An experiment is described in which people with auditory hallucinations were brought into contact with each other. On an evening television talk show, a patient--diagnosed several times as having schizophrenia--talked about her voices. Four hundred and fifty people who also were hearing voices reacted to the program by telephone. A questionnaire was sent to those who responded to the television program in order to get more information about their way of coping with the voices. From those who filled out the questionnaire, 20 people were selected who explained their experiences in a clear way. A meeting for people hearing voices was organized, and the 20 persons were invited to become the speakers. In this article the experiences described by the participants are reported as well as the many ways in which they coped with these experiences.

The form and the content of chronic auditory hallucinations were compared in three cohorts, namely patients with schizophrenia, patients with a dissociative disorder, and nonpatient voice-hearers. The form of the hallucinatory experiences was not significantly different between the three groups. The subjects in the nonpatient group, unlike those in the patient groups, perceived their voices as predominantly positive: they were not alarmed or upset by their voices and felt in control of the experience. In most patients, the onset of auditory hallucinations was preceded by either a traumatic event or an event that activated the memory of earlier trauma. The significance of this study is that it presents evidence that the form of the hallucinations experienced by both patient and nonpatient groups is similar, irrespective of diagnosis. Differences between groups were predominantly related to the content, emotional quality, and locus of control of the voices. In this study the disability incurred by hearing voices is associated with (the reactivation of) previous trauma and abuse.

A questionnaire comprising 30 open-ended questions was sent to 450 people with chronic hallucinations of hearing voices who had responded to a request on television. Of the 254 replies, 186 could be used for analysis. It was doubtful whether 13 of these respondents were experiencing true hallucinations. Of the remaining 173 subjects, 115 reported an inability to cope with the voices. Ninety-seven respondents were in psychiatric care, and copers were significantly less often in psychiatric care (24%) than non-copers (49%). Four coping strategies were apparent: distraction, ignoring the voices, selective listening to them, and setting limits on their influence.

BackgroundChildhood hallucinations of voices occur in a variety of contexts and have variable long-term outcomes.AimTo study the course of experience of voices sequentially over a 3-year period in those with and those without a need for mental health care (patient status).MethodIn a group of 80 children of mean age 12.9 years (s.d.=3.1), of which around 50% were not receiving mental health care, baseline measurement of voice characteristics, voice attributions, psychopathology, stressful life events, coping mechanisms and receipt of professional care were used to predict 3-year course and patient status.ResultsThe rate of voice discontinuation over the 3-year period was 60%. Patient status was associated with more perceived influence on behaviour and feelings and more negative affective appraisals in relation to the voices. Predictors of persistence of voices were severity and frequency of the voices, associated anxiety/depression and lack of clear triggers in time and place.ConclusionsNeed for care in the context of experience of voices is associated with appraisal of the voices in terms of intrusiveness and ‘omnipotence’. Persistence of voices is related to voice appraisals, suggesting that experience of voices by children should be the target of specific interventions.

Previous work suggests that auditory hallucinations in children and adolescents occur frequently in the absence of psychotic illness, although a number of such children go on to develop more severe psychotic symptomatology and need for care. We examined prospectively what factors are associated with formation of delusions in adolescents who are hearing voices. Eighty adolescents (mean age 12.9 years, SD = 3.1) who reported hearing voices were examined at baseline and followed-up three times over a period of 3 years. Fifty percent were receiving professional care, but 50% were not in need of care. Baseline measurement of voice appraisals, attributions, psychopathology, global functioning, dissociation, stressful life events, coping mechanisms, and receipt of professional care were used as predictors of delusion formation, measured as a score of 6 or greater on the extended BPRS items: "suspiciousness," "unusual thought content" and "grandiosity." Thirteen children (16%) displayed evidence of delusional ideation over at least one of the three follow-up periods, of which seven (9%) de novo. Adjusting for presence of baseline delusional ideation, delusion formation over the follow-up period was associated with baseline voice appraisals and attributions such as tone of the voice (hazard ratio voice "variably friendly and hostile" compared to "always friendly": HR = 6.8, 95% CI: 1.1, 41.0), perceived location of the voice (outside vs. inside head: HR = 2.9, 95% CI: 1.0, 8.7), and whether the voice resembled that of a parent (HR = 3.5, 95% CI: 1.0, 12.0); baseline BPRS anxiety/depression (HR = 6.4, 95% CI: 1.9, 21.4), baseline BPRS disorganization (HR = 5.0, 95% CI: 0.98, 26.1) and the baseline amount of reported recent stressful life events (HR continuous life events score: 1.8, 95% CI: 1.0, 3.3). In addition, in older children, the perceived influence of the voices on emotions and behavior was strongly associated with delusion formation (HR = 5.1, 95% CI: 1.0, 25.9). Delusion formation in children hearing voices may be responsive to triggering events and facilitated by feelings of anxiety/depression. The results also highlight the role of attributions associated with external sources, authority figures, perceived influence or "power" over the person, as well as emotional appraisal processes and cognitive disorganization.