Voices and stigma
One of the main challenges of talking about voices is the stigma that surrounds the experience. Many people worry that if they tell someone they hear voices, that person will immediately assume they are mentally ill, violent and a danger to themselves or others.
Internalising negative stereotypes and public misconceptions about voice-hearing can also cause feelings of shame, low self-worth, and lead people to choose to keep their voices a secret.
I felt really ashamed ‘cause you know when you think ‘ah, you’re hearing voices’ you felt a bit crazy and mental you know. So I kept it for myself for a very long time. … I didn’t tell my family for months, and months, and months. I kept it to myself.
Some people are particularly reluctant to disclose they hear voices when they first occur. They may be confused about their experiences (Am I really hearing voices or is this something else?), scared that they are ‘going mad’, concerned about the consequences of disclosure, or find the content of the voices too upsetting to share with other people. Some researchers think that non-disclosure or hiding one’s experience is protective – a coping strategy. Others have found that it is often not until someone reaches a crisis point regarding their experience of distressing voices that they choose to tell others and seek help. By this point, people often feel they have reached a stage where stigma, shame and worries about how others will react are outweighed by the negative effects of remaining silent.
On the other hand, some people do not feel they need to hide their voices. Some have become comfortable with their identity as a voice-hearer and find talking about voices no different to talking about other feelings and experiences, such as the thoughts that go through their heads when they are feeling nervous. And young children often talk about voices without realising that they are not a shared experience. In certain situations – where there is a positive framework around voice-hearing in the family, culture or spiritual group – difficulties may only arise if and when the person comes into contact with the mainstream view of voices as a sign of madness. For example, in one study of people with anomalous experiences (including voices) that they often viewed as part of their spiritual beliefs, participants described a fear of telling their counsellors in case these experiences were pathologized.
Keeping voices a secret because of stigma – experienced or anticipated – can have negative consequences. Concealing a stigmatised identity has been linked to increased psychological stress, lack of access to positive ‘normalising’ information and peers, and a delay in developing a positive sense of self.
Voices in the media
The way that voice-hearing is depicted in the media both reflects – and is arguably partly responsible for – public misunderstandings of the experience. A recent analysis of over 181 newspaper articles in the US found that:
- 84% of the articles contained no suggestion that voice-hearing can be ‘normal’
- 81.8% of the articles connected hearing voices to mental illness, most usually schizophrenia
- Over half the articles linked voice-hearing to criminal behaviour, mostly involving violent crimes.
These media stereotypes about voice-hearing directly contradict research which shows that voices can be an ordinary part of many people’s everyday lives. They worsen problems associated with stigma and self-stigma, and can negatively affect how voice-hearers react to and interpret their experiences. Is it really surprising that many choose to keep their voices a secret?
Find out more: Charles Fernyhough (2014). Voices in the News. Psychology Today.
Did you know?
Stigma and public misunderstandings of voice-hearing can intensify the distress associated with hearing voices and increase an individual’s need for clinical care.
A recent review of the literature on the topic found that stigma and self-stigma can promote secrecy, prevent disclosure and potentially lead to voice-hearers becoming isolated from friends and family. Stigma can also:
- Lead to voices being perceived as more powerful, less controllable and more distressing.
- Influence what the voices say and make them more negative.
- Make the voices more frequent and increase their intensity.
Find out more: Shannon Peters (2016). Stigma may increase distress in individuals who hear voices. Mad in America.
Case study: What do people in an Early Intervention in Psychosis Service say helped or hindered disclosure?
Research into voice-hearing and experiences of disclosure is at a very early stage and mostly limited to studies which take place in mental health settings. A qualitative study of 20 voice-hearers within Early Intervention in Psychosis services in Manchester and Sussex identified some of the barriers to talking about voices for the first time, and some of the things that can enable it and make it possible.
Explore the quotations below to see what some of the participants said about why they either chose or didn’t choose to share their experiences. The slides move automatically, but you can also click on the arrows to move to the next quotation.
These quotations are taken directly from the research study, with thanks to the researchers for their kind permission to reproduce the material here.
I felt the need to talk about it because there is a lot of stigma around it and I was internalizing the stigma about it. So I felt like I had to sort of say ‘Well, it doesn’t mean I’m a psycho’. So I try and it explain it to people and see what they thought it was as well.
[The voice] was shouting at me at this point. Sort of saying things like ‘Shut up! Don’t’ say anymore. What are you doing? Sort of thing. But, I just literally couldn’t help it. I felt like I had that little doorway where I could suddenly start shouting out. Sort of telling people what was going on.
I just thought like, well my dad, my sister’s suffered with mental illness … I knew that I didn’t want to put any more pressure on my dad … I think I felt a bit scared. I thought of my dad going through all that with my sister and I didn’t want to put any more pressure on him. So again it was that thing of not worrying anyone else, sort of deal with it on my own.
So my mum’s mum heard voices. Her dad heard voices and I think her aunties heard voices. So it’s not you know, they weren’t too shocked. They were a little bit like ‘for God’s sake here we go again’.
It’s like I never really spoke about anything … because I never saw my dad, my brother or my grandad sort of show any emotion. So I never saw them crying. I never saw anything. So I just thought ‘it’s not a man’ sort of, no ‘a male sort of thing to do’. So I just kept it all in.
A summary of the findings from this study is presented in the table below:
Barriers to disclosure
Enablers to disclosure
|Denial that one is hearing voices or that the voices are problematic||Reaching a crisis point where it’s no longer possible to cope with the experience alone|
|Stigma, shame and fear of negative reactions from others||Stigma and a desire to challenge public misunderstandings about the experience|
|Voices are intimidating and forbid talking about them|
|Concern for others – worries about causing stress, increasing pressure on or becoming a burden to significant others in their lives||Concern for others – worries about ‘betraying’ or ‘deceiving’ significant others if experiences aren’t shared|
|Negative experiences of family and friends’ attitudes towards mental health||Positive experiences of family and friends’ attitudes towards mental health|
|Not knowing how to ask for support or having the confidence to express the experiences|
|Not having a trusted other to confide in|