Hello, I have recently started treatment for anxiety – SSRIs and CBT. During my visits to my GP and my therapist I have mentioned about what is happening in my head which my GP seems to think is voices while my therapist see as negative automatic thoughts.
The best way I can describe it as having at least two people in my head. Myself at the front of my head and these other people at the back of my head. They are always a bit quieter and sometimes don’t finish what they say or ask and I somehow know what they will say, however, it does not feel like I have any control over it. It may sound like someone I know, or be unfamiliar, male or female, sometimes I cannot say. Sometimes it will talk directly to me, sometimes will ask me questions and I feel the compulsion to answer (occasionally out loud), sometimes I will hear conversation about me until I interrupt. They sound very thought like, however, it doesn’t feel like these thoughts belong to me even though they run very close to what I am consciously thinking of. They also seem to be closely related to my moods and I can sometimes identify different emotions in what or who I hear or which part of my head they come from. Some are critical, others more positive, angry, irritated or completely neutral. Sometimes I will “hear” different people asking me questions that a therapist would and help me get insight or solve a problem and give me an idea. When I am down, they become louder and clearer, while other times if I am falling asleep for example will sound like a radio or if I am daydreaming like a chatter in my head. Sometimes it is annoying or scary, sometimes it doesn’t bother me.
I have been experiencing this since I was a little girl, however it became a lot more noticeable in the last few years as I would engage with them even more. I know they are not real and just in my head and probably self generated, however they do not feel mine. Generally, I can live with it, I just want to know if they really are automatic thoughts or if I am hearing voices in my head, so I can see what is the best course of action for me?
A. Based on the information you have provided, it would seem that the voices are not automatic thoughts (in the context of cognitive behavioral therapy) or what is also known as an inner voice. They seem to be more characteristic of auditory hallucinations. There is more than one voice, they are unrecognizable, and are not something that you can control. They are also causing significant distress.
In the clinical world, hearing voices that do not come from the external world would most frequently be categorized as hallucinations. Hallucinations are associated with psychotic disorders such as schizophrenia and some medical disorders including seizures and migraines, but not everyone who experiences hallucinations is mentally ill or has a chronic disease. Oliver Sacks, (recently deceased) is a famous neurologist, who has written extensively about the nature of hallucinations. He observed that many people have hallucinations in the form of seeing and hearing things that are not there. He estimated that approximately 10% of people experience hallucinations but are not mentally ill.
The nature of your hallucinations and how to treat them should be thoroughly addressed with your mental health providers and your general practitioner. Medication or therapeutic techniques can decrease their distressing effect upon your life. You might also consider reading the book Hallucinations by Oliver Sacks. Another book that may be of interest to you is called The Voices Within: The History & Science of How We Talk To Ourselves by Charles Fernyhough. I wish you the best of luck. Please take care.
Dr. Kristina Randle
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