2 14908 May 12, 2020 at 03:44 Author of the publication: Ekaterina Krestnikova, doctor - psychiatrist-narcologist Editors: Evgenia Alekseeva, doctor; Ekaterina Korotkikh, psychologist
“Voices in my head. They exhaust me and don’t allow me to live normally. I already confuse the dialogue with the interlocutor and my internal dialogue with them. They sound, sound, sound! It is impossible to run away from them, or to hide, or to hide. You can't run away from what's inside you. I close myself, at home alone, cover my ears with my hands and... Oh God! When will this stop! Their impossible cacophony makes you want to jump out the window! I hear voices in my head, what should I do?
Definition of the concept
Although auditory hallucinations are commonly associated with mental illnesses such as bipolar disorder, they are not always a sign of illness. In some cases, they may be caused by lack of sleep; marijuana and stimulant drugs can also cause sensory disturbances in some people. It has been experimentally proven that hallucinations can occur due to prolonged absence of sensory stimuli: in the 1960s, experiments were conducted (which would now be impossible for ethical reasons) in which people were kept in dark rooms without sound. Eventually people began to see and hear things that were not there in reality. So hallucinations can occur in both sick and mentally healthy people.
Research into the nature of this phenomenon has been going on for quite some time: psychiatrists and psychologists have been trying to understand the causes and phenomenology of auditory hallucinations for about a hundred years (and maybe longer). In the last three decades, it became possible to use encephalograms, which helped researchers of that time understand what was happening in the brain during moments of auditory hallucinations. And now we can look at the different parts of it that are involved during these periods using functional magnetic resonance imaging or positron tomography. These technologies have helped psychologists and psychiatrists develop models of auditory hallucinations in the brain—mostly related to language and speech function.
Therapy methods
There is no specific treatment for auditory hallucinations. Since this is just a symptom of the underlying pathological condition, therapy methods are aimed at eliminating it or stopping its manifestations.
All patients are indicated for hospitalization in a specialized department. Treatment is selected individually and in the acute stage is taken under the supervision of the attending physician. You should not self-medicate, especially following the advice of people who are in no way connected with medicine. This can lead to harmful consequences.
In psychiatric practice, auditory hallucinations most often accompany various forms of schizophrenia. In this case, antipsychotic drugs are prescribed, long-term and systematic use of which can reduce the likelihood of relapse.
If hallucinations are caused by taking medications (anticonvulsants, antimigraines and others), then the attending physician should adjust their dosage or prescribe a more acceptable analogue.
Proposed theories of the mechanisms of auditory hallucinations
Some studies have shown that when patients experience auditory hallucinations—that is, hearing voices—an area of their brain called Broca's area increases in activity. This zone is located in the small frontal lobe of the brain and is responsible for speech production: when you speak, it is Broca's area that works. One of the first to study this phenomenon were professors Philip McGuire and Suchi Shergill from King's College London. They noticed that their patients' Broca's area was more active during auditory hallucinations compared to when the voices were silent. This suggests that auditory hallucinations are produced by the speech and language centers of our brain. The results of these studies led to the creation of internal speech models of auditory hallucinations.
When we think about something, we generate inner speech - an inner voice that voices our thinking. For example, when we ask ourselves, “What will I eat for lunch?” or “What will the weather be like tomorrow?”, we generate inner speech and are thought to activate Broca's area. But how does this internal speech begin to be perceived by the brain as external, not coming from itself? According to internal speech models of auditory verbal hallucinations, such voices are internally generated thoughts or internal speech that is somehow misidentified as external, foreign. This leads to more complex models of the process of how we monitor our own inner speech.
©Kate MacDowell
English neuroscientist and neuropsychologist Chris Frith and other scientists have suggested that when we engage in the process of thinking and inner speech, Broca's area sends a signal to an area of our auditory cortex called Wernicke's area. This signal contains information that the speech we perceive is generated by us. This happens because the transmitted signal presumably dampens the neural activity of the sensory cortex, so it is not activated as intensely as by external stimuli, such as someone talking to you. This model is known as the self-monitoring model, and it suggests that people with auditory hallucinations have a deficit in this process, causing them to be unable to distinguish between internal and external speech. Although the evidence for this theory is currently quite weak, it is certainly one of the most influential models of auditory hallucinations to emerge in the last 20–30 years.
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What does a hearing test tell you?
An online hearing test allows you to quickly and easily determine your hearing status. In just 3 minutes you can determine its spiciness. The result of the hearing test is called an “audiogram” and is an indication for doctor’s prescriptions.
