Varieties of Voice-Hearing: Psychics and the Psychosis Continuum

Abstract

Hearing voices that are not present is a prominent symptom of serious mental illness. However, these experiences may be common in the non-help-seeking population, leading some to propose the existence of a continuum of psychosis from health to disease. Thus far, research on this continuum has focused on what is impaired in help-seeking groups. Here we focus on protective factors in non-help-seeking voice-hearers. We introduce a new study population: clairaudient psychics who receive daily auditory messages. We conducted phenomenological interviews with these subjects, as well as with patients diagnosed with a psychotic disorder who hear voices, people with a diagnosis of a psychotic disorder who do not hear voices, and matched control subjects (without voices or a diagnosis). We found the hallucinatory experiences of psychic voice-hearers to be very similar to those of patients who were diagnosed. We employed techniques from forensic psychiatry to conclude that the psychics were not malingering. Critically, we found that this sample of non-help-seeking voice hearers were able to control the onset and offset of their voices, that they were less distressed by their voice-hearing experiences and that, the first time they admitted to voice-hearing, the reception by others was much more likely to be positive. Patients had much more negative voice-hearing experiences, were more likely to receive a negative reaction when sharing their voices with others for the first time, and this was subsequently more disruptive to their social relationships. We predict that this sub-population of healthy voice-hearers may have much to teach us about the neurobiology, cognitive psychology and ultimately the treatment of voices that are distressing.

Keywords: continuum; control; distress; hallucinations; phenomenology; schizotypy.

Fig. 1.

Early voice-hearing experiences. (a) Retrospective report of voice-hearing age of onset in individuals interviewed who have hallucinations with a diagnosed psychotic disorder (P+H+) and individuals who self-identify as clairaudient psychics (P−H+). (b) Proportions of each group who rated their first experiences discussing their voice-hearing with another person as positive (blue), negative (orange), and neutral (gray). (c) Age of onset plotted as a factor of the emotional valence of discussing voices for the first time. Error bars represent 1 SEM. *P < .05; ***P < .001.