Leaflet (1) the introduction to this Website offered a quick introduction on the services offered by the Deptford Hearing Voices Project and the people who might find the services helpful. The purpose of leaflet 2 is to provide more information about the experience of ‘hearing voices’, sometimes known as ‘auditory’ or ‘verbal hallucinations’. Included are references to articles and books (indicated in the footnotes at the bottom of each page) which can be ordered from your local library or book-shop.

‘Voice hearing' is not easy to define. When they occur, such ‘voices’ are ‘felt’ or ‘seen’ by the voice hearer as being somehow different. The ‘voice’ or ‘voices’ may be in the form of whispering, mutterings, strange noises or plain speech. They can sound very alien to the hearer and may be male, female or a mixture: quite often people can't tell the gender of the voices. Some voices can sound like they come from a young child or children, others from adults or older people; at times the voices less easily described maybe machine like. For some hearers the ‘voices’ can sound quite similar in tone to people that they may know or have known.

Sometimes the voices say good or nice things, even wise things, at other times the ‘voices’ can say bad things, swear or make nasty comments to or about the hearer. The ‘voices’ can even, at times, ‘command’ the hearer to do things, or not do things, that the hearer may or may not want to do. Often these ‘voices’ just come, or appear, as the person is doing something, talking or just thinking (Elfferich, 1993).

The voice hearers’ description of their ‘voices’ will often reflect their individual experiences with the ‘voices’. Not surprisingly many people find it difficult to describe their experience to non-’voice hearers’. Medically the ‘voices’ are generally classified as coming into three different forms: (1) ‘voices’ that speak your thoughts out, (2) the hearing of two or more ‘voices’ arguing or having a discussion about you, or other people, and (3) hearing a ‘voice’ speak out constantly about you and/or your actions, or other people and/or their actions, as they occur or constantly telling you what to do (Thomas & Leudar, 1996). There are also ‘voices’ that can repeat words or phrases constantly. These ‘voices’ can seem to come from the space around a person’s head or from within their head. For a number of people voices can come from TV or Radio, passing traffic, birds or other animals, the rustle of leaves or machine generated noise.  Listening to how ‘voice hearers’ describe their experiences suggests that ‘voices’ can appear in many different ways and not always in line with the strict medical categories.

Most people think that only mentally ill people hear ‘voices’; the truth is that only a proportion of people who ‘hear voices’ are mentally ill. For example, some people who take certain types of ‘street drugs’, or who have a history of excessive alcohol use, can also begin to ‘hear voices’. There are also people who ‘hear voices’ who have no history of illness, nor do they take ‘street drugs’ or alcohol. In some cases certain types of physical illness, or ageing, can cause people to ‘hear voices’ (Tien, 1991)³. Understandably, the common link made between ‘hearing voices’ and mental illness means that some people will be reluctant to talk about their ‘voices’ to a GP or even to people who are close to them.

Much of our knowledge and understanding of ‘voices’ is based mostly on ‘voice hearers’ who have, or have had, mental illness. Medical research into the physical causes of ‘voices’ suggests that there are similarities in the areas of the brain which are used when a voice hearer is ‘hearing a voice’ and when they are actually hearing someone speak to them (McGuire et al, 1993 & 1995; Murray, 1996)^4;5;6.

Research by psychologists has shown that, even in laboratory conditions, many people report hearing sounds that are not there! ‘Such sounds [auditory hallucinations] can be a noise, music, single words, a brief phrase or a whole conversation’ (Chadwick et al, 1996)⁷. Certain situations can cause the brain to be super alert to a sound that we may decide is important to us. In this situation the brain’s super alertness means it can occasionally misinterpret a sound from elsewhere (background noise) as the sound we are listening for. For example, the sound may be interpreted as our name being called out, the rustle of leaves in the darkness as someone following us or, for parents, the sound of a baby crying, from sounds in road outside or neighbours next door, when their baby is actually fast asleep!

There are few studies on people in the general population who ‘hear voices’ but who have not been diagnosed as mentally ill (Thomas & Leudar, 1996)². A number of studies, including an American survey of 15,000 people, suggests that ‘... as many as 55% of people have experienced hearing voices at some time in their lives, often following ... [severely distressing] ... events such as the loss of someone close to them or other major life changes’ (Baker, 1995).⁸ These same studies also indicate that up to 4% of the general population may hear ‘voices’ regularly. Results from other studies give lower average figures of about 1-2% for regular ‘voice hearing’ amongst the general population (Thomas & Leudar, 1996)². Increasingly, researchers and practitioners in mental health are beginning to accept that there are people who ‘hear voices’ who do not appear to suffer mental illness ^8;9.

