The Neurology Of Hearing Voices

Imagine the familiar hum of your own thoughts starting to shift. Conversations around you might take on a peculiar, disorienting quality. Slowly, you may begin to wonder: Are those words truly spoken by others, or could they be emerging from somewhere within your own mind?

For many individuals living with schizophrenia, this bewildering experience can be a stark reality. One recognizable symptom of schizophrenia tends to be the presence of auditory hallucinations or paracusia. Auditory verbal hallucinations (AVHs) usually involve hearing voices without external stimulation. AVHs and other auditory hallucinations can be a sign of psychotic disorders like schizophrenia. As many as 75% of individuals with schizophrenia may report the presence of auditory hallucinations.

While the origins of schizophrenia are not yet fully understood, neuroscientists continue to examine the potential connections between brain function and the experience of these phantom sounds. It’s thought that differences in the connection between Broca’s area and Wernicke’s area in the brain may play a part in auditory hallucinations. Often, hallucinations and other symptoms of schizophrenia can be treated with a combination of medication and therapy.

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The experience of hearing voices in schizophrenia and bipolar disorder 

The experience of hearing voices within the context of schizophrenia may be anything but uniform. Some people might hear voices that hurl insults or cruel taunts, while others encounter a blend of neutral or even encouraging statements. These voices may seem to have a singular, identifiable source or seem like an indistinct murmur emanating from all directions, like hearing music or chatter in the background of a crowded room. Some people may even have full conversations with the voices they hear, believing them to be real and tangible.

Sometimes, the voices may elicit a whirlwind of emotions — terror, despair, or even rage. In other cases, people may experience an oddly detached feeling, as if they were merely overhearing a conversation with no personal connection.

The intensity and frequency of these voices can take many forms. Some individuals find them a relentless accompaniment to their daily lives. For others, the voices appear and disappear in unpredictable waves. They may be booming and forceful or merely a whisper that's easily lost within the flow of everyday thought.

Auditory hallucinations don't automatically signal a diagnosis of schizophrenia. Other mental health disorders may also include this phenomenon, including bipolar disorder, certain types of depression, and post-traumatic stress disorder. There can even be instances when those with no underlying mental health diagnoses briefly experience these sensations, particularly during times of extreme stress or lack of sleep.

Brain regions and connectivity

Thanks to advanced brain imaging techniques like functional magnetic resonance imaging (fMRI), scientists have been able to visualize the regions of the brain that tend to become unusually active when someone experiences an auditory hallucination. Two areas come to the forefront: Broca's area, which plays a role in how we produce speech, and Wernicke's area, which is part of how we understand spoken language.

Beyond brain activity

While the differences in brain activity may be significant, they only offer a partial picture of why auditory hallucinations occur. Our cognitive processes — the mechanics of how we think — also seem to influence both the experience of hearing voices and the way individuals react to them.

People with schizophrenia may encounter difficulty in clearly determining the origin of a particular thought — whether it started within themselves or came from an outside source. The perception of oneself and self-concept clarity may also play a role in the intensity and frequency of auditory hallucinations for individuals with schizophrenia. 

Self-concept clarity generally involves understanding our own thoughts, feelings, and values. This is a process that usually becomes more challenging when experiencing symptoms of schizophrenia. Stress and emotional turmoil can exacerbate this inner confusion, make the voices worse, and blur the line between internal and external stimuli. As a risk factor for schizophrenia and other psychological disorders, distress could trigger or worsen the perceptual experience of voice-hearing.

When you hear voices: Living with schizophrenia and hallucinations

Schizophrenia can be a treatable condition, and with the right approach, those who live with it may lead full and meaningful lives. If you have any concerns about yourself or a loved one who hears voices, seeking professional help is often the first step. The earlier treatment begins, the better the outlook tends to be.

There’s a vast network of resources dedicated to supporting both individuals with schizophrenia and their families. Typical treatment plans for schizophrenia often involve a combination of doctor-prescribed medication and therapy. Medication can lessen the severity of symptoms, while therapy typically offers individuals the tools they deserve to understand, cope with, and better manage their condition.

Living with schizophrenia often means facing a unique set of challenges. The experience can seem unpredictable at times. Symptoms may wax and wane in intensity, with some days being easier to navigate than others. However, no matter how loud or persistent the voices may be, it can be possible to find ways to cope and live a fulfilling life. With continued research into the neurological basis of schizophrenia and ongoing support for individuals living with this condition, there may be hope for improved treatment and support.

The path forward

Our expanding knowledge about the neurological roots of auditory hallucinations may serve as a beacon for researchers as they seek more refined, targeted treatments. The overarching objective is generally to combine insights into brain activity with a nuanced understanding of cognitive processes. This synthesis could yield a far richer model of why these hallucinations manifest in the first place.

Such a comprehensive understanding may promise to reshape the landscape of therapeutic approaches. Instead of relying on broad, generalized treatments, we could develop strategies tailored to the underlying brain differences and intricate thought patterns that can worsen the distress of auditory hallucinations. 

Cognitive behavioral therapy (CBT) for hearing voices

Cognitive behavioral therapy (CBT) may demonstrate potential in this area. CBT can empower people with schizophrenia, offering them tools to confront negative thought patterns associated with hearing voices and mitigate the intensity of the emotions these voices can evoke. 

Repetitive transcranial magnetic stimulation (rTMS) is another technique that's gaining traction for schizophrenia treatment. rTMS usually involves targeting specific regions of the brain with magnetic fields, potentially modulating activity levels in those areas that could contribute to auditory hallucinations.

Do you experience auditory hallucinations?

Get help from a licensed therapist online

Online therapy may also offer the potential to address challenges specific to schizophrenia. Individuals experiencing auditory hallucinations may find traditional in-person therapy sessions overwhelming due to the external stimuli and social interactions involved. Online therapy can offer a less stimulating space to engage with therapists while developing coping mechanisms for auditory hallucinations and navigating the complexities of schizophrenia. Additionally, online therapy can provide an alternative for individuals who may find traditional in-person therapy difficult or impractical. Increased flexibility may be helpful for people with schizophrenia who might struggle with transportation, social interaction, or the rigidity of fixed appointment times. 

Remote therapy for schizophrenia and mental health

Remote therapy can offer a beneficial alternative to traditional in-person therapy for individuals with schizophrenia, particularly when in-person resources may be limited. Research demonstrates that remote interventions can effectively improve outcomes for those with schizophrenia. Further studies exploring how to widely implement remote therapy programs could significantly benefit the field, potentially helping to shape clinical decisions and expand availability of mental health care for this population. However, some individuals experiencing psychosis may need to seek in-person care.