Hearing voices as a feature of typical and psychopathological experience

Abstract

Hearing a voice in the absence of any speaker can be a significant feature of psychiatric illness, but is also increasingly acknowledged as an important aspect of everyday, non-pathological experience. This recognition has led to a growth of interest in voice-hearing in individuals without any psychiatric diagnosis, coupled with greater attention to the subjective experience of voice-hearing across diagnostic groups. Research has also focused on the overlap between some aspects of voice-hearing phenomenology and everyday experiences such as ‘hearing’ the voices of fictional characters and spiritual experience. In this Review, we synthesize research on the range of cognitive, neural, personal and sociocultural processes that contribute to voice-hearing as it occurs in clinical, non-clinical and everyday experience, with particular emphasis on linking mechanism to phenomenology. Heterogeneous forms of voice-hearing can be understood in terms of differing patterns of association among underlying mechanisms. We suggest an approach to hallucinatory experience that sees it as partly continuous with everyday inner experience, but which is critical regarding whether continuity of phenomenology across the clinical–non-clinical divide should be taken to entail continuity of mechanism. Hearing voices has long been associated with severe mental illness but also occurs in the general population. In this Review, Toh et al. describe the cognitive, neural, personal and sociocultural processes that contribute to voice-hearing in clinical, non-clinical and everyday experience, with emphasis on linking mechanism to phenomenology.