Given that Christian scripture and tradition are replete with descriptions of the hearing of voices of angels, saints, demons, and of God himself, and that contemporary accounts of religious experiences involving voices are also not hard to find, what do these voices mean?
One possible answer might be to argue that such voices are meaningless.
Whilst it is not always explicitly asserted, this appears to be the implicit view of the many authors who have asserted that prophets, saints and mys-tics, and even Jesus Christ, all heard voices because they were mentally ill.1 A softer version of this approach might normalise the phenomenon to some degree, recognising that many people who hear voices are not diagnosed as mentally ill. Nonetheless, such voices are still to be explained on the basis of a variety of scientific models which privilege cause over meaning. The phenomenon may have meaning as a sign or symptom of some kind, but the content of the voice – what it says – remains meaningless or unimportant.
The validity of this approach is increasingly coming under pressure from voice hearers who assert that their experiences do have meaning (Woods, 2013), and in particular from the Hearing Voices Movement (Corstens et al., 2014). Moreover, the finding of meaning in what voices say is proving to be relevant to effective treatment (Dillon and Hornstein, 2013). The reduc-tionist approach, and especially its cruder psychiatric manifestations, are thus increasingly being found unsatisfactory at best, and stigmatising at worst. In this context, spiritual and religious content of what voices say – amongst other things that they say – is again being recognised as potentially meaningful.
An approach adopted by some who affirm the importance of spirituality/
religion is to assert that some voices might be indicative of mental illness, but that others might be “genuine” spiritual/religious experiences. Thus, for example, Menezes and Moreira-Almeida (2010) have suggested criteria by which a differential diagnosis may be made between spiritual experiences and psychotic disorder.2 This approach is problematic for a number of rea-sons. First, it offers a mutually exclusive choice. Either someone is psychotic, or they are having a genuine spiritual experience, but not both. It is not at all clear why this has to be the case. Why can someone not be psychotic and having a spiritual experience?3 Second, the criteria do not relate to the
content of the hallucinations or other phenomena, but only (or mainly) to the form of the psychopathology and associated signs and symptoms. They thus prioritise psychiatry over spirituality. Third, the distinction is largely one of exclusion. If mental illness is not present, then the experience seems to be accepted as spiritually “normal” in some sense. The criteria do not discriminate between good and bad, helpful or unhelpful, spiritual content.
The notion that there might be spiritual truth to be conveyed by what a voice says is potentially a big claim. On the one hand, it might be acknowl-edged as a kind of personal truth, meaningful to the individual whether or not God actually exists. In this case, any assertions about a spiritual realm, or theological reality, made by the voice hearer or their voices need not be accepted by another person. On the other hand, the preceding chapters of this book have sought to make clear that there are many cases within differ-ent faith traditions, and particularly within the Christian tradition, where a spiritual or theological truth conveyed by a voice has been understood as more widely meaningful. That is, other people have shared with the hearer of the voice a sense that what the voice conveyed was spiritually or theologi-cally significant. This wider sense of asserting the spiritual or theological validity of what a voice has said is potentially problematic within a faith community, and even more so in a context of spiritual/religious plurality.
Who is to judge what is a genuine spiritual/religious experience, and on what grounds?
As we have seen in earlier chapters of this book, Christian scripture and tradition offer ample scope for claiming that people have heard the voices of God, of saints and angels, and even of demons. According to the Niceno-Constantinopolitan Creed, God has “spoken by the prophets”, and Pentecostal and charismatic Christians, amongst others, do not consider this to be something that ceased in a bygone age. As discussed in Chapter 6, there are plenty of contemporary examples of religious experiences involv-ing voice hearinvolv-ing. There is also evidence that social stigma (high levels of which are experienced by voice hearers in general) is less amongst more reli-gious (mainly Christian) people specifically in relation to those who report hearing the voice of God, but only as long as the reported content of the voice is positive (Phalen et al., 2018). This suggests that the possibility of hearing the voice of God is positively accepted, and perhaps even affirmed, within at least some Christian communities.
