Auditory hallucination
Encyclopedia
An auditory hallucination, or paracusia, is a form of hallucination
that involves perceiving sounds without auditory stimulus
. A common form involves hearing one or more talking voices. This may be associated with psychotic
disorders such as schizophrenia
or mania
, and holds special significance in diagnosing these conditions.
There are three main categories into which the condition can fall: a person hearing a voice speak one's thoughts, a person hearing one or more voices arguing, or a person hearing a voice narrating his/her own actions.
However, individuals may hear voices without suffering from diagnosable mental illness
. The Hearing Voices Movement
is a support and advocacy group for people who hallucinate voices, but do not otherwise show signs of mental illness or impairment.
Other types of auditory hallucination include exploding head syndrome
and musical ear syndrome
. In the latter, people will hear music playing in their mind, usually songs they are familiar with. Recent reports have also mentioned that it is also possible to get musical hallucinations from listening to music for long periods of time. This can be caused by: lesions on the brain stem
(often resulting from a stroke
); also, tumors, encephalitis, or abscesses. Other reasons include hearing loss and epileptic activity.
, a famous music composer, spent the end of his life experiencing auditory hallucinations. Schumann’s diaries state that he suffered perpetually from imagining that he had the note A5
sounding in his ears. The musical hallucinations became increasingly complex. One night he claimed to have been visited by the ghost of Schubert and wrote down the music that he was hearing. Thereafter, he began making claims that he could hear an angelic choir singing to him. As his condition worsened, the angelic voices transmogrified into demonic voices.
Joan of Arc
claimed to hear the voices of Saints who were the force that guided her and was resolved to obey these messages as she believed they were sent directly from God. She first began hearing voices when she was thirteen and soon after had visions of St. Francis, St. Catherine and St. Margaret.
). Beginning in the 16th century Insane Asylums were first introduced in order to remove “the mad dogs” from the streets and left them chained to walls and living in their own filth. These asylums acted as prisons until the late 18th century. This is when doctors began the attempt to treat patients. Often attending doctors would douse patients in cold water, starve them, or spin patients on a wheel. Soon, this gave way to brain specific treatments with the most famous examples including Lobotomies, shock therapy
and branding the skull with hot iron.
. In these cases, patients show a consistent increase in activity of the thalamic and strietal subcortical nuclei, hypothalamus, and paralimbic regions; confirmed via PET
scan and fMRI. Other research shows an enlargement of temporal white matter, frontal gray matter, and temporal gray matter volumes (those areas crucial to both inner and outer speech) when compared to control patients. This implies both functional and structural abnormalities in the brain can induce auditory hallucinations, both of which may have a genetic component. Mood disorders have also been known to cause auditory hallucinations, but tend to be milder than their psychosis induced counterpart.
High caffeine
consumption has been linked to an increase in the likelihood of experiencing auditory hallucinations. A study conducted by the La Trobe University
School of Psychological Sciences revealed that as few as five cups of coffee a day could could trigger the phenomenon.
See Electromagnetic Weapon
. A very low frequency, low voltage electromagnetic signal similar in form to normal brain waves could cause the brain to interpret the signal as an acoustic "sound" received through the ears. Tinnitus is a similar effect. In Tinnitus a sound or sounds are "heard" without there being an external, acoustic source for the sound. In tinnitus the brain is interpreting an internally-generated electromagnetic signal as an acoustic sound or sounds.
medications which affect dopamine metabolism. If the primary diagnosis is a mood disorder (with psychotic features), adjunctive medications are often used (e.g., antidepressants or mood stabilizers). These medical approaches may allow the person to function normally but are not a cure as they do not eradicate the underlying thought disorder
or ECT has been shown to reduce psychotic symptoms associated with schizophrenia, mania, and depression, and is often used in psychiatric hospitals.
In recent years, repetitive transcranial magnetic stimulation (rTMS) has been studied as a biological method of treatment for auditory hallucinations. rTMS plays a role in altering neural activity over language cortical regions. Studies have shown that when rTMS is used as an adjunct to antipsychotic medication in treatment-resistant cases, the frequency and severity of auditory hallucinations can be reduced.
