Is it Normal to ‘Hear Voices’? (2023)

Is it Normal to ‘Hear Voices’? (1)

The Torment of St. Anthony, Michaelangelo (1487)


“Voices inside my head, echo the things that you said.”

—The Police, “Voices Inside My Head"

Auditory hallucinations–loosely defined as hearing something when there’s no actual noise to hear–are one of the more stereotypical and recognizable symptoms of those who have psychotic disorders like schizophrenia. Among those with mental illness, the most common form of this particular symptom is the experience of hearing people talking, known colloquially as “voice-hearing” or, more technically, as auditory verbal hallucinations (AVH).

Despite the fact that AVH are a prototypical example of a psychotic symptom, it has long been debated whether voice-hearing should always be equated with the presence of a psychotic disorder. I tackled this issue a few years ago with the publication of a paper called “Hallucinations in Non-psychotic Disorders: Towards a Differential Diagnosis of “Hearing Voices” [1]. In it, I highlighted how voice-hearing is known to occur in people without psychotic disorders as well as people without mental illness. It is well known, for example, that many historical luminaries were voice-hearers, including Socrates and Plato, Joan of Arc, Sigmund Freud and Carl Jung, and Martin Luther King, Jr. to name a few. In the paper’s conclusion, I suggested that:

“Similar to the likening of psychosis to fever, auditory hallucinations might be best compared to coughs–normal and even functional experiences that can occur spontaneously or in response to environmental stimulation, reflect or be part of a larger clinical disorder, or be malingered [feigned]. As with coughs, clinicians and researchers ought to focus on recognizing what makes AH clinically relevant, distressing, or functionally impairing. Depending on these factors, potential treatment strategies might include watchful waiting, palliative therapies directed at the “symptom” itself, or targeting the larger, underlying disease.”

A study published earlier this year, based on a World Health Organization (WHO) survey of over 30,000 people across 18 countries, revealed that 2.5% of respondents reported voice-hearing at some point in their lives [2]. I was subsequently interviewed by U.S. News & Report about this paper, with the reporter expressing surprise that voice-hearing was such a common experience. In fact, the reported prevalence of 2 to 3 voice-hearers out of every 100 people is low compared to other similar studies that have found rates of anywhere from less than 1% to 84% [3].

Why such widely varying rates? For one thing, it appears that the detection of voice-hearing depends on who’s being asked, how they’re being asked, and who’s doing the asking. For example, the highest prevalence of voice-hearing was found in a small study of just 55 mental health nurses in the U.K. who filled out a written questionnaire about hearing a voice “as if someone had spoken aloud rather than a thought or feeling” [4]. This questionnaire included such experiences as hearing one’s name called “like in a store when you walk past some people… but know they didn’t really say my name,” “hearing the doorbell or phone ring when it didn’t” (without any actual voice-hearing), and hearing a voice while falling asleep or awakening (hypnopompic and hypnagogic hallucinations, which are not unusual in those with sleep disturbances). When considering those commonplace experiences along with the use of an anonymous pencil-and-paper questionnaire to elicit them (which might result in a greater willingness to divulge experiences suggestive of mental illness), the study’s 84% response rate is not so surprising. In contrast, the lowest reported voice-hearing prevalence of only 0.6% was found in a study using a telephone interview administered in the U.K., Germany, and Italy that specifically excluded the hypnopompic and hypnagogic hallucinations experienced by nearly everyone in the study at some point in their lives [5].

In the recent WHO study, interviews of all 30,000+ subjects were conducted in person using the question, “Have you ever heard voices that other people said did not exist?” Positive responses while “dreaming or half-asleep or under the influence of drugs” or from anyone with a psychotic disorder or bipolar disorder were not included in the 2.5% positive response rate.