A more critical hermeneutic might dismiss much of this as pre-scientific and naïve and embark upon a programme of demythologisation.4 However, quite apart from the fact that many ordinary Christians do not take this view, it is not at all clear in a context of increasing scientific awareness of the nature of voice hearing that voices can or should be “demythologised”
at all. Voices and visions, for Bultmann, were to be understood as a part of a pre-scientific mythical world view (as discussed in Chapter 2). They are now very firmly a part of a scientific and non-mythical understanding of human experience.
Spiritual/religious meaning is not the only kind of meaning that might be identified in voices. Some voices might indeed be signs or symptoms of mental illness, not only according to professional opinion, but also according to the understanding of the person hearing the voice. Jones et al.
(2003) identified six constellations of beliefs by way of which voice hearers understood their experiences, only three of which involved any element of spirituality. In this study, two out of twenty participants adopted a mental illness framework for understanding their voices. Four subjects understood their voices within a personal, psychological and biographical, framework.
However, the six clusters of beliefs were not found to be entirely mutually exclusive. One subject, for example, adopted both a spiritual and a psy-chological framework for understanding their voices and such an approach may have much to commend it. Voices may have meaning at multiple dif-ferent levels at the same time – psychologically, spiritually, biographically, and in other ways.
In the next chapter, the focus will be on a critical exploration of whether and how voices that are spiritually or theologically meaningful may be dis-tinguished – in the Christian tradition – from those that are not. However, a prior question must first be explored. Given what is now known scientifi-cally about voices as naturally occurring phenomena, which may or may not include spiritual/religious content, is it ever possible to understand them as being divinely inspired? This question becomes most acute when the voice is understood to be the voice of God, but it is still important when the voice is understood to be that of an angel, saint, spirit, or demon. How can the possibility of a spiritual communication be reconciled with scien-tifically explicable processes within the nature order – if at all? In order to address this question, we must turn first to the scientific literature. What has scientific research revealed about the nature and development of the phenomenon of hearing voices?
Varieties of voices
Experts now seem to be agreed that AVHs5 are found in a wide range of psychiatric disorders (Kelleher and Devylder, 2017, Waters and Fernyhough, 2017)6 and are also seen in the absence of pathology, as a manifestation of neurodiversity (Schrader, 2013). There is also general agreement that AVHs are diverse and do not represent a unitary phe-nomenon. However, they may be subtyped and classified on a variety of different grounds, including phenomenology, cognitive processes, neurol-ogy, causal antecedents, response to treatment, psychiatric diagnosis, and voice hearers’ own attributions (McCarthy-Jones et al., 2014a). There is currently little agreement as to the best single approach to classification.7
In the preceding chapters, diverse examples have been given of differ-ent ways in which people have had the experience of hearing spiritual and religious voices. The heavenly voice at Jesus’ baptism, the voice heard by
Francis at San Damiano, the voices heard by Margery Kempe or Joan of Arc, are all very different. Jesus, Francis, and Margery all heard the voice of God; Margery heard the voices of Jesus, God the Father, and various saints, not to mention non-verbal sounds that she took to be the Holy Spirit. Joan heard the voice of an angel and the voices of saints for whom there now appears to be no historical basis. She heard the voices – to put it bluntly – of people who never lived. For Jesus and Francis, the voices seem to have been very infrequent. For Joan and Margery, they were very common – more or less daily – experiences for much of their lives. All of this might be taken to reflect the same kind of diversity that current scien-tific research has shown to be in the nature of the phenomenon. However, ancient voices clearly present greater difficulties than contemporary accounts. The more scientific approach that is now adopted by historians was not the context within which any of the texts in question were written and, arguably, literary approaches to interpreting the texts have as much or more to contribute than the historical-critical method.
We simply cannot know exactly what the experiences of Jesus or Peter were, far less of Ezekiel or Moses (assuming that the latter was an his-torical character at all). The narratives with which we are left still situate voice hearing firmly within the Judeo-Christian tradition, but do they have any historical basis at all? Given that religious experience is insepa-rable from cultural and religious context, this is very significant. Jews and Christians believe in a God who is taken – according to their sacred texts – to “speak” to his people. Contemporary accounts of hearing God speak, whether derived from biographies or research studies, must to some extent reflect the expectations that this tradition creates, but this does not mean that they are the same kinds of experience as those found in the tradition.