Dr. Charles Fernyhough, of the University of Durham poses one theory among many but stands as a reasonable example of the literature. Given standing evidence towards involvement of the inner voice in auditory hallucinations, he proposes two alternative hypotheses on the origins of auditory hallucinations in the non-psychotic. Both of which rely on understanding of the internalization process of the inner voice.
Level One (External Dialogue) involves the capacity to maintain an external dialogue with another person, i.e. a toddler talking with their parent(s).
Level Two (Private Speech) involves the capacity to maintain a private external dialogue, as seen in children voicing the actions of play using dolls or other toys.
Level Three (Expanded Inner Speech) is the first internal level in speech. This involves the capacity to carry out internal monologues, as seen in reading to ones self, or going over a list silently.
Level Four (Condensed Inner Speech) is the final level in the internalization process. It involves the capacity to think in terms of pure meaning without the need to put thoughts into words in order to grasp the meaning of the thought.
Hallucination
A hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid,...
that involves perceiving sounds without auditory stimulus
Stimulus (physiology)
In physiology, a stimulus is a detectable change in the internal or external environment. The ability of an organism or organ to respond to external stimuli is called sensitivity....
. A common form involves hearing one or more talking voices. This may be associated with psychotic
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
disorders such as schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
or mania
Mania
Mania, the presence of which is a criterion for certain psychiatric diagnoses, is a state of abnormally elevated or irritable mood, arousal, and/ or energy levels. In a sense, it is the opposite of depression...
, and holds special significance in diagnosing these conditions.
There are three main categories into which the condition can fall: a person hearing a voice speak one's thoughts, a person hearing one or more voices arguing, or a person hearing a voice narrating his/her own actions.
However, individuals may hear voices without suffering from diagnosable mental illness
Mental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
. The Hearing Voices Movement
Hearing Voices Movement
Hearing Voices Movement is a philosophical trend in how people who hear voices are viewed. It was begun by Marius Romme, a professor of social psychiatry at the University of Limburg in Maastricht, the Netherlands; and Sandra Escher, a science journalist, who began this work after being challenged...
is a support and advocacy group for people who hallucinate voices, but do not otherwise show signs of mental illness or impairment.
Other types of auditory hallucination include exploding head syndrome
Exploding head syndrome
Exploding head syndrome is a parasomnia condition that causes the sufferer occasionally to experience a tremendously loud noise as originating from within his or her own head, usually described as the sound of an explosion, roar, gunshot, loud voices or screams, a ringing noise, or the sound of...
and musical ear syndrome
Musical ear syndrome
Musical ear syndrome describes a condition seen in people who have hearing loss and subsequently develop auditory hallucinations. It is comparable to Charles Bonnet syndrome and some have suggested this phenomenon could be included under this diagnosis.The occurrence of MES has been suggested to...
. In the latter, people will hear music playing in their mind, usually songs they are familiar with. Recent reports have also mentioned that it is also possible to get musical hallucinations from listening to music for long periods of time. This can be caused by: lesions on the brain stem
Brain stem
In vertebrate anatomy the brainstem is the posterior part of the brain, adjoining and structurally continuous with the spinal cord. The brain stem provides the main motor and sensory innervation to the face and neck via the cranial nerves...
(often resulting from a stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
); also, tumors, encephalitis, or abscesses. Other reasons include hearing loss and epileptic activity.
Famous examples
Robert SchumannRobert Schumann
Robert Schumann, sometimes known as Robert Alexander Schumann, was a German composer, aesthete and influential music critic. He is regarded as one of the greatest and most representative composers of the Romantic era....
, a famous music composer, spent the end of his life experiencing auditory hallucinations. Schumann’s diaries state that he suffered perpetually from imagining that he had the note A5
Scientific pitch notation
Scientific pitch notation is one of several methods that name the notes of the standard Western chromatic scale by combining a letter-name, accidentals, and a number identifying the pitch's octave...
sounding in his ears. The musical hallucinations became increasingly complex. One night he claimed to have been visited by the ghost of Schubert and wrote down the music that he was hearing. Thereafter, he began making claims that he could hear an angelic choir singing to him. As his condition worsened, the angelic voices transmogrified into demonic voices.