We suggest the following hearing tests: signs of hearing loss; online frequency hearing test; hearing test in noise; speech recognition; modeling signs of hearing loss.
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Consequences of hallucinations
About 70% of people with schizophrenia hear voices to some degree. They are treatable, but not always. Typically (though not in all cases), voices have a negative impact on quality of life and health. For example, patients who hear voices and do not respond to treatment have an increased risk of suicide (sometimes the voices encourage harm to themselves). One can imagine how difficult it is for people even in everyday situations when they constantly hear humiliating and offensive words addressed to them.
But auditory hallucinations do not only occur in people with mental disorders. Moreover, these voices are not always evil. Thus, Marius Romm and Sandra Escher lead the very active “Society of Hearing Voices”, a movement that talks about their positive aspects and fights their stigmatization. Many people who hear voices live active and happy lives, so we cannot assume that voices are inherently bad. Yes, they are often associated with aggressive, paranoid and anxious behavior of patients, but this may be a consequence of emotional disturbance, and not the presence of voices. It is also not surprising that anxiety and paranoia, which are often at the core of mental illness, manifest themselves in what these voices say. But, as already mentioned, many people without a psychiatric diagnosis report hearing voices, and for them this can also be a positive experience, since voices can calm them down or even give them direction on where to move in life. Professor Iris Sommer from the Netherlands has carefully studied this phenomenon: the healthy people she studied who heard voices described them as something positive, useful and giving them self-confidence.
The beginning: when a person suddenly hears voices that were outside in his head
In a child who has suffered major psychological trauma, voices in the head most often appear during adolescence. Then the human psyche completes its formation, all possibilities for development are exhausted, and the psyche begins to manifest itself as it has developed. Everything that a child has managed to absorb and develop, he begins to implement in life.
Voices in the head often begin with shouts of name, but they are not given attention - “it seemed.” Further, it can already be a scolding, insulting voice, and even detailed dialogues. Most often, voices in the head are the sound of spoken words, meanings that have a traumatic effect.
People without a sound vector divide “the world inside” and “the world outside” as “there is me” and “there is the environment where I direct my actions.” And only a person with a sound vector is the only one whose world inside and the world outside are in him. The object of his attention is his own I (psyche, soul), which in sensations he perceives as separate from his body. The sound artist often talks to himself out loud or conducts an internal dialogue. If from childhood he was forced to hide from the painful world outside inside himself, then his perception is distorted. The ability to distinguish the voices outside from the dialogue inside is lost when one’s own thoughts begin to sound like strangers that do not belong to oneself.
The main desire of a sound artist, even if often not realized by him, is to reveal the psychic, unconscious, and spiritual. Recognize what is hidden behind the visible world, listening, thinking about the essence of things. Traumatized in childhood, he cannot realize himself, partially or completely loses the ability to hear the meaning of other people’s words and focuses even more on his internal mental states. A person with a sound vector, locked inside himself, experiences a splitting of internal dialogue - it turns into painful, haunting voices in his head.
A sound artist can mistake the voices in his head for his own dialogues - until it becomes impossible to control them, when they begin to torment him and he will not have the opportunity to “escape from his own head.”
Whose voices does he hear in his head?
If we are talking about a sounder with an anal vector, he often hears the mother’s voice. This voice is scolding, criticizing, threatening, penetrating everywhere. A person with an anal vector has a special relationship with his mother. The mother’s insulting words remain forever in the memory and are remembered in the mode of internal dialogue, which is not realized. He argues with her within himself, responds to her insults.
A sound artist with a skin vector may have voices in his head about material theft, destruction of his material assets, voices may talk about causing direct property damage, about pursuers, ill-wishers. Sometimes a severe beating, for example, becomes a psychotraumatic situation for a sound artist with a skin vector. Then voices may appear with the threat of harm from others, the fear that everyone wants to harm him. The fear of robbery, loss of property and health arises in the skin vector - suspicion appears, thoughts “I’m being robbed”, “they are planning evil for me.”
Treatment of hallucinations
People diagnosed with schizophrenia are usually treated with antipsychotic medications that block postsynaptic dopamine receptors in the striatum, called the striatum. Antipsychotics are effective in many cases: treatment reduces psychotic symptoms, especially auditory hallucinations and mania. Some patients, however, do not respond well to antipsychotics. Approximately 25–30% of patients who hear voices have little effect from medications. Antipsychotics also have serious side effects, so these medications are not suitable for everyone.