We should therefore be wary of assuming too much common ground between contemporary and historic experiences of “hearing voices”, even within the Christian tradition. It would appear that we are likely to be dealing with a wide variety of phenomena, some of which might be quite similar and others quite different. However, there is also little or no reason to believe that voice hearing as currently reported is a new experience, com-pletely unknown to the ancient or medieval world. We might reasonably assume that people then, as now, were hearing voices but that their experi-ence was simply understood differently – whether as a religious or mystical experience, as due to demons or magic, or in some other way. We should therefore also be wary of assuming too little common ground between con-temporary and historical experiences of hearing voices. At least some of the voices recorded in scripture and other historical, mystical and theologi-cal literature may well reflect similar underlying experiences to those who report hearing voices today. We must simply remember that we do not have any direct access to those underlying experiences. We only have the texts that have been passed down to us.
The phenomenology of voice hearing
What are the voices that people hear today actually like?
In a study of the phenomenology of AVHs in 30 outpatients (Stephane et al., 2003), drawn from a larger sample with diagnoses of schizophrenia, schizoaffective disorder and psychotic depression, a cluster analysis revealed two main types of voices. The first had low linguistic complexity, were repetitive, located in outer space, but identified as one’s own, and patients attempted to control them. The second type had high linguistic complexity, systematised content, were often multiple voices, were located in inner space and were attributed to others. Three important dimensions of voices were identified: linguistic complexity, attribution to self or others, and location in inner or outer space.
In a more recent and larger study, McCarthy-Jones et al. (2014b) studied the phenomenology of voices of 199 psychiatric patients (81 per cent with a diagnosis of schizophrenia). The results of the cluster analysis partly repli-cated those of Stephane et al. (2003) but also produced some new findings.
The first cluster was described by the authors as “Constant Commanding and Commenting” and represents the typical voice-hearing experience of patients with schizophrenia. This group were seen as being similar to the first type identified by Stephane et al, and were typically repetitive. Three less common subtypes were also identified. The “Replay” type experienced voices which were identical to memories – something which Stephane et al.
did not study – and which might be related to a history of traumatic abuse.
An “Own Thought” type comprised first person voices which were recog-nised as possibly belonging to the patient’s own voice/thoughts. This group included some voices/thoughts which were similar to (but not identical) with memories. Overall, 39 per cent of patients reported voices that seemed to be similar to, or identical with, memories of conversations. Finally, the
“Nonverbal” type included words that did not make sense and other non-verbal sounds.
In a major UK study of 153 participants recruited by advertisement from voice hearing groups and clinical/mental health contexts, most voice hear-ers (81 per cent) described multiple voices, and less than half (46 per cent) reported literally auditory voices (Woods et al., 2015). Although voices were often associated with unpleasant affective states (anxiety, depression, fear), 31 per cent reported a positive emotional experience, and for 32 per cent it was a neutral emotional experience.
Importantly, voices are not “just” voices. Woods et al (2015) reported that 69 per cent of their respondents had “characterful” qualities. The voice was either identifiable as a specific, recognisable, individual (22 per cent) or at least had person-like qualities – of age, gender, emotional tone and intent. 16 per cent of voices in this study were identified as emanating from supernatural agents. Voices are generally perceived as being the voice of someone specific – an individual “agent” (Wilkinson and Bell, 2016, Leudar et al., 1997). They are thus acts of communication and many voice
hearers can engage in dialogue with their voice and may form a relationship with “the voice” or, rather, the agent understood to be the source of the voice (Chin et al., 2009). These observations may have important implica-tions both for the chronicity of the experience (Benjamin, 1989) and for potentially effective forms of therapy (Corstens et al., 2012), Deamer and Wilkinson, 2015.
Voices may also be described as a “presence”. Paradoxically, some voice hearers describe awareness of this presence even when the voice is not speaking (Alderson-Day, 2016).
“Voices” may thus be more like thoughts than (out-loud) voices, but they are also more than simply voices. They are encounters – both with a charac-terful entity, perhaps even a personality – and also with elements of oneself, with memories and traumas of the past.