Joan of Arc
Joan of Arc
Saint Joan of Arc, nicknamed "The Maid of Orléans" , is a national heroine of France and a Roman Catholic saint. A peasant girl born in eastern France who claimed divine guidance, she led the French army to several important victories during the Hundred Years' War, which paved the way for the...
claimed to hear the voices of Saints who were the force that guided her and was resolved to obey these messages as she believed they were sent directly from God. She first began hearing voices when she was thirteen and soon after had visions of St. Francis, St. Catherine and St. Margaret.
Individual accounts
The onset of delusional thinking is most often described as being gradual and insidious. Patients described an interest in psychic phenomena progressing to increasingly unusual preoccupations and then to bizarre beliefs "in which I believed wholeheartedly". One author wrote of their hallucinations: "they deceive, derange and force me into a world of crippling paranoia". In many cases, the delusional beliefs could be seen as fairly rational explanations for abnormal experiences: "I increasingly heard voices (which I'd always call ‘loud thoughts’)... I concluded that other people were putting these loud thoughts into my head". Some cases have been described as an "auditory ransom note".Presentation
The ancient world viewed hallucinations as it did most of the natural world, with awe and superstition. As such, it was viewed as either a gift or curse by God, or the gods (depending on the specific culture). The oracles of ancient Greece were known to experience auditory hallucinations while breathing in certain neurologically active vapors, while the more pervasive delusions and symptomology were often viewed as possession by demonic forces as punishment for misdeeds.Treatments
Treatment in the ancient world is ill documented, but there are some cases of therapeutics being used to attempt treatment, while the common treatment was sacrifice and prayer in an attempt to placate the gods. The Dark Ages saw the most horrific accounts where the suffered of auditory hallucinations were subjected to trepanning or trial as a witch. In other cases of extreme symptomology individuals were seen as being reduced to animals by a curse, these individuals were either left on the streets or imprisoned in insane asylums. It was the latter response that eventually led to modern psychiatric hospitals.Presentation
Auditory hallucinations, like most everything else in Europe, was rethought during the enlightenment. As a result, the predominant theory in the western world beginning in the late 18th century was that auditory hallucinations were the result of a disease in the brain and treated as such as mania.Treatments
There were no effective treatments for hallucinations at this time. Conventional thought was that clean food, water, and air would allow the body to heal itself (SanatoriumSanatorium
A sanatorium is a medical facility for long-term illness, most typically associated with treatment of tuberculosis before antibiotics...
). Beginning in the 16th century Insane Asylums were first introduced in order to remove “the mad dogs” from the streets and left them chained to walls and living in their own filth. These asylums acted as prisons until the late 18th century. This is when doctors began the attempt to treat patients. Often attending doctors would douse patients in cold water, starve them, or spin patients on a wheel. Soon, this gave way to brain specific treatments with the most famous examples including Lobotomies, shock therapy
Electroconvulsive therapy
Electroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...
and branding the skull with hot iron.
Associated diseases
The premier cause of auditory hallucinations in the case of psychotic patients is schizophreniaSchizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
. In these cases, patients show a consistent increase in activity of the thalamic and strietal subcortical nuclei, hypothalamus, and paralimbic regions; confirmed via PET
Positron emission tomography
Positron emission tomography is nuclear medicine imaging technique that produces a three-dimensional image or picture of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide , which is introduced into the body on a...
scan and fMRI. Other research shows an enlargement of temporal white matter, frontal gray matter, and temporal gray matter volumes (those areas crucial to both inner and outer speech) when compared to control patients. This implies both functional and structural abnormalities in the brain can induce auditory hallucinations, both of which may have a genetic component. Mood disorders have also been known to cause auditory hallucinations, but tend to be milder than their psychosis induced counterpart.
Non-disease associated causes
Auditory hallucinations have been known to manifest as a result of intense stress, sleep deprivation, drug use, and errors in development of proper psychological processes. Genetic correlation has been identified with auditory hallucinations, but most work with non-psychotic causes of auditory hallucinations is still ongoing.High caffeine
Caffeine
Caffeine is a bitter, white crystalline xanthine alkaloid that acts as a stimulant drug. Caffeine is found in varying quantities in the seeds, leaves, and fruit of some plants, where it acts as a natural pesticide that paralyzes and kills certain insects feeding on the plants...
consumption has been linked to an increase in the likelihood of experiencing auditory hallucinations. A study conducted by the La Trobe University
La Trobe University
La Trobe University is a multi-campus university in Victoria, Australia. It was established in 1964 by an Act of Parliament to become the third oldest university in the state of Victoria. The main campus of La Trobe is located in the Melbourne suburb of Bundoora; two other major campuses are...