Now that we have a better understanding of the apparent commonality of voice-hearing, how do we make sense of these experiences? The prevailing approach in psychology now is to conceptualize voice-hearing that is part of mental illness and voice-hearing that isn’t as existing on a continuum. In other words, they’re fundamentally the same experience – hallucinations – but they differ somehow in terms of severity. More specifically, studies that have compared voice-hearing among “clinical” (help-seeking patients receiving professional treatment) and non-clinical persons reveal that voice-hearers who seek help tend to have voices that are perceived with greater frequency, more negative content, more associated distress, longer duration, less control, and greater associated interference with their lives and well-being [6]. As expected then, voice-hearers who don’t seek help tend to experience voices with more pleasant or neutral content that are more controllable and cause less distress or life interference.


  • What Is Psychosis?
  • Find a therapist to treat psychosis

Recently, researchers have turned to neuroimaging to explore how voice-hearing might differ between clinical and non-clinical individuals in terms of brain function. For example, investigators in the Netherlands used functional magnetic resonance imaging (fMRI) to explore how areas of brain activation during voice-hearing might differ between these two groups [7]. Rather than detecting differences, they found that “normal” or “non-psychotic” voice-hearing appears to involve the same areas of brain activation as “pathological” or “psychotic” voice-hearing. This supports the continuum model of hallucinations, or what I call the “lumping hypothesis,” that invites the comparison of hallucinations to coughs. Sometimes coughs are normal, if potentially annoying experiences that serve a purpose, while at other times they’re serious symptoms of a life-threatening condition. Maybe that’s the case with AVH.

And yet, I think it’s premature to discard the opposing “splitting hypothesis”, which argues that voice-hearing in clinical populations might be fundamentally different from that of non-clinical voice-hearers. Perhaps, for example, when “normal” people report voice-hearing, they aren’t really talking about AVH at all. This hypothesis best explains the wide range in rates of voice-hearing in epidemiologic surveys. For example, the U.K. investigators that found the 84% rate of hallucinations among mental health nurses conceded that the high rate might have reflected a conflation of actual hallucination and metaphorical expression [4].

Psychosis Essential Reads

Transitioning Back to a Clear Mind

The Hallucinations You've Never Heard Of

These days in psychiatry, we rarely talk about one’s “inner voice,” though the concept is almost ubiquitous in pop-psychology and layspeech (see for example, Robert Firestone and Psychology Today Blogger Lisa Firestone's 2002 book, Conquer Your Critical Inner Voice). Most of us routinely think using language, even mentally addressing ourselves “in our heads” using both first and second person (e.g. saying to oneself, “I’m going to be late” or “you’re going to be late”). Often this kind of self-talk can take on a critical tone (e.g., “I’m ugly,” “You’re going to be single forever,” “You’re never going to find happiness”) and sometimes we even seem to argue with ourselves in a kind of internal dialogue (e.g. “I want that piece of cake, but I know I shouldn’t… because you’re too fat!”). My favorite TV character when I was growing up, Magnum P.I., often talked about his “little voice” that reflected intuitions and hunches that emerged in his detective work – was Magnum a non-clinical hallucinator? I think we would all agree that the answer is no; that he was experiencing something altogether different than actually hearing a voice, as in a seemingly acoustic experience, which has been central to the definition of an AVH.

Sometimes though, patients and clinicians confuse things while attempting to find a common language to communicate. As a clinician, it can be tricky to distinguish auditory hallucinations from other frequently reported experiences that might be described similarly, such as our “inner voices” and internal thoughts. Among people who are clinically depressed, critical self-talk can often become unwanted, repetitive, and intrusive (in psychiatry, we call these “depressive ruminations”). Sometimes this might even create the impression, if not the actual belief or experience, that the thoughts aren’t quite one's own (psychiatrists call this “ego-dystonic”). Although people might use the word “voice” to describe these experiences, or might respond positively when asked by a clinician about “hearing voices,” these are not what psychiatrists mean when we ask about “hearing a voice when no one is around.”

