Harvard Mental Health Letter

Farewell to the voices

Any man or woman on the street can tell you that voices in the head are the chief sign of madness. It's true: Auditory hallucinations are the most familiar and the most common psychotic symptom of schizophrenia, occurring in more than two thirds of people with the disorder. The voices praise and condemn, threaten, command, argue, make predictions, and even hold conversations with the listener, who may develop delusions or commit violent actions in response. Researchers, clinicians, and patients themselves are still searching for ways to suppress or neutralize these hallucinations.

An antipsychotic drug usually helps. It may eliminate the voices or at least make a patient indifferent to them. But drugs don't always work, and not all patients can or want to take them consistently. If a chemical treatment doesn't do the job, for some patients an electrical one may. A meta-analysis of 10 controlled trials found that patients get some relief with repetitive transcranial magnetic stimulation of the brain regions that govern speech perception. This technique is still experimental, and it's not known how long the effects last.

Except for drugs, the most common approaches to treatment are behavioral and cognitive, often building on what schizophrenic patients do to help themselves — mainly humming, counting, praying, reading aloud, listening to music, or engaging in conversation to distract themselves. Some say it helps just to repeat what the voice says, and one study found that simply opening the mouth was effective — presumably because it prevented patients from speaking under their breaths. Shouting back and arguing seem to be less effective, although not necessarily for everyone. Different approaches work in different situations, and studies have found that none stands out as particularly effective.

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