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Expert Q&A

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How can I make the voice in my head stop?

Asked by David, Tucson, Arizona

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I am a 50-year-old male and have been experiencing a voice talking to me. I lost most of my central vision about 11 years ago from a virus and am legally blind. I was diagnosed with depression two years ago by my doctor and he put me on 20 mg of paroxetine a day. I have always been an antisocial person but even more so after losing most of my vision. For the last several months there has been a voice talking to me. It just carries on normal conversations and warns me of various things, remarks about the news, people, daily activities (don't eat that, eat this instead), stay away from this or that person because they are out to harm you, your neighbors are watching you, etc. What is happening to me? Can you give me some suggestions on how to make the voice stop? I would greatly appreciate any suggestions you can give me. Thank You

Expert Bio Picture

Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear David, I am sorry to hear of your problems -- the blindness, the depression and now the occurrence of what I would call a "monosymptomatic auditory hallucination," by which I mean that you appear, from your question, to be having a single hallucination.

First let me reassure you that, although what you are experiencing is not normal, it is not that unusual for people to hear a voice that isn't there and not have a lot of other psychotic symptoms. When this happens, the person is often older (and for psychiatric stuff 50 is older) or has had some type of organic insult to the brain or has a history of very heavy drinking and has now quit. In these situations people often maintain good insight -- as you seem to have --that the voice is a product of their own brains, no matter how real it seems.

So although you've had a rough time, the fact that you fit into this clinical picture (I don't know whether you've been a heavy drinker in the past) is actually good news. It's not the voices themselves that set people to wreck and ruin, it's the fact that they so often emerge in the context of either bipolar disorder or schizophrenia, which are two of the most disastrous conditions that can befall a person. When people hear voices in these full-blown psychotic diseases, the voices are often telling them to do terrible things like kill themselves.

And most of the time, people with schizophrenia or a bipolar mania are convinced that the voices are real and not just the voices. All sorts of completely false and bizarre ideas often seem completely true to these patients. Most often they become convinced that they are being followed or watched or monitored or that everyone is trying to hurt them in one way or other. But I've had patients who believed even stranger things. One believed he was Michael Jackson. Many have believed they were Jesus. One woman believed she was the Virgin Mary and Eva Braun (Hitler's girlfriend) at the same time.

I don't know why you have started hearing a voice, and the answer may never be known. Sometimes loss of a sensory modality seems to increase the risk of hallucinations. Most of the time visual loss promotes visual, not auditory, hallucinations, but there might be a connection. Sometimes when people become very depressed they'll start hearing voices. You mentioned you got depressed two years ago. I don't know if you are still depressed, but this is a possible cause.

Having said all this, given your age and the fact that the voice is new, you might consider seeing a neurologist or psychiatrist to get a brain scan to check for something like a tumor and get an EEG to make sure you are not having seizures and don't know it. This happens more often than you'd think.

Whatever the cause of the voice, there are things you can do to make it go away or at least diminish its intensity. It turns out that antipsychotic medications (of which there are many currently available) are probably more effective at stopping voices than they are for any of the other symptoms that afflict people with full psychotic disorders. You might find that taking a lowish dose of one of these medications will make the voice go away altogether.

Most people who hear voices find that they are worsened by being alone, being in very quiet places or being under a lot of stress. You mentioned that you were antisocial, which in this case I suspect means that you keep to yourself a lot. If so, you can help reduce the voice by trying to spend more time around other people. When you are alone, play music or leave the television running. I've had patients who found that even running a loud fan helped quiet the voices.

Whatever else you do, keep telling yourself that the voice comes from a malfunction in your brain and under no circumstances pay any heed to what the voice says.

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