In a recent piece for the Guardian’s Inner Voices series, Dr Sam Wilkinson (Postdoctoral Research Associate in Philosophy, Hearing the Voice) and Dr Felicity Deamer (Postdoctoral Research Associate on the Language and Mental Health Project) write:

Somebody hears a voice, but nobody is speaking. It seems reasonable to assume that there is something going on in the head of this person that is similar to what is going on in the head of somebody actually hearing someone speak. The challenge is to explain why this is happening in the absence of a speaker.

One popular strategy is to explain it in terms of someone’s ordinary “inner speech” somehow becoming “loud”. This will explain why somebody has an auditory, and specifically verbal, experience in the absence of sound waves hitting their eardrum. However, it does not explain why so many cases of voice hearing are perceived to come from another speaker.

Perhaps we need to think outside the box. Perhaps we should not focus on sounds and how hearing works, but rather on communication and how that works. There are a number of reasons not to focus on audition. One is that some voice-hearers describe an experience of “soundless voices”. For example, one participant in a recent study told us: “It’s hard to describe how I could ‘hear’ a voice that wasn’t auditory; but the words used and the emotions they contained were completely clear, distinct and unmistakeable, maybe even more so than if I had heard them aurally.”

Another is that “voices” are also experienced by congenitally deaf people. Jo Atkinson, a researcher in London, has done very important work correcting the “audio-centrism” of mainstream clinical perspectives on voice-hearing. She has shown that deaf voice-hearers experience vague visual imagery like being addressed in sign-language, or of disembodied lips. At other times they see text. But they do not have auditory experiences at all.

What has been overlooked is an aspect of how we normally perceive speech. The usual conditions of someone speaking, and one’s understanding them, do not only involve the sounds that they make, but also what they intend to communicate. The study of communication is the territory of pragmatics, the branch of linguistics that studies utterances rather than sentences. Utterances are sentences used in context, at a particular moment and place, by a particular person.

It is important to recognise that a voice-hearing experience is the experience of a spoken utterance, not a sentence. So on hearing an utterance, a hearer will automatically interpret its meaning. It is this interpretation process that might be able to explain why there so often is a speaker (eg a person, a demon, or a god) behind the voice. In order to interpret the meaning of an utterance, a hearer must consider the intentions behind its use at that moment. In fact, some theorists in pragmatics argue that you can never get any meaning out of an utterance without attributing some kind of intention. And intentions are never free-floating: they are always the intentions of someone (or something with a mind).

A voice-hearer might hear the utterance “He is a loser”. Without knowing whom the speaker is referring to, the hearer can’t know what is meant by that utterance. And yet it seems that voice-hearers generally know who is being referred to in their voices, and what the voices mean. This suggests that the voice-hearer takes there to be a speaker behind the voice, with an intention to communicate.

Within this approach, where voice-hearing experiences are primarily viewed as communicative rather than auditory, it becomes less surprising that the voice is taken to come from a speaker, since this is a necessary dimension of all communication.

This points us in fruitful therapeutic directions. It indicates that therapies shouldn’t solely focus on getting the voice, the auditory experience, to simply go away, but instead aim to change the voice-hearer’s relationship towards the voice (the speaker). Two recent therapies are in keeping with this. In one, voice-dialoguing, a therapist encourages the voice-hearer to repeat what the voice says so that the therapist can “converse” with it. In another, avatar therapy, the voice-hearer is encouraged to build an avatar – a visual representation of the voice – with which they can interact as though it were a real person. Both have shown promising results.

This article was originally published here in the Guardian’s ‘Notes and Theories’ science blog on 26 August 2014.

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