This may be a stupid question, but, those affected by schizophrenia who experience auditory hallucinations might hear a young or old voice that might be male or female. Is there any rhyme or reason why someone might hear a female voice or a male voice? a young versus old voice? like where does the brain draw inspiration from when it generates these hallucinations.
Thanks for any input/answers!
In: Biology
Psychiatrist here!
One thing data has demonstrated about auditory hallucinations are that what they say and their tone are largely influenced by location/the culture where the sufferer grew up. Voices in Western cultures tend to be angry, critical, paranoid, and often scary; whereas voices in eastern and generally more collectivist cultures tend to be friendly and benevolent.
Its so interesting to me because the people who experience those voices in other countries are not necessarily distressed by them, and there are far fewer safety concerns when the voices are not angrily telling the person to hurt themself or other people – to the extent I start to wonder, is it really accurate to label this as the same schizophrenia people experience here in the US? Our biggest concern when someone experiences auditory hallucinations is if the hallucinations become “command” AH – that is, telling the person to do things, because it frequently escalates to the voice telling the person to hurt or kill themself or someone else, often because there is paranoia/delusions at play making the person feel unsafe.
In terms of the specifics of the voices people hear – such as whether the voices are male or female – some data suggest that spontaneous voices are more likely to be male.
Ultimately, however, it’s important to remember there are also several chemical imbalances at play that can contribute to auditory hallucinations. The most predominant theory is excess dopamine, especially at the D2 receptor, resulting in “positive” psychotic symptoms such as hallucinations (and delusions); most older antipsychotics work by blocking dopamine at this receptor and are very effective at decreasing hallucinations and delusions. There is also likely some involvement of the serotonin system, though different specific receptors than those targeted by SSRIs (common antidepressants), and most new antipsychotics target this to varying degrees. Drug use and withdrawal can also cause AH. The reason this is important is because it’s not a purely psychological phenomenon – there are physical abnormalities at play which contribute to and may influence the nature of the specific voices produced, though we don’t have the ability to study and discern that yet.
Some patients, particularly those with a history of childhood trauma, are able to identify their voices as belonging to former authority figure(s) in their life. I’ve had patients say the voice they hear is someone beloved and brings them comfort. Sometimes the nature of the voice(s) will change depending on the person’s mood state – loving voices when happy, angry and scary voices when sad, etc. Most often, patients experiencing auditory hallucinations hear more than one voice.
Latest Answers