Medical Humanities approaches to the Phenomenology of Auditory Verbal Hallucinations

Dr Angela Woods, a Senior Lecturer in Medical Humanities from Durham University, opened Sheffield University’s ‘Medical School Humanities Lecture Series’ by presenting preliminary findings from the innovative study “What is it like to hear voices?” This research is part of a larger project called “Hearing the Voice” which brings interdisciplinary and medical humanities approaches to the study voice-hearing, or auditory verbal hallucination. The project involves academics from a range of disciplines including: Neuroscience, Psychology, Psychiatry, Medicine, Geography, Sociology, Anthropology, Theology, Medical Humanities andEnglish literature, as well as Clinicians, Health Care Practitioners, Service Users, Voice hearers and other “experts by experience”.

Unfortunately we live in a culture where there is stigma attached to those who hear voices. Hearing voices is commonly associated with being a symptom of a serious mental illness, for example it is one of the four main symptoms of a psychotic episode. The experience of an auditory verbal hallucination is the same as hearing a voice normally except for one main difference; the sound of the voice has no external source. Often the hearer has very little control, if any, over the voices and the experience can be the cause of pain and misery, and result in inner turmoil. At times the voice narrative can also be hateful, cruel and damaging causing a great deal of distress not only to the ‘hearer’ but also their friends and family. A common misconception of hearing voices is that it is rare and is reported in isolated cases, however as Angela acutely points out approximately 10% of the population at some point in their lifetime will hear voices that are otherwise regarded as ‘not real’. So I think we can all agree this is and should be a topic of great relevance.

Despite the experience of voice hearing being culturally universal and evident throughout history (as just one example Julian of Norwich 1342-1416 is quoted saying she “hears the voice of God”) it is astonishing that our understanding of subjective ‘first hand’ accounts of this human experience remains opaque and devalued. Although there is a wealth of research on auditory verbal hallucinations, Angela and her colleagues argue this phenomenological data is biased as it has mainly been collected in clinical settings, which “has potentially shaped what kinds of experiences are reported and how they are interpreted“.

Statue of Julian of Norwich.

Statue of Julian of Norwich, Norwich Cathedral, Voice Hearer.

The “What is it like to hear voices?” study, conducted in partnership with the Lived Experience Research Network is a qualitative report asking people to reflect in their own words what it is like to have these experiences. As the website for the ‘Hearing the Voice’ Project says, Angela and her colleagues aims to “provide a better understanding of the experience of hearing voices in the absence of any external stimuli“. For this purpose Angela and her colleagues created an online questionnaire carefully scripted for ‘voice hearers’ utilizing both open and closed ended questions. They were successful in recruiting over 150 people from all over the world who varied greatly in their demographics, mental health and voice hearing experiences.

The pioneering research of the Hearing the Voice team attempts to gain a better understanding of voice hearing by addressing questions that so far have received scant in-depth attention including: interpersonal agency of voices, their relationship to thoughts, and their manifestation in the body.. For example one voice hearer who is a professional writer explained her experiences by saying, “that whilst I am writing a book it is almost like I am dictating the character by the voice I am hearing“.

Angela and her colleagues hope the results of interdisciplinary qualitative research into voice-hearing can help “nourish the ethical core of scientific enquiry” by redefining the parameters of auditory verbal hallucinations, challenging conventional notions and preconceptions, and seeing it as not just a sign of severe mental illness but also a human experience. Angela points out that individuals who have traumatic childhoods are more likely to have the experience of hearing voices later in life, thus suggesting the narrative and dialogue of voices may be of therapeutic significance and should not be disregarded or shunned in therapy.

Of course there are issues and limitations of using an interdisciplinary framework. However, overall the approach offers a broad investigation of a subject incorporating different schools of thought whilst at the same time magnifying the ‘lens’ we look through allowing for more redefined questioning. As a result, Angela and her colleagues put forward in their paper (2014) that the findings from this study and research like it have far reaching implications for the field of Psychiatry and beyond. In addition, the research produced by the ‘Hearing the Voice’ Project has the potential to offer, “voice hears richer, potentially more empowering ways to make sense of their experiences”, although the challenge now is to integrate interdisciplinary approaches into mainstream hallucination research.

Find out more about future events

Hearing the Voice Research Team (2013). Hearing the Voice. [Online] Available from: [https://www.dur.ac.uk/hearingthevoice/] Accessed 26th October, 2014.

Woods, A., et al. (2014). Interdisciplinary Approaches to the Phenomenology of Auditory Verbal Hallucinations. Schizophrenia Bulletin, 40(4), S246 – S254.