Are voices imaginary, or real? My (mostly imaginary it turns out) disagreement with Hearing Voices USA

Anyone who attempts to list a “hearing voices” group at the new Hearing Voices USA website will find that they are asked if their group assumes that “voices, visions, and other experiences are real” or if the group assumes that “voices, visions, and other experiences are imaginary.”

In this case, it seemed clear that the answer the website owners wanted was that the group assumes that “voices, visions, and other experiences are real.” [Actually it turns out that the website owners are just looking at this as one clue about how the group views voices, and they don’t make any decisions based on just this question.  See the remarks by an HVUSA person in the comments section.  That’s why I changed my title to say that my disagreement was “mostly imaginary” as I had just imagined how they were using the answers and I wasn’t correct.  I still think that the question of whether voices are best seen as real or imaginary is an interesting one, and that my angle on this is different than the official hearing voices network position, so I encourage people to still read this post.]

While I am all for the hearing voices movement as a whole, and I’m really happy to see additional work going into organizing the hearing voices network in the US, I have a lot of problems with this question being used as a screening criteria to determine which groups are acceptable to the network.

For one thing, it seemed wrong that people were being asked to choose one or the other:  but why should a group be rejected if it doesn’t make an assumption about whether voices are real or imaginary, but leaves it up to each participant to choose for themselves?  After all, that would be consistent with the hearing voices approach to other aspects of voice hearing experience, where multiple points of view are respected.

A second and more complex objection to the website question would be that some groups might see or assume that voices and visions could be real in some sense, and yet imaginary in another sense.  This in a way is the most common sense sort of interpretation:  after all, we see dreams as imaginary, but they are also a real experience, and something is “really happening” when we dream, even if others don’t share the experience.  Voices and visions are also experiences that are real to the experiencer, yet not consciously “imagined” or created by that experiencer, and are “really happening” within the experiencer even though they are not experienced by others.

Consider what distinguishes a “thought” from a “voice.”  If a “thought” is associated with an imagined or perceived sound of it being spoken aloud, and if it is imagined or believed that the “speaker” is not the person themselves, then it is pretty universally considered to be a “voice.”  So clearly, one can make a thought into a voice just by adding in some imagination.  Of course, it is also possible to think a voice is being produced by imagination while in reality it is being produced by something else:  for example, someone might think she just imagined hearing someone call her name, when in reality someone actually did just call it out.

So it is really difficult to have an open minded talk about voices if one decides in advance to exclude imagination as possibly having anything to do with them!  Why might an otherwise open minded group like the hearing voices network have this hostility to discussing imagination in reference to voices?

I think the reason has to do with the history of the way the traditional mental health system has treated what it labeled “hallucinations.”  The traditional approach has been to simply say that they are “unreal” and so should either be erased by drugging, or the person should be trained to ignore them as much as possible.  Anyone who wanted to pay attention to them was by definition crazy for wanting to do so, and mental health workers were discouraged from talking about them with the experiencer.  I think this extreme pressure at one extreme by the mental health system has caused the hearing voices movement to go to a bit of an extreme in retaliation:  if the mental health system insists voices are “unreal” then let’s insist that they are real!

Both may be misunderstanding the imagination, which lies somewhere between reality and unreality.  What we dream about is not exactly “reality” but it isn’t totally “unreality” either.  In our dreams, we picture life events and conflicts in particular kinds of ways, and we work through them to some extent.  I think the same can happen in the “waking dream” type of experiences such as voices and visions.

One setup to hearing voices can be trauma or a stressful conflict a person doesn’t know how to solve.  The person may consciously be overwhelmed by the problem, or be doing their best to avoid even thinking about the problem, but then the voices start talking.  The voices may then “represent” the problem or parts of the solution to the person.  This can function as part of a creative problem solving process, but if the voice hearing itself is seen by the person and by those around him or her as a new threat, the person may react by becoming more overwhelmed, leading to more voices, etc. in a vicious circle.

When a person believes the voices are “unreal” and part of a disease process, then that person will likely feel defective due to hearing them, which makes the person desperate to get rid of them, which in turn makes the voice hearing experience itself into an overwhelming trauma.  When on the other hand the person sees the voice hearing experience as being natural for him or her at that point in life, and something that can be handled successfully, then the person becomes capable of reacting without more stress and trauma, so ending the vicious circle.

But notice this doesn’t require seeing the voices as “not imaginary.”  Instead, a person may want to see the voices as a natural part of their imagination, triggered by certain situations, that they can eventually learn to use to their advantage.

The person can also notice that, as with other forms of imagination from art to dreams, the voices and visions may represent reality in a metaphorical way that sometimes conveys more of “reality” than does more literal forms of thinking.  So voices and visions, at least some of them, may be of great value, and “real” in some sense, but not others.

It would be great to see our entire society get educated about these issues.  And I hope the Hearing Voices movement can take a more open minded approach to whether voices are “imaginary” or not.  (Please note that I see the Hearing Voices network and HVN-USA as making a tremendous contribution to opening our minds around voices:  this post should not be taken as a put-down of the movement, but just me offering some thinking around one tricky issue that may need a bit of clarification.)

P.S.:  Recent brain research shows that people who have voices that seem more “real” to them, have increased activity on the right side of the brain, a side associated with imagination.  In the article “Subjective Loudness and Reality of Auditory Verbal Hallucinations and Activation of the Inner Speech Processing Network” it is stated that “a relatively increased contribution from right hemisphere language areas may be responsible for the more complex experiential characteristics, such as the nonself source or how real AVH are.”