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Normalisation of Symptoms of Schizophrenia: Hearing Voices by Dr Oren Griffiths

Schizophrenia is a troubling and often debilitating disorder. People who have this disorder can experience a wide range of distressing symptoms. These include: hearing voices say offensive personal messages, disruption of normal thought and language, perceptual changes (colours and sounds seem more intense than normal, or seeing illusory sights or feeling illusory sensations), losing the ability to visually express emotion, losing the ability to initiate action, and holding very strong convictions that are not supported in fact (e.g. that I am Jesus, or that I am being stalked by my neighbour). The combination of these symptoms can be very distressing and thus cause people to act in unusual ways. For example, if someone with schizophrenia enters into a dialogue with a voice they are hearing, it may appear as if they are speaking to themselves.

For a long time, it was thought that these symptoms represented a complete break from normal experience; that some brain system was “broken” in people with schizophrenia and therefore that non-pharmaceutical interventions were simply a "waste of time". This view has been recently challenged on a number of fronts. For example, talk therapies focused on changing how people think and interact with their worlds have successfully reduced distress associated with these symptoms and even reduced the symptoms themselves. Even more interestingly, research has shown that one of the symptoms thought to be a defining feature of schizophrenia, hearing voices, are experienced by surprisingly large numbers of otherwise healthy people.

Beavan et al (2011) recently reviewed numerous surveys of thousands of people from all around the world, and found that hearing voices is not particularly unusual. Overall, about 20% of the people questioned had experienced at least one instance of hearing a voice when no one spoke to them. However, depending on the particular group sampled the estimate varied widely between 1% to 84%. Note that these refer to non-psychiatric samples. For example, some surveys were given to all the nurses in a particular hospital, others were given to all the people who attended a GP clinic (but did not have a mental health diagnosis). These were ordinary people going about their lives, and many of them hear voices from time to time. More than this, for many people without schizophrenia, the experience of hearing a voice talk to them is not unusual; these people regularly hear voices talking to them. The current estimates are that 2-4% of people regularly hear voices, which equates to up to one million Australians, far more than are diagnosed with schizophrenia.

In fact, for most people it is quite normal to hear voices during times of stress. There is evidence that many people hear voices after an extended period without sleep or immediately following the loss of a loved one.
Fatigue. A recent study at the University of Bonn (Petrovsky et al, 2014) showed that after only a single night of sleep deprivation, 24 otherwise healthy adults began to present with mild symptoms that are associated with schizophrenia, including auditory hallucinations. Chronic insomnia (greater than 100 hours without sleep) has been argued to produce more dramatic symptoms in otherwise healthy people.
Grief. In a large study of elderly German widows and widowers, recently bereaved people often reported hearing their lost partner speaking to them for some time after the death. About 30% of recently widowed elderly people report hearing their partner’s voice speak to them in the month following their death, and for 6% this experience continued after the first month.

For most people, as stress reduces, so too does the frequency of hearing voices. This research is promising for people who have schizophrenia for two reasons. First, it shows that many people who hear voices are not troubled by them; just because you hear a voice does not automatically consign you to a life of heavy medication and lengthy hospital admissions. Second, the observation that people hear voices at times of acute stress but not when the stress subsides, suggests that efforts to reduce emotional distress may reduce how often voices are heard, or how affecting this experience is. This is a primary goal of psychological therapy for schizophrenia.

References
Petrovsky, N., Ettinger, U., et al (2014) Sleep deprivation disrupts prepulse inhibition and induces psychosis-like symptoms in healthy adults. The Journal of Neuroscience, 34, 9134-9140.
Beavan, V., Read, J. & Cartwright & Cartwright, C. (2011) The prevalence of voice-hearers in the general population: A literature review. Journal of Mental Health, 20, 281-292.
www.intervoiceonline.org “Essential facts”

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