As for other methods, there are many non-drug treatment options. Their effectiveness also varies. For example, cognitive behavioral therapy (CBT). Its use in the treatment of psychosis is somewhat controversial because, as many researchers believe, it has little effect on the symptoms and overall outcome of the disease. But there are types of CBT designed specifically for patients who hear voices. This therapy usually aims to change the patient's attitude towards the voice so that it is perceived as less negative and unpleasant. The effectiveness of this treatment remains questionable.
I'm currently leading a study at King's College London to see if we can teach patients to self-regulate neural activity in the auditory cortex. This is achieved using neural feedback that is sent in real time using MRI. An MRI scanner is used to measure the signal coming from the auditory cortex. This signal is then sent back to the patient via a visual interface, which the patient must learn to control (i.e. move a lever up and down). The hope is that we can teach patients who hear voices to control the activity of their auditory cortex, which in turn may allow them to better control their voices. Researchers are not yet sure whether this method will be clinically effective, but some preliminary data will be available in the next few months.
Prognosis and ways to prevent voice disorders
A huge number of diseases - including diseases of the respiratory system, as well as organ systems that ensure blood circulation in the body, pathologies of the endocrine system and the hearing system, harmful factors, injuries to the vocal apparatus - can provoke voice disorder. The result of treatment depends on many factors, including the causes of the pathology and the start of treatment. With severe modifications of the vocal apparatus or paralysis, the voice often cannot be restored to its previous state, although its sound can be improved. Functional voice disorders are usually eliminated completely, although some patients who do not follow the instructions of the speech therapist experience relapses of the disease. The patient’s desire to be cured also plays a huge role.
Prevention of voice disorders involves giving up bad habits, such as smoking and drinking alcohol. It is also not recommended to talk loudly, sing or shout in the cold. It is recommended to carry out prevention and timely treatment of colds. When you have a cold, you need to stick to the voice mode. People in vocal professions are advised to learn diaphragmatic breathing and correct voice delivery.
If you notice any suspicious symptoms, you should consult a doctor as soon as possible.
Population Prevalence
About 24 million people worldwide live with a diagnosis of schizophrenia, and about 60% or 70% of them have heard voices. There is evidence that 5% to 10% of the population without a psychiatric diagnosis have also heard them at some point in their lives. Some of us sometimes felt like someone was calling our name, only to find out that no one was there. So there is evidence that auditory hallucinations are more common than we think, although precise epidemiological statistics are difficult to come by.
The most famous person to hear voices was probably Joan of Arc. From modern history, one can recall Syd Barrett, the founder of Pink Floyd, who suffered from schizophrenia and auditory hallucinations. But, again, some may find inspiration for art in voices, and some even experience musical hallucinations - something like vivid auditory images - but scientists still doubt whether these can be equated with hallucinations.
Unanswered questions
Science currently does not have a clear answer to the question of what happens in the brain when a person hears voices. Another problem is that researchers don't yet know why people perceive them as foreign from an external source. It is important to try to understand the phenomenological aspect of what people experience when they hear a voice. For example, when tired or taking stimulants, they may experience hallucinations, but do not necessarily perceive them as coming from outside. The question is why people lose the sense of their own agency when they hear voices. Even if we assume that the cause of auditory hallucinations is excessive activity of the auditory cortex, why do people still think that God, a secret agent or an alien is speaking to them? It is also important to examine the belief systems that people build around their voices.
The content of auditory hallucinations and their source is another issue: do these voices originate from inner speech or are they stored memories? What is certain is that this sensory experience involves activation of the auditory cortex in the speech and language areas. This tells us nothing about the emotional content of these messages, which are often negative, which in turn suggests that it may also be due to problems in the brain processing emotional information. In addition, two people may experience hallucinations very differently, which means that the brain mechanisms involved may also be very different.
Classification of voice disorders
In medicine, voice disorders are divided according to the degree of manifestation of the disorder into:
- Dysphonia is a disorder in which the strength of the voice decreases, its color and pitch change. With dysphonia, the voice becomes hoarse, lowers, and becomes hoarse;
- aphonia is a disorder during which the voice disappears completely. With aphonia, a person can only whisper.
According to the mechanism of development, these disorders are divided into:
- organic;
- functional.
Based on the location of lesions of the vocal apparatus, voice disorders are:
- central - voice disorder resulting from pathological processes occurring in the middle of the vocal apparatus;
- peripheral - pathological changes occur in the peripheral part of the vocal apparatus.
