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Hearing voices as a feature of typical and psychopathological experience

Nature Reviews Psychology volume 1, pages 72–86 (2022)Cite this article

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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.

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Fig. 1: Auditory signal detection tasks.
Fig. 2: Varieties of continuum models.

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Acknowledgements

W.L.T. was supported by an Australian National Health and Medical Research Council New Investigator project grant (GNT1161609). C.F. was supported by Wellcome Trust grant WT108720.

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  1. Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia

    Wei Lin Toh

  2. Department of Psychology, Northumbria University, Newcastle upon Tyne, UK

    Peter Moseley

  3. Department of Psychology, Durham University, Durham, UK

    Charles Fernyhough

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W.L.T. and P.M. are joint lead authors. All authors contributed to researching data for the article, discussing the content and writing, reviewing and editing the manuscript before submission.

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Glossary

Autoscopic

The psychic duplication of a part or the whole of one’s body in external space; in other words, an out-of-body experience.

Functional connectivity

A measure of the temporal correlation of activity in different brain regions.

Structural connectivity

A group of measures of how much different parts of the brain are anatomically connected.

Default mode network

A network of brain regions showing significant activation when the participant is not engaged in any task, thought to be related to self-referential processing.

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Toh, W.L., Moseley, P. & Fernyhough, C. Hearing voices as a feature of typical and psychopathological experience. Nat Rev Psychol 1, 72–86 (2022). https://doi.org/10.1038/s44159-021-00013-z

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