Instead, when AVH occur as a part of mental illness, they typically take the form of distinctly hearing someone else’s voice rather than one’s own. One psychological theory currently in vogue suggests that AVH represent our own inner speech that is, for pathological reasons, experienced as coming from outside of ourselves. I’ve never been fond of this theory as an over-arching explanation of voice-hearing however. For one thing, patients with schizophrenia who have AVH still have intact inner speech that they experience as their own thoughts [8]. Also, regardless of diagnosis, voice-hearers don’t just experiences voices as external sound (as opposed to internal thoughts), they often clearly recognize the voice as someone else, attributing it to a family member or a known person from their past. For example, among victims of sexual abuse, it’s not unusual to hear the voices of one’s assailant. Because of such experiences, other theories have suggested that AVH might represent memories. My feeling is that is that there are probably many different experiences, in terms of what causes them, how they are subjectively experienced, and what’s going on inside the brain, that all fall under the broad umbrella of voice-hearing. It may therefore be necessary to consider multiple models to explain each of these experiences and perhaps one day we will come to view only a subset of these experiences as AVH [9,10].

As noted, voice-hearing in clinical and non-clinical persons appears to involve similar areas of brain activation, but there is other evidence from neuroimaging studies to support the splitting hypothesis. For instance, differences in brain activation during inner speech, self-criticism, intrusive thoughts, auditory imagery, and AVH suggest that these are all distinct experiences [11,12,13]. Furthermore, when comparing clinical and non-clinical voice-hearers, there appear to be differences in many other areas of the brain that might affect how voices are experienced, potentially contributing to differences in salience (how much people pay attention to their voices), localization (where the voice seems to be coming from), or character (what the voice sounds like) [13].

So, is it normal to hear voices? To a certain extent, it can be, but it’s also possible that when people talk about voice-hearing, they’re talking about a wide variety of different experiences. A more important question might be what it means to hear voices. While some people clearly report that voice-hearing can be a meaningful and even positive experience, many do not. Almost by definition, those seeking professional help for voice-hearing would prefer to do without the experience. A careful clinical evaluation first involves taking care to separate AVH from other non-psychotic experiences that might respond to distinct types of treatment, whether psychotherapy or other medications besides antipsychotics [14]. Second, since people with mental illness don’t usually just report voice-hearing alone (there is no such thing as “hallucination disorder”), a thorough examination would also carefully explore for other symptoms, such as delusional thinking or evidence of mania or depression, that might lead to a clinician to a clearer diagnosis that would guide appropriate treatment.

In a previous blogpost, I argued against a “non-medical” approach to psychosis advocated by some and recently supported by the British Psychological Society (BPS), so I won’t repeat that debate here. However, it’s worth reviewing what medical research tells us about the clinical significance of psychotic symptoms like voice-hearing that makes psychiatrists concerned. For example, “subclinical psychotic experiences” like voice-hearing that aren’t associated with distress or help-seeking do appear to increase the risk of later developing a mental disorder, whether psychotic or otherwise [15,16]. A study just published this year found that psychotic symptoms such as AVH also increase the risk of premature death [17]. Still, an increased risk is not the same as a certainty and some people who report no distress from voice-hearing do just fine without professional help. But for those that do seek or otherwise end up under professional care, voice-hearing warrants a careful clinical evaluation and discussion of available treatment options that might relieve their burden.

Dr. Joe Pierre and Psych Unseen can be followed on Twitter at To check out some of my fiction, click here to read the short story "Thermidor," published in Westwind earlier this year.


1. Pierre JM. Hallucinations in non-psychotic disorders: Towards a differential diagnosis of “hearing voices.” Harvard Review of Psychiatry 2010; 18:22-35.

2. McGrath JJ, Saha S, Al-Hamzawi A et al. Psychotic experiences in the general population: A cross-national analysis based on 31,261 respondents from 18 countries. JAMA Psychiatry 2015; 72:697-705.

3. Beavan V, Read J, Cartwright C. The prevalence of voice-hearers in the general population: A literature review. Journal of Mental Health 2011; 20:281-292.

4. Millham A, Easton S. Prevalence of auditory hallucinations in nurses in mental health. Journal of Psychiatric and Mental Health Nursing 1998; 5:95-99.

