Dear Dr. I am a mental health worker. I work with several clients that hear voices. Can you explain where these voices come from, and is there any treatment
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Hearing voices is referred to as auditory hallucinations. People can have those and many other types of hallucinations such as visual, olfactory (smell), taste, and sensation (pain, etc).
Along with hallucinations people with a psychotic illness experience delusions. Delusions are disturbances in the way a person with a psychosis thinks. Just as hallucinations are not real, delusions are ways of thinking that are not based on reality.
For example, a person with a psychotic illness may hear voices telling them to do something. Along with the hallucinations they will have delusional thoughts that the FBI is out to arrest them or that someone in the neighborhood wants them poisoned. Delusions of this type are called paranoid because the patient falsely believes and lives in fear of harm being done to them. The auditory hallucinated voices may warn them to seek safety.
These delusions and hallucinations are the result of the brain malfunctioning. The human brain is made up of approximately ten billion neurons or nerve cells that have many functions one of which is to carry messages back and forth from the outside world to the inside and to many organs in the body and, most importantly, to and around the brain. The transmission of these messages is important because they allow us to see, hear, feel and adjust to things happening outside of our bodies and inside of our bodies. A complex system of brain chemicals called neurotransmitters help carry the messages across the ten billion nerve cells to the parts of the brain that make sense of the information. This is what happens when we read this page or when we speak to someone or watch television, etc.
In the case of psychotic illnesses we know that many of the ten billion neurons do not work correctly and that the chemicals or neurotransmitters are not correctly balanced in the brain. As a result all the information becomes distorted for these patients. One of the distortions is that these patients hear voices or have the other symptoms described above.
What it is important to understand is that because the neurons are sick and the chemicals are out of balance these patients really do hear voices just like you hear your friend speaking to you during a conversation. In other words, someone who hears voices does not imagine them but really, really hears them, and the same with the other types of hallucinations.
Very powerful anti psychotic medications are used to help these people no longer have hallucinations or to have them with less intensity. Along with individual and group psychotherapy, usually in some type of full day hospital or agency program these patients can learn to understand what is happening to them and to control their symptoms. However, even with medications these people remain fragile. They need to experience as little stress as possible or their symptoms can return even with medicine.
I hope this information helps and thank you for your important question.