For many people that start of what we call ‘hearing voices’ can be literally a startling experience, which is why some researchers call this the 'startling phase'. Once the voice hearer has got over the shock of hearing the voices the next stage is to try to make sense of the voice, this is called the coping or 'organisation' phase. The coping phase is a difficult time in which the person hearing the ‘voices’ may want to escape or deny the ‘voices’ in some way. Some people might take months or years to acknowledge the ‘voices’ exist. Reports from ‘voice hearers’ suggest that early acceptance of the existence of the ‘voices’ is an important first step towards coping with them (Romme & Escher, 1993: pp 17-20).⁹ The next phase, called 'stabilisation', is the period when the voice hearer somehow fits the experience of ‘hearing voices’ into their everyday life and when they feel able to pick and choose what they want to do as opposed to doing what the voices say (Romme & Escher, 1989).¹⁰

How people cope with ‘hearing voices’ depends on a number of things: (i) the age when they first started to ‘hear voices’, (ii) the circumstances under which the ‘voices’ started, (iii) where the ‘voices’ appear to come from, (iv) what the ‘voices’ seem to say, (v) how the ‘voices’ sound and their loudness, (vi) whether people like or dislike the ‘voices’, and (vii) whether the ‘voices’ seem to interfere with a person’s thinking or actual behaviour and finally; (viii) whether people feel the voices to have command over them. What people do about the ‘voices’ very much depends on what they believe about them (Chadwick, Birchwood & Trower, 1996).⁷

Some people have had voices since childhood, perhaps starting as their 'invisible friends', for others the voices start later in teenage years or young adulthood. Generally the least frequent experience is for people to start hearing voices in late adulthood such as in middle age 45 - 65. Its usual for people not to necessarily remember the exact circumstances of when their voices started but research shows that 75% of people who do hear voices have often had some significant events in their lives involving early loss of parents or people close to them or suffered physical and or emotional shock from some event or mistreatment, such mistreatment also very often includes sexual abuse.

Having more information about ‘hearing voices’ through reading articles and books mentioned in this leaflet may help ‘voice hearers’ decide whether it would be useful to tell someone else, such as a partner, a relative, a close friend, a carer or a professional worker. Talking with someone who knows about the ‘voices’ can also be helpful in deciding what to do. Most ‘voice hearers’ seem to feel that the more they can find out and talk about their ‘voices’, especially to those who have some understanding of them, the better it usually is for themselves.

The Deptford Hearing Voices Services (DHVS) was set up as a small pilot project, or ‘start-up’, service to see whether people who ‘hear voices’ (along with their workers and carers) and living in the North Lewisham area would find its service useful. The Project has since that time been funded year by year until 2001: from April of 2001 the service has now been given permanent funding by South London and Maudsley Mental Health NHS Trust and is open to all residents of the borough of Lewisham. This service is not intended to replace any of the professional services already being used by ‘voice hearers’, but simply to add to the range of help available.

It is important to note that since the service came into being there are more and more different types of mental health workers as well as people who use mental health services who are taking up training and interest in this area. There are now a range of formal closed support groups offering structured psychological approaches to helping people both cope with and manage their voices and other non-ordinary experiences often run by psychologists. There also a much wider range of open support groups with offering more informal but informative and effective support to 'voice hearers', such groups may be run exclusively by 'voice hearers' themselves (peer support groups), or in some form of joint partnership between 'voice hearers' and other mental health workers.

The worker for this Project offers information, advice, education or treatment either individually or through one of the three weekly support groups (one of which is specifically for ‘voice hearers’). The Project worker works to a specific timetable in different locations during the week so as to be available to as many people as possible. These locations on the worker’s timetable include the Compass Centre, the Northover Centre, the New Cross and the Deptford 999 Clubs and the Crypt Club in St Paul’s church. The DHVS worker will also visit other places to talk to groups of ‘voice hearers’, other workers and people who care for ‘voice hearers’ who want to know more about the experience of ‘hearing voices’ and/or the services offered by the service.

The worker can be contacted by telephone to discuss what the Project offers. The telephone number on which to contact the worker is 0208 694 6519 which is the Compass Centre (opening hours are Monday to Friday between 9.30am and 4.30pm) who will take a message if the worker is not available at that moment (see also Leaflet 4 - How Best to Use the Service).

‘Voice hearers’ can, if they want this type of help, be given a specific psychological method to help them understand and cope with the ‘voices’. This psychological method is called cognitive behaviour therapy or CBT. CBT uses a specific method in helping voice hearers look at their ‘voices’ (sometimes in relation to the person’s past history) and experiments with different techniques to deal with their ‘voices’ (Persaud & Marks, 1995).¹¹ CBT is not designed to cure the ‘voices’ but can help voice hearers to cope with their ‘voices’. Some research has shown that using both medicines and CBT can be more helpful than using either of them alone.

There is a specific group held weekly for people who hear ‘voices’ and is run by the worker. Some voice hearers may find that they are more comfortable to talk about their ‘voices’ can help people feel less alone and also learn new ways of coping with the ‘voices’. Some people find talking about the ‘voices’ can make them seem worse for a while but this often gets better, so being aware that this might happen helps people be prepared.

It is for intended for the DHVS  to be run as an ongoing research project. Users of the Service may be asked and subject to consent to give a little of their time answering short questionnaires to check that the service remains relevant and useful to them.

The main UK office for the Hearing Voices Network is based in Manchester and their telephone number is 0161 834 5768. The Manchester Hearing Voices Network keep a list of all Hearing Voices groups around the UK and also provide various leaflets on ‘hearing voices’ for a small charge: there are now about 100 groups in the UK. Other organisations that may provide information about ‘voices’ are MIND on telephone number 0208 519 2122.