If you are the kind of person whose random thoughts literally sound like voices in your head—either you talking to yourself, a voice talking to you or a gaggle of voices in conversation with each other—you might start to wonder if you are “normal.” You might even think you hear those voices with your ears, as if they were coming from outside of yourself. That sure seems like a call for help. After all, the early stages of some forms of dementia are associated with hallucinations—and hearing voices is a classic sign of schizophrenia. You may be surprised to know that the phenomenon is not all that uncommon—or necessarily abnormal. But some types of experiences are less “normal” than others.

Most people who admit to hearing voices are not crazy. In fact, 10% to 15% of the general population experience auditory hallucinations, ranging from simple sounds like hissing and ticking to dialogue among several voices.

One recent study of 153 men and women who reported regularly hearing voices found that it occurs across a wide range of psychiatric and mental health conditions, not just in people diagnosed with psychosis or dementia—and occurs in people who are otherwise perfectly normal. In the study, participants answered a survey of questions that allowed them to describe their unique experience of hearing voices (whether from within their minds or seemingly audibly) in detail. They were also asked whether they had ever had a psychiatric diagnosis and what the most recent diagnosis was. (The information on mental health diagnoses was corroborated with medical records.)

Seventeen percent of the study group were not mentally or emotionally ill, 16% had schizoaffective disorder (a combination of psychosis and either bipolar disorder or depression) and 14% had bipolar disorder. Other reported psychiatric diagnoses, represented to a lesser degree, included post-traumatic stress disorder, depression, anxiety disorder, obsessive-compulsive disorder and a few others. A little less than half (46%) of all the participants described the voices as auditory and about one-third described them as partly auditory and partly thoughtlike. Only 9% of the group described the voices they “heard” as exclusively thoughtlike.

WHAT YOU HEAR MATTERS

The nature of the voices people heard, either internally or externally, ranged widely. For some, voices commented on what was happening at the moment or were single or multiple voices in conversation that could interrupt or distract from real conversations. For others, the voices expressed commands that could be positive, neutral or negative. For example, one study participant reported that voices would tell her to do things such as take out the garbage or call a particular friend…whereas another participant reported that her voices were in the habit of screaming that she was damned and that God hated her. Another participant reported that the voices he heard could be “brutally sarcastic.”

Although hearing voices often, understandably, elicited negative emotions (fear, anxiety, depression and stress), the experience could be emotionally uplifting as well. Slightly more than 30% of the study participants reported that their voices could, at least sometimes, elicit positive emotions. Notably, participants who did not have a psychiatric disorder were least likely to associate the voices they heard with fear or depression.

WHEN SHOULD YOU ACT ON WHAT YOU HEAR?

Besides psychiatric illnesses, hearing voices also can be triggered by stress, bereavement, sleep deprivation, a physical ailment (such as a brain tumor), use of marijuana or other illicit substance, and certain medications, such as antidepressants, or they can simply just occur, says Jan Dirk Blom, MD, PhD, assistant professor of psychiatry at the University of Groningen in The Netherlands. Dr. Blom was not involved in the study described above but is a top expert on auditory hallucinations. One theory for why they occur in some people is that parts of the brain associated with hearing and language are being overstimulated.

What separates normalcy from pathology in people who hear voices comes down to the ability to control the voices, the frequency of occurrence and the tone and content of the voices, says Dr. Blom.

Healthy people who hear voices internally or externally tend to have more control over them than do people who are mentally ill. That is, they can ignore or reasonably interpret them or turn them off. The phenomenon tends to occur less frequently in them than in the mentally or emotionally ill, and what is heard tends to be agreeable or neutral rather than negative. These characteristics can predict the lack of a psychotic disorder in up to 92% of voice-hearers, said Dr. Blom.

“Of course, when the experience of hearing voices is frequent and distressing and interferes with your daily functioning by, for example, causing difficulty concentrating or by giving commands that you know would be wrong to follow, chances are you need medical evaluation,” says Dr. Blom. If you are troubled about hearing voices and your doctor has ruled out a physical cause, such as a medication side effect, Dr. Blom suggests finding a psychiatrist who specializes in psychotic disorders who can best assess whether you indeed have a psychotic or emotional disorder, another condition or merely have an odd quirk. Depending on the diagnosis, treatment (if needed) may include antipsychotic drugs or cognitive behavioral therapy.

If your voices don’t cause discomfort and don’t interfere with leading a normal life, the risks and side effects of drug treatment for auditory hallucinations might outweigh the benefits, says Dr. Blom. He reminded Daily Health News that some very famous folks who influenced history for the better heard voices—Joan of Arc, Gandhi, Socrates, Charles Dickens and Sigmund Freud among several others.

SUPPORT FOR PEOPLE WHO HEAR VOICES

Self-help and peer-support groups for people who hear voices do exist, including the International Hearing Voices Network, an international group that provides a safe space for people to share their experiences and support one another. Actor Anthony Hopkins, in fact, participates in the group! Sometimes all you need is just to be able to put an odd experience into context and know that you are not alone.