By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
How many types of auditory hallucinations are there?
Hearing voices or sounds that no one else hears occurs in people both with and without a diagnosable mental illness. Originally this question came in from a reader who asked about types of voices. What that reader was asking about was, voices that speak in the first, second, or third person, a very different discussion from what we are talking about here. Their question got me thinking that all those things that get referred to as “auditory hallucinations” can be quite different experiences.
Since these auditory events can vary so much it may be useful to consider some types of auditory hallucinations, “hearing voices” as the auditory hallucinations are often referred to, and we can see just how different these auditory hallucinations might be. Some of these events are easily explained and other sound events are reasons to suspect a long-term mental illness is present.
Some “voices” are misinterpreted sounds.
Hearing voices or other sounds and then finding out that others did not hear what you heard, happens more often than most people realize. At several times in the human lifespan, this is so common that it appears normal. In children and adolescents and then again among the elderly these auditory hallucinations type “hearing voices” are common enough that we are inclined to think this is a normal developmental event.
Mistaking one sound for another is a type of auditory hallucination.
Say you are sitting at a table eating lunch and then you think you hear someone calling your name. You look around and no one is there. Leaving out religious or supernatural interpretations here, you have just had an “auditory hallucination.” If you hear an indistinct sound, your brain is likely to interpret this sound as something familiar, like your own name.
We have limited information on what these auditory hallucinations are like.
Auditory hallucinations are very individual experiences. Since part of the definition of auditory hallucinations is that they are heard by one person and not others we have only two sources of information most of the time. We, as in counselors, can rely on the reports of those who hear them or we can have observers who see people they believe are having auditory hallucinations describe how this is affecting the person who presumably is hearing voices. More information is coming in from brain scans but it will be some time before this begins to be widely used for diagnosis.
This more “objective” evidence of auditory hallucinations based on professional’s observations is subjective and involves a lot of guesswork and inferences. Clinicians may refer to a client as “internally preoccupied” and the presumption is that the client is listening to voices but they may also be lost in thought or because of concussions or dementia be unable to think coherently.
The experience of having an auditory hallucination has many personal features. The voice can vary in frequency from one time only to constant running commentary that never stops. Voices or other sounds can vary in intensity. Some voices are louder than others. Those hearing voices report varying degrees of ability to control the voices.
A person hearing voices may develop unique or special relationships with the voices for good or bad. Young children, especially those who have been under stress or traumatized, can begin to hear voices.
Here are some of the possible auditory hallucinations that have been reported by both clinical and non-clinical populations. Auditory hallucinations have been described in many ways and this list is far from inclusive.
Hearing hums or rhythmic sounds.
People who later develop distinct voices sometimes have told me that the “voices” began as indistinct humming or tapping sounds. For some people, this progresses and for others, it does not. Hearing issues, tinnitus, and hearing loss have similar symptoms.
Non-word sounds are more commonly heard by seniors, which does not automatically mean they are developing a psychotic condition. One research study I read recently reported that an imbalance in hearing between the two ears increases the risk that sounds will be miss-attributed. This is more pronounced if the left ear has less hearing ability than the right.
For this reason and a bunch of others, seniors are getting prescribed a lot of sedating antipsychotic medication.
Mumbling, whispers, or indistinct conversations or laughter.
Clients whose auditory hallucinations went on to become distinct voices have told me that in the early stages this was more like whispering or several people talking at once. Over time the voices are likely to get more distinct and clearer.
Positive voice or voices.
This kind of voice may be a departed relative or friend, guardian angel, or other spiritual force offering you encouragement. Clients have reported that they hear their grandfather, grandmother, or other relative telling them they can do something.
This coincides with research that reports hearing voices does not appear to make you mentally ill or worsen an existing mental illness if you take the voices to be positive things. Your beliefs about hearing voices determine how much it will bother you when you do hear those voices (Hill, et. al., 2012)
A recognizable person who is known to the client.
Young children especially those who have been under stress or traumatized can begin to hear voices. These voices are often someone who has been negative, criticizing, or even abusive. These kinds of voices may well be more a matter of memory failure, not being able to remember who said this to you in the past, than a current auditory hallucination.
A single unknown voice.
These voices do not appear to be anyone the person recognizes having heard in the past. This voice may be good, bad, or may vary over time. What this voice says and how the person hearing it interprets this experience is important in how it will affect them.
Male only or female-only voices.
This may be a part of a single voice as above or multiple voices described next. Sometimes this connects to a specific life experience and sometimes not. Freudian psychoanalysts can have a field day with these kinds of voices.
Multiple voices speaking at the same time or taking turns.
These voices may be talking to each other or they may be talking to the hearer. What they are talking about is sometimes significant. With this one and most of the ones to follow medication is highly indicated if it has not been tried yet.
A malevolent threatening voice.
This is a bad sign. Especially if the person hearing this voice has lost the ability to shut the voice up.
God or religious figure can talk to you.
Some people find this comforting, others think the devil is in their head and freak out.
Voices from inside the head.
It has been suggested this is the result of an “attribution” error. If you lose track of when you are having internal thoughts and your own thoughts begin to sound like voices this is a problem.
Voices from outside the head.
More problematic, less likely the person hearing these voices will accept that these are their own thoughts or misinterpretations of sounds.
Voices that are only heard in certain situations.
Some people only hear voices when they are very depressed or when they are very anxious. These can be their own depression and anxiety taking on the role of speaking to them or we might interpret this as problems with the brain as a result of a deficit in a neurotransmitter. Treat the depression and these kinds of voices usually go away.
Voices giving commands – command hallucinations.
This is very worrisome to me. How can the person who hears the voices all the time resist these commands? Anyone having command hallucinations, even potentially good commands, needs treatment. If the voices never stop, people will act on the voices, sometimes giving in and sometimes self-harming just to get the voices to shut up.
Voice is part of re-experiencing a past event.
Sometimes voices are the result of re-experiencing the past. An abuser said bad things about you and you remember their voice calling you names. But then again I tell my students that when they take licensing exams I hope they will remember my voice telling them the answers. A good teacher hopes their student will take their voice with them. Bad teachers find the student can’t get that critical voice out of their head.
Hearing voices is not always a bad thing.
I should also mention that not everyone agrees that hearing voices, is a bad nor an abnormal event. Take a look at some of the things that the Hearing Voices Movement has to say about their perspective on hearing voices.
If you have experienced voices or have talked with someone who does feel free to comment. I will get to the comments as quickly as I can and this time of year that may take a while but rest assured eventually I will respond to your comments.
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