brain areas linked to symptoms.
– Hearing aids – Wearable devices that amplify ambient sounds may help suppress unpleasant voices.
– Support groups – Peer support provides validation and shares strategies for managing voices. Reduces isolation.
While challenging, auditory hallucinations can be managed with a combination of medications, therapy, and self-help techniques. Many people with recurring voices learn to cope effectively and regain quality of life. Support networks also provide an essential reminder to patients that they are not alone in their experiences.
Example Case of Auditory Hallucinations
To make these concepts more concrete, let’s walk through a hypothetical case example of a patient dealing with troublesome auditory hallucinations:
Jim, a 19 year old college student, was diagnosed with schizophrenia after experiencing his first psychotic episode. During this episode, Jim became convinced the government was spying on him through the radios on campus. He also began hearing threatening voices that would shout insults at him and tell him to harm himself.
The voices initially sounded like they were coming from outside dorm room and down the halls. But soon the voices took on an internal, subjective quality – sounding as if they were coming from inside Jim’s own head. Though at times vivid and distinct, other times the voices were more muted, like strangers whispering just out of earshot.
Mostly, the voices were menacing, telling Jim he was “worthless” and to “kill yourself.” At their worst, the voices formed a deafening chorus of different voices laughing, yelling, and screaming all at once. Rarely, Jim would hear a calm, reassuring voice telling him the other voices weren’t real. But this only added to the confusion over what was and wasn’t real.
Jim found himself unable to concentrate in class or complete assignments with the constant verbal abuse. He became socially withdrawn to hide what he was experiencing. Distressed and exhausted, he was unable to sleep and turned to heavy drinking to try and dampen the voices. Though scary, the voices felt completely outside Jim’s control – they came and went whether he wanted them there or not.
After being stabilized on an antipsychotic medication, Jim started to respond to cognitive behavioral therapy aimed at teaching him ways not to engage with or react to the troubling voices. He practiced acknowledging the voices without obeying their commands or arguing back. Over time, he learned to identify triggers that made the voices worse, and developed healthier coping behaviors such as calling a support line, playing music, or going for a walk.
While the voices did not disappear entirely, Jim found that consistent treatment allowed him to function again with support from his family and psychiatric team. Managing his schizophrenia and dealing with residual symptoms like hallucinations remained an ongoing process, requiring maintenance medication, therapy, and lifestyle balance. But Jim continued pursuing his college degree and career ambitions, rebuilding a purposeful life.
Conclusion
Auditory hallucinations are an incredibly disruptive and frightening experience for many living with mental health conditions like schizophrenia, bipolar disorder, PTSD, and severe depression and anxiety. Hearing voices or sounds that other people do not experience challenges perceptions of reality and can feel like a loss of control over one’s own mind.
Yet while often deeply stigmatized, these hallucinatory experiences are far more common than many realize. Understanding what the voices may sound like, identifying triggers and patterns, and accessing professional treatment tailored to the individual’s needs can help someone regain stability and control. There are many paths to recovery.
Though a complex and variable phenomenon, research continues to reveal clues into the brain activity gone awry behind auditory hallucinations. No single cause likely explains all cases. Untangling the science can help remove assumptions that hearing voices is somehow a personal failing or character flaw. On the contrary, these hallucinations are an involuntarily occurring health condition rooted in malfunctions in auditory and language processing regions of the brain.
While the subjective experience of hearing voices defies any simple description, common themes give insight into the inner world of those struggling with this profound disruption of reality. It is a realm that takes compassion, patience and shared understanding to navigate. But people can and do find ways to live full, meaningful lives alongside even chronic hallucinations. Their resilience provides hope to the many still searching for that balance.