The Peopled Wound

What does it mean to hear voices that others cannot? (‘auditory verbal hallucinations’ in psychiatric parlance’)

Many, perhaps most, would claim it to be a symptom of a brain disease or a mental illness. Indeed, hearing voices is listed in the Diagnostic and Statistical Manual of Mental Disorders as a characteristic symptom of schizophrenia (APA, 2000).

Whatever meaning is given to the experience there is no doubt that often it is associated with great distress and impairment of life’s journey. Yet many people will cope well with the experience, and never feel the need to contact mental health professionals.

The meaning society gives to hearing voices is of crucial importance, as it impacts upon both how society treats people who hear voices, and how the person who hears voices comes to understand and cope with their own experiences.

At present, a narrow biomedical model is the dominant explanatory paradigm for hearing voices. Yet this biomedical understanding can have many negative effects on how society treats people with voices, which, as noted above, are seen as synonymous with mental illness. A study by Mehta and Farina (1997) found that members of the general population gave a person they were told had a mental illness (which was actually a confederate of the experimenter) stronger electric shocks on a learning task if they though that person’s mental illness was caused by biochemistry than if they thought they had it was due to psychosocial factors (“some things that happened to me as a kid”).

Aside from its stigmatising effects, a good reason to reconsider a narrow biomedical model of hearing voices is that such models predominantly focuses on neural changes in the brain associated with voices without considering the events in the life of the voice-hearer that may have led to such changes.

Over the past two decades much research has demonstrated that hearing voices is linked to traumatic and adverse life events (irrespective of what diagnosis the person has been given). For example, hearing voices has been shown to be associated with an increased probability of having experienced childhood abuse, e.g., being physically, sexually or emotionally abused (Read et al., 2003). Other life events that have been highlighted as potentially triggering voices include being bullied, one’s parents going through a divorce, and experiencing bereavement. Of course not all people who undergo such events begin to hear voices and what differentiates the two groups remains unclear (we may speculate that both shame and guilt, genetics, and interactions between such factors may play a role).

It is of great importance to note that the voices resulting from such events are often not just random utterances. Many voice-hearers are able to link the identity of their voices to people involved in these traumatic events, be it the voice of some who has abused them, or, in the case of combat veterans with PTSD, the voice of someone they have killed in combat, who is now telling them to kill themselves (e.g., Mueser & Butler, 1987; Romme et al., 2009).

Given this link to traumatic events, I would suggest to suggest that hearing voices is perhaps more accurately characterised not as a brain disease, but as a mental wound one has received (which obviously has physiological correlates).

Harold Pinter, in an essay on Shakespeare, uses the phrase “the wound is peopled”, which seems like an excellent metaphor to apply to voice hearing. Hearing voices may usefully understood, in many cases, as peopled wound.

Once we start to seriously consider this proposal, it will help us to reconceptualise the meaning of hearing voices, and will in turn affect the way in which mental health services might try to help people distressed by their experiences. This might not be a wound that can simply be medicated away. Indeed, if feelings of shame or guilt are involved these might not be best treated with a pill…

Readings

Mehta, S., & Farina, A.  (1997). Is being “sick” really better? Effect of the disease view of mental disorder on stigma. Journal of Social and Clinical Psychology, 16, 405-419.

Mueser, K. T., & Butler, R. W. (1987). Auditory hallucinations in combat-related chronic posttraumatic stress disorder. American Journal of Psychiatry, 144, 299-302.

Pinter, H. (2005). Various Voices Prose, Poetry, Politics (1948-1998). London: Faber and Faber.

Read, J., Agar, K., Argyle, N., & Aderhold, V. (2003). Sexual and physical abuse during childhood and adulthood as predictors of hallucinations, delusions and thought disorder. Psychology and Psychotherapy: Theory, Research and Practice, 76, 1–22.

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