Speech and language difficulties have been reported in people with schizophrenia since the early 19th century, but they have been relatively poorly characterized. Research has mostly focused on pragmatics and the social aspects of communication, but changes in voice quality are common and can also interfere with intelligibility of speech, thus adding to the patient's disability. These changes in voice quality are not entirely related to effects of neuroleptics. A few common vocal characteristics have been identified; indeed, the most consistent vocal characteristic in people with schizophrenia may be the lack of consistent characteristics between patients. There has been little speculation about the etiology of vocal changes; they have been regarded as “neurological soft signs” indicative of mild central nervous system dysfunction but may be related to longstanding insensitivity to comprehension cues from the listener. Response to speech therapy in people with schizophrenia has been disappointing overall. We present three patients with schizophrenia and representative vocal changes, and we also discuss the sparse available literature available through the PubMed database. This may be a fruitful and relatively unexplored area of investigation with potential to substantially improve social interactions and quality of life for some patients with schizophrenia. [ Psychiatr Ann . 2020;50(1):33–37.]