This article originally appeared on VICE Italy.
Cristina Contini, 54, has been hearing voices for 35 years. “Assuming you can sleep at night, the voices haunt you from the moment you wake up,” Contini says. For her, they’re almost always saying disparaging things in the voices of people she knows, like parents and relatives.
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Contini says she started hearing voices at 19, after being in a coma following surgery. “When I woke up, I was the same person, except for some strange symptoms,” she explains. “I heard dozens of voices, including my dead grandmother’s, and I didn’t understand where they came from.”
Auditory hallucinations are often associated with schizophrenia, but Contini does not fit the other criteria used to diagnose this mental illness. This is also true for many other voice hearers. In fact, after an initial period of adjustment, Contini went on to lead a seemingly normal life. “I had a career, a child and found meaning in what happened to me by helping others,” she says.
In 2005, she founded the association Sentire le Voci (Hearing Voices), following the international charity network Intervoice. The organisation welcomes patients from all over Italy and connects them with a multidisciplinary team of professionals and other voice hearers for support.
Cristina Contini demonstrating what it’s like to hear voices (in Italian).
“The phenomenon is actually more widespread than we may think,” says Francesco Bocci, a psychotherapist working with the association. “Around one in ten people hears or has heard voices, but only 15 to 20 percent develop a mental illness.” Other studies indicate lower estimates and suggest that, in 80 percent of the cases, the hallucinations disappear over time.
According to Bocci, the experience of hearing voices is very different from person to person, and there isn’t a single diagnosis that works for everyone. “There are elements of depression, of paranoia and of dissociative disorder, but almost all psychiatric categories are limiting,” says Bocci. He thinks the only thing that voice hearers have in common is some form of post-traumatic stress disorder.
Contini’s association helps people who have verbal auditory hallucinations make sense of their experiences. “Sharing their condition with somebody who understands makes voice hearers feel calmer,” she says. They coordinate group therapy sessions with patients, family members and professionals of different backgrounds, coupled with individual sessions.
This multidisciplinary approach is certainly a departure from traditional psychiatry, which associates every symptom with a precise diagnosis and a corresponding pharmacological cure. But according to psychiatrist Paolo Cozzaglio, another collaborator, it is also more helpful. “Making sense of things, rather than just prescribing drugs, is important in therapy,” he said. Blocking auditory hallucinations with prescriptions often makes the patient more passive, and isn’t an effective long-term solution: “Voices are a part of a persistent condition with which we have to learn to live with – they express a part of us.”
Voice hearers usually hear tens or even hundreds of voices at the same time. Some are muffled, others distinct. Some belong to real people in their lives, others to strangers. Deciphering them and telling them apart is a key step towards coping with the condition.
The main starting point is trying to understand whether the hearer perceives a voice as internal or external. “When voices are obsessive thoughts perceived as coming from inside, the person hearing them will tend to self-harm to try and make them stop,” says Contini. If the voices are perceived as external, it can make the hearer angry towards others. “If you hear your mother constantly putting you down, it’s normal for you to be aggressive towards her, even though the reason is clearly not real.”
Many of the voice hearers Contini works with are children and teenagers. “Usually the voices come four or five years after the trauma,” she says. “Working with adults is much more complicated, because they neglect their symptoms and tend to put up psychological barriers difficult to break down.”
That’s why it’s so important to raise awareness. The stigma surrounding auditory hallucinations often makes people close in on themselves, shutting out family members and therapists who are trying to help.
Voices are “nothing more than the amplification of certain parts of the self”, Bocci explained. They depend on your subjective experience, on your relationships, emotions and cultural context. Bocci calls his method an “emotional diagnosis” since it focuses on pinpointing the trauma at the origin of the hallucinations and understanding which feelings it generated and how the hearer interpreted them.
Ultimately, Contini wants people to know that it’s possible to live a rich and fulfilling life while hearing voices, as she shows herself.
