When the Voices Finally Arrived

For most of my life with schizophrenia, I did not hear voices.

Diagnosed with paranoid schizophrenia in 2014, I often found myself questioning the diagnosis because one of its most iconic symptoms was absent. The accounts I encountered online described voices commenting on people's actions, narrating their daily lives, or arguing amongst themselves about the person hearing them. I experienced none of this.

As a child and later as a teenager, I can recall only two occasions where I was clearly hallucinating.

The first occurred when I was around ten or eleven years old. I was lying in bed preparing to sleep when I very clearly heard the words, "I'm here," spoken into my right ear. The voice resembled that of my Uncle David. He was a gentle man with a warm voice. I was not frightened by the experience and did not interpret it as a sign of mental illness. Instead, I viewed it as evidence of the supernatural.

Years later, I was alone in an empty house. I had just made a coffee and was leaving the kitchen when the voice of an older man with a thick Cockney accent whispered a single word into my right ear:

"Boo."

The experience startled me so much that I froze and spilled the coffee. Once again, I concluded that the house was haunted.

Both experiences predated my exposure to cannabis. While my first psychotic episode followed a period of heavy cannabis use, these earlier experiences suggest that I was likely already genetically or neurodevelopmentally vulnerable to psychosis.

During my first psychotic episode, I experienced one or two auditory hallucinations but failed to recognise them as such. On one occasion, I heard a high-pitched ringing that gradually became louder and louder until it was physically painful. At the time, I interpreted the experience through the lens of my delusions. Rather than considering it a hallucination, I concluded that someone was directing sound into my skull or attempting to implant messages.

During my second psychotic episode, I experienced externally located auditory verbal hallucinations for the first time.

A member of NHS staff would walk past me and, while looking at the back of their head, I would hear dialogue or commentary in their voice. These experiences were impossible to reality test in the moment because they sounded entirely real. To my mind, a nurse had just walked past and called me a "ponce."

When I complained to the ward manager, who had been present at the time, he explained that nobody had said anything.

The experience reminded me of my own time working as a healthcare assistant. Years earlier, I had accompanied a woman with schizophrenia to a local shop. The shop assistant briefly turned away from the counter in silence to retrieve an item. The woman immediately became distressed.

"What did you call me?"

The assistant looked confused.

"Did you hear what she just called me?"

At the time, I was struck by how unusual this style of voice hearing seemed. Years later, I found myself experiencing something remarkably similar.

For the next decade, however, I largely escaped auditory verbal hallucinations.

That changed last year.

I was once again lying in bed preparing to sleep when I heard several bars of a song I had never heard before. The music resembled progressive rock and was surprisingly enjoyable. What struck me most was its location. Unlike my earlier experiences, the sound was clearly situated inside my head. Phenomenologically, it felt as though a speaker had been installed inside my skull. The music possessed all the qualities of a genuine acoustic signal, yet it was obviously not arriving through my ears.

Since then, I have begun experiencing a variety of auditory verbal hallucinations.

Most commonly, I hear the voices of people close to me expressing concern for my wellbeing. Sometimes the voices appear just behind my right ear, as they did when I was younger. At other times they seem to originate entirely within my head. Occasionally, the experience occupies both locations simultaneously, feeling somehow internal and external at the same time.

What strikes me most is the variety.

There does not appear to be a single phenomenological profile for these experiences. The voice may seem internal, external, or both. It may be immediately recognisable as a hallucination or almost impossible to distinguish from reality.

When I hear my former partner ask whether I am okay, my first thought is not, "I am hallucinating."

It is:

"How did you get into the flat?"

Only a few seconds later do I realise that nobody is there.

This delay fascinates me because it illustrates how convincing these experiences can be. Even with years of psychoeducation and a diagnosis of schizophrenia, my first interpretation is often the mundane one.

I am also intrigued by what these experiences might tell us about theories of inner speech and sub-vocalisation. The fact that some voices seem clearly external while others feel entirely internal suggests a degree of variation that simple explanations may struggle to capture.

Fortunately, the voices I experience are largely benign. They are often pleasant and rarely distressing. They occur infrequently enough that my daily life is not constantly interrupted.

I consider myself fortunate in this respect.

At the same time, I remain fascinated by the experience itself. For many years I wondered whether I really fit the stereotype of schizophrenia because I did not hear voices. Now that I do, I am struck less by their presence than by their diversity. They seem capable of occupying different locations, carrying different emotional tones, and presenting different challenges to reality testing.

The more I experience them, the less convinced I become that there is any such thing as a typical voice.