how can there be voices in our head in situations like schizophrenia?

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Are these voices part of our character or are they distinct characters we’ve never met? How can these mental voices just leave after medications?

In: Biology
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Just remember, anything that gets processed in the brain can get processed incorrectly. Something in your brain is tracking where your fingers are, and you can misplace them (mostly gently; i.e., you brush your own leg and don’t realize it was yourself until you look). Something is tracking that the color of a ball is actually connected to that ball and not just a floating color in space.

Schizophrenia is still being researched. We aren’t 100% certain, but one theory is that the hallucinations (perhaps in general) are just “source errors.” Source errors are a thing that happen to anyone, but typically, it’s where you misremember something as coming from yourself. For example, a friend tells you a cool idea, then days later, you have that idea but mistakenly think it is your idea that you came up with.

In schizophrenia, it’s the other way around: they are listening to their own thoughts, but the part of their brains that’s meant to track the source is not working as intended. So it feels like the voice is not their own. And clearly, this is something that CAN happen. People dream, and the people in their dreams talk but SEEM to be other people. What separates “I imagined” from “I heard” is just the ability to track the source.

I have schizophrenia. I hear voices. My full understanding is because of the chemical imbalance Neurons fire incorrectly causing you to think you heard voices. Medications (i.e Antipsychotics – Seroquel) restore this chemical imbalance rather quickly by blocking dopamine and serotonin receptors allowing the chemicals to build to natural levels.

Accuracy preamble!

The short answer is no one’s 100% sure because the brain is extremely complicated, and disorders of the brain are even more complicated. Here’s a summary of what I was taught as the best thinking around why this happens. Keep in mind that some of this is almost certainly wrong and we don’t know it yet, and there’s also stuff that’s probably been discovered since I studied neurobiology at university. I may also just get some stuff wrong, though I’ll try not to – I was a biology major who enjoyed brain stuff, not a psych/neuroscience major.

The stuff around how the brain processes pictures is pretty settled science (as far as anything in neuroscience is settled). The stuff about how our brains imagine and perceive is less settled, but fairly strong. The stuff around exactly how hallucinations work is probably the least settled.

PREAMBLE OVER let’s get to the eli5:

Our brains like to be efficient. But processing all the info that comes from our eyes and ears is complicated. So instead, we use a combination of what our ears actually hear, and what we *expect* to hear. Our expectations are made up of info from our other senses (especially what we see) plus our memories and experiences of similar situations.

Say you’re at a loud concert and someone’s talking to you. You’ll hear much better if you can see their face. This is because our brains use the movement of their face to help figure out what they’re saying, in combination with what sort of thing we *expect* them to say, and how we *expect* them to sound. But we don’t generally experience that as ‘I can’t quite hear, but I magically know what you’re saying’, because that’s unnecessarily complicated. Instead, we just ‘hear’ more clearly. This is actually an illusion created by our brains. Every single sound we’ve ever experienced is assembled by our brains this way. The difference between normal hearing and a hallucination is largely down to how well that process works, and how heavily it’s used.

For someone who hears voices, their brain is looking for patterns in sounds where there aren’t any, and it’s filling in the blanks to a huge extent. It’s kind of like the auto-complete feature on a phone. Most people only use it for a word here or there, filling in the blanks in sentences that already have a lot of information in them. But if you hit auto-complete repeatedly, your phone will just make sentences based on the patterns it’s used to. For people who hear voices regularly, their brain is kinda doing that, but much more sophisticated. I say ‘regularly’ because this actually happens to everyone to some extent. Have you ever been in a crowd, or a noisy environment, and thought you heard someone call your name? There’s a good chance that was a illusion. It’s just a brain hiccup that happens occasionally. Some people hear voices quite regularly, without having any other signs of a neurological disorder.

Our brains also have a kind of ‘quality checking’ filter on our consciousness, that stops us from experiencing things that are way outside of what we expect. You can see this in action if you browse through r/confusingperspective . Notice that even when you see an image incorrectly, it often looks *wrong*. Once you ‘figure out’ what’s actually happening in a confusing image, it becomes difficult to see the ‘wrong’ version again. This is that filter in action. But in order for it to kick in, we need a good enough grasp of reality – ie. expectations of how things should look – in order to identify when something is wrong.

Now, our ability to imagine is a core part of this as well. Our brain uses the same bits of wiring to *imagine* an apple as it does to *recognise* an apple, or to imagine or recognise someone’s voice. But we also have wiring that helps us keep track of what came from our imaginations and what came from the world around us. This specific bit of wiring is what’s not working correctly during psychosis. This also causes problems with our ‘quality checking’ filter, because it relies on our sense of reality to work correctly. So, a lot more hallucinations get past the filters to a person’s consciousness, and it’s a lot more difficult for that person to figure out what’s real and what’s not.

There aren’t. You are hearing cross talk from parts of the brain communicating with the next, your brain then interprets that as external.

It’s like hearing your own voice on a phone with a broken cord and thinking it’s someone elses.