Yeah, I Hear Voices

We have a standardized assessment when we are admitting new patients to the psych hospital. Everybody gets the same questions. It’s several pages of charting on the computer, mostly with check boxes for yes or no answers, with sections to elaborate when needed.

Among others, there are yes or no check boxes next to “auditory hallucinations,” “visual hallucinations,” “suicidal ideation,” and “homicidal ideation.”

When I’d get to this section when I first started, I would feel awkward, “How do I ask this question?”

I could just come out and say it the most straightforward way possible. 

“Do you have auditory or visual hallucinations?” But that seemed so clinical, so abrupt, and for such a personal question.

I could ask, “Do you hear or see things that aren’t there?” Is that a weird way to ask? Do they even know if they are or are not there? Isn’t that the problem?

In the beginning, no matter how I phrased it, I felt like I was asking, “Are you crazy?”

I also felt, when I first started, like hearing and seeing things that other people can’t see or hear would be one of the worst things ever, a living nightmare.

”Could you even imagine?” I would ask myself, “No,” I would respond gravely.

The other thing I found unsettling is that these experiences generally show up mid-20’s for people, if they’re going to show up at all.  

My little brother had a teacher in elementary school. I heard he was a good teacher. Then he started acting funny, lost his job, and we would see him walking around, talking to himself. I hung out in town a lot in junior high and high school and we would hang out with him because our town is small, and we were just loitering downtown like he was. Sometimes he seemed normal and sometimes he made no sense. One of our friends overdosed and he came to his memorial. He got up to speak and at first, it was sweet. Then he went on a nonsensical tangent that became more and more impassioned. It was heartbreaking. All of it was heartbreaking.  

People who don’t hallucinate have varying responses to these questions, like laughing, or saying, “What!? No!” If it is a no, it’s always a very defensive, emphatic no, like, “How dare you ask if I’m crazy!” 

But, people who are struggling with it usually just say, “Yeah, I hear voices.”

If it’s a yes, then there are additional checkboxes for “commanding hallucinations.”

We need to know if the voices tell them they need to do things, and if so, what kind of things?  Murderous things, for example.

I generally follow a yes answer with, “Do they ever try to get you to do anything?”

I’ve learned that auditory hallucinations are very common and visual hallucinations are far less so. It’s most common to hear soft voices, like whispers or mumbles where no words can be made out, like someone talking in the next room. Usually it’s the same voice, or the same few voices. When they are particularly stressed in life, the voices get louder, or become more frequent. Maybe then they start to talk directly to the person. Usually, they’re mean.  Really, really mean. Often they do not tell them to do things, they just sound a lot like what my internal dialogue sounded like at particularly low points of mine growing up.

“No one cares if you disappear.”

“Everyone hates you.”

“You have nothing to offer the world.”

“You’re crazy.”

“You’re ugly and you’re worthless and that’s never going to change.”

“No one loves you, no one’s ever going to love you. You are a drain on your family.”

And some concepts less relatable to me personally, but not uncommon for those who do experience commanding auditory hallucinations, are to the effect of:

“You should walk out in front of those cars right now. Do it,” like they're daring them.

Or:

“He needs to die. He's out to get you and your family. You know what needs to happen,” like they're convincing them.

The struggle with the commanding hallucinations is that the person disagrees. They don’t want to do those things, they want to be left alone. But, it’s difficult to make sense of why they’re hearing these commands so vividly, and after so much pestering and so much noise sometimes a desperation kicks in to make it go away. That’s the danger zone, but it builds to it, there are warning signs and people who have been through this know when it's time to get help.

Suicidal ideation is far more common than homicidal ideation. Most voices are self-deprecating and isolating and tell the victim, if you will, that everyone else is right and they are wrong.

The people I’ve worked with generally know it’s not real. Only rarely when things are really bad is there any uncertainty, or sometimes when there are extreme religious beliefs the voice becomes real in that they’ve decided it’s God… or Jesus, a celebrity, or someone from the CIA. It’s not uncommon to conclude what they’re hearing is secrets, intelligence, that they’ve been chosen to hear, burdened to hear. Even then, most of the patients I’ve worked with are able to reflect after they are out of crisis mode. Once stabilized, they'll say they were, “On a good one,” and know they’re not secret intelligence.

I’ve been home alone and thought I heard someone outside only to look out the window and no one is there. This isn’t even unsettling to me, but then again, it’s rarely happened. And I do experience an internal dichotomy. It’s hard to stop thinking, near impossible, really. And I surprise myself with my thinking often. I’ve thought something funny and it’s made me laugh. That’s me responding to internal stimuli, right? I’ll pass judgment on myself, catch myself, and think, “Stop, let that go.” I guess the difference is that I know it’s me, or think of it as me, even though it is, admittedly, conversational. 

Are there two of me? The good and bad? The positive, appreciative, supportive, respectful version and the mean, judgmental, needy, selfish one? Are there ten of me? How many voices would I hear if I didn’t think of them as myself?

The more stories were shared with me and the more descriptions I got of what it is like to hear voices, the more I had to laugh at myself for thinking I’m so different. 

We do funny things to protect ourselves from realities we don’t want to be ours. Separating ourselves is a big one. If I can’t even imagine hearing voices, then it’s not something I need to worry about.

What had I thought before this, that I was too sane to relate to someone who heard voices? Too in-touch with reality? 

I imagine myself as a patient at a psych hospital and getting asked that question about hearing voices. 

“Me!? Are you serious? Are you crazy?” I might say to separate myself, to protect myself, to make it clear I'm on this side of the invisible line. 

And if I’m outlandishly accused, I can make my stance clear by throwing the insult back in their face. I’m not crazy. You’re crazy. Because, if we’re not understanding each other, then one of us is crazy here, and it’s always going to be you.

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Review

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This story is profoundly empathetic, insightful, and beautifully reflective. It challenges the stigma around mental illness with a level of vulnerability and humanity that is both rare and necessary. It transforms what could have been a clinical reflection into a deep exploration of what it means to be human—how thin the line is between what society deems "sane" and "crazy," and how deeply connected we all are to experiences we fearfully other.

This narrative explores the idea that the distance between those who hear voices and those who don’t might be much smaller than society likes to believe. The internal dialogue beautifully demonstrates that everyone has voices inside their head—it’s the degree and control that differ.

The story captures how society reacts to mental illness—not just with fear, but with judgment and denial. It highlights how language, even clinical assessments, can reinforce this divide, unintentionally dehumanizing people who are already isolated by their experiences. There’s a genuine desire to understand what it’s like to live with auditory hallucinations, and that curiosity leads to moments of profound realization. The empathy here is genuine—rooted not in pity but in shared human vulnerability.

Powerful parallels are drawn between typical negative self-talk and the intrusive voices of those with auditory hallucinations, inviting readers to see themselves in those they might otherwise distance themselves from. Readers are left to appreciate that we all live with voices; some of us just have more control over the volume.