School of Psychological Sciences revealed that as few as five cups of coffee a day could could trigger the phenomenon.
See Electromagnetic Weapon
Electromagnetic Weapon
Electromagnetic weapons are a type of directed energy weapons which use electromagnetic radiation to deliver heat, mechanical, or electrical energy to a target to cause various, sometimes very subtle, effects. They can be used against humans, electronic equipment, and military targets generally,...
. A very low frequency, low voltage electromagnetic signal similar in form to normal brain waves could cause the brain to interpret the signal as an acoustic "sound" received through the ears. Tinnitus is a similar effect. In Tinnitus a sound or sounds are "heard" without there being an external, acoustic source for the sound. In tinnitus the brain is interpreting an internally-generated electromagnetic signal as an acoustic sound or sounds.
Pharmaceuticals
The primary means of treating auditory hallucinations is antipsychoticAntipsychotic
An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...
medications which affect dopamine metabolism. If the primary diagnosis is a mood disorder (with psychotic features), adjunctive medications are often used (e.g., antidepressants or mood stabilizers). These medical approaches may allow the person to function normally but are not a cure as they do not eradicate the underlying thought disorder
Psychological therapies
Cognitive-Behavioral Therapy has been shown to help decrease the frequency and distressfulness of auditory hallucinations, particularly when other psychotic symptoms were presenting. Enhanced Supportive Therapy has been shown to reduce the frequency of auditory hallucinations, the violent resistance the patient displayed towards said hallucinations, and an overall decrease in the perceived malignancy of the hallucinations. Other cognitive and behavioral therapies have been used with mixed success.Non-conventional therapies
Electroconvulsive therapyElectroconvulsive therapy
Electroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...
or ECT has been shown to reduce psychotic symptoms associated with schizophrenia, mania, and depression, and is often used in psychiatric hospitals.
In recent years, repetitive transcranial magnetic stimulation (rTMS) has been studied as a biological method of treatment for auditory hallucinations. rTMS plays a role in altering neural activity over language cortical regions. Studies have shown that when rTMS is used as an adjunct to antipsychotic medication in treatment-resistant cases, the frequency and severity of auditory hallucinations can be reduced.
Non-psychotic symptomology
There is on-going research that supports the prevalence of auditory hallucinations, with a lack of other conventional psychotic symptoms (such as delusions, or paranoia), particularly in pre-pubertal children. These studies indicate a remarkably high percentage of children (up to 14% of the population sampled) experienced sounds or voices without any external cause, though it should also be noted that "sounds" are not considered by psychiatrists to be examples of auditory hallucinations. Differentating actual auditory hallucinations from "sounds" or a normal internal dialogue is important since the latter phenomena are not indicative of mental illness.Causes
The causes of auditory hallucinations are unclear.Dr. Charles Fernyhough, of the University of Durham poses one theory among many but stands as a reasonable example of the literature. Given standing evidence towards involvement of the inner voice in auditory hallucinations, he proposes two alternative hypotheses on the origins of auditory hallucinations in the non-psychotic. Both of which rely on understanding of the internalization process of the inner voice.
Internalization of the inner voice
The internalization process of the inner voice is the process of creating an inner voice during early childhood, and can be separated into four distinct levels.Level One (External Dialogue) involves the capacity to maintain an external dialogue with another person, i.e. a toddler talking with their parent(s).
Level Two (Private Speech) involves the capacity to maintain a private external dialogue, as seen in children voicing the actions of play using dolls or other toys.
Level Three (Expanded Inner Speech) is the first internal level in speech. This involves the capacity to carry out internal monologues, as seen in reading to ones self, or going over a list silently.
Level Four (Condensed Inner Speech) is the final level in the internalization process. It involves the capacity to think in terms of pure meaning without the need to put thoughts into words in order to grasp the meaning of the thought.