5. Ohayan MM. Prevalence of hallucinations and their pathological associations in the general population. Psychiatry Research 2000; 97:153-164.

6. Johns LC, Kompus K, Connell M, et al. Auditory verbal hallucinations in persons with and without a need for care. Schizophrenia Bulletin 2014; 40:S255-S264.

7. Diederen KMJ, Daalman K, de Weijer AD, et al. Auditory hallucinations elicit similar brain activiation in psychotic and nonpsychotic individuals. Schizophrenia Bulletin 2012; 38:1074-1082.

8. Langdon R, Jones SR, Connaughton E, et al. The phenomenology of inner speech: Comparison of schizophrenia patients with auditory verbal hallucinations and healthy controls. Psychological Medicine 2009; 39:655-663.

9. Pierre JM. Naming names: Auditory hallucinations, inner speech, and source monitoring. Psychological Medicine 2009; 39:1578-1579.

10. Jones SR. Do we need multiple models of auditory verbal hallucinations? Examining the phenomenologic fit of cognitive and neurological models. Schizophrenia Bulletin 2010; 36:566-575.

11. Jones SR, Fernyhough C. Neural correlates of inner speech and auditory verbal hallucinations. Clinical Psychology Review 2007; 27:140-154.

12. Longe O, Maratos FA, Gilbert P, et al. Having a word with yourself: Neural correlates of self-criticism and self-reassurance. NeuroImage 2010; 49:1849-1856.

13. Diederen KMJ, van Lutterveld R, Sommer IEC. Neuroimaging of voice hearing in non-psychotic individuals: A mini-review. Frontiers in Human Neuroscience 2012; 6:1-5.

14. Pierre JM. Non-antipsychotic therapy for monosymptomatic auditory hallucinations. Biological Psychiatry 2010; 68:e33-34.

15. Kaymaz N, Drukker M, Lieb R et al. Do subthreshold psychotic experiences predict clinical outcomes in unselected non-help-seeking population-based samples? A systematic review and meta-analysis, enriched with new results. Psychological Medicine 2012; 42:2239-2253.

16. Weberloff N, Drukker M, Dohrenwend BP et al. Self-reported attenuated psychotic symptoms as forerunners of severe mental disorders later in life. Archives of General Psychiatry 2012; 69:465-475.

17. Sharifi V, Eaton WW, Wu LT, et al. Psychotic experiences and risk of death in the general population: 24-27 year follow-up of the Epidemiological Catchment Area study. British Journal of Psychiatry 2015; 207:30-36.


Is it Normal to ‘Hear Voices’? ›

While hearing voices can be a symptom of some mental health problems, not everyone who hears voices has a mental illness. Hearing voices is actually quite a common experience: around one in ten of us will experience it at some point in our lives. Hearing voices is sometimes called an 'auditory hallucination'.

What causes a person to hear voices? ›

Mental health problems – you may hear voices as a symptom of some mental health problems, including psychosis, schizophrenia, bipolar disorder, schizoaffective disorder or severe depression.

Is it normal to randomly hear voices? ›

Hearing voices is a very common experience. Hearing voices may be a symptom of a mental illness. A doctor may diagnose you 'psychosis' or 'bipolar disorder'. But you can hear voices without having a mental health diagnosis.

Can you hear voices and not be schizophrenic? ›

Hearing voices (i.e. auditory verbal hallucinations) is mainly known as part of schizophrenia and other psychotic disorders. However, hearing voices is a symptom that can occur in many psychiatric, neurological and general medical conditions.

What do schizophrenia voices sound like? ›

There can be “voices that are more thought-like,” says Jones, “voices that sound like non-human entities, voices that are perceived as the direct communication of a message, rather than something you're actually hearing.” Voices aren't always voices, either. They can sound more like a murmur, a rustle or a beeping.