Inner speech
Voices are quite like the inner speech which characterises the waking mental life of almost all human beings. When people “think” about things, this pro-cess of thought is conscious, private, coherent, active (something we “do”) and – notably for the present purpose – it is usually linguistic (Fernyhough, 2016, p.7). It is not always the case that we think in words, images also play a part and some thoughts are a bit ineffable, and a small number of people seem not to engage in inner speech at all, but to a large extent the thoughts that pass through most of our minds are rather like an inner voice. This inner speech is important. It helps to motivate us, to regulate and evaluate our behaviour, and simply to be conscious of ourselves (Fernyhough, 2016, p.11). Inner speech is often dialogical – we can have a conversation with ourselves. It is creative and reflective.8 It also forms the basis for much men-tal prayer, although this is not an aspect of inner speech that has attracted much scientific research to date.
Like inner speech, voices (verbal hallucinations) frequently talk about mundane things related to the ongoing activities of the person hearing them.
They influence the decisions that people make. They are dialogical, impart-ing information and makimpart-ing suggestions (Leudar et al., 1997). Of course, they are also different to inner speech in some important ways. Most patients with schizophrenia clearly distinguish their voices from their own thoughts.
In particular they identify them as recognisably not their own voice, dis-tinctly different in content, and outside their own control (Hoffman et al., 2008).9 Other voice hearers also distinguish between their voices and their thoughts, although the distinctions are apparently not always clear-cut. In a cross-diagnostic study, including clinical and non-clinical voice hearers, Woods et al. (2015) found that 9 per cent of respondents reported that their voices were more thought like than auditory, and 37 per cent reported a mixture of auditory and thought-like qualities. Interestingly, most subjects who reported non-auditory voices still referred to them as “voices”.
The voices heard by people not diagnosed with schizophrenia are, in general terms, similar to the voices of those who are so diagnosed. It is not possible to reliably distinguish the hallucinations of schizophrenia from other diagnostic groups or from non-clinical groups of voice hearers (except perhaps on the basis of age of onset). Non-clinical groups do tend to report more positive interpretations of their voices, and more positive affective concomitants, but these differences are not reliable for making a diagnosis (Honig et al., 1998, Jenner et al., 2008, Johns et al., 2014, Woods et al., 2015, Waters and Fernyhough, 2017).
This acknowledgement of the similarity of voices (AVHs) with inner speech has formed the basis for the most popular and influential theory of how voices arise. Source monitoring theory (SMT) proposes that individu-als use a variety of cognitive monitoring processes in order to determine whether an experience arises from within the self of from the external world. According to the theory, AVHs are utterances of inner speech which, due to some kind of fault in the monitoring process, are wrongly attributed to external sources (Garrett and Silva, 2003). Neuroscientific research finds some support for this theory both in neuroimaging studies, which show acti-vation of similar areas of brain cortex during AVHs and inner speech,10 and also electromyographic studies which show subvocalisation (contractions of vocal muscles similar but smaller than those occurring during normal speech) during both inner speech and AVHs. Recently, a reduction in the length of the paracingulate sulcus – a brain region with a previously estab-lished role in reality monitoring – has been associated with an almost
This acknowledgement of the similarity of voices (AVHs) with inner speech has formed the basis for the most popular and influential theory of how voices arise. Source monitoring theory (SMT) proposes that individu-als use a variety of cognitive monitoring processes in order to determine whether an experience arises from within the self of from the external world. According to the theory, AVHs are utterances of inner speech which, due to some kind of fault in the monitoring process, are wrongly attributed to external sources (Garrett and Silva, 2003). Neuroscientific research finds some support for this theory both in neuroimaging studies, which show acti-vation of similar areas of brain cortex during AVHs and inner speech,10 and also electromyographic studies which show subvocalisation (contractions of vocal muscles similar but smaller than those occurring during normal speech) during both inner speech and AVHs. Recently, a reduction in the length of the paracingulate sulcus – a brain region with a previously estab-lished role in reality monitoring – has been associated with an almost