Should I be worried if I hear voices? ›

While hearing voices can be a symptom of some mental health problems, not everyone who hears voices has a mental illness. Hearing voices is actually quite a common experience: around one in ten of us will experience it at some point in our lives. Hearing voices is sometimes called an 'auditory hallucination'.

What age does schizophrenia start? ›

In most people with schizophrenia, symptoms generally start in the mid- to late 20s, though it can start later, up to the mid-30s. Schizophrenia is considered early onset when it starts before the age of 18. Onset of schizophrenia in children younger than age 13 is extremely rare.

How do I stop hearing voices? ›

Challenge your voices
  1. Stand up to them. Tell them they have no power over you.
  2. Ignore their commands or threats. Tell them you're not going to listen to them or do what they say.
  3. Be assertive. Imagine what you'd say or do if you weren't afraid of your voices. Practice acting in that way until it feels more natural.

Is the voice in my head me? ›

It consists of inner speech, where you can “hear” your own voice play out phrases and conversations in your mind. This is a completely natural phenomenon. Some people might experience it more than others. It's also possible not to experience internal monologue at all.

What does a psychotic episode look like? ›

People with psychosis typically experience delusions (false beliefs, for example, that people on television are sending them special messages or that others are trying to hurt them) and hallucinations (seeing or hearing things that others do not, such as hearing voices telling them to do something or criticizing them).

What can mimic schizophrenia? ›

A few disorders have some of the same symptoms as schizophrenia (schizophrenia spectrum disorders), including:
  • Schizotypal personality disorder. ...
  • Schizoid personality disorder. ...
  • Delusional disorder. ...
  • Schizoaffective disorder. ...
  • Schizophreniform disorder.

What triggers schizophrenia? ›

The exact causes of schizophrenia are unknown. Research suggests a combination of physical, genetic, psychological and environmental factors can make a person more likely to develop the condition. Some people may be prone to schizophrenia, and a stressful or emotional life event might trigger a psychotic episode.

What triggers psychosis? ›

Psychosis can also be triggered by traumatic experiences, stress, or physical conditions, such as Parkinson's disease, a brain tumour, or as a result of drug misuse or alcohol misuse. How often a psychotic episode occurs and how long it lasts can depend on the underlying cause.

How do you know if a person is schizophrenic? ›

The symptoms of schizophrenia are usually classified into: positive symptoms – any change in behaviour or thoughts, such as hallucinations or delusions. negative symptoms – where people appear to withdraw from the world around then, take no interest in everyday social interactions, and often appear emotionless and flat.

Do schizophrenics know they are schizophrenic? ›

Unfortunately, most people with schizophrenia are unaware that their symptoms are warning signs of a mental disorder. Their lives may be unraveling, yet they may believe that their experiences are normal. Or they may feel that they're blessed or cursed with special insights that others can't see.

Do bipolar people hear voices? ›

While many recognize it as a condition characterized by “high” and “low” mood swings, BD symptoms can also include auditory hallucinations. In fact, up to 25 per cent of people who have BD experience auditory hallucinations at some point during their illness.

Are you schizophrenic if you hear voices? ›

Some people suffering from severe mental illness, particularly schizophrenia, hear “voices,” known as auditory hallucinations. This symptom, which afflicts more than 80% of patients, is among the most prevalent and distressing symptoms of schizophrenia.

How do you get rid of auditory hallucinations? ›

Distraction techniques, such as listening to music on headphones, exercising, cooking or doing a hobby may help quiet the voices. Joining a support group with other people who experience auditory verbal hallucinations. Taking control, such as ignoring the voices or standing up to them.

What drugs cause auditory hallucinations? ›

Drug-induced hallucinations

People can experience hallucinations when they're high on illegal drugs such as amphetamines, cocaine, LSD or ecstasy. They can also occur during withdrawal from alcohol or drugs if you suddenly stop taking them.

What happens if schizophrenia is left untreated? ›

Research has shown that untreated schizophrenia can lead to neurological damage. Individuals dealing with schizophrenia may also have thoughts of harming themselves or others. Persistent paranoid delusions, especially when left untreated, may eventually lead someone to act on those thoughts.

What is borderline schizophrenia? ›

Borderline schizophrenia is a term that is used to describe the occurrence of both BPD and schizophrenia. However, it is not an established diagnosis. BPD and schizophrenia are separate conditions that can occur together. They also share many similarities.

What does mild schizophrenia feel like? ›

Schizophrenia usually involves delusions (false beliefs), hallucinations (seeing or hearing things that don't exist), unusual physical behavior, and disorganized thinking and speech. It is common for people with schizophrenia to have paranoid thoughts or hear voices.

Why do I have 2 voices in my head? ›

There are many significant factors that can cause hearing voices. The major factors that contribute to this condition are stress, anxiety, depression, and traumatic experiences. In some cases, there might be environmental and genetic factors that cause such hearing of voices.

Can stress and anxiety cause auditory hallucinations? ›

Anxiety can cause someone to “hear things.” Examples of this can be complex, from hearing one's name, to hearing popping sounds. Most of this is due to anxiety's heightened awareness as a result of the fight or flight system.

Do schizophrenics hear voices inside or outside their head? ›

The auditory hallucinations experienced by people with schizophrenia are phenomenologically diverse. One dimension on which the sounds and voices vary is their perceived location. Although always perceived as if other-generated, they may be heard as coming from some external location or from inside the head.

Is having conversations in your head normal? ›

In fact, "thought-chatter" is completely normal for human beings. Usually, whenever our attention isn't occupied, a stream of mental associations flows through our minds — thoughts about the future or the past, fragments of songs or conversations, daydreams about alternative realities or friends or celebrities.

How can I stop hearing voices naturally? ›

3. Suggest coping strategies, such as:
  1. humming or singing a song several times.
  2. listening to music.
  3. reading (forwards and backwards)
  4. talking with others.
  5. exercise.
  6. ignoring the voices.
  7. medication (important to include).

Does everyone have voices in their head? ›

Different brains experience internal speech differently (and some not at all) Most people have some level of internal monologue going through their heads throughout their day, however there is a small group of people who do not experience any self-talk at all.

What to do when someone is hearing voices? ›

But there are lots of positive things you can do to support them.
  1. Accept that their experience of the voices is real. Everyone will have a unique experience of hearing voices. ...
  2. Try not to make judgements about what hearing voices means for them. ...
  3. Learn their triggers. ...
  4. Remember that they're still the same person.

How do you stop hearing voices? ›

Challenge your voices
  1. Stand up to them. Tell them they have no power over you.
  2. Ignore their commands or threats. Tell them you're not going to listen to them or do what they say.
  3. Be assertive. Imagine what you'd say or do if you weren't afraid of your voices. Practice acting in that way until it feels more natural.

What is the treatment for hearing voices? ›

Cognitive behavioural therapy (CBT)

CBT will focus less on why you're hearing voices. It will focus more on how the voices make you feel or think about yourself, and how they affect your life. CBT may help you: Reduce your distress about the voices.

What mental illness is it when you hear voices and see things? ›

Hallucinations are typically a symptom of a psychosis-related disorder, particularly schizophrenia, but they can also result from substance use, neurological conditions and some temporary situations. A person may experience a hallucination with or without the insight that what they're experiencing isn't real.


Top Articles
Latest Posts
Article information

Author: Duncan Muller

Last Updated: 03/09/2023

Views: 6100

Rating: 4.9 / 5 (59 voted)

Reviews: 90% of readers found this page helpful

Author information

Name: Duncan Muller

Birthday: 1997-01-13

Address: Apt. 505 914 Phillip Crossroad, O'Konborough, NV 62411

Phone: +8555305800947

Job: Construction Agent

Hobby: Shopping, Table tennis, Snowboarding, Rafting, Motor sports, Homebrewing, Taxidermy

Introduction: My name is Duncan Muller, I am a enchanting, good, gentle, modern, tasty, nice, elegant person who loves writing and wants to share my knowledge and